Dental Information – Quick full-arch zirconia implant remedy utilising the ability of robot help and virtual scanning

Long past are the times of making plans surgical procedures on 2D photographs and messy impressions and sufferers leaving toothless. Of their position, trendy dentistry now has seamless integration of CBCT with virtual making plans of implant surgical procedures, and this virtual plan can also be carried over to the operatory and reproduced with robot help.^1–4 Virtual scanning of implant positions can produce correct 3D modelling, and developments in fabrics and prosthesis fabrication strategies permit sufferers to depart with tooth the similar day because the surgical operation. Those developments have revolutionised the artwork and science dentists use to way remedy in their sufferers. This text will display one of the most leading edge generation, fabrics and strategies and probabilities of full-arch zirconia implant remedies by the use of a case record.

Case record

The affected person introduced with a couple of periapical radiolucencies related to failing endodontically handled tooth, a horizontal root fracture and a failing long-span bridge (Fig. 1). A deficient long-term diagnosis used to be given to the entire closing mandibular tooth apart from teeth #46 (Fig. 2), and the remedy choices, barriers and dangers had been reviewed totally with the affected person. The affected person didn’t need a detachable recovery and didn’t wish to cross an afternoon with out tooth and sought after to have biologically pleasant fabrics used for remedy. It used to be made up our minds to accomplish a direct implant surgical operation and give you the affected person with a strong transient recovery to offer protection to the therapeutic implants for long-term luck.

One-piece zirconia implants (SDS Swiss Dental Answers) had been selected for his or her number of diameters and lengths, power and suitability for fast temporisation. Zirconia implants have proven identical long-term luck to titanium implants and not more bacterial adhesion,^5–7 making them an ideal candidate for a hard and fast full-arch resolution. Enamel #37, 44 and 46 had been to stay in position right through the transient therapeutic section to lend a hand stabilise the transient recovery, supply posterior stops for occlusion and give protection to the implants right through the therapeutic section.

Preoperative making plans used to be carried out the use of CBCT (Axeos and Galileos, Dentsply Sirona; Fig. 3) and YomiPlan making plans instrument (Neocis) to choose and parallel the entire implants (Fig. 4). Preoperative maxillary, mandibular and chew scans had been curious about CEREC Primescan (Dentsply Sirona) and despatched to the laboratory for a short lived mock-up (Fig. 5). This allowed the laboratory technician to pre-plan a short lived recovery and talk about implant positions and ultimate prosthetic answers.

Surgical section

Complex platelet-rich fibrin (A-PRF⁺) and injectable platelet-rich fibrin (i-PRF) had been produced the use of horizontal centrifugation (Bio-PRF). Atraumatic extractions had been carried out, and the sockets decontaminated the use of curettage, degranulation burs and ozone remedy.

The Yomi hyperlink used to be hooked up at the mandibular left by the use of chew registration, and a CBCT scan with fiducial arrays used to be taken (Fig. 6). The hyperlink placement allowed whole visible get entry to of the surgical box from teeth #33 to teeth #46. Surgical procedure used to be initiated below robot help at websites #45, 43, 41 and 31. The osteotomies had been incrementally greater in line with producer’s suggestions, and drill orientation had been showed intra-orally and by the use of Yomi dynamic are living CBCT navigation. A hit placement in line with tight anatomical parameters and with parallelisation of implants used to be conceivable with prime self assurance by the use of the haptic controls and locked drill trail and intensity the use of Yomi robotic help. SDS1.2 implants had been positioned into the websites. The sockets had been due to this fact grafted with allograft (Cortical Mineralized/Demineralized Mix, particle measurement: 0.25–1.00 mm; Maxxeus CTS) hydrated with i-PRF, and an A-PRF⁺ membrane used to be positioned over each and every web site and sutured in position. The primary section of surgical operation used to be finished in roughly 90 mins, and the Yomi hyperlink used to be got rid of and the information arm indifferent.

Surgical procedure persisted at the mandibular left quadrant, and an strive used to be made to re-link the affected person with Yomi robotic the use of the implants, nevertheless it used to be unsuccessful. Yomi’s standard workflow permits roughly one quadrant at a time to be labored on. A brand new scan and 4 or extra strong tooth are had to anchor the hyperlink. This has now been triumph over with the more moderen Yomi bone hyperlink, which might were excellent on this explicit case. Then again, freehand fast placement and parallelisation of implants had been conceivable with the visualisation of the 4 up to now positioned implants.

Virtual impressions had been curious about CEREC Primescan (Fig. 7) and despatched to the laboratory for same-day fabrication of the transient recovery (Flexcera Smile Extremely+, Desktop Steel; Fig. 8). Suturing used to be finished, and the full-arch transient recovery used to be adjusted and seated with transient cement (Fig. 9).

At 5 months of therapeutic, the rest failed dentition used to be got rid of and the comfortable tissue allowed to heal for seven weeks. Preparation of the implants for the overall recovery consisted of elimination of the transient recovery, preparation of the abutments the use of a positive (red-striped) diamond bur and fabrication of a chew jig to seize the vertical size of occlusion (Figs. 10 & 11). This is able to be used when making ready the implants to ensure correct relief of the abutments. The entire implants had been ready to permit passive draw, and haemostatic agent and retraction paste had been positioned on the sulcus (Fig. 12).

A full-arch virtual impact used to be taken the use of CEREC Primescan and a traditional impact used to be curious about polyvinylsiloxane (PVS) impact subject material. The laboratory showed the standard of the scan after which returned a brand new transient full-arch recovery (Fig. 13). This is able to be used to check the occlusion and accuracy of the virtual and PVS impressions. When merging the virtual scans and PVS impact and seating the transient recovery, a discrepancy used to be famous. A jig created from zirconia used to be fabricated to seat over the abutments. The affected person returned a couple of weeks later, and the zirconia abutment jig used to be seated, sectioned and luted, and a pick-up PVS impact used to be taken. Serving as a checkpoint within the ultimate recovery fabrication, a brand new virtual impact the use of titanium dioxide scanning powder used to be taken (Fig. 14), as a result of it’s been famous that extremely polished or reflective subject material would possibly distort the virtual impact (Fig. 15). The dental technician verified the scan knowledge (Fig. 16) and famous a vital exchange from our first scan.^1, 2, 8

A last full-arch zirconia recovery used to be manufactured, and the overall seating used to be verified with radiographs (Fig. 17) and cemented with PANAVIA SA Cement Common (Kuraray Noritake Dental). The affected person returned two weeks later for an occlusion take a look at and adjustment at the side of an oral hygiene take a look at. Red company gingiva round the entire implants used to be famous such that it used to be even tough to get a probe into the sulcus (Fig. 18).

Conclusion

This example learn about has showcased the transformative attainable of recent dental generation in fast full-arch zirconia implant remedy. The implementation of CBCT imaging, robot help, virtual scanning and complex production with biocompatible fabrics has revolutionised the sphere of dentistry, providing sufferers enhanced precision, convenience and fast effects.

As implementation of recent applied sciences will increase, studying some barriers of the generation is a part of the evolution. On this case, it used to be famous that scanning powder for taking virtual impressions of a couple of ready zirconia implants used to be vital and that a couple of one-piece zirconia implant abutments didn’t supply sufficient retention for a Yomi-linked surgical operation. Those demanding situations had been addressed and triumph over with changes of method, studying the features of the generation and leaning at the basics of implant surgical operation and restorative dentistry.

Total, those new approaches to full-arch zirconia implant remedy constitute a paradigm shift in dental care. They now not handiest supply sufferers with a fast and biologically pleasant resolution, but in addition allow precision implant placement and prosthesis fabrication. With cast medical basics in dentistry, the clinician can utilise the consistent evolution of dental generation to improve the probabilities and products and services introduced, raising the usual of take care of dental sufferers.