Temporary Cement Research Articles

The Masquelet technique in the treatment of a non-infected open complex fracture of the distal tibia with severe bone and soft tissue loss: A case report

The treatment of open distal tibia fractures remains challenging, particularly when the fracture involves severe soft tissue damage and segmental bone loss.We present the case of a 33-year-old woman who sustained an open distal tibia fracture type 43-A3.3, with segmental bone loss, and a closed bifocal fibular fracture.The fractures were initially fixed with a temporary external fixator. The open distal tibial fracture underwent an intramedullary nailing on day six post-trauma, while the segmental bone loss was refilled with a temporary cement spacer, in order to create a biologic chamber, according to the technique by Masquelet et al.At three months post-trauma, the temporary cement spacer was removed and the bone loss was filled with an autologous bone graft obtained with the Reaming Irrigation Aspiration (RIA) system. The fracture successfully healed at 13 months post-trauma.Masquelet technique, in association with the RIA system, represents a valid strategy in the treatment of non-infected open complex fracture of the distal tibia with severe bone and soft tissue loss.

Influence of margin location and luting material on the amount of undetected cement excess on CAD CAM implant abutments and cement‐retained zirconia crowns

Background As cement remnants of fixed implant-supported restorations have been associated with clinical and radiographic signs of peri-implantitis, there is a need for reducing the probability of leaving subgingival cement excess. High flexibility in designing the subgingival part of CAD CAM abutments and the individual positioning of the shoulder finish line may eliminate the problem of undetected cement residues. However, so far there is only little data available to support this hypothesis. Aim/Hypothesis To test whether or not an epimucosal position of an abutment margin with temporary zinc oxide non-eugenol cement or methacrylate cement is superior to a submucosal margin position in terms of remaining cement following cementation of reconstructions on customized CAD CAM molar abutments. Material and Methods A total of 20 titanium CAD CAM abutments (Semados, BEGO, Bremen, Germany) with a convex emergence profile and different margin positions (from 0 to 1, 2, and 3 mm below the mucosa) were virtually designed and centrally manufactured. The master cast was scanned, duplicated by a 3D printer, and individual gingival masks were produced to simulate peri-implant soft tissues. 20 zirconia crowns (Zirlux, Henry Schein, Germany) were produced and cemented to the abutments with two different luting materials (Temp Bond NE, Kerr Dental, Germany, Panavia V5, Kuraray, Japan). To ensure retrievability of the crown abutment connection, occlusal openings providing access to the abutment screws were designed. Cement excess was thoroughly removed and the crown abutment units were unscrewed to evaluate the occurrence of cement residues. All quadrants of each specimen were evaluated for calculation of the ratio between the cement remnant area and the total specimen area using Adobe Photoshop (p 0.05). Results Cement remnants were found in every depth of the crown abutment complex and in almost every area investigated. The amount of cement residues was influenced by the location of the crown-abutment margin. A significant increase in remnants was detected when the crown-abutment margin was located more submucosally. Deep crown–abutment margin positions (deeper than 1 mm below mucosa) increased the risk of cement excess. Oral and interdental areas are more prone to cement remnants than other surface areas. The investigation showed, that cement remnants were not only found at the margins of the crown-abutment complex, but also underneath (basal) of the abutment itself, where literally no cleaning was possible at all. No statistical difference in the effect of a temporary zinc oxide non-eugenol cement (Temp Bond NE, Kerr Dental) and a methacrylate cement (Panavia V5, Kuraray, Japan) on the frequency of excess cement could be demonstrated. Conclusions and Clinical Implications Given the results obtained in the present investigation the margin of CAD CAM molar abutments should be located as coronally as possible to minimize the amount of cement remnants. Due to esthetic reasons this ideal margin location is frequently not feasible. However, it cannot be recommended to place the margin of molar abutments deeper than 1.5 mm in the interdental and oral regions. There was no evidence that the type of cement had an influence on the amount of remnants after cleaning.

Influence of Luting Materials on the Retention of Cemented Implant-Supported Crowns: An In Vitro Study.

The retention force of cemented crowns on implant abutments with various luting materials was evaluated. Cobalt–chromium crowns were cemented onto tapered titanium abutments (Camlog) with eugenol-free temporary cement (RelyX TempBond NE), composite-based temporary cement (Bifix Temp), zinc phosphate cement (Harvard Cement), glass-ionomer cements (Meron, Fuji I), and resin-modified glass-ionomer cements (Fuji II, Fuji Plus, Ketac Cem Plus). Specimen aging via hydrostress was performed in artificial saliva at 37 °C for 14 days (S1), followed by hydrothermal stress with thermocycling (S2). The crowns were removed, and the force was recorded (T1). Subsequently, the crowns were recemented, aged, and removed, and the force was recorded (T2, T3). The retention forces differences were statistically significant according to the storage conditions at T1 (p = 0.002) and T3 (p = 0.0002). After aging (S1), Ketac Cem Plus had the highest retention force median value difference (T3 versus T1) (−773 N), whereas RelyX TempBond NE had the lowest (−146 N). After aging (S2), Meron had the highest retention force median value difference (−783 N), whereas RelyX TempBond NE had the lowest (−168 N). Recementation decreased the retention force of the implant-supported cobalt–chromium crowns cemented and recemented with the same luting materials. Luting materials (at T1) and aging conditions significantly impacted the retention force.

A 30 year old female with continuous dull pain following perforation during root canal treatment in lower left first molar tooth

This article has no abstract. The first 100 words appear below: A 30 year old female reported to the Department of Conservative Dentistry and Endodontics with the complaint of continuous dull pain in her lower left first molar tooth. She told that the tooth was attempted for endodontic treatment three weeks before and the perforation might occur at that time. On clinical examination, although the tooth was found sealed coronally with a temporary cement but it was sensitive to percussion and palpation. The mean probing pocket depth was within the normal level of 2 mm. Radiographic examination revealed a destruction of pulpal floor area with radiolucency.

Antibacterial Effect of a Temporary Cement-Dissolving Liquid.

Methods for removing temporary cement with an antibacterial effect might improve prosthetic treatment prognosis. Three removal methods were assessed: (1) immersion of an acrylic provisional restoration in a temporary cement dissolver (Temp-off); (2) mechanical removal with a dental explorer; and (3) sandblasting. Two temporary cements, one with eugenol (Temp-Bond) and one without eugenol (Temp-Bond NE) and of two thicknesses (100 μm and 250 μm), were examined. Immersion in Temp-off produced the most effective bacterial count decrease compared to the other methods (P < .05). No significant difference was found between the two cement types, although the decrease in count was more evident in the thicker (250 μm) cement layer. Temp-off dissolving liquid used for removal of temporary cement exhibited an antibacterial effect and nonmechanical cleaning ability.

The effect of surface texture on the retention of single implant-supported crowns cemented on wide-platform abutments

OBJECTIVE: This in vitro study evaluated the retention of copings cemented with a provisional cement and a permanent cement on wide-platform short abutments with different surface texture.METHODS: Two wide-platform abutments (height 4.0 mm) with machined (original) or modified surface (air-blasted with 50-µm aluminum oxide) were connected to two implant replicas under torque of 35 N.cm. Ten copings were cast in Cr-Co alloy from calcinable cylinders. Each coping was luted on the abutment under an axial force of 5 kg for 10 min, and the specimen was stored in a humid environment at 37°C for 20 h. After mechanical cycling simulating masticatory fatigue for 7 days (5754 cycles, 60 cycles/min, 200 N, 37°C), the specimens were subjected to a uniaxial tensile test at 0.5 cm/min, and the maximum retention strength (N) was recorded. After testing, the surfaces were cleaned, and the procedures were repeated for each coping in the experimental group. Data were analyzed by Student t test for paired samples. RESULTS: For the temporary cement, the mean retention (SD) was 36.1 (10.7) N for the machined surface and 49.6 (2.7) N for the blasted surface (P=0.004) (37% increase). For the zinc phosphate cement, the values were 292.0 (89.8) N and 440.6 (48.1) N, (P&lt;0.001) (42% increase).CONCLUSION: The results suggest that the air-blasting of short and wide abutments increases the retention of the cast coping cemented with temporary or permanent cement.

The Effect of CAD/CAM Crown Material and Cement Type on Retention to Implant Abutments.

To evaluate the pullout resistance of CAD/CAM implant-supported crowns cemented with provisional and definitive cements on Ti-base implant abutments. Sixty crowns were milled for use in Ti-base implant abutments and divided (n = 15/group) according to material, as follows: (a) [Pr] Temporary acrylic resin; (b) [Co-Cr] Cobalt-Chromium alloy; (c) [Zr] polycrystalline zirconia; and (d) [Ti] titanium. The cementation was performed with RelyX Temp NE (RxT) cement or RelyX U200 self-etching resin cement, under a 50 N (5 kg) load for 10 minutes. Twenty-four hours after cementation, the crowns were subjected to the pullout test in a universal test machine, at a 1.0 mm/min crosshead speed. The tests were performed first without cement to evaluate frictional resistance (Baseline), then with provisional cement (RelyX Temp NE without cement again (Baseline After RxT), and finally with resin cement (U200). The results were analyzed by ANOVA and Tukey test (p < 0.05). Data evaluation as a function of cement type demonstrated the superiority of resin-based cements relative to provisional and baseline groups (p < 0.01). While Co-Cr crowns presented the highest pullout strength values, Pr showed the lowest values (data collapsed over cement) (p < 0.001). Retentiveness data as a function of both factors demonstrated similar pullout resistance between groups without cement (p < 0.001), except Zr baseline. Also, Co-Cr presented higher pullout strength compared to other materials. Self-adhesive resin cement exhibited superior retention compared to temporary cement, regardless of crown material. Co-Cr and titanium presented higher levels of retention to Ti-base abutment after being cemented.

The effect of the petroleum jelly on the hardness of Zinc Oxide Eugenol dental cement

Dental cement is one of few materials which have been developed specifically for dental use, most of the other dental materials have been borrowed from other environment and then modified to meet the particular requirements of dentistry (1).The zinc oxide eugenol is one of the most dental cement that is used as a base material beneath metallic dental restoration and as an insulating temporary filling material and cement temporary crown, it is required to improve the physical properties of zinc oxide eugenol in order to be superior than other cement, notably in respect of its palliative effect on the pulp so the addition of additives such as O –ethexy benzoic acid (EBA) and polystyrene may increase the strength of ZOE cement (2,3,4,5,6,7), such additives may have a deleterious effects on the film thickness and solubility (8,3,9) .Zinc oxide are mixed with eugenol the mix sets to a hard cement , it is supplied as a powder and liquid or two pasts system, Simple mixed of these plain tow materials harden in the mouth in about 12 hours (1) but did nothave great strength when compared with other types of cements (11,12), An attempt to achieve a convenient setting time and strength of cement changing the ratio of base to accelerator has been advocate (6,7,13).So generally recognized or as a company suggestion to improve the handling and physical properties (hardness) of commonly used temporary ZOE cement by combining it with a mixture of semisolid saturated hydrocarbons lubricant of petroleum jelly (14).Aim of Study: Comparing (in-vitro) the hardness of Zinc Oxide Eugenol cement before and after adding different amount of Petroleum jelly.

Effect of CAD/CAM Abutment Height and Cement Type on the Retention of Zirconia Crowns

To evaluate Ti-Base abutment height and cement type on the retentiveness of zirconia-based restorations. Four millimeter (tall) and 2.5-mm-height (short) abutments along with temporary (provisional), glass ionomer (Meron), self-adhesive (U200), and conventional resin cement (Ultimate) were evaluated using pull-out testing (n = 10 crowns/group). Tall and short abutments demonstrated similar retention for all within cement comparisons, except U200 (P = 0.032). Resin cements exhibited superior retentiveness than others (P < 0.01). Although no significant difference was evidenced between resin cements for short abutments, Ultimate evidenced higher retention than U200 for tall abutments (P = 0.043). Although Ti-Base abutment height has not influenced zirconia superstructures' retentiveness, resin-based cements significantly evidenced higher retention than glass ionomer and temporary cements.

Evaluation of retention of two implant supported ceramic crowns using two temporary cements

Aim: The purpose of this in vitro study was to evaluate the effect of two temporary cements (Resin based cement and Eugenol Free Zinc oxide cement) on the retention of two titanium implant supported crowns made of (Polymer infiltrated hybrid glass ceramic and Yttrium stabilized tetragonal zirconia).Materials and methods: 20 dummy implants were inserted in epoxy resin blocks. The twenty blocks were divided according to the crown material into two groups (n=10): Group I: VITA ENAMIC™ crowns, Group II: BurxZir™ zirconia crowns. Each group were further sub-divided into two sub-groups (n=5), according to the temporary cement material used (Sub-group A: crowns cemented with DentoTemp™ cement, Sub group B: crowns cemented with Tempbond NE™ cement). The crowns were fabricated with CAD-CAM technology. Each crown had two wings on the mesial and distal surfaces to aid in retention analysis. The crowns were cemented to the titanium abutments and then retention was measured using uni-axial tensile force test.Results: DentoTemp™ cement showed a higher retentive values with both crown materials. The retentive values of the DentoTemp™ temporary cement was significantly higher than those of the Tempbond NE™ cement when used with BruxZir™ Zirconia crowns.Conclusions: Resin based temporary cement showed significantly higher retention results than non-eugenol temporary cement while the difference in crown material showed no significant difference.

Shear bond strength of luting cements to fixed superstructure metal surfaces under various seating forces.

PURPOSEIn this study, the shear bond strengths (SBS) of luting cements to fixed superstructure metal surfaces under various seating forces were investigated.MATERIALS AND METHODSSeven different cements [Polycarboxylate (PCC), Glass-Ionomer (GIC), Zinc phospahate (ZPC), Self-adhesive resin (RXU), Resin (C&B), and Temporary cements ((RXT) and (TCS))] were bonded to a total number of 224 square blocks (5×5×3 mm) made of one pure metal [Titanium (CP Ti) and two metal alloys [Gold-Platinum (Au-Pt) and Cobalt-Chrome (Co-Cr)] under 10 N and 50 N seating forces. SBS values were determined and data were analyzed with 3-way ANOVA. Pairwise comparisons and interactions among groups were analyzed with Tukey's simultaneous confidence intervals.RESULTSOverall mean scores indicated that Co-Cr showed the highest SBS values (1.96±0.4) (P<.00), while Au-Pt showed the lowest among all metals tested (1.57±0.4) (P<.00). Except for PCC/CP Ti, RXU/CP Ti, and GIC/Au-Pt factor level combinations (P<.00), the cements tested under 10 N seating force showed no significantly higher SBS values when compared to the values of those tested under 50 N seating force (P>.05). The PCC cement showed the highest mean SBS score (3.59±0.07) among all cements tested (P<.00), while the resin-based temporary luting cement RXT showed the lowest (0.39±0.07) (P<.00).CONCLUSIONPolycarboxylate cement provides reliable bonding performance to metal surfaces. Resin-based temporary luting cements can be used when retrievability is needed. GIC is not suitable for permanent cementation of fixed dental prostheses consisting of CP Ti or Au-Pt substructures.

Prosthetic Rehabilitation using a Telescopic Crown constructed with Computer-assisted Design and Computer-assisted Manufacturing: A Case Report with a 2-year Follow-up

Aim and background: This case report describes a 74-year-old female patient whose teeth were rehabilitated using telescopic crowns (TCs) on abutments and fixed dental prostheses (FDPs) in the maxillary arch with the aid of computer-assisted design and computer-assisted manufacturing (CAD/CAM) technology. The mandibular arch was restored using casted removable dental prostheses (RDPs) and surveyed crowns. Case report: The treatment sequences were followed as recommended in the dental literature. First, existing defective restorations were eliminated, caries was removed, and excellent mouth preparation was performed. Subsequently, root canal treatments and post and core placements were conducted. The casts were mounted, and a new vertical dimension was established. Maxillary telescopic FDP and mandibular prostheses were fabricated. Finally, a regular and proper follow-up and maintenance program was implemented. Conclusion: The patient was satisfied with the esthetics and function of the telescopic FDP in the presence of the established occlusion. Clinical significance: The secondary coping of the telescopic FDP is cemented with temporary cement, which can be changed easily whenever it is loose. Furthermore, it is completely opposed to RDP in the mandibular posterior masticatory area. The prognoses will be good improvement; the patient was medically fit, motivated, and followed continual oral hygiene protocol. Keywords: Computer-assisted design, Computer-assisted manufacturing, Esthetic, Maxilla, Telescopic crown.

Release of antimicrobial compounds from a zinc oxide-chelate cement.

This study examined the release of cetylpyridinium chloride and benzalkonium chloride from fatty acid chelate temporary dental cement and their antimicrobial effects. The cement was Cavex Temporary, and either cetylpyridinium chloride or benzalkonium chloride was added (1% or 5% by mass), incorporating into the base paste. Release of the additives was determined by reverse-phase high-performance liquid chromatography. Possible chemical interactions between the cement components and additives were examined by Fourier transform infrared (FTIR) spectroscopy. Antimicrobial effects were assessed by measuring the zone of inhibition around sample discs after 24 h in a Streptococcus mutans culture. FTIR spectroscopy showed no interaction with cement components. For both additives, release was by diffusion for approximately the first 6 hours, with equilibration after about 2 weeks. Diffusion coefficients were 1.76 m2 s½ to 8.05 × 10-12 m2 s½ and total release was 10.3 to 44.7% of additive loading. Zones of inhibition with additive were significantly larger than those for control discs. In conclusion, the antimicrobial properties of Cavex temporary cement are improved by the addition of the antimicrobial compounds cetylpyridium chloride and benzalkonium chloride, which are released by a diffusion process.

Effect of exposure time of eugenol containing temporary cement on tensile bond strength of permanent restorations luted with Self-Adhesive dual cure resin cement-An in vitro study

Purpose: This study was conducted to evaluate the tensile bond strength and fracture mode of permanent restorations luted with self-adhesive resin luting agent following provisional cementation with eugenol containing luting agents

Effect of Margin Level Setting in Abutments Created by CAD/CAM on Residual Cement

Background: Various complications of dental implants have been reported as cases with long-term implant use increase with its spread of use. It has been reported that residual cement is involved in approximately 80% of the peri-implantitis cases, and prompt management of residual cement is important. This study examined cementation of the superstructure and how the level of gingival margin of abutments affected the amount of residual cement. The study also examined the level of abutment margin to avoid residual cement.Materials and Methods: Working models were prepared using epoxy resin. Implants were placed in one part of the maxillas. Silicone rubber was used to simulate peri-implant gingiva. Morphological designing was performed for the abutments and superstructures on the prepared models. The examination was performed on four levels of abutment margins: the same level as the margin of the gingiva (ML0), 1 mm subgingival (ML-1), 2 mm subgingival (ML-2), and 3 mm subgingival (ML-3). Temporary cement was placed in each superstructure which was then placed on the abutment. An access hole was created on the superstructure, and the abutment and superstructure were removed from the model. Observations were made on the cement remaining subgingivally (residual cement). The cement above the margin and residual cement were collected.Results: If the margin level was subgingival, there was a tendency for residual cement to adhere to the entire subgingival area regardless of the margin depth. The residual cement weight percentage was significantly higher for the ML-2 and ML-3 margins than for ML-0 margins. The percentages of supragingival cement did not differ significantly among different abutment margins.Discussion and Conclusion: The results of this study suggest that when the abutment margin is ML-2 or lower, the cement does not extrude supragingivally and tends to remain subgingivally.

Analysis of sealing ability of endodontic cements apical plugs.

BackgroundIt is unknown whether the bioactivity of Biodentine characterized by the precipitation of hydroxyapatite and formation of tags into the dentinal tubules improve its sealing ability as an apical plug. Aim: To evaluate the sealing ability provided by Biodentine and mineral trioxide aggregate (MTA) apical plugs, with or without phosphate-buffered saline (PBS) intracanal dressing, using a glucose leakage method.Material and MethodsThe space of the canal of 100 root segments with about 12 mm long was shaped using Gates-Glidden. After created an apical retrograde cavity, the root segments were randomly divided into 4 groups (n = 25): G1 – Biodentine; G2 - Biodentine + PBS intracanal dressing; G3 - MTA and G4 - MTA + PBS intracanal dressing. All access openings were filled with temporary cement and all root segments were introduced in floral foams moistened with PBS. After 2 months, all root segments were prepared to evaluate the glucose leakage. The amount of glucose leakage was quantified by a spectrophotometer and the data were analyzed using chi-square test (p<0.05).ResultsTraces of the glucose were observed in a higher of samples that received Biodentine apical plug (p<0.05). The exposure to intracanal PBS did not influence the sealing provided by Biodentine and MTA.ConclusionsThe Biodentine had lower sealing ability than MTA. The interaction with PBS intracanal dressing did not improve the sealing ability provided by sealers. Key words:Apexification, dental cements, dental leakage, glucose, pressure.

Reconstruction Plate-Based Antibiotic Cement Spacers: Clinical Outcomes and Description of Technique.

The standard of care for chronic deep peri-prosthetic hip infection is a two-stage exchange with placement of a temporary antibiotic cement spacer and treatment with intravenous antibiotics. Several commercially available cement spacer options exist. We report on a novel antibiotic spacer that may be an efficient, cost-effective alternative. Medical records of all patients treated for deep peri-prosthetic hip infection after total hip arthroplasty between 2004 and 2012 were reviewed. Each antibiotic spacer was constructed from a 12- to 16-hole recon plate bent to provide adequate soft tissue tension and a cement ball that matched the acetabulum. Premature failure of the plate and duration of implantation were measured. Failure was defined as fracture of the plate or dissociation of the cement head from the plate. Costs were compared with commercially available cement spacers. A total of 24 spacers were identified in 21 patients (mean age 68.9 years, mean body-mass index 26.4). The mean time between spacer placement and re-implantation was 6.4 months (range: 1.8-18 months). One patient had an indolent infection that was unresponsive to antibiotic therapy and required a hip disarticulation. At the time of reimplantation, 17 of 17 handmade spacers had no failures. Of the premade spacers, six of the seven had no failures. One premade spacer fractured at the femoral component trunion. The cost of the plate and antibiotic cement was $909-1000, approximately $5000 less than premade spacers. Antibiotic spacers can be readily constructed intraoperatively and offer good clinical outcomes with a low incidence of failure. This type of spacer saved $5000 per patient.

Effect of removal of temporary cement on zirconia-dentin bond strength

Effect of removal of temporary cement on zirconia-dentin bond strength

Effect of Polymerization Accelerator on Bond Strength to Eugenol-Contaminated Dentin.

To evaluate the effect of a polymerization accelerator on the microtensile bond strength (µTBS) of etch-and-rinse and self-etch adhesives to eugenol-contaminated dentin. Sixty flat dentin surfaces were prepared from human molars. Half of the specimens were restored with zinc oxide eugenol temporary cement (IRM) (eugenol-contaminated group) and the other half remained without restoration (control group). After 24-h storage, the cement was mechanically removed. Then the specimens in each group were further divided into three subgroups based on the application procedure of a polymerization accelerator (p-toluenesulfinic acid sodium salt; Accel): no application, 10-s application, or 30-s application. After air drying, the dentin surfaces were bonded with either a three-step etch-and-rinse adhesive (OptiBond FL) or a two-step self-etch adhesive (Clearfil SE Bond) and restored with composite. After 24-h water storage, the bonded specimens were subjected to the µTBS test. Data were analyzed by three-way ANOVA and Dunnett's T3 test (p < 0.05). The eugenol-contaminated groups had significantly lower µTBS than the control groups with both types of adhesives (p < 0.05), and the application of Accel significantly increased the compromised µTBS to eugenol-contaminated dentin. Optibond FL presented significantly higher µTBS to eugenol-contaminated dentin than did Clearfil SE Bond (p < 0.05). The application of a polymerization accelerator on eugenol-contaminated dentin prior to adhesive resin application increased the μTBS of both the three-step etch-and-rinse and two-step self-etch adhesive.

Metal free, full arch, fixed prosthesis for edentulous mandible rehabilitation on four implants

PurposeThe goal of this work is to describe an implant-prosthetic protocol for rehabilitation of edentulous mandible, by using a fixed prosthesis made of fiber-reinforced composite material (FRC). The protocol contemplates a minimal invasive surgery and ensures predictable and safe results, with good aesthetic and performance combined to cost savings. MethodsFRC material is used to build the substructure of a prosthetic framework supported by four short implants (5mm long and 4mm wide). The prosthesis substructure is made of Trinia immersed in a matrix of epoxy resin (FRC). It is supplied in milling blocks (pre-cured) for the CAD/CAM (computer-aided design/computer-aided manufacturing) technique.Implants are placed in lower edentulous jaw in position of first molar and canine, each side. Four month after, a resin bar is build based on a stone model, denture teeth are placed and the occlusion is checked. The resin bar and the stone model with milled abutments are scanned and a FRC bar is achieved with the CAD/CAM technique. The teeth are mounted to the substructure trough denture resin. Temporary cementation of framework is achieved on the abutments connected to the implants. ConclusionA protocol for a fixed mandibular implant-prosthetic rehabilitation is described. The protocol contemplates a minimal invasive surgery and ensures predictable and safe results, with good aesthetic and performance combined to cost savings. In addition, this technique allows performing basic surgery also in presence of atrophy.