I case study _ prosthodontic rehabilitation management of implant failure is also a clinical reality. In this clinical report, the failure of one implant at a crucial location indicated the need for re-fabrication of the whole implant prosthesis. As the patient desired a high level of aesthetics, full-ceramic restorations were selected. By prescribing tooth-coloured ceramic abutments and full-ceramic restorations, prosthesis margins were made at the gingival level and gingival retraction procedures were eliminated during impression and prosthesis insertion. Full-arch prosthodontic rehabilitation using fixed prostheses usually requires longer-term provisional restoration in order to facilitate a predictable treatment outcome. In this patient, the existing maxillary prosthesis served as a long-term provisional restoration for verifying her adaptability and multiple professional clinical adjustments of provisional restorations was not required. This treatment sequence increased the margin of safety in the execution of the definitive fullceramic restoration. Intra-oral verification of the new treatment occlusal scheme and detailed in situ clinical adjustment of the restorations on the day of prostheses insertion still formed the essential foundation for proper treatment execution. In any major prosthodontic treatment, the patient should be informed of the potential financial and time implications should the need for re-fabrication of the restorations arise. Fig. 7 Fig. 7_Completed maxillary implant-supported prosthesis; note the placement of the supra-gingival margins. abutments with gold-alloy fitting surface (Procera, Nobel Biocare) were CAD/CAM fabricated according to the prosthesis design. The development of the planned definitive maxillary restoration was carried out using a CAD/CAM process. The maxillary definitive cast with the custom full-ceramic abutments (Fig. 3) were scanned (Zeno Scan, Wieland Dental+Technik), and the prosthesis framework was designed using a software program (D700, 3Shape). The framework was milled in zirconium-base material (Zeno Zr Bridge, Wieland Dental+Technik) with a milling machine (Zeno 4030 M1, Wieland Dental+Technik). The prosthesis framework was sintered according to the manufacturer’s recommendations. Subsequently, overlaying low-fusing, tooth-coloured porcelain material (IPS e.max, Ivoclar Vivadent) was manually applied onto the exterior to create proper anatomic form (Fig. 4). Low-fusing, gingival-coloured porcelain material (IPS e.max) was applied to create proper lip support (Fig. 5). During the delivery clinical session, the old prosthesis was removed and the new custom abutments were torqued to 32 Ncm (Fig. 5). The new prosthesis was tried-in to verify colour, occlusion, lip support, teeth form, and comfort. Upon confirmation of the patient’s acceptance, the implant abutments were sealed in gutta-percha (Fig. 6) and the prosthesis was cemented in resin-modified glass-ionomer luting agent (RelyX Unicem, ESPE). The patient was evaluated two weeks post-operatively. Anterior guided occlusal schemes were verified intra-orally before and after prosthesis cementation (Fig. 7). The patient reported no discomfort and she had been functioning well with the new restorations. No abnormal clinical signs were noted. _Conclusion The functional management of an edentulous maxilla using a full-ceramic implant-supported maxillary prosthesis has been reported. New CAD/CAMbased restorative materials were used in treating this case. The use of high-strength full-ceramic restorations enhances overall aesthetic predictability and long-term functional outcome._ Editorial note: A complete list of references is available from the publisher. _contact cosmetic dentistry _Discussion Osseo-integration is a well-documented and predictable clinical treatment option. On the other hand, Dr Ansgar C. Cheng Specialist Dental Group™ 3 Mount Elizabeth #08-10 Singapore 228510 Republic of Singapore E-mail: drcheng@specialistdentalgroup.com 12 I cosmetic dentistry 4_ 2009