case study _ prosthodontic rehabilitation I Fig. 3 Fig. 4 resin teeth supported by a gold alloy metal framework. The implant at the patient’s maxillary right canine area was exposed. No symptoms were reported by the patient (Fig. 1). An occlusal examination revealed a stable maximal inter-cuspation position with insignificant centric relation to maximal inter-cuspation slide at the teeth level. A canine-guided occlusal scheme was noted. No para-functional habits were reported. Sub-optimal maxillary lip support was noted. A significant amount of dead space was identified between the intaglio surface of the prosthesis and the maxillary soft tissue. Upon removal of the maxillary prosthesis, all the maxillary implants were found to be osseointegrated. The patient desired to correct the failing implant, restore lip support, masticatory function and facial aesthetics. The overall treatment plan included removal of the implant at the maxillary right canine area, replacement of a new implant at the maxillary right canine region and fabrication of a full-arch, zirconium oxidebased ceramic restoration in the maxilla. Under local anaesthesia, the implant at the maxillary right canine area was removed surgically (Fig. 2) and a new 13 mm-long regular platform implant was placed (NobelReplace, Tapered Groovy). The new implant was submerged and primary wound closure achieved. Her existing prosthesis was re-inserted during the healing period to serve as a provisional prosthesis. Once osseo-integration was achieved a few months later, the new implant was exposed and the maxilla was ready for prosthodontic rehabilitation after a few weeks of soft-tissue healing. Six implant-level impression copings (NobelReplace) were placed onto the maxillary implants. High-viscosity, vinyl polysiloxane material (Aquasil Ultra Heavy, DENTSPLY DeTrey) was carefully injected around all the impression copings. A stock tray loaded with putty material (Aquasil Putty, DENTSPLY DeTrey) was seated over the entire maxillary arch to make the definitive impression. A jaw-relation record at the treatment vertical dimension was made with a vinyl polysiloxane material (Regisil PB, DENTSPLY DeTrey). The maxillary and mandibular definitive casts were mounted arbitrarily in the centre of a semi-adjustable articulator (Hanau Wide-vue, Teledyne Waterpik) using average settings.17,18 The custom zirconium oxide Fig. 3_Maxillary prosthesis after the application of tooth-coloured porcelain: Excessive crown length was noted at this stage. Fig. 4_Completed maxillary prosthesis with gingival-coloured porcelain applied to provide adequate lip support: Excessive crown height was reduced. Fig. 5_Anterior view showing the CAD/CAM-fabricated full-ceramic implant abutments at the approximated vertical dimension of occlusion. Fig. 6_Occlusal view of the maxillary arch before insertion of the maxillary prosthesis: Favourable anterior-posterior spread allowed the replacement of posterior teeth with distal cantilevering. Fig. 5 Fig. 6 cosmetic dentistry 4 _ 2009 I 11