:sharpen(level=0):output(format=jpeg)/up/dt/2024/04/A-fully-guided-digital-workflow-for-predictable-implant-planning-and-placement-Fig.-1a.jpg "Implant placement with totally guided virtual workflow")
Step one was once to acquire a CBCT scan of the maxillary arch, which published periapical pathology in tooth #12-22 (Figs. 2 & 3). Moreover, teeth #21 exhibited vital lack of buccal bone, and a small piece of amalgam was once recognized within the bone close to teeth #21. After an intensive research of the radiographic findings, a remedy plan was once established to extract tooth #12-22 and carry out ridge preservation to scale back bone loss within the extraction websites.
As is regimen protocol in my dental apply, we captured a virtual impact of the maxillary and mandibular arches with the DEXIS IS 3800 intra-oral scanner (Figs. 4a–c), at the side of intra-oral pictures to record the preliminary oral situation. Those virtual fashions had been used for the fabrication of the brief detachable prosthesis.
Fig. 7: CBCT scan of the maxillary anterior area after the extractions.
Upon receiving approval from the insurance coverage corporate for the proposed remedy plan, all 4 tooth had been extracted. After the extractions, the extraction sockets had been meticulously debrided with EthOss degranulation burs and full of EthOss grafting subject material to advertise number one closure and therapeutic of the wound (Fig. 5).
To keep each the cultured and useful facets for the affected person all the way through the time between extraction of the tooth and the brand new bridgework, a brief detachable prosthesis was once fabricated (Fig. 6). The affected person’s normal dentist has additionally been running totally digitally for years, and the brief prosthesis was once created from a virtual impact and published fashions.
Two months after the extractions, we got a CBCT scan of the maxilla (Fig. 7) and captured virtual impressions the usage of our DEXIS IS 3800 intra-oral scanner (Fig. 8). Those scans had been crucial for starting off the implant making plans procedure and developing the surgical information.
Fig. 9: Implant making plans for all 4 positions.
Throughout the implant making plans segment, we created a initial plan the usage of 3-d imaging tool with a prosthetically pushed implant making plans way (Figs. 9 & 10), and the plan was once exported into surgical information making plans tool for ultimate making plans and development of the surgical drilling information (Figs. 11a–c). The implants had been deliberate in all 4 positions with the thing of figuring out the 2 maximum optimum and out there websites for the location of 2 implants and the corresponding bridge recovery.
After crowning glory of the making plans and drilling reconstruction, the surgical information was once 3-d-printed with a Stratasys printer the usage of MED610 resin (Stratasys). The 2 implants (4.1 × 12.0 mm Straumann Bone Stage Tapered, Common CrossFit, SLActive, Roxolid) had been then positioned utilising the Straumann guided surgical treatment equipment for exact steering. The remainder piece of amalgam within the bone of teeth #21 was once in moderation got rid of—just a small piece within the gingiva remained (Fig. 12). The buccal bone was once once more thickened with EthOss, and the wound was once closed with a semi-submerged methodology, facilitating right kind therapeutic and integration of the implants (Figs. 13a & b).
After a ten-week osseointegration and therapeutic duration, the affected person returned for a last review of the implant balance the usage of the implant balance quotient size.
The following step will contain the crowning glory of the general prosthesis, which will probably be carried out by way of the affected person’s normal dentist. To create the screw-retained monolithic bridge, a virtual impact will probably be got the usage of an intra-oral scanner, and the dental technician may even paintings totally digitally—so far as conceivable—for the general prosthesis.