:sharpen(level=0):output(format=jpeg)/up/dt/2024/08/Digital-technology-for-full-arch-implant-prostheses_Fig.1_Title.jpg "Virtual generation for full-arch implant prostheses")
Moreover, virtual generation improves verbal exchange and collaboration between the affected person, dental crew and laboratory. The computerised procedure allows seamless knowledge sharing and digital remedy making plans, leading to a coordinated and precise strategy to the manufacturing of full-arch implant prostheses.
The next case record used to be deliberate and done the use of the DIGILOG thought, which is a hybrid of virtual and analogue workflows that mixes the most productive options of each approaches for the introduction of brief and definitive prostheses. This idea allowed us to have optimum verbal exchange with the implant crew and our affected person, who won two full-arch implant prostheses. Within the maxilla, two Straumann zygomatic implants and two Straumann BLX implants have been positioned, and within the mandible, 4 Straumann BLX implants have been positioned.
Preliminary scenario
A 57-year-old feminine affected person who used to be systemically wholesome and a non-smoker and had no related clinical historical past got here to our sanatorium mentioning that she used to be not able to devour with out ache and had completely no self assurance or pleasure in her smile or general look. She had additionally spotted flaring and revolutionary spacing of her anterior enamel and complained of meals impaction. She desired a full-mouth fastened rehabilitation and sought after to fortify the placement of her enamel to regain the arrogance to grin.
No abnormalities have been discovered all the way through the extra-oral exam. The affected person offered with a low smile line. The intra-oral exam published terminal dentition because of generalised periodontal illness. The affected person offered with critical resorption of the posterior maxilla bilaterally (Fig. 1). The radiographic exam confirmed generalised alveolar bone resorption with vertical bone defects (Fig. 2).
According to the radiographic and medical analysis, the affected person case used to be labeled as surgically and prosthodontically advanced in relation to the World Staff for Implantology’s SAC classification (Fig. 3). The SAC classification aids in assessing the level of issue and chance related to implant-related rehabilitation.
Remedy making plans
Our affected person used to be offered with quite a lot of remedy plans, encompassing each detachable and glued rehabilitation choices. Amongst those, the affected person used to be knowledgeable concerning the DIGILOG remedy thought. After making an allowance for the selections offered, the affected person selected to continue with the DIGILOG possibility.
The DIGILOG thought used to be evolved in collaboration with oral and maxillofacial surgeon Dr Christopher A. Gurries. This manner allows verbal exchange between surgeon and prosthodontist with the usage of virtual generation and analogue surgical remedy, supporting predictable remedy results. Two steps have been incorporated in our workflow for instant full-arch remedy the use of the DIGILOG thought: the printing of prototypes of the prostheses to evaluate the peripheral borders, vertical size of occlusion, aesthetics, phonetics and occlusion; and the scanning of the intaglio surfaces, peripheral borders and occlusion and switch of that knowledge to the laboratory to finalise the peripheral borders and vertical size of occlusion earlier than milling the monolithic ultimate prostheses.
CoDiagnostiX instrument (Dental Wings) used to be used for making plans the analogue surgical placement of 2 Straumann zygomatic implants and two Straumann BLX implants within the maxilla and of 4 Straumann BLX implants within the mandible. The protocol selected used to be instant placement after atraumatic extraction of the rest enamel whilst protective the rest bone (Figs. 4 & 5). The affected person’s STL record used to be generated and despatched to the in-house laboratory to create a 3D-printed style for the surgical making plans, permitting us to acquire a surgical style (Fig. 6).
To keep away from advanced procedures for implant placement and to lower morbidity and prices for the affected person, no augmentation used to be deliberate. At the similar day as implant placement, the milled prostheses could be delivered. Six months later, two digitally fabricated fastened full-arch implant prostheses could be positioned.
Fig. 7
In abstract, the remedy workflow used to be as follows:
- knowledge acquisition for fabrication of 2 brief PMMA prostheses;
- implant surgical operation and instant placement of the brief prostheses;
- virtual design and manufacture of the overall zirconia prostheses; and
- supply of the overall prostheses and an occlusal splint six months after implant surgical operation.
Surgical process
Sooner than surgical operation, an intra-oral scanner used to be hired to obtain the virtual knowledge for the design of the brief prostheses (Fig. 7). The enamel have been digitally got rid of, and virtual prostheses have been created. The information of the almost built prostheses used to be due to this fact transmitted to a milling system for the fabrication of monolithic PMMA prostheses.
The remedy used to be performed beneath native anaesthesia with 2% lidocaine and 1:100,000 adrenaline. A crestal incision used to be made and a full-thickness mucoperiosteal flap raised. The implant beds have been ready with the Straumann Surgical Cassette, and two Straumann BLX implants (4.5 × 10.0 mm, SLActive, Roxolid) and two Straumann zygomatic implants (4.3 × 40.0 mm) have been positioned within the maxilla (Fig. 8). Following the similar protocol, 4 Straumann BLX implants (4.5 × 10.0 mm, SLActive, Roxolid) have been inserted within the mandible. Straumann screw-retained abutments have been situated directly to the implants (Fig. 9).
The mucoperiosteal flap used to be sparsely tailored and sutured. The brief screw-retained prostheses have been then positioned at the day of the surgical operation (Fig. 10). The protheses have been checked for spaces of over the top power and altered. The affected person used to be given postoperative and oral hygiene directions. Two weeks after surgical operation, the sutures have been got rid of, and the therapeutic were uneventful.
Prosthetic process
The affected person used to be adopted up, and at six months after implant placement, an oblique digitisation of the back-poured grasp solid used to be performed, making an allowance for superimposition of the enamel place to the implant place (Fig. 11). The general enamel set-up and occlusal scheme have been performed digitally to verify optimised aesthetics and serve as (Fig. 12). As soon as the entirety were digitally verified, the overall zirconia prostheses with layered porcelain gingivae have been fabricated (Fig. 13). The occlusion used to be checked, and the affected person used to be given a 3D-printed occlusal splint to give protection to the implant-supported prostheses, appearing as an absorber and distributor of occlusal forces (Fig. 14). A wide ranging radiographic used to be taken to observe the well being across the dental implants at supply of the prostheses (Fig. 15). The affected person used to be supplied with hygiene directions and scheduled for normal check-ups to verify ongoing care and tracking.
Remedy results
Virtual and analogue can also be seamlessly built-in to allow a complete evaluation and remedy. Optimum making plans and meticulous exam play pivotal roles in figuring out the results of the remedy. A personalized surgical manner is crucial to deal with the various wishes and necessities of each and every particular person affected person.
At the similar day as extraction surgical operation, using the main of immediacy and with out the need of guided bone regeneration, an excellent purposeful and aesthetic consequence used to be achieved with two Straumann BLX implants and two Straumann zygomatic implants within the maxilla and 4 Straumann BLX implants within the mandible. Six months later, the affected person used to be very happy with the retention and aesthetics of the overall full-arch implant prostheses. The medical and radiographic analysis yielded solid and beneficial effects, indicating sure development. The prostheses fulfilled the affected person’s expectancies and desires. She used to be thrilled with the numerous exchange in her smile and in her high quality of existence (Figs. 16 & 17).
Authors’ testimonial
The DIGILOG thought, the use of virtual generation to counterpoint elementary surgical and prosthetic rules, together with a scientifically designed armamentarium, allowed for remedy of this situation and a predictable consequence.