The Global Consensus for Clinical Guidelines (GCCG) provides a structured, evidence-based framework for treatment planning in the rehabilitation of the edentulous maxilla. 'Patient Selection' is illustrated in this case report of a 65-year-old male with well-controlled hypertension, hyperlipidaemia, and type II diabetes mellitus who presented with severe tooth wear, loss of occlusal vertical dimension, limited vertical restorative space, and partial edentulism. A lobulated torus palatinus extending posteriorly was considered unfavourable for conventional complete denture retention. Dissatisfied with his removable partial denture, the patient sought a fixed prosthetic solution to improve mastication and comfort. Assessment of aesthetics, lip support, phonetics, and facial profile demonstrated adequate support without the need for a denture flange. Prosthetically driven digital planning identified sufficient bone volume for standard-length implants in the anterior and left posterior maxilla, but inadequate vertical bone height in the right posterior maxilla. Treatment options included segmental implant-supported fixed bridges, a full-arch implant-supported fixed dental prosthesis, a full-arch implant-retained overdenture, and a non-implant fixed-removable rehabilitation. Following structured discussion of the biological and prosthetic risks, maintenance requirements, treatment duration, costs, and anticipated outcomes of the available options, the patient elected immediate full-arch implant-supported fixed rehabilitation through a shared decision-making process.
Full-arch implant-supported restorations are widely regarded as a predictable treatment modality for edentulous patients, demonstrating high implant survival rates over long-term follow-up. However, the maintenance phase is frequently characterized by a substantial burden of biological, hygienic, and mechanical complications that extend far beyond implant survival alone. Current literature often reports survival outcomes exceeding 90% after 10 years,1 yet these metrics fail to adequately reflect the recurrent maintenance interventions required throughout the lifespan of the prosthesis. This paper proposes a three-domain framework for understanding complications in full-arch implant-supported restorations: biological complications, hygiene-related challenges, and long-term prosthetic wear with recurrent mechanical complications. Rather than treating these events as isolated phenomena, this model emphasizes their interdependence and the central role of prosthetic design, implant positioning, and maintenance accessibility. Biological complications include peri-implant mucositis, peri-implantitis, and marginal bone loss. Hygiene-related challenges arise from prosthetic contours and geometries that compromise plaque control and long-term maintainability. Long-term prosthetic wear includes recurrent technical complications such as screw loosening, screw fracture, material degradation, veneering failure, and implant or abutment fracture. Recent evidence from the Global Consensus for Clinical Guidelines (GCCG) highlights the lack of standardized maintenance protocols and the high prevalence of prosthetic complications in implant-supported fixed complete dentures. A shift toward maintenance-oriented and prosthetically driven treatment planning appears essential to improve long-term outcomes.
PURPOSE:The 1st Global Consensus for Clinical Guidelines (GCCG 2026) introduced the first internationally standardized, evidence-based framework for rehabilitation of the edentulous maxilla. This case report illustrates how the structured GCCG 2026 diagnostic recommendations translate into clinical practice in a complex, anatomically asymmetric case. MATERIALS AND METHODS:A 50-year-old man with maxillary edentulism secondary to stage IV generalised periodontitis underwent a GCCG-aligned diagnostic workflow: facial analysis, per-quadrant full-arch classification, flangeless try-in for pre-prosthetic ridge assessment, and dual-scan CBCT for prosthetically driven planning. Per-quadrant classification identified a case with anatomical asymmetry (Class III, first quadrant; Class IV, second quadrant), confirming an FP3 design and a quadrant-differentiated surgical strategy. RESULTS:The structured diagnostic workflow enabled convergent, evidence-based decisions at every stage. Pre-prosthetic diagnosis established FP3 necessity and validated lip support. The dual-scan protocol supported prosthetically driven pilot-guided surgery. Definitive monolithic zirconia prostheses were delivered with verified passive fit at six months. CONCLUSIONS:The GCCG 2026 diagnostic framework is directly applicable in anatomically asymmetric edentulous maxilla cases. Per-quadrant assessment and pre-prosthetic diagnosis determined all downstream clinical decisions.
This case report describes the prosthodontic rehabilitation of a 53-year-old male with failing dentition using a maxillary implant-assisted overdenture (IOD). Following full dental clearance and immediate complete denture provision, a total of six implants were placed in the maxilla with the aid of digital planning utilising a dual-scan CBCT technique and a 3D-printed surgical guide. The maxillary IOD incorporated an open-palate horseshoe design with metal reinforcement and Novaloc stud attachments, providing improved retention and reduced palatal coverage. At two-year follow-up, all implants were functional with improved patient-reported outcomes, supporting maxillary IODs as an effective rehabilitation strategy aligned with the current consensus guidelines.
Zygomatic implants (ZIs) have become a predictable graftless treatment option for rehabilitation of the severely atrophic edentulous maxilla. Recent Global Consensus for Clinical Guidelines (GCCG) recommendations have emphasized prosthetically guided treatment planning and advanced surgical expertise due to the anatomical complexity associated with ZI placement. This case report describes the digital planning workflow of a navigation-assisted hybrid rehabilitation approach in a 58-year-old male patient presenting with severe posterior maxillary atrophy and sufficient anterior residual bone for conventional implant placement. Following cone-beam computed tomography and intraoral scanning, a prosthetically driven virtual wax-up was performed for full-arch rehabilitation. Four anterior conventional implants and two posterior zygomatic implants were digitally planned according to anatomical and restorative considerations. Dynamic computer-assisted implant surgery (D-CAIS) with fiducial marker-based registration was subsequently integrated into the workflow to facilitate navigation-assisted implant placement. The present case illustrates illustrating the integration of prosthetically driven digital planning with navigation-assisted implant surgery in hybrid zygomatic implant rehabilitation.
Rehabilitation of the edentulous maxilla poses significant clinical challenges for the clinicians and patients due to progressive ridge resorption, compromised retention and stability, altered phonetics, aesthetic concerns, and increased functional demands. The Global Consensus for Clinical Guidelines (GCCG) for the rehabilitation of the edentulous maxilla has discussed the literature on the rehabilitation process under five heads - Patient Selection, Diagnostics, Treatment Planning, Treatment Procedures and Maintenance. The present case report discusses the rehabilitation of the maxillary arch of an edentulous patient with an implant supported fixed dental prosthesis (IFDP) in the light of the GCCG guidelines.
PURPOSE:To describe a new clinical protocol for prosthetically guided implant placement with the assistance of a robotic system. MATERIALS AND METHODS:A patient presenting a single missing tooth was selected for robotic-assisted implant surgery. The participant underwent a preoperative CBCT scan and an intraoral scan. A virtual implant placement and drilling protocol was established prior to surgery. During the procedure, the robotic system executed the osteotomy and implant placement semi-autonomously under the supervision of the surgeon. The implant stability quotient (ISQ) was measured, and postoperative CBCT scans were acquired to assess deviations between the planned and actual implant positions. RESULTS:The single implant was successfully placed without major complications. An implant stability of 80 ISQ was obtained. The platform, apex, depth, and angular deviations were 0.37 mm, 0.49 mm, 0.33 mm, and 1.33 degrees, respectively. CONCLUSIONS:Correct values of stability and accuracy were obtained with the semi-autonomous robotic system. The findings of this study suggest the potential of the robotic system for accurate implant placement and provide preliminary evidence supporting its use in the dental office environment.
PURPOSE:To evaluate the surface roughness and color stability of three-dimensionally (3D) printed zirconia crowns after treatment with three different chairside polishing systems, in comparison with conventionally milled zirconia. MATERIALS AND METHODS:One hundred twenty maxillary incisor monolithic zirconia crowns were fabricated using subtractive (milled, n=60) and additive manufacturing (3D-printed, n=60). Specimens were further divided into as-received, unpolished, and polished subgroups. Polishing was performed using three systems: Zolid Sinter-State (Amann Girrbach), OptraGloss (Ivoclar Vivadent), and Meisinger Zirconia Polishing Kit (Meisinger) (n=20/subgroup). Surface roughness (Ra) was measured using a noncontact 3D optical profilometer. Specimens were then immersed in coffee solution for 30 days (simulating ≈2.5 years of clinical exposure), and color differences (ΔE₀₀) were calculated using the CIEDE2000 formula. Surface morphology was examined using scanning electron microscopy. Data were analyzed using two-way ANOVA and post-hoc Bonferroni tests (α=0.05). RESULTS:Polishing significantly reduced surface roughness in both milled and 3D-printed zirconia (p<0.001). As-received milled zirconia exhibited higher Ra (0.69±0.12 µm) than printed zirconia (0.60±0.14 µm) (p<0.001). After polishing, no significant difference was observed between manufacturing techniques (p=0.095, p>0.05). For milled zirconia, all polishing kits performed similarly (p>0.05); for printed zirconia, Amann Girrbach produced lower Ra (0.03±0.016 µm) than Meisinger (0.04±0.01 µm) and OptraGloss (0.04±0.008 µm) (p<0.001). Coffee staining caused significant color change in all specimens (p=0.001), with no significant difference between milled and printed zirconia across polishing subgroups (p>0.05). All polished surfaces achieved Ra values below the clinically accepted threshold of 0.2 µm. CONCLUSIONS:3D-printed zirconia represents a clinically reliable alternative to milled zirconia, as initial surface roughness differences are eliminated after standardized polishing. All polishing systems achieved clinically acceptable smoothness. Both materials exhibited comparable staining susceptibility, suggesting discoloration depends more on material composition than on surface finishing.
PURPOSE:The objectives of the current study were to evaluate and compare the retention loss and wear rates of locater attachments made of three different materials under cyclic load. MATERIALS AND METHODS:Three locater attachments, including those made of titanium nitride-coated (conventional Locator), titanium carbon nitride-coated (Locator R-Tx), and zirconia (TAV Locker), were used to produce 42 specimens. Half of the samples in each group were placed straight, while the other half were positioned at the maximum recommended angulation in custom aluminum molds. Each sample was treated to 5,000 insertion-separation cycles. Retention forces were assessed after 10, 500, 1,000, 4,000, and 5,000 insertion-separation cycles. Furthermore, the wear of the attachments was assessed using the mass loss technique and scanning electron microscopy. RESULTS:Although the mean retention values of the angle-placed attachments did not differ significantly across all cycles (p > 0.05), there was a statistically significant difference in the mean retention values of the straight-placed attachments across all cycles. titanium carbon nitride demonstrated higher retention values in each retention test cycle compared to titanium nitride-coated and zirconia locator attachments (p≤0.001). The greatest weight loss among the locator attachments was observed in the titanium carbon nitride-coated angle-placed group (-0,066), while among the nylon inserts, the titanium nitride-coated angle-placed group exhibited the most significant weight loss. (-2,727). CONCLUSION:The retention force of the titanium carbon nitride-coated group was statistically higher both in straight and angle-placed specimens at the beginning and end of the study compared to the other attachment groups.
PURPOSE:The aim of this study was to evaluate the effect of using the VirTeaSy Dental simulator in conjunction with a virtual reality headset on student performance in conventional fixed prosthodontics simulations. MATERIAL AND METHODS:The study involved 85 novice dental students from the Dental Faculty of XX University, who were randomly assigned to two groups. In phase one, the control group (G1, n=42) completed conventional simulation exercises according to a standardized protocol, while the test group (G2, n=43) performed a combination of immersive haptic simulation followed by conventional simulation exercises. In phase two, the groups were subdivided: G1a and G2a performed the conventional simulation only, while G1b and G2b engaged in both immersive haptic and conventional simulation. This design assessed the effects of continued, delayed, discontinued, or no exposure to immersive haptic simulation. Student performance was evaluated using single-unit prosthetic preparations after each phase using the software prepCheck 3.0. A Bonferroni adjustment was used to control the overall alpha level. A significance threshold of p < 0.025 (5%/2) was used for comparison of the results from phase 1, and p < 0.008 (5%/6) was used for comparisons for phase 2. RESULTS:The results from phase one showed a slightly higher mean score for prosthetic preparation quality in G2 (17.19 ± 1.53) than G1 (16.55 ± 1.80), although the difference was not statistically significant (p > 0.05). In phase two, the four subgroup scores were comparable with no significant differences (G1a: 21.90 ± 3.20, G1b: 22.38 ± 2.33, G2a: 22.10 ± 2.40, G2b: 22.95 ± 2.93). In both phases, no statistically significant differences were observed between the groups. CONCLUSIONS:Combining immersive haptic and conventional simulation in various modalities does not significantly improve student performance in prosthetic preparation compared to conventional simulation alone.
PURPOSE:To assess how three virtual articulator programming strategies, including jaw motion tracking, reproduce a predefined reference occlusal contact scheme (ROCS) after crown fabrication by evaluating occlusal contact presence/absence and interference intensity. MATERIALS AND METHODS:Maxillary and mandibular casts with preparations on the maxillary left central incisor, maxillary left first premolar, and mandibular right second molar were mounted in a semi-adjustable articulator. Forty-five crowns were fabricated and allocated to three groups: grou,1 designed with full dynamics recorded by an electronic jaw tracking device; group,2 designed with a virtual articulator programmed using individualized parameters from dynamic recordings; and group,3 designed with default CAD settings. Occlusal contacts in maximum intercuspation and eccentric movements were evaluated with articulating paper. Weighted kappa measured agreement with the ROCS, and chi-square test evaluated contact intensity. RESULTS:Significant differences were observed among groups for contact presence/absence and interference distribution. Agreement with the ROCS was low: group 1 (κ = 0.291), group 2 (κ = 0.254), and group 3 (κ = 0.163). Anterior guidance showed higher agreement: group 1 (κ = 0.500), group 2 (κ = 0.409), and group 3 (κ = 0.233). Groups 1 and 2 generated fewer and weaker interferences, whereas group 3 showed more strong contacts. CONCLUSIONS:Arbitrary virtual articulator programming increased the likelihood of strong occlusal contacts after milling, whereas dynamic and individualized programming improved agreement with the ROCS. However, agreement remained only fair in all groups, indicating that further refinement of current programming strategies is required.
BACKGROUND:Despite growing emphasis on patient-centered care, the extent to which patient-reported outcome measures (PROMs) are used, reported, and interpreted in prosthodontic randomized controlled trials (RCTs) remains unclear. This study evaluates the frequency, reporting quality, and interpretability of PROMs in RCTs in prosthodontics published between 2020 and 2025. MATERIAL AND METHODS:228 RCTs from high-impact dental and prosthodontic-specific journals were included. Date were extracted on PROM inclusion and use as primary outcomes, reporting of point estimates and confidence intervals, evidence of validity, reliability, and responsiveness, and use of minimal important difference (MID). Univariable and multivariable logistic regression assessed factors associated with PROM inclusion. RESULTS:Among 228 trials, 44.3% (n=101) reported PROMs in abstracts and 49.6 % (n=113) in the main text; 39.8 % (n=45) used them as primary outcomes. Only 38.1 % (n=43) reported point estimates with confidence intervals. Evidence of PROM validity, reliability and responsiveness was rarely (15%, n=17) reported. Only two studies (1.8 %) used a MID to interpret trial results. PROM use was more likely in studies assessing the effect of complete denture and esthetic interventions. A slight upward trend in PROM use was observed over time. However, it was not statistically significant. CONCLUSION:The use of PROMs is increasing slightly but remains inconsistent and lacks methodological rigor. The absence of PROM data in RCTs limits clinical applicability. Greater adherence to methodological standards and reporting statements, including the use of MID and core outcome sets, is essential to improve the quality and relevance of future prosthodontic research.
PURPOSE:To compare the trueness and precision of digital implant impressions using coded healing abutments (CHA) and scan bodies (SB) with conventional impression technique (ANA), and to evaluate the influence of implant angulation in vitro. MATERIALS AND METHODS:Two mandibular models with parallel (M1) and angulated (M2) implants were fabricated. Sixty impressions (n=10 per subgroup) were obtained using CHA, SB, or ANA. Digital impressions were acquired with an intraoral scanner; conventional casts were digitized with a laboratory scanner. A coordinate measuring machine served as the reference. Linear inter-implant distance, angular deviations, and three-dimensional implant position were analyzed. Trueness was calculated as deviation from the reference, and precision as standard deviation. Data were analyzed using one-way analysis of variance with Tukey post hoc tests, independent t tests for model comparisons, and Levene's test to assess variance homogeneity, with α=.05. RESULTS:SB showed values closest to the reference for inter-implant distance. Digital techniques (SB and CHA) demonstrated comparable trueness (P>.05) and significantly higher precision than ANA for linear distance and angular deviations (P<.05). SB exhibited higher precision than CHA for anterior implant Y2 and Z2 coordinates (P=.001, P=.004). Implant angulation negatively affected ANA but did not significantly influence digital techniques. CONCLUSIONS:SB and CHA provided comparable digital impression accuracy under controlled conditions. Conventional impressions demonstrated greater variability, particularly in angulated conFigurations. CLINICAL RELEVANCE:Digital implant impressions using CHA may serve as a clinically acceptable alternative to SB, with greater reliability than conventional techniques in angulated implant scenarios.
PURPOSE:To investigate and compare the clinical performance, esthetics, and patient-rated outcomes of porcelain-fused-to-metal (PFM) fixed partial dentures (FPDs) with CoCr-alloy-based and Au-alloy-based frameworks. MATERIAL AND METHOD:A total of 92 patients with 117 FPDs in either CoCr- or Au-alloy-based frameworks were followed for 5-9 years. Two calibrated examiners performed clinical and radiological examinations and recorded survival and biological and technical complications using a modified California Dental Association (CDA) index and a structured patient questionnaire on function, esthetics, and complications. Statistical analyses were conducted using chi-square, Fisher's exact, and multiple regression tests. RESULTS:The survival rate was 98.3% for CoCr-alloy-based FPDs and 93.0% for Au-alloy-based FPDs. While the incidence of chip-off fractures was similar between the two groups on FPD level, the difference was statistically significant on unit level with 4.7 % in the CoCr-alloy-group and 9.5% in the Au-alloy-group (p=0.009). CDA assessments showed overall acceptable outcomes in both groups, with differences observed in anatomical form, marginal characteristics, and patient-reported outcomes. CONCLUSIONS:In the present study, both Au-alloy-based and CoCr-alloy-based FPDs showed high survival rates. Chip-off fractures were more common in Au-alloy-based frameworks. Accordingly, CoCr-alloy-based frameworks are a cost-effective and clinically reliable alternative for PFM frameworks.
PURPOSE:To evaluate the influence of implant angulation on the trueness, and precision of complete arch implant digital scans acquired using an intraoral photogrammetry system. MATERIAL AND METHODS:Two edentulous mandibular models with six implants each were fabricated and assigned to two groups based on implant angulation: parallel implants and posterior angulated implants. In the angulated group, posterior implants were angled (<30° relative to the reference axis), resulting in interimplant angulations of up to approximately 45° due to their spatial relationships. Each group was scanned 20 times (n=40) using an intraoral scanner incorporating intraoral photogrammetry technology under standardized ambient lighting conditions (1000 lux). Linear and angular deviations were calculated by comparing the test scans with reference datasets obtained using a calibrated laboratory scanner. The Shapiro-Wilk, Mann-Whitney U, and Levene tests were used to analyze differences in trueness and precision between groups (α=.05). RESULTS:For trueness, the parallel group showed significantly lower linear deviations (median 0.066 mm; IQR 0.063-0.071) than the angulated group (median 0.159 mm; IQR 0.155-0.162) (P < 0.001). For angular deviations, the angulated group showed lower values (median 0.353°; IQR 0.347-0.380) than the parallel group (median 0.457°; IQR 0.450-0.467) (P < 0.001). No statistically significant differences in precision were found for either linear (P=.664) or angular (P=.070) measurements. CONCLUSIONS:Implant angulation significantly influenced trueness, while precision remained unaffected. Higher angulation resulted in increased linear deviations, although angular deviations may not be clinically significant.
A 65-year-old Caucasian female was seen for the treatment of a failing mandibular fixed dental prosthesis (FDP). When the abutment teeth were evaluated, tooth 44 had an extensive carious lesion and was determined non-restorable, and tooth 47 was deemed salvageable. The patient presented and accepted a treatment plan involving the extraction of tooth 44, a three-unit zirconia implant-supported FDP to replace teeth 44,45, and 46, and a zirconia crown for tooth 47. At the time of insertion, when the interim restoration covering tooth 47 was removed, the cementum and dentin of the tooth separated from the underlying tissues, leaving the tooth with reduced coronal dimensions. In this case report, the interim restoration with the coronal tissues attached was scanned and used as a reference to fabricate a long-term 3D-printed restoration. This restoration faithfully replicated the cameo surface contours of the interim restoration. It provided an intimate adaptation to the remaining intraoral coronal tissues since it closely replicated the tissue features inside the interim restoration recorded during scanning.
PURPOSE:This study aimed to characterize the adhesion and biofilm formation of key denture-associated microbes-Candida albicans, Porphyromonas gingivalis, and Streptococcus mutans-on a 3D-printed photopolymer resin (FotoDent®). MATERIALS AND METHODS:Discs were fabricated at three distinct printing orientations (0°, 45°, and 90°) to assess the impact of layer deposition on surface properties and microbial colonization. Conventionally polymerized ProBase® cold resin discs served as controls. All specimens underwent comprehensive surface characterization, including measurement of areal surface roughness, static contact angle with polar and apolar liquids, and surface free energy components. Adherent microbial cells were quantified using species-specific quantitative real-time PCR (qPCR) following standardized biofilm assays. RESULTS:Microbial adhesion to the 3D-printed resin was highly dependent on print orientation, with cell counts for all three species decreasing significantly (p<0.05) from the 0° to the 90° orientation. This trend was paralleled by an increase in surface roughness (Ra) with higher print angles. A strong, statistically significant positive correlation was observed between the surface roughness of FotoDent® discs and biofilm cell numbers for C. albicans (r=0.815), P. gingivalis (r=0.883), and S. mutans (r=0.903). In contrast, adhesion to the control ProBase® material was consistently higher and showed no significant correlation with any measured surface characteristic-roughness, wettability, or surface energy. CONCLUSION:These findings indicate that for 3D-printed dental resins, printing parameters, especially orientation, critically determine the final surface topography, which in turn is a affects microbial adhesion and biofilm formation.
PURPOSE:To investigate the effect of over-scanning and different cut-out/rescanning procedures on the local trueness of 3D-datasets. MATERIALS AND METHODS:A typodont with a prepared tooth (#26) was digitized using an intraoral-scanner (Cerec Primescan, v5.2) to create a master-die. Full-arch scans with a retraction-cord covering the preparation margin were performed and duplicated to obtain four identical scans to be used for each test group: Die-cut Re-scan (Die-RS), Cord-cut Re-scan (Cord-RS), Segmental-cut Re-scan (Seg-RS), and Over-scan (Over-S). After removing the cord, group-specific cut-out-rescanning procedures were performed on each duplicate. For the Over-S group, no cut-out modifications were made; the scanning procedure was continued until the cord's image disappeared. The time-expenditure of rescinding procedures were recorded in seconds for each group. The trueness between the reference master-die and experimental scans (N=15 per-group) was evaluated by the absolute-mean-deviation, root-mean-square-error (RMSE), and the top 0.5% percentile calculations. Data were analyzed with the Kruskal-Wallis test with the Bonferroni corrections, one-way-ANOVA with Tukey HSD tests (α =0.05). RESULTS:The Seg-RS showed lower RMSE (6.26±1.13µm) and 0.5% percentile values (20.20±6.18µm) than the other groups (P<0.05). The absolute-mean-deviation of Seg-RS (5.04±0.85µm) was lower than the mean deviations of Die-RS (7.97±2.91µm) and of Cord-RS (5.81±1.61µm) (P<0.05), but not significantly different from Over-S (4.99±2.19µm) (P=1.000). Concerning time expenditure, the Die-RS (34±9s) showed significantly lower values among the groups (Seg-RS:44±5s, Cord-RS:51±8s and, Over-S:52±7s) (P<0.05). CONCLUSION:The Seg-RS demonstrated the highest trueness values among the groups. While Die-RS was the most time-efficient approach, the trueness compared to Seg-RS was significantly lower.
