Prosthetic Rehabilitation Research Articles

Prosthetic Rehabilitation With a Tooth-Supported Overdenture Utilizing Ball Attachments and a Customized Intraoral Tracer: A Case Report

Giant Pleomorphic Adenoma of the Hard Palate: Surgical Management and Prosthetic Rehabilitation

Background/Objetives: Zygomatic implants are an effective solution for the prosthetic rehabilitation of atrophic maxillae, but their placement can alter maxillary sinus anatomy and influence surgical outcomes. This study presents a computational algorithm for automated segmentation and volumetric assessment of the maxillary sinus from cone-beam computed tomography (CBCT) images, offering a reproducible and clinically oriented tool. Methods: Six sinus samples from four patients undergoing pterygoid or zygomatic implant surgery were analyzed. The algorithm was designed to integrate image binarization, surface detection, and iterative reconstruction to delineate sinus boundaries and compute volumes with minimal operator dependence. Results: Postoperative analyses consistently revealed reductions in sinus volume, with relative changes ranging from 1.1% to 24.5%, validated by expert review. Conclusions: These results demonstrate the feasibility of algorithm-driven volumetric assessment as a non-invasive approach to support surgical planning and monitor anatomical changes. Although limited by the small sample size, this pilot study establishes a foundation for further research and highlights the clinical potential of computational methods to enhance precision and safety in zygomatic implantology.

Introduction: Acromegaly is a chronic endocrine disorder caused by excessive secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Acromegaly leads to a wide range of systemic alterations, including metabolic disturbances, abnormalities in bone microarchitecture, soft tissue overgrowth, and morphological changes in the maxilla and mandible. All these factors may significantly complicate the planning and success of implant therapy. Study Aim: This narrative review aimed to critically analyze the impact of acromegaly on bone healing and osseointegration, with particular emphasis on the stability of implant biomaterials, and to assess whether the disease constitutes a contraindication to implant prosthetic treatment. Methods: A narrative literature review was conducted using the PubMed, Scopus, and Web of Science databases, covering publications from 2000 to August 2025. Manual screening of reference lists from key articles was also performed. Peer-reviewed publications in English, including experimental and preclinical studies, case reports, biomaterials research, and conceptual reviews, were included based on their relevance to acromegaly, bone metabolism, stomatognathic alterations, and implant therapy outcomes. No formal inclusion or exclusion criteria were applied, and methodological quality was not formally assessed, reflecting the exploratory and conceptual nature of this review. Results: Patients with acromegaly exhibit persistent structural bone deficits, such as reduced trabecular number, irregular trabecular distribution, and increased cortical porosity, despite normal or even elevated bone mineral density. In parallel, profound changes in soft tissues and dentition are observed, including macroglossia, diastemas, gingival overgrowth, and mandibular prognathism, which further complicate prosthetic rehabilitation. Animal studies suggest that GH and IGF-1 may support early osseointegration, although the long-term effects of their excess remain inconclusive. Clinical data, although limited, indicate that implant placement in patients with acromegaly is feasible when treatment is meticulously planned and carried out within an interdisciplinary setting. Standard biomaterials, such as titanium and its alloys, may undergo degradation under conditions of chronic inflammation and oxidative stress, underscoring the need for innovative solutions integrating bioactive and immunomodulatory materials, as well as patient-specific implants manufactured using 3D printing technologies. Conclusions: Acromegaly should not be regarded as an absolute contraindication to implant therapy; however, the current evidence is limited. Implant placement requires individualized planning, endocrine control, and interdisciplinary coordination. Further clinical and preclinical studies are needed to establish reliable treatment protocols for this population.

Introduction and Importance: The reconstruction of large anterior maxillary defects poses a significant challenge due to the complex three-dimensional anatomy and functional demands of the midface. While autogenous bone grafts are the gold standard, vascularized free flaps, particularly the fibula, offer superior outcomes for large defects. This case report highlights the application of computer-aided design and computer-aided manufacturing (CAD/CAM) technology to enhance the precision and predictability of such reconstructions. Case Presentation: A 22-year-old male presented with a substantial anterior maxillary defect following resection for ameloblastic carcinoma. The reconstruction was performed using a virtual surgical plan to guide the harvest and inset of a vascularized fibula osteocutaneous flap. Pre-bent patient-specific plates and 3D-printed surgical guides were utilized. The procedure was successful, with uneventful healing. Five months post-reconstruction, four dental implants were placed into the fibula graft using a guided surgical protocol, achieving good primary stability. Subsequent prosthetic rehabilitation resulted in the successful restoration of function and aesthetics. Clinical Discussion: This case illustrates that a CAD/CAM-guided approach allows for the precise translation of a virtual plan to the operating room, ensuring optimal graft positioning and contour. The integration of a vascularized fibula flap provided a viable bony foundation for endosseous implants, enabling definitive prosthetic rehabilitation. The digital workflow streamlines the surgical process, reduces intraoperative unpredictability, and facilitates a prosthetic-driven treatment plan from the outset. Conclusions: CAD/CAM-guided vascularized fibula graft reconstruction is a highly effective method for managing complex maxillary defects. The technology enables accurate anatomical restoration and creates ideal conditions for dental implant placement, ultimately leading to successful functional and aesthetic rehabilitation. This approach underscores the critical importance of interdisciplinary collaboration and advanced digital planning in modern maxillofacial reconstruction.

Introduction. In recent years, despite significant advancements in the prevention and treatment of dental diseases, the demand for dental care, including prosthodontic services, has continued to rise. Objective. To enhance the effectiveness of prosthodontic treatment for patients with hard tissue defects of primary teeth using inlays, through the development of methods aimed at preventing complications. Participants and Methods. The study involved 93 patients aged 18 to 59, divided into three groups: control group (30 patients) included individuals without hard tissue lesions, with physiological occlusion and no prosthodontic restorations, who presented for consultation; second group (31 patients, 34 inlays) consisted of individuals with defects restored with inlays following the classical protocol; third group (32 patients, 38 inlays) included participants with inlays placed with an additional treatment and prevention protocol. All participants underwent a comprehensive clinical examination with informed consent in accordance with bioethical standards. Electroodontodiagnostics (EOD) was performed using the “Endoest-3D” device, following a standardized protocol (oral hygiene, tooth isolation, drying, probe lubrication with gel, application of minimal current) to assess pulp sensitivity and excitability on days 1 and 30. The thickness of suprapulpal dentin was measured using the “Dentometer” mode. Inlays were fabricated from digital impressions obtained with the SHINING 3D Aoralscan 3 scanner. Results. A significant difference in EOD indices was observed between the second group (ages 18–29: 1.5 ± 0.02 μA) and the control group (3.6 ± 0.11 μA) (p < 0.05), indicating the negative impact of tooth preparation and increased postoperative sensitivity of primary teeth. On the first day following preparation, patients in the second group (aged 18–29 and 30–44 years) reported sensitivity to tactile, thermal, and chemical stimuli, which resolved upon stimulus removal and differed from typical pulp pain. Among patients aged 45–59 years, sensitivity was primarily to thermal and chemical stimuli, with tactile sensitivity reported in four cases. Patients in the third group reported similar but less pronounced symptoms. A significant difference (p < 0.05) between the third group (18–29 years: 2.40 ± 0.12 μA) and the second group (1.5 ± 0.02 μA) confirms the efficacy of the additional treatment and prevention protocol. This trend was consistent across other age subgroups (30–44 and 45–59 years). Overall, the third group exhibited fewer complaints in response to irritants compared to the second group. After one month, a statistically significant difference (p < 0.05) persisted between the second group (18–29 years: 1.70 ± 0.21 μA) and the third group (2.75 ± 0.15 μA) when compared to the control (3.6 ± 0.11 μA), reflecting elevated pulp excitability in the second group and reduced excitability in the third — further supporting the effectiveness of the comprehensive protocol. A similar pattern was noted in older age groups: 30–44 years: 1.77 ± 0.12 μA (second group) vs. 3.23 ± 0.11 μA (third group); 45–59 years: 3.58 ± 0.19 μA vs. 4.51 ± 0.46 μA, respectively. Follow-up assessments at 1, 6, and 12 months confirmed the efficacy of the proposed algorithm and the advisability of additional protection of prepared tooth surfaces during inlay fabrication. Conclusion. The use of supplementary protective measures on prepared tooth surfaces significantly reduces postoperative sensitivity and plays a crucial role in preventing pulp complications both in the short and long term, thereby improving the overall effectiveness of prosthetic rehabilitation.

Guided bone regeneration (GBR) has been widely used in the repair and reconstruction of alveolar bone defects. However, conventional GBR techniques often fail to achieve the desired bone augmentation for severe bone defects (diameter≥5 mm). To address this limitation, several innovative GBR-based approaches, such as the tenting and sausage techniques have been developed, achieving varying degrees of clinical success. Nonetheless, these methods still face considerable challenges, including secondary trauma from autogenous bone harvesting, high technical sensitivity, and limited scalability. In response, our team proposed a novel treatment concept centered on the principle of "stability-core", and developed a new therapeutic strategy that avoids the use of autogenous bone. This strategy involves the development of a new series of tent-peg medical devices and the introduction of the pouch technique, which has been successfully applied in clinical practice. This case report presents the successful use of the pouch technique for vertical ridge augmentation in the maxillary posterior region. At 8-month follow-up, substantial vertical bone gain and restoration of the alveolar ridge contour were achieved. Implant placement and prosthetic rehabilitation were completed with satisfactory functional recovery. The patient reported a positive treatment experience. This technique offers a promising and practical solution for alveolar bone reconstruction.

Velopharyngeal insufficiency (VPI) following oncologic resection of the soft palate in edentulous patients presents a major clinical challenge, often leading to hypernasal speech, nasal regurgitation, and impaired swallowing. Advances in digital technology have enabled the fabrication of precise and functionally efficient prostheses through computer-aided design/computer-aided manufacturing (CAD/CAM) and three-dimensional (3D) printing. This report describes the prosthodontic rehabilitation of a 68-year-old male with post-radiotherapy soft palate resection using a fully digital workflow to fabricate a 3D-printed complete denture with an integrated speech bulb. Following a conventional preliminary impression, the definitive cast was digitised, and all subsequent stages --including custom tray design, virtual denture base modelling, and prosthesis fabrication --were performed using CAD software and additive manufacturing. The speech bulb extension was digitally contoured to achieve functional velopharyngeal closure. At insertion and during the three-month follow-up, the prosthesis demonstrated excellent adaptation, retention, and comfort, with significant improvement in speech intelligibility, swallowing, and overall quality of life. This case highlights the clinical advantages of integrating digital workflows and 3D printing in maxillofacial prosthetic rehabilitation, providing a reproducible, minimally invasive, and patient-centred approach for managing velopharyngeal insufficiency following oncologic resection.

Eight-year follow-up of oral health-related quality of life in anodontia patients after dental implant rehabilitation.

Bone remodeling is a tightly controlled process coordinated by osteocytes, which regulate both bone formation by osteoblasts and bone resorption by osteoclasts. Titanium dioxide (TiO₂) implants are widely used in orthopedic and dental prosthetic rehabilitation, with likelihood of leaching titanium particles, raising concerns about their potential impact on bone cell functions. This study aimed to investigate the influence of TiO₂ microparticles (TiO2-MPs) and nanoparticles (TiO2-NPs) on the functionality of osteocytes. MLO-Y4 cells were treated with varying concentrations of TiO2-MPs or TiO2-NPs for viability studies. Cells were treated with 100 µg/mL TiO2-MPs and TiO2-NPs for 21 days, and conditioned media (CM) was obtained for quantifying sclerostin release using ELISA. Indirect osteocyte-osteoblast co-culture was developed by treating MC3T3-E1cells with CM from cells treated with 100 µg/mL TiO2-MPs and TiO2-NPs. Indirect osteocyte-osteoclast co-culture was developed by treating RAW 264.7 cells with CM and RANKL. Osteocyte-osteoblast co-culture was assayed colometrically for Alkaline Phosphatase, RANKL and OPG using ELISA; and TNF- α, IL − 1ß, OC and Runx2 by qPCR. Mineralization was evaluated using Alizarin and calcium quantification. Osteocyte-osteoclast co-culture was assayed for TRAP and Cat K expression. Viability studies demonstrated 100 µg/ml MPs and NPs as a favorable concentration. Sclerostin release was particle size and time-dependent: TiO₂-MPs group, levels measured were 31.13, 14.86, 13.7, and 23.06 pg/ml over time, indicating a pronounced and sustained release compared to the TiO₂-NPs group, showing 24.3, 10.94, 10.55, and 13.71 pg/ml. Osteocyte-osteoblast co-culture showed high RANKL (1709.88 vs 155.06 pg/ml), TNF- α (16.17 vs 1.07-fold), and IL − 1ß (2.08 vs 0.92-fold) in TiO₂-MPs. ALP (12.64 U/ml) and OPG (471.45 pg/ml) were decreased with less amount of nodules in MPs CM compared to control (ALP: 19.46 U/ml; OPG: 1065 pg/ml) and NPs CM (ALP: 17.95 U/ml; OPG: 645.46 pg/ml). Osteocyte-osteoclast co-culture showed upregulation of TRAP (25.24-fold) and Cat K (10-fold) in MPs CM compared to both control and NPs CM. In conclusion, TiO₂ particles disrupt osteocytes functionality through release of sclerostin and RANKL that inhibit osteoblastogenesis and promote osteoclastogenesis in in-vitro osteocyte-osteoblast and osteocyte-osteoclast co-cultures, with microparticles behaving more harmful than nanoparticles.

This clinical report aims to highlight the complications associated with cocaine use, particularly focusing on oronasal perforations, and demonstrate the efficacy of using a maxil-lary obturator for rehabilitating palatal defects to restore oral functions. Material and Meth-ods: A 60-year-old male patient with a history of cocaine abuse presented with an oronasal perforation in the hard and soft palate after multiple surgical interventions. He reported issues with hypernasal speech and difficulties swallowing. A prosthodontic approach was employed; a removable obturator was fabricated using impression techniques with care to minimize weight and maximize functionality. Post-delivery, the obturator successfully restored the patient's ability to speak and swallow normally, with significant improvements reported in aesthetic outcomes. Regular follow-ups demonstrated the prosthesis's stability. The findings suggest that prosthetic rehabilitation with an obturator is a viable and effective solution for managing palatal perforations resulting from cocaine use, significantly improving oral functions and quality of life. This approach highlights the need for comprehensive treatment plans that include both prosthetic management and encouragement toward substance abstinence, emphasizing the multifaceted public health implications of cocaine addiction and its complications.

Relevance. Complete secondary edentulism remains one of the most significant problems in prosthetic dentistry, especially in cases of severe alveolar ridge atrophy and thin mucosa. Even with the implementation of CAD/CAM and additive manufacturing technologies, there is still a lack of clinical research evaluating the effectiveness of modern protocols considering the use of adhesive agents. Objective. To evaluate the clinical effectiveness of a newly developed method for prosthetic rehabilitation of patients with complete edentulism and unfavorable conditions for removable denture fixation. Materials and methods. The study included 48 patients (aged 52–74 years) with complete edentulism, divided into two groups: the main group — prosthetic treatment using the author’s protocol, and the control group — conventional technology with 3D printing. Effectiveness was assessed using the Kapur Index, Galonsky-Radkevich adaptation index, and OHIP-EDENT at 7, 14, 30, and 60 days after prosthesis delivery. Statistical analysis included Student’s t-test, Mann-Whitney U test, and ANOVA, with p < 0.05 considered significant. Results. The author’s method showed a consistent advantage: by day 60, the Kapur Index reached 91.4 ± 3.6% compared to 74.2 ± 4.9% in the control group (p < 0.01); the Galonsky-Radkevich index — 2.86 ± 0.14 vs. 2.24 ± 0.28 (p < 0.01); OHIP-EDENT score — 14.1 ± 2.6 vs. 27.9 ± 3.9 (p < 0.01). No complications requiring prosthesis correction were observed in the main group, while in the control group such cases accounted for 16.7%.

Ectodermal dysplasia (ED) presents significant dental and craniofacial challenges, particularly in prosthetic rehabilitation due to anodontia or oligodontia, underdeveloped alveolar ridges, and altered vertical dimensions. Although diverse treatment modalities have been described, no consensus exists on the most effective rehabilitation protocol. To systematically review the literature on prosthetic rehabilitation in patients with ED, encompassing removable dental prostheses, fixed dental prostheses, and implant-supported prostheses, and to evaluate outcomes in terms of survival, function, aesthetics, patient satisfaction, and complications. A comprehensive manual and electronic search of PubMed (MEDLINE), Web of Science, Scopus, and Google Scholar (grey literature) was conducted. Clinical studies, case series, and case reports involving prosthetic rehabilitation in ED patients were included. Data extraction was performed independently, and risk of bias was assessed using ROBINS-I and the JBI Critical Appraisal Checklist. Twenty-nine studies were included, comprising case reports, case series, and prospective and retrospective cohort studies. Treatment approaches varied widely, including removable dental prostheses, fixed dental prostheses, and implant-supported prostheses. Most studies emphasised early intervention, multidisciplinary planning, and periodic revision of prostheses during growth. Implant-supported prostheses showed favourable long-term outcomes in adolescent and adult patients. Risk of bias ranged from low to moderate across studies. Prosthetic rehabilitation in ED requires an individualised, multidisciplinary approach. While implant-supported prostheses demonstrate promising outcomes, early removable solutions remain essential in paediatric cases. Further prospective studies with standardised protocols are needed to guide evidence-based treatment strategies.

Prosthetic rehabilitation of a marginally resected mandible with complete denture: a case report

This single case report describes the rehabilitation of a 71-year-old man with a hemimaxillary defect following resection of maxillary gingival carcinoma and reconstruction with a pedicled submental island flap. Conventional prosthetic rehabilitation had failed to provide adequate retention, and implant therapy was contraindicated due to prior radiotherapy. A suction cup denture was fabricated as a minimally invasive alternative to restore function. At six months, the denture demonstrated satisfactory retention, stability, and masticatory efficiency, with the patient reporting improved comfort, speech, and quality of life, and no persistent mucosal complications were observed. This case suggests that suction cup dentures may serve as a temporary, low-cost, and functionally effective option for hemimaxillectomy patients with specific indications, provided that wearing time is restricted and close follow-up is maintained to minimize risks.

Mandibular reconstruction following Odontogenic Keratocyst (OKC) resection poses significant challenges in restoring both structural integrity and functional dentition. Traditional approaches require multiple surgeries and extended rehabilitation periods. This case report presents a 70-year-old male requiring anterior mandibular reconstruction following OKC resection from teeth #31 to 46. Using an innovative fully digital workflow, a patient-specific titanium implant (PSI) with pre-integrated dental implants via Direct Metal Laser Sintering (DMLS) was designed and fabricated. The PSI featured a gradient mesh architecture optimized through finite element analysis, with dental implants precisely positioned and laser-welded during fabrication. Single-stage surgical placement was followed by prosthetic rehabilitation at 3 months using a digitally designed DMLS-fabricated acrylic-metal hybrid prosthesis. At 18-month follow-up, the patient demonstrated complete functional restoration with optimal mastication, speech articulation, and facial symmetry. Radiographic evaluation confirmed excellent osseointegration without complications. The integrated digital workflow reduced treatment time by 40% compared to conventional protocols. This case represents the first reported use of pre-mounted dental implants within a PSI for mandibular reconstruction, demonstrating how advanced digital technologies can streamline complex rehabilitative procedures while achieving superior functional outcomes.

Dear Editor, Mandibular atrophy secondary to aging and prolonged edentulism can lead to superficialization of the inferior alveolar and mental nerves[1]. This condition may result in chronic pain, paresthesia and hyperesthesia, significantly reducing patients’ quality of life and complicating prosthetic rehabilitation. In such cases, removable dentures often fail due to loss of retention, mucosal overload and nerve compression, which in turn lead to both functional and psychological problems [2]. Superficialization of the inferior alveolar nerve (IAN) is usually reported by patients as complaints of pain, paresthesia, or hyperesthesia. Radiographically, IAN superficialization was defined on cone-beam computed tomography (CBCT) imaging as an alveolar crest-to-mandibular canal distance of ≤2 mm and/or a cortical bone thickness overlying the canal of <1 mm, or complete loss of the cortical plate. These radiological findings were evaluated together with the patients’ clinical complaints of pain and paresthesia, both of which may severely compromise quality of life. In atrophic mandibles, nerve superficialization carries the risk of iatrogenic nerve injury, particularly during placement of prostheses or implants, as these may exert pressure on the nerve. Autogenous block bone grafting, which has been reported with high success rates, represents a promising method for both relieving pain and paresthesia and creating adequate bone volume for rehabilitation [3]. In this letter, the authors present their clinical experience with autogenous bone grafting in patients suffering from pain and paresthesia due to nerve superficialization in severely atrophic mandibles, and emphasize its potential as a low-risk and effective treatment option.

This study aimed to evaluate the satisfaction of patients rehabilitated with maxillary fixed prostheses supported by zygomatic implants, using the Liverpool Oral Rehabilitation Questionnaire (LORQ-v3) and the Oral Health Impact Profile (OHIP). Fifty-two patients with maxillary bone defects who were rehabilitated with fixed prostheses supported by zygomatic implants were included in this questionnaire-based study. Patients were asked to evaluate their dental problems both before prosthesis fabrication and at 1 year post-rehabilitation, using LORQ-v3 and OHIP-14. Responses were assessed on a Likert scale. Patient perceptions of quality of life were measured in relation to general satisfaction, comfort and stability, speech, esthetics, self-esteem, and functionality. Overall improvement in oral health-related quality of life (OHRQoL) was observed among all participants. In LORQ-v3, item-specific improvement ranged from 8% pretreatment to 43% posttreatment. In OHIP, scores improved from 21% to 69% between baseline and 1 year. Prosthetic rehabilitation with zygomatic implants for maxillary defects significantly improved patients' OHRQoL.

Hypodontia, defined as the congenital absence of one or more teeth (excluding third molars), is a common developmental anomaly with significant esthetic, functional, and psychosocial consequences, particularly when it involves the anterior region. The maxillary lateral incisors are among the most frequently missing teeth, and their absence during the mixed dentition stage requires comprehensive treatment planning. This case report describes the multidisciplinary management of a 12-year-old girl with congenitally missing maxillary right and left lateral incisors, associated with a high labial frenum attachment and tongue thrusting habit. The treatment protocol involved sequential steps of habit interception using myofunctional exercises followed by a fixed tongue guard appliance, frenectomy, orthodontic space creation with open coil springs, and interim prosthetic rehabilitation with a removable partial denture. This staged approach successfully restored function and esthetics, while also addressing the psychosocial needs of the patient. The case highlights the importance of early diagnosis and timely intervention in pediatric patients with hypodontia to establish a stable foundation for future definitive treatment. Keywords: Hypodontia, Tongue thrusting habit, Frenectomy, Orthodontic space creation, Prosthetic rehabilitation

Complete edentulism is a common challenge, and the protocol prosthesis is one of the main alternatives for resolving this impasse. Traditionally, its fabrication takes 3 to 6 months due to the osseointegration of dental implants (DIs). However, the immediate loading technique allows the prosthesis to be installed within 72 hours after the DIs are placed, quickly restoring function and quality of life. In this context, the objective of this study is to report oral rehabilitation with a fixed complete denture, from the DIs installation to their fixation through guided surgery and immediate loading. A 65-year-old male patient presented to the dentist reporting dissatisfaction with the use of an upper removable partial denture. During the anamnesis, periodontal and aesthetic impairment of the present teeth was observed. Multiple extractions and rehabilitation with an upper implant-supported prosthesis were planned. After the anamnesis, the patient’s arches were scanned and a digital plan was created to create a 3D-printed surgical guide(SC) with biocompatible resin. The extractions were then performed, and with the help of the SC, five Morse taper implants were placed, associated with five mini-abutment abutments and their respective provisional cylinders. A removable complete denture was previously fabricated, and holes were drilled in it to position the provisional cylinders. This was then captured using self-curing acrylic resin. Following this, occlusal adjustment, finishing, and polishing of the piece were performed, and installation was performed. Thus, oral rehabilitation with implants through the guided surgery technique and immediate loading is a procedure that brings comfort and predictability in rehabilitation, reducing postoperative morbidity, favoring installation in the appropriate regions and allowing immediate prosthetic rehabilitation.