This study added important clinical and histological data to contribute in the decision-making process between indication of FGG or ADM.

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Implant-supported rehabilitations show higher patient satisfaction when compared with conventional prostheses. Systemic conditions, however, can affect treatment planning of dental implant supported rehabilitations. The oral structures that are commonly affected in patients with Down syndrome include the tongue (macroglossia), teeth (number and shape), and poor quality alveolar and jaw bones (osteoporotic-like). This clinical case presents an interdisciplinary team approach aimed at achieving functional, phonetic, and esthetic outcomes in a patient with Down syndrome.

The original protocol for implant prosthesis recommends the use of a gold framework for acrylic and ceramic prosthesis. However, due to its high cost, the use of alternative alloys is desired. This study compares the marginal accuracy of pre-made cylinders versus plastic cylinders cast with two different base metal casting alloys. Five samples each of (1) plastic cylinder cast in cobalt-chromium alloy, (2) plastic cylinder cast in nickel-chromium alloy, and (3) silver-palladium pre-made cylinder (control) were examined for marginal accuracy according to: (A) vertical gap; (B) horizontal gap and (C) horizontal gap depth at the abutment/cylinder interface. Data were submitted to statistical analysis (ANOVA and Student-Newman Keuls, p<0.05). Mean values for vertical, horizontal and gap depth were 4.13µm, 14.5µm and 6.93µm for pre-made cylinder, 23.18µm, 33.2µm and 88µm for Ni-Cr cast cylinder and 25.6µm, 51.8µm and 114.54µm for Co-Cr cast cylinder. No statistically significant differences were found between cast groups (1 and 2), but significant better fit was obtained with pre-made metal cylinders when compared to cast cylinders with Ni-Cr and Co-Cr alloys, for all analyses.

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