I case study _ prosthodontic rehabilitation Complete maxillary implant prosthodontic rehabilitation utilising a CAD/CAM fixed prosthesis Authors_ Dr Neo Tee-Khin, Dr Ansgar C. Cheng, Dr Helena Lee & Ben Lim, Singapore _Endosseous implant treatment has been widely reported as a highly predictable treatment modality with a low percentage of clinical complications. Prudent clinical judgement and careful consideration of the risks and benefits of various treatment options are essential for the treatment planning and longterm success of prosthodontic treatment.1 Traditional implant prostheses are commonly fabricated using acrylic resin teeth supported by a metal framework. Significant space is designed at the tissue surface of the prosthesis to enhance oral hygiene maintenance. However, application of this prosthetic design in the maxillary arch is occasionally aesthetically inadequate and speech may be compromised. Conventional porcelain-fused-to-metal-restorations require the placement of labial restoration margins below the free gingival margin in order to mask the hue and value transition between the subgingival implant sub-structures and the supra-gingival crown restorations. From a periodontal point of view, sub-gingival placement of restoration margins is related to adverse periodontal tissue response.2–5 As a result, restoration margins are best placed coronally from the free gingival margin.4,5 Porcelain-fused-to-metal restorations are commonly used in the posterior teeth because of their well-documented long-term clinical track record.6–13 CAD/CAM ceramic-based materials are prescribed nowadays, owing to their demonstrated promising physical properties14,15 and clinical longevity.16 This article describes the clinical application of high-strength zirconium oxide restorations in the prosthodontic management of an edentulous maxilla with a failing implant prosthesis. Fig. 1_Pre-treatment intra-oral frontal view: A large space was noted between the intaglio surface of the prosthesis and the maxillary tissue, and there was significant tissue resorption on the labial surface of the implant over the maxillary right canine area. The patient was asymptomatic. Fig. 2_Full thickness flap revealed the advanced bone loss on the labial surface of the implant. In spite of the tissue damage, this implant was clinically firm. _Clinical report A 62-year-old female with an implant-supported maxillary prosthesis was evaluated at the Specialist Dental Group in Singapore. She presented clinically with a maxillary fixed complete denture supported by six endosseous implants (NobelReplace, Tapered Groovy, Nobel Biocare). The prosthesis had acrylic Fig. 1 Fig. 2 10 I cosmetic dentistry 4_ 2009