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J Prosthet Dent. 2015 Jun;113(6):520-3. doi: 10.1016/j.prosdent.2015.01.011. Epub 2015 Mar 24.

Technique for systematic bone reduction for fixed implant-supported prosthesis in the edentulous maxilla.

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Program Director and Maxillofacial Prosthodontist, Post-Graduate Prosthodontics, University of Connecticut Health Center, Farmington, Conn; and Private practice, Meriden, Conn. Electronic address:


Bone reduction for maxillary fixed implant-supported prosthodontic treatment is often necessary to either gain prosthetic space or to conceal the prosthesis-tissue junction in patients with excessive gingival display (gummy smile). Inadequate bone reduction is often a cause of prosthetic failure due to material fractures, poor esthetics, or inability to perform oral hygiene procedures due to unfavorable ridge lap prosthetic contours. Various instruments and techniques are available for bone reduction. It would be helpful to have an accurate and efficient method for bone reduction at the time of surgery and subsequently create a smooth bony platform. This article presents a straightforward technique for systematic bone reduction by transferring the patient's maximum smile line, recorded clinically, to a clear radiographic smile guide for treatment planning using cone beam computed tomography (CBCT). The patient's smile line and the amount of required bone reduction are transferred clinically by marking bone with a sterile stationery graphite wood pencil at the time of surgery. This technique can help clinicians to accurately achieve the desired bone reduction during surgery, and provide confidence that the diagnostic and treatment planning goals have been achieved.

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