Dear Colleagues,

We hope you enjoyed the summer with your family and friends! We are excited to share this end-of-summer newsletter with you about some information on our office and a few recent cases and clinical pearls to help you in your practice.

Our office is staffed by 2 Board Certified Prosthodontists, Dr. Avinash Bidra and Dr. Xiao Chun Li, who are committed to excellence and offer only the highest quality of dental treatment. Dr. Bidra also serves as Director of the Prosthodontics Residency Program at UConn Dental School in Farmington, CT. (Go Huskies!) Our office is located right in the center of Glastonbury, and we serve patients who travel from various parts of Connecticut and across the country.

As specialists, we are not only committed to helping patients with advanced dental needs but also committed to helping other dentists who need help serving their own patients. Whether you are looking to get some guidance on difficult cases that you want to complete on your own, or are stuck halfway or need help referring patients with complex situations such as occlusal plane issues, vertical dimension challenges, multiple failing teeth, restorative space issues, or bone grafting failures or implant misangulation or implant failures, we are here to help! As an educator for 17 years, Dr. Bidra loves to teach!

We will offer complimentary consultation for your patients and refer them back to you for their maintenance after treatment is complete. We are out of network with all dental insurances but will offer your patients a very fair and reasonable price for their treatment. Our office is certified for IV sedation, and we will provide a safe and comfortable "one stop" experience for their dental treatment. Please check out the cases of the month and visit our website for additional such cases. Thank you for your time and we look forward to working with you!

This is a long-distance, medically compromised patient who was tired of traveling to multiple dental offices for consultations for surgery and restorative treatment. His general dentist got one of Dr. Bidra's newsletters and then referred him with the stipulation that all his treatment should be completed in one office in as few visits as possible. His diagnosis was terminal dentition due to caries (caused by xerostomia), and the treatment plan was straightforward for the All-on-4 procedure. After digital scans and fabrication of digital dentures, the patient was scheduled for a Teeth in a Day procedure under oral sedation. All treatment was completed in our office, and the patient was treated with an immediately loaded fixed prosthesis converted and inserted right after surgery. The patient was very pleased with the esthetics and comfort of the immediately loaded prosthesis. After 4 months of healing, new scans were taken and minor modifications were made (especially the mandibular midline), and then a new monolithic full arch zirconia prosthesis was fabricated and delivered. The total treatment time was under 6 months, and the patient was extremely delighted with the efficiency and his new teeth!

This patient was referred to Dr. Li by her general dentist for a smile makeover, with concerns regarding tooth size, contour, color, and overall proportion. With a professional background in marketing and entertainment, the patient had highly specific cosmetic expectations related to her treatment, and provided photographs of her previous composite veneers as a reference. Her goal was a natural and individualized result that preserved some of the distinctive features of her original smile rather than appearing overly uniform. Clinical examination revealed deteriorating resin composite restorations, wear facets, incisal chipping, and minor anterior crowding. Eight minimally prepared lithium disilicate veneers were cemented from teeth #5 to #12, achieving the personalized result she envisioned!

Residual cement is a frustrating problem in implant dentistry. However, equally frustrating is the problem of broken abutments, screws, and screw-retained restorations. A popular trend for restoring anterior implant crowns is to throw a scan body on an implant and send the file to the lab to fabricate a screw-retained crown with a request for a fast turnaround. In this spirit, the lab technician often uses a stock Ti-base and designs an implant crown with a hole, bonds it, and sends it back to the dentist, who then delivers a screw-retained crown and feels elated to have delivered the crown in record time! While this may work out well in many scenarios, especially in the posterior region, anterior implant restorations require customized emergence profiles for superior esthetics and almost always call for custom abutments. These custom abutments can either be used to support cement-retained restorations or screw-retained restorations when the access channel is on the cingulum (by making a hole in the ceramic crown). When screw-retention is not possible, cement-retained crowns are an excellent choice as they offer simplicity and a cost-effective solution. In the previous newsletters we showed you techniques of using the copy abutment and retrieval matrix to mitigate these problems.

Indiscriminate use of screw-retained restorations with stock Ti-base abutments will have consequences, especially when the patient's tooth/crown size is small, because the Ti-bases are of standard sizes, and to accommodate the given emergence profile the lab technician would have to thin out the zirconia material so much that fracture is inevitable after a few months. This will result in a costly remake and an unhappy patient, dentist, and lab technician. The situation is resolved by requesting a custom titanium abutment. Do not request a custom zirconia abutment, because they are now obsolete due to significant reports of fracture. Dr. Bidra and colleagues wrote a scientific article in 2011 describing the amazing success and survival rate of titanium/metal abutments in the anterior region at 100%! Below is an example of a patient who presented to us with symptoms of a broken implant crown restored within a year at another office, and how the situation was managed.

We offer complimentary consultations and will refer patients back to you for maintenance after treatment is complete.