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ORAL IMPLANTOLOGY Figure 1. C.M. (male, 50): a, b) radiographic appearance of localized severe periodontitis 11, 42, 41, 31, 32, also apical periodontitis 42, 32; c) clinical presentation after extraction of hopeless teeth and completing initial therapy; d) upper and lower interim removable partial dentures for edentulous spaces 11, 42, 41, 31, 32; e) radiographic appearance after implant placement 11; f) radiographic appearance after implant placement 42, 32 oral evaluation, photographs, and impressions for diagnostic casts, the patient was referred to the Department of Graduate Periodontics at the UNC School of Dentistry. Following extraction of hopeless teeth (11, 42, 41, 31, 32) and completion of the initial therapy the patient returned to the Prosthodontics Department for restorative treatment options (Fig 1 c). Interim removable partial dentures were fabricated (Fig. 1 d) for the healing phase, while the patient was presented with several treatment options from removable prosthodontics to fixed partial dentures and implant supported restorations. The patient elected to have a number of posterior crowns with questionable prognosis being remade. As for the edentulous spaces, he decided to go for implant supported crowns/fixed prosthodontics. The patient returned to the Department of Periodontics to have implants placed into the following positions: 11 Straumann tissue level Regular Neck (internal connection) - (Fig 1 e); 42 and 32 Straumann tissue level Narrow Neck (external hex connection) – (Fig 1 f). After implants placement, abutments selection/ fabrication (Fig. 2 a, b), and impressions the patient abruptly asked to be reassigned to a different provider within the Department of Graduate 132 Prosthodontics. We received the lab work (Fig.2 c, d) and saw the patient at delivery appointment, when he appeared satisfied with the outcome and after examining the restorations in the mirror consented to final cementation (Fig. 2 e). At that time we delivered a number of posterior porcelain fused to metal crowns (PFMs) along with implant supported PFM crown on 11 and implant supported fixed partial denture (FPD) from 32 to 42. In a matter of weeks the patient returned complaining about the shape of the lower FPD: “the bridge is off the tract”, the way it is touching the tongue and the lower lip is not comfortable, there are “too big gaps between the bridge/crown and original teeth”, “food scraps are collected in the spot”, “I cannot talk with someone else at lunch or dinner”, it does not look natural. It was immediately clear that the restoration was not accepted anymore, so we removed it and what followed was a series of provisional restorations as we tried different morphologies with more or less prominent cingulums, various curvatures, and different bucco-lingual thicknesses, but after another couple of months in the business, there was still no acceptance of our designs. During this time, Mr. CM provided us with several drawings of STOMA.EDUJ (2014) 1 (2)