The use of craniofacial implants to assist in retaining auricular prostheses often requires complex laboratory procedures, involving production of an accurate casting, fitting of a precious alloy bar, and the use of clips. A simplified method for the retention of an auricular prosthesis with a composite bar and magnets is described in this article. (J Prosthet Dent 2003;89:446-9.) The use of craniofacial implants for retention of extraoral prostheses, such as ears, offers excellent support and retentive abilities 1-3 and improves a patient's appearance and quality of life. The use of implants can eliminate or minimize the need for adhesive and allows for proper orientation and seating of an ear prosthesis by the patient. However, a satisfactory outcome may only be achieved by careful planning in terms of the number and position and orientation of the implants and the proper connection of the ear prosthesis to implant retention structure with a cast or machined bar. Precious alloys are commonly used for construction of a bar because of their excellent strength, but casting precious alloys onto wrought metals may not result in a perfect union. 4 The dental laboratory procedures involved are complex and expensive. The use of magnets is advantageous over conventional bar and clips for maintenance because metal clips may fracture over time making revision and repair difficult. 5,6 This clinical report describes an auricular prosthesis retained by implants with a composite bar and magnets. CLINICAL REPORTA 20-year-old man with right hemifacial microstomia was referred by his plastic surgeon to the Maxillofacial Prosthdontic Clinic at The University of Hong Kong for fabrication of a right ear prosthesis. On examination, the patient had a bilaterally symmetrical face after orthognathic surgical reconstruction of maxilla and mandible, but the right ear was aplastic. To assist the placement of implants, a full contour wax pattern of the missing auricle was fabricated before implant placement. After proper positioning of the wax pattern, the surgeon outlined the boundary of ear prosthesis with gentian violet on the patient's skin. Two 4-mm flanged implants (model no. SEC 002-0; Branemark, Nobel Biocare, Goteborg, Sweden) were placed in the temporal bone. Three months after the placement of the implants, 5.5-mm abutments (model SEC 007-0; Branemark) were inserted (Fig. 1). A moulage impression was made at the abutment level with polyvinyl siloxane impression material (Aquasil; Dentsply, Milford, Del.).Two gold cylinders (model no. DCA 073-0; Nobel Biocare) were positioned on the abutment replicas (DCB 175-0; Nobel Biocare) and secured with laboratory guide pins. A light-polymerizing composite

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This is the final paper of a four part series on the management of worn dentition. The factors affecting the selection of restorative techniques for generalized toothwear, such as pulpal vitality, jaw relationship and occlusal guidance are discussed. The practical steps of oral rehabilitation using fixed prostheses are illustrated with two clinical cases.

Objective To prospectively evaluate patient‐reported outcome measures (PROMs) and treatment outcomes of mandibular two‐implant retained overdentures (IOD) in an edentulous geriatric cohort with history of deficient complete dentures (CD). Materials and Methods A total of 103 patients with deficient CD received new optimal CD. After a period of 3 months, 80 of the patients voluntarily received IOD. Outcomes collected at pre‐, post‐CD/post‐IOD treatment annually up to 5 years, included (a) Clinical outcomes: denture‐quality (Woelfel's index), complications, and maintenance events, (b) PROMs: patient complaints (maxillary, mandibular functional complaint scores, generic aesthetic complaint scores, frequency, and intensity of complaints) and patient satisfaction, and (c) Maintenance events: technical complications and adverse events. Results Five‐year data were collected from 67 patients (mean age at initiation = 71.3 years, mean observation = 5.9 years) with cumulative implant survival rate = 98.72%. Multiple comparisons for 8 time points showed significant improvements in denture quality and PROMs after new CD and IOD delivery. Further significant improvements were only after IOD delivery in: mandibular denture‐quality, mandibular and generic functional complaints, frequency, intensity of complaints, and overall patient satisfaction score. Thereafter, denture‐quality and PROMs remained stable. Maintenance events clustered on 1st year and within a minority of patients. Technical complications and overall maintenance events significantly correlated with overall patient satisfaction score at 1st year. Conclusions Mandibular IOD was a beneficial treatment option for seniors with history of deficient CD, improving denture‐quality, patient satisfaction, and reducing patient complaints up to 5 years. Maintenance events clustered on 1st year, showing no significant impact on long‐term patient satisfaction and other PROMs.

This is the second paper in a four-part series detailing the relative merits of the treatment strategies, clinical techniques and dental materials for the restoration of health, function and aesthetics for the dentition. In this paper the management of wear in the anterior dentition is discussed, using three case studies as illustration.