Virtual workflow complements edentulism remedy

Entire edentulism is an irreversible situation that could be a identified marker of illness burden for oral well being.¹ Edentulism considerably influences each oral and total well being, in addition to high quality of lifestyles.² Complete-arch implant-supported rehabilitation has emerged as a competent and predictable remedy choice for edentulism circumstances.³ New tendencies equivalent to digital making plans applied sciences be offering an optimum method for implant placement, aligning with the correct prosthetic place and minimising each intra-operative trauma and process period.⁴

Fig. 2

The next case record demonstrates the a hit control of a 70-year-old affected person experiencing masticatory difficulties. Thru a maxillary full-arch implant-supported rehabilitation with six Straumann Bone Stage Tapered (BLT) implants facilitated with a virtual workflow, we progressed her high quality of lifestyles and fulfilled her expectancies.

Preliminary scenario

The wholesome feminine affected person without a medicine, allergic reactions or smoking addiction got here to our medical institution in search of a answer for her issues of chewing. Moreover, she reported a historical past of continual dental and oral malodour. The affected person expressed a need to regain her skill to consume like prior to and get well her high quality of lifestyles and self assurance.

The additional-oral exam confirmed a low smile line, and the intra-oral exam discovered a detachable bridge from enamel #13 to enamel #23 that was once poorly tailored and confirmed indicators of decay. The maxillary tooth, apart from enamel #18, have been cell. Generalised gingival irritation, bleeding on probing and dental caries have been additionally provide (Fig. 1). The radiographic exam uncovered serious bone loss within the posterior of the maxillary left quadrant, in addition to caries and apical lesions on maxillary tooth (Fig. 2).

After accomplishing each radiographic and medical checks, the affected person was once categorized as having a posh situation in step with each the surgical and prosthodontic SAC classifications. This classification gadget, advanced via the Global Staff for Implantology, assists in comparing the extent of problem and doable headaches connected to implant-related recovery (Fig. 3).

Fig. 3

Remedy making plans

After an intensive dialog with the affected person in regards to the more than a few remedy possible choices, a joint choice was once reached that the selected method would contain a virtual workflow, quick implant placement and maxillary full-arch implant-supported recovery.

The remedy workflow concerned:

virtual implant placement making plans the use of coDiagnostiX (Dental Wings);
design and printing of the bone aid information, surgical information and resin fashions;
extraction of the hopeless tooth within the maxilla;
fixation of the surgical information and quick implant placement of six Straumann BLT implants within the maxilla;
filling of the gaps with Straumann XenoGraft;
supply of the brief screw-retained prosthesis;
supply of the overall screw-retained prosthesis 12 weeks after surgical operation; and
periodontal supportive remedy each 3 to 4 months.

The use of coDiagnostiX for virtual making plans of the implant placement proved to be of paramount importance in safeguarding the adjoining anatomical buildings and reaching constant and dependable results. Moreover, this device facilitated the introduction of a extremely exact surgical information adapted to our affected person’s wishes. Upon finalising the design, the next move concerned generating the surgical information via 3D printing and crafting resin fashions.

Surgical process

Previous to the surgical process, a cautious evaluate was once carried out to make sure the proper becoming of the surgical information. Therefore, native anaesthesia the use of 2% lidocaine with 1:100,000 adrenaline was once administered. An open flap get admission to was once carried out with mid-crestal and intrasulcular incisions (Fig. 4). Subsequent, the bone aid information was once positioned, and the holes for the anchor pins have been drilled and the pins securely inserted (Fig. 5).

The bridge was once got rid of, the tooth have been atraumatically extracted and the extraction sockets have been meticulous curetted. After the dental extractions, a discount of the vertical ridge was once performed (Fig. 6). Therefore, the surgical information was once located to start up the drilling process for the instant implant placement (Fig. 7).

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 11

Six Straumann BLT implants made out of the fabric Roxolid and with the SLActive floor (implant #16: 4.8 × 10.0 mm; implant #14: 4.1 × 14.0 mm; implant #12: 3.3 × 14.0 mm; implant #21: 4.1 × 12.0 mm; implant #23: 3.3 × 12.0 mm; implant #26: 4.1 × 14.0 mm) have been positioned (Fig. 8). The gaps have been stuffed with Straumann XenoGraft, and 6 brief titanium copings for screw-retained abutments have been therefore positioned (Fig. 9).

Maxillary full-arch impressions have been taken, using suitable affect copings for an open-tray method the use of a polyether affect subject matter (Impregum, 3M ESPE). After a couple of hours, a dental dam was once positioned across the brief copings to offer protection to the recent surgical websites. The prior to now ready brief prosthesis created from a resin-based provisional subject matter was once then affixed in position (Figs. 10–12).

The affected person was once prescribed painkillers and antibiotics and given directions for postoperative oral care, which incorporated rinsing the oral hollow space two times an afternoon for every week with a zero.2% chlorhexidine gluconate mouthwash and cleansing the brief prosthesis with an excessively cushy toothbrush. The sutures have been got rid of 12 days after the surgical process.