[23, 24] Tooth preparation was performed preceding the endodontic treatment to determine restorability. All teeth were subjected to a comprehensive endodontic evaluation. Abou-Rass[25] recommended that teeth subjected to chronic trauma should be evaluated carefully, as the foundation

for the crown should be solid. A tooth was considered restorable with a good prognosis if it fell within http://www.selleckchem.com/products/sorafenib.html the following criteria: (1) Minimum alveolar bone loss, Class I furcation involvement, less than 2 mm of attachment loss, and a favorable root shape and length[26-28] Teeth not confirming to the previous criteria were extracted. Implants were used to replace the missing teeth instead of a 3-unit FPD, because a single-crown implant (SCI) has a better long-term prognosis with less complication than a three-unit FPD.[23, 24, 32, 33] Also, an SCI preserves the alveolar bone after extraction and provides ease for the patient to maintain proper oral hygiene.[34] Immediate implant placement was considered if there was an intact buccal plate with enough residual bone for primary stability.[35, 36] A two-stage surgical approach was followed. Implant loading was performed 12 weeks after implant placement. Screw-retained

temporary implant restorations were inserted and modified for a 6-week period to permit soft tissue maturation. Final fixture impressions were taken, and the casts were mounted to fabricate the custom abutments. Dual custom abutments (ATLANTIS Abutments, Dentsply) were fabricated and GC pick-up (Pattern Resin LS) copings Sirolimus were 上海皓元 processed over the custom abutments. One of the dual abutments was inserted and torqued to the manufacturer’s recommendation. The other dual abutment was kept for laboratory use. The final impression was taken for the natural teeth with the pick-up of the GC copings (Fig

14). Cross mounting was performed between the working casts using the diagnostic provisional casts. All-ceramic zirconia-based restorations were selected in the anterior region of the mouth. Clinical research shows an equal success rate for the all-ceramic restorations with better esthetics compared to ceramo-metal restorations.[37, 38] Ceramo-metal restorations were used in the posterior region. High noble alloy was selected for the metal framework, as it shows a predictable bond with the veneering porcelain with an ease of casting.[39, 40] All crowns were cemented with self-cured resin cement (RelyX Unicem; 3M ESPE, St. Paul, MN) (Figs 15-17). The restoration of all teeth with final crowns provided the patient with a mutually protected occlusion with a progressive disocclusion pattern (Figs 18, 19). A heat-processed acrylic-resin maxillary occlusal device was created for use during sleep and during the day as needed. The importance of the maintenance of a high standard of oral hygiene was stressed.