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ePaper created 2014-06-27, 16:55:00 | version 1.30.01
By Tarun Agarwal, DDS, PA n Today’sdigitalimpressiontechnol- ogy enables dentists to create a vir- tual, computer-generated replica of the hard and soft tissues in the mouth quickly and accurately, using their choice of optical scanning device. As an ardent supporter of digital impres- sions,Imakeeveryattempttodigitize our restorative workflow. There are numerous benefits to a digital impres- sion: • Efficiency: It takes less time to take a digital impression than a tradi- tional impression. • Quicker turnaround time: Clini- cians often forget or fail to realize the true value of this. Getting resto- rations back faster is better for the patient, the practice and the overall case outcome. • Cost savings: Have you ever cal- culatedthecostoftakingatraditional impression for a final restoration? If you add up what your office spends on impression materials, chair time and case shipping fees, you will be amazed at how much is spent on tra- ditional methods. Case presentation The female featured in this article has been a patient in our practice for nearly eight years. She has a porce- lain-fused-to-metal bridge from tooth #5 to #12, replacing missing #7 to #10. She is not terribly unhappy with the look and feel of the bridge, but the bridge has been no stranger to the big issue facing PFM restorations: the chipping of porcelain from the metal substructure. During the past eight years, we have patched various corners and lingual surfaces. Recently, the patient agreed to replace her long-span PFM bridge with an implant-supported bridge on #7 to #10 and individual crowns on the abutment teeth. However, she was adamant about not going a day without teeth. We advised her that this would not be an issue. Because of the complexity of her implant surgery, immediate loading was not possible. This meant we needed a long-term esthetic provi- sional that would last the duration of the treatment, could be removed for surgery and was adjustable for post- surgical contouring. A BioTemps® provisional bridge (Glidewell Laboratories; Newport Beach, Calif.) was the quick and easy answer. Traditionally, BioTemps are made prior to preparation and relined chairside. In this case, I wanted to havetheBioTempsmadetofitthefinal preparations of the abutment teeth, which would later be converted to individual restorations. As an advo- cate of digital impressions, I chose to follow a digital workflow. The provisional BioTemps bridge offers the following important advan- tages in this case: 1) Trial smile: The patient gets a “trial” of the new contours. Any modificationstolengthorcontourcan be made chairside, avoiding costly remakes and unhappy patients. 2) Long-term durability: Because of the complexity of this case, full treatment will take well over 12 months. An acrylic provisional fabri- cated chairside simply won’t hold up this long. 3) Removability: For implant sur- gery, the specialist will need the ability to remove and re-cement the provisional with relative ease. 4) Adjustability: The necks of teeth #7to#10willneedtobeadjustedafter surgerytoremoveanypressuretothe surgical sites. BioTemps are easily adjusted. 5) Surgical assistance: The con- tours and esthetics of the BioTemps will serve as a “guide” to the surgeon for grafting and placement of the implants. As this case illustrates, digital impressions are not just limited to final restorations, and certainly not just to single units. It’s time for you to take a closer look at digital restora- tive technologies and see how they can benefit your practice and your patients. exhibitors30 Chicago Midwinter Meeting — Feb. 21, 2014 Utilizing a digital workflow for provisionalization with BioTemps Case illustrates that digital impressions aren’t limited to final restorations and single units Here in Chicago FormoreinformationonBioTempspro- visional bridges, stop by the Glidewell booth, No. 4420. About the author Dr.TarunAgarwalmaintainsafull-time private practice emphasizing esthetic, restorative and implant dentistry in Raleigh, N.C. You can contact him via e-mail at dra@raleighdentalarts.com or visit www.raleighdentalarts.com. 5 Fig. 1: Preoperative photograph of the patient’s existing longspan PFM bridge. Note the bulky and gray margins, unesthetic contours and ‘patch’ composites used to repair areas of chipped porcelain. 5 Fig. 2: The original abutment preps are cleaned and reduced to the appropriate margin thickness. 5 (Photos/Provided by Glidewell Laboratories) 3 Fig. 3: A digital impression is taken using the CEREC Omnicam (Sirona Dental Systems Inc., Charlotte, N.C.). This occlusal view illustrates how precisely the Omnicam captures a full-color digital impression. 4 Fig. 4: A labial view of the abutment teeth preparations captured with the CEREC Omnicam. An added benefit of digital impressions is that changes don’t require an entire new impression, only a new digital capture of the changed area. 5 Fig. 5: The BioTemps bridge at delivery, seated with provisional cement.