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   Table of Contents - Current issue
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October-December 2020
Volume 20 | Issue 4
Page Nos. 335-442

Online since Thursday, October 8, 2020

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EDITORIAL  

Sleep apnea and prosthodontic implications Highly accessed article p. 335
N Gopi Chander
DOI:10.4103/jips.jips_323_20  
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REVIEW ARTICLES Top

Marginal and internal adaptation of lithium disilicate partial restorations: A systematic review and meta-analysis p. 338
Natalia Almeida Bastos, Sandro Basso Bitencourt, Renan Figueiredo Carneiro, Brunna Mota Ferrairo, Samira Sandy Ferreira Strelhow, Daniela Micheline dos Santos, Juliana Fraga Soares Bombonatti
DOI:10.4103/jips.jips_112_20  
Aim: The aim of this meta analysis was to evaluate the influence of the processing method on the marginal and internal gaps of lithium disilicate inlays/onlays. Settings and Design: A systematic literature review was conducted using the PubMed/Medline, Embase, Scopus, and Cochrane Library databases. This review was registered on the PROSPERO platform. Materials and Methods: The studies were selected according to the marginal and internal gaps of two different fabrication methods for lithium disilicate (milled and pressed). Statistical Analysis Used: The meta analysis was performed based on the Mantel–Haenszel and inverse variance methods, using the random effects model and a 95% confidence interval. Results: From all databases, 127 studies were identified. Four in vitro studies were included in the qualitative analysis and three in the meta analysis. Moreover, 197 restorations were evaluated (103 pressed and 94 milled). During the evaluation of only the internal gap, there was a statistically significant difference favoring the pressed technique (P = 0.002). There was no statistically significant difference in the analyses of the marginal gap (P = 0.530) and the total gap (P = 0.450). Conclusion: Both the techniques provided acceptable marginal and total gaps, although the pressed technique revealed a more favorable internal adaptation than the milled onlays/inlays.
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Positioning of iris in an ocular prosthesis: A systematic review p. 345
Seema Sathe, Sweta Pisulkar, Sharayu Vinod Nimonkar, Vikram Belkhode, Anjali Borle
DOI:10.4103/jips.jips_374_19  
Aim: To evaluate different methods, techniques, and concepts documented in the literature to assess iris positioning accurately to the related dimensions needed to effectuate maxillofacial rehabilitation of ocular prosthesis. Settings and Design: This systematic review was conducted as per the PRISMA guidelines which is the most opted reporting protocol. Materials and Methods: Two electronic databases PubMed and Cochrane Library) were searched for manuscripts published from 1969 till September 30, 2019. An electronic search (of peer review restricted to English language dental literature was conducted to identify the relevant scientific article on iris positioning in maxillofacial prostheses. Two observers independently read the abstracts and selected 17 full text articles fulfilling the inclusion criteria. Statistical Analysis Used: No meta-analysis was conducted due to heterogeneity of data obtained. Results: All the 17 documented articles related to determination of the iris positioning to perform maxillofacial prosthetic rehabilitation depicting the use of a strip of plastic template, a Boley's gauge, a millimeter ruler, a pupillometer, window light, an ocular locator with fixed caliper, inverted anatomic tracings, a transparent graph grid were reviewed systematically. Conclusion: Currently, there is no evidence in the form of a systematic review of the available literature discussing the best technique available for perfectly matching the iris positioning. However, the latest techniques making use of digital technology such as digital photography, is believed to be more precise for iris positioning in the ocular prosthesis.
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Efficacy of different lasers of various wavelengths in treatment of peri-implantitis and peri-implant mucositis: A systematic review and meta-analysis p. 353
Ritu Saneja, Bappaditya Bhattacharjee, Atul Bhatnagar, P G Naveen Kumar, Arju Verma
DOI:10.4103/jips.jips_144_20  
Aim: Peri implant diseases lead to pathological changes in the peri implant tissues and loss of osseointegration. The purpose of this analysis is to evaluate the effect of various lasers and photodynamic therapy (PDT) on peri implant diseases compared to conventional procedures. Setting and Design: This meta analysis was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. Materials and Methods: A systematic search of the electronic databases such as PubMed, ICTRP, CT.gov, Embase, and Cochrane Library was done additional to manual search of peer review article on peri-implant diseases. Eleven randomized control clinical trials were included in which laser therapy and PDT were used as an interventional procedure. Results and Statistical Analysis Used: Review Manager 5.03 (RevMan, Nordic Cochrane Center, Copenhagen, Denmark), and random effects model were used to assess mean difference (MD). Bivariate differential mean statistic was used in intergroup estimate with 95% confidence interval (CI). I2 test statistics was applied for heterogenity and P < 0.05 was considered significant statistically. The literature search yielded a total of 113 articles among which 11 articles were included for quantitative analysis. The selected outcome PD reported MD −0.01 with 95% CI (−0.13, 0.16), P = 0.84, and CAL reported MD −0.09 with 95% CI (−0.32, 0.14), P = 0.45, respectively. Conclusion: Laser treatment as an adjunctive therapy or monotherapy in peri implantitis does not show any superior effects than conventional measures as per evidence. However, cases with peri implant mucositis have shown far more promising results with laser therapy compared to peri implantitis.
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ORIGINAL ARTICLES Top

Effect of post etching cleansing on surface microstructure, surface topography, and microshear bond strength of lithium disilicate p. 363
Nikita Agarwal, Sanchit Bansal, Umesh Yeshwanth Pai, Shobha J Rodrigues, Thilak B Shetty, Sharon J Saldanha
DOI:10.4103/jips.jips_443_19  
Aim: This study assessed the effect of postetch cleansing on the surface microstructure, surface topography, and microshear bond strength (μSBS) of lithium disilicate and the resin cement. Setting and Design: In Vitro analytical study. Materials and Methods: Fifteen discs (10 mm diameter and 2 mm thickness) were fabricated from highly translucent lithium disilicate IPS Emax 2 ceramic (Ivoclar Vivadent, Schaan, Liechtenstein). Four resin cement (RelyX Ultimate, 3M ESPE) cylinders (0.9 mm diameter and 4 mm high) were placed on each ceramic disc (total n = 60). The samples were divided into three groups based on the surface treatment of the ceramic discs (20 resin cement cylinders on 5 discs in each group). Group I (HF) (control) etched with 9.6% HF with no postetch cleansing, Group II (HFP) etched with 9.6% HF for 20 s followed by rinsing with water and postetching cleansing with 37% phosphoric acid, and Group III (HFPU) etched with 9.6% HF followed by active application of 37% phosphoric acid followed by postetch cleansing in ultrasonic bath for 5 min. μSBS of resin cement to ceramic surfaces was tested following a standard protocol. Surface roughness was evaluated using an atomic force microscope. Surface topography and elemental analysis were analyzed using SEM/EDX. Mode of failure was also assessed. Statistical Analysis Used: The data were analysed using one way analysis of variance and post hoc tukeys test. Results: The μSBS were found to be highest for Group III (HFPU), followed by Group II (HFP) followed by Group I (HF) and were statistically significant. There was a difference in the surface topography and surface microstructure between the three groups. Mode of failure was predominantly adhesive. Conclusion: The μSBS, surface topography, and surface microstructure were found to be superior in the groups, in which postetch cleansing was done as compared to the control in which no postetch cleansing was done.
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Anatomic variations of the osteomeatal complex and its relationship to patency of the maxillary ostium: A retrospective evaluation of cone-beam computed tomography and its implications for sinus augmentation p. 371
Ramandeep Sandhu, Mohit Gurunath Kheur, Tabrez Amin Lakha, M Supriya, Pascal Valentini, Bach Le
DOI:10.4103/jips.jips_113_20  
Aim: The aim of this study is to determine the incidence of obliterated osteomeatal complex (OMC) due to the presence of anatomic variants. Settings and Design: Retrospective Study. Materials and Methods: In this retrospective study, a total of 71 patients, 34 males and 37 females, aged 35–65 years were included in the study. Cone beam computed tomography (CBCT) scans of patients were assessed to identify the status of the OMC in the presence of anatomic variants and their incidence was recorded. The radiological assessment of the anatomical variants was made by viewing the coronal sections of the scans. The variants observed were deviated nasal septum, uncinate process), agger nasi, Haller cells, middle turbinate variants, enlarged bulla, accessory ostium, and maxillary sinus abnormalities). Ostium patency was evaluated in the coronal section of each sinus and classified as “patent” or “obstructed.” The most common variants observed were then correlated with the patency of the ostium. Statistical Analysis Used: Chi square test was performed to assess the association between the anatomic variants and the patency of the OMC. Results: In the present study, the incidence of an obliterated OMC due to the presence of anatomic variants was 73.2%. The four most common variants associated with the possibility of an obliterated OMC were the deviated nasal septum (76.2%), middle turbinate (86.4%), enlarged bulla (77.8%), and sinus cavity variants (80.0%). A statistically significant association was noted between middle turbinate variants and Haller cells and the patency of the OMC. Conclusion: Thorough pretreatment CBCT evaluation should be performed to assess the presence of anatomic variants and thereby, the patency of the ostium before sinus floor elevation procedures. The pre and postsurgical treatment plans and regimes can be modified according to anticipated postsurgical sequelae, thereby avoiding postsurgical complications and enhancing the success of the graft procedure.
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Evaluation of biological changes at the proximal contacts between single-tooth implant-supported prosthesis and the adjacent natural teeth – An in vivo study p. 378
Maria Roseme Kandathilparambil, Vizaikumar Vasudha Nelluri, Bhanu Chander Vayadadi, Naveen Kumar Gajjam
DOI:10.4103/jips.jips_155_20  
Aim: The aim of the study is to evaluate the proximal contact tightness (PCT) between single-tooth implant-supported prosthesis (ISP) and the adjacent natural teeth with and without the intervention of the Essix retainer at the end of 1 year. Settings and Design: In vivo -experimental study. Materials and Methods: Forty patients with a single ISP in the first molar region of the mandibular arch are included in the study who were randomly divided into two groups – Group I (20): those without an intervention of Essix retainer and Group II (20): those with the intervention of Essix retainer (2 mm thickness) (Thermo Vac, Inc. USA) delivered immediately after the restoration of implant with the definitive prosthesis. The groups are further subdivided into Subgroups A (control) and B within Group I and Subgroups C (control) and D within Group II. Mesial and distal PCT values were recorded in each quadrant using the digital force gauge, and values obtained at the end of 1 year were subjected for statistical analysis. Statistical Analysis Used: Independent sample t-test was performed. P < 0.05 was taken as statistically significant. Results: On nonusage of Essix retainer, in comparison to the control group, there were a 57.9% decrease in PCT values for the ISP on mesial contact (P < 0.05) and a 38.9% decrease for the distal contact (P > 0.05), whereas on the usage of Essix retainer, the PCT values for ISP on mesial contact decreased to 25.3% (not significant) and 33.7% on the distal contact (P > 0.05). The incidence of contact loss was found to be 30%, whereas it decreased to 15% on the usage of Essix retainer. Conclusion: The usage of Essix retainer showed a significant difference in increasing the PCT values, especially on the mesial contact. The incidence of contact loss, which was found to be 30%, decreased to 15% on its usage.
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The evaluation of agreement between high-frequency ultrasonography and research diagnostic criteria for the diagnosis of temporomandibular joint internal derangements p. 387
Ravza Eraslan, Kerem Kılı, Meryem Etöz, Damla Soydan
DOI:10.4103/jips.jips_136_20  
Aim: The aim of this study is to compare the diagnosis of patients with temporomandibular joint (TMJ) internal derangements which had been diagnosed using Research Diagnostic Criteria/Temporomandibular Disorders (RDC/TMD) with the dynamic high resolution sonography findings. Settings and Design: Axis I section of RDC/TMD form had been applied to participants. Participants were divided into three groups as healthy TMJ, disc displacement with reduction, and disc displacement without reduction. The diagnoses had been compared with the dynamic high-resolution sonography findings. Materials and Methods: Twelve of the patients had been treated with laser therapy, whereas 13 patients were treated with stabilization splint. Seventeen patients were treated with anterior repositioning splint (n = 42). After the application of different treatment modalities, the position of the articular disc had been determined with Axis I of RDC/ TMD form and dynamic high-resolution sonography. The findings were compared and statistically analyzed. Statistical Analysis Used: Statistical analyses of data were analyzed with Turcosa Cloud (Turcosa Ltd Co, Turkey). Results: For the right TMJ, pretreatment and posttreatment ultrasonography (USG) diagnoses and RDC/ TMD clinical diagnoses were found similar (κ = 0.125–0.008). No statistically significant relationship was found (P > 0.05). For the left TMJ, pretreatment USG diagnosis and RDC/TMD clinical diagnose were found similar (κ = 0.070). No statistically significant relationship was found (P > 0.05). For the left TMJ, posttreatment USG diagnosis and RDC/TMD clinical diagnose were compared. A statistically significant difference was found (κ = 0.256). A statistically significant relationship was found (P < 0.05). Conclusions: Axis 1 of RDC/TMD form which is used for the diagnosis of internal derangements and dynamic high resolution sonography was not found in the agreement.
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Evaluation of the effect of ultraviolet light polymerized clear adhesive on shear and tensile bond strength of heat cure denture base resin to the cobalt-chromium retentive minor connector: An in vitro study p. 394
Minal Sanjay Kumthekar, Shivsagar Tewary, Pronob Kumar Sanyal
DOI:10.4103/jips.jips_85_20  
Aim: The aim of this study is to evaluate the efficacy of new material ultraviolet (UV) light polymerized clear adhesive on shear and tensile bond strength of heat cure denture base resin (Polymethylmethacrylate (PMMA)) to cobalt-chromium (Co-Cr) retentive minor connector. Setting and Design: Comparative evaluation- In-vitro study. Materials and Methods: Sixty samples of Co-Cr plates mimicking minor connectors were fabricated. Thirty samples were coated with new material UV light polymerized clear adhesive and cured under UV light source for 10 min. In gun-metal flask, metal plates were placed in the lower compartment over it. Heat cure acrylic resin was packed in the dough stage with the help of clamps and processed according to the manufacturer's instructions. Samples were kept in artificial saliva for 90 days. Shear and tensile bond strengths were calculated of each sample with a Universal testing machine, and results were statistically analyzed. Type of bond failure was observed for each sample under stereomicroscope. Statistical Analysis Used: Unpaired t test. Results: Tensile bond strength, as well as shear bond strength, showed that 0.93 N and 1.64 N respectively for without application of new adhesive was more as compared to that of samples with the application of new adhesive which is 0.75 N and 1.54 N respectively. Bond failure was found to be an adhesive failure in resin–metal interface. Conclusions: Excellent bonding seen between the new adhesive and acrylic interface but limited effect on the metal interface. To increase bond strength between metal and resin interface, some surface treatment with the metal surface is needed to increase the bonding of the new adhesive to the metal surface.
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An anthropometric study to evaluate the correlation of vertical dimension at rest and length of thumb: A multi-national, multi-centre pilot study p. 402
M C Suresh Sajjan, Prashanti Eachempati, Rupinder Singh Dhall, Deepthi Fulari, Kamal Shigli, Htoo Htoo Kyaw Soe
DOI:10.4103/jips.jips_313_20  
Aim: A variety of anthropometric techniques have been proposed to determine the correct vertical dimension of occlusion. However, none have reported correlating thumb length (TL) with vertical dimension at rest (VDR). This study aimed to correlate the VDR to measurements of the thumb in a multi-national, multi-centric trial in participants with and without orthodontic treatment and establish a regression equation for each region. Settings and Design: A cross-sectional multi-national, multi-centric correlation trial. Materials and Methods: A cross-sectional study was conducted in India and Malaysia with a total of 688 participants. Measurements of thumb and VDR were obtained using a modified Willi's gauge using a standard operating procedure. Statistical Analysis Used: Pearson's correlation coefficient was calculated to determine the correlation between TL and VDR. A multiple linear regression was done to correlate VDR from gender, orthodontic treatment, and length of thumb. Results: Correlation coefficient between TL and VDR in patients with orthodontic treatment was 0.829 and 0.774 in patients without orthodontic treatment. The correlation between TL and VDR in patients with orthodontic treatment in North India was 0.484, P = 0.010 and Malaysia was 0.946, P < 0.001. There were significant correlations between TL and VDR in patients without orthodontic treatment in all regions (P < 0.001). Regression equations were obtained for different ethnic groups for calculating the VDR. Conclusion: There was an overall positive correlation between TL and VDR in patients with and without orthodontic treatment. The regression equations presented in this article could help clinicians in their clinical practice and researchers to conduct future trials.
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A finite element analysis to study the stress distribution on distal implants in an all-on-four situation in atrophic maxilla as affected by the tilt of the implants and varying cantilever lengths p. 409
Anju Kumari, Puja Malhotra, Shefali Phogat, Bhupender Yadav, Jaiveer Yadav, Sumit Singh Phukela
DOI:10.4103/jips.jips_70_20  
Aim: The aim of this work was to evaluate stress distribution on implants in All-on-Four situation with varying distal implant angulations (30°,40°,45°) and varying cantilever lengths (4 mm, 8 mm, 12 mm, 16 mm) in atrophic maxilla using finite element analysis. Setting and Design: A in vitro study, finite element analysis. Materials and Methodology: Three-dimensional finite element model of an edentulous maxilla restored with a prosthesis supported by four implants was reconstructed to carry out the analysis. Three different configurations, corresponding to 3 tilt degrees of the distal implants (30°, 40°, and 45°) were subjected to 4 loading simulations. Statistical Analysis Used: The results of the simulations obtained were evaluated in terms of Von Mises equivalent stress levels at the bone-implant interface. Result: From a stress-level viewpoint, the 45° model was revealed to be the most critical for peri-implant bone. In all the loading simulations, the maximum stress values were always found at the neck of the distal implants. With increasing distal implant tilt, cantilever length reduces depending on the quality of bone. At 30° angulation of distal implant a maximum cantilever length of 16 mm may be given if the quality of bone is D3 but only 8 mm cantilever may be recommended if bone quality is D4. At 40° angulation, 16 mm in D3 bone and 0 mm in D4 bone whereas at 45° angulation, it reduces to 12 mm in D3 bone and no cantilever is recommended with D4 bone. Conclusion: The 45° tilt induced higher stress values at the bone-implant interface, especially in the distal aspect, than the other 2 tilts analyzed. Stress values increased with increased cantilever length which was further influenced by the distal implant tilt and the quality of the bone.
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Propolis extract and bovine bone graft combination in the expression of VEGF and FGF2 on the preservation of post extraction socket p. 417
Utari Kresnoadi, Louisa Christy Lunardhi, Bambang Agustono
DOI:10.4103/jips.jips_106_20  
Aim: To determine the potential of propolis extract and BBG combination on the quantity of fibroblast growth factor 2 (FGF-2), vascular endothelial growth factor (VEGF), and osteoblasts in the preservation of tooth extraction socket on days 3 and 7. Settings and Design: Laboratory in vivo reseach using animal model. Materials and Methods: Fifty-six Cavia cobaya were divided into eight groups containing seven animals in each group. The extraction socket on the lower left incisor was filled with polyethylene glycol (PEG) at a concentration of 2% (Groups I and II) as a control; active materials consisted of propolis extract and PEG (Groups III and IV); active materials consisted of BBG and PEG (Groups V and VI); and active materials consisted of propolis extract, BBG, and PEG (Groups VII and VIII). Then, an examination was done using immunohistochemistry to perform an expression of VEGF, FGF2, as well as histology of osteoblasts. Statistical Analysis Used: The statistical analysis performed using a one-way ANOVA and Tukey's honestly significant difference test. Results: Propolis extract, BBG and PEG had the most significant result related to the formation of FGF2, VEGF, and osteoblasts. Conclusion: The combination of propolis extract with BBG and PEG in socket preservation is effective in increasing the expression of FGF2, VEGF, and osteoblasts.
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Clinical evaluation of “componeers” and direct composite veneers using minimally invasive enamel preparation technique: In vivo study p. 424
Parag Dua, Sanjay Manohar Londhe, Gaurav Dua, Atul Kotwal, Sachin Gupta
DOI:10.4103/jips.jips_95_20  
Aim: The aim of this study was to evaluate the clinical behavior of prefabricated componeers and direct composite veneering. The objective of the study was to compare the changes in color, surface texture, marginal integrity, and gingival response for componeers and direct composite veneers. Settings and Study Design: This was an in vivo, comparative study. Materials and Methods: Ten patients indicated for anterior veneers were selected and divided into Groups A and B of five patients each. Group A was restored with componeers and Group B with direct composite veneers. Both the groups were compared for color changes, surface textural changes, marginal integrity, and gingival response, starting immediately post veneering and at 3, 6, 9, and 12 months subsequently. Statistical Analysis Used: Friedman's two-way analysis of variance and Mann–Whitney test were used for statistical analysis. Results: Results for color ranged from excellent to good with minimal color changes post veneering. Overall, “gingival response,” in both the groups, showed statistically significant differences in mean rank scores (P ≤ 0.05). The data depicted an improvement in gingival response for all patients during the period of the study. Surface textural changes were significant only for maxillary right canine and maxillary left lateral incisor (P = 0.024 and 0.039, respectively) in both the groups. Maxillary right canine in both the groups showed significant changes in marginal integrity. Intergroup comparison of gingival response, surface texture, and marginal integrity depicted no significant difference between the groups (P > 0.05). Conclusions: This study concluded that the intergroup comparison of componeers and direct composite veneers for the parameters, gingival response, surface texture, and marginal integrity did not depict any significant differences. Both the groups displayed minimal changes in color, surface texture, and marginal integrity and improved gingival response.
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CASE REPORTS Top

Utilizing DICOM data to generate custom computer-aided designing and computer-aided machining polyetheretherketone healing abutments for an ear prosthesis p. 431
Mohit Dhiman, Sudhir Bhandari, Sunil Gaba
DOI:10.4103/jips.jips_62_20  
Soft tissue healing around implants may turn out to be the most decisive factor in the success or failure of the prosthesis. Dimension, configuration, and material of the healing abutments play a pivotal role in achieving optimal soft tissue architecture around implants. Digital imaging with computer-aided designing and computer-aided machining (CAD-CAM) technology, has made it easier to illustrate, design, replicate maxillofacial structures, and generate its supporting elements in a reliable, faster, and more convenient manner. This case report highlights the issue relevant to the implant-supported prosthetic replacement, on a site previously attempted for surgical reconstruction of the missing ear. Presurgical DICOM data were used to obtain custom CAD-CAM polyetheretherketone (PEEK) healing abutments on implants in a patient with an excessive amount of tissue in the missing right ear region. It is probably the first extraoral use of PEEK as a healing abutment in the workflow of implant retained maxillofacial prosthetics. No issue warranting the removal of the PEEK component was observed during the duration of its use.
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Restoration of converging implants: Restorative complexity to facilitate retrievability p. 436
James Dudley
DOI:10.4103/jips.jips_258_20  
Implant treatment should be restoratively driven, however at times, ideal implant positioning may be sacrificed for surgical convenience at the expense of restorative complexity. A prosthesis incorporating a novel design was constructed to restore two converging implants placed in close proximity utilizing standard implant impression componentry and simple clinical stages. As the use of angulated screw channel technology was not possible, a customized cast “rest” abutment and overlying telescopic crown was fabricated that facilitated access for oral hygiene and retrievability as required. The complexity of the case design was transferred to the laboratory phases of construction. The case presented a satisfactory clinical outcome for an initially challenging implant presentation and reinforced the need to work closely with the laboratory technician.
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