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ePaper created 2014-10-07, 09:31:41 | version 1.30.01
case report _ smile design combined with guided implantology I Today, the valuable information obtained by these methods can be digitised via computer software to aid patient case analysis and communication be- tween all parties involved in a patient’s treatment.2 In 2007, DSD was introduced to the dental field. DSDisaninnovativeprotocolthroughwhichclinicians are able to manipulate patient’s digital photographs and simulate future complex treatment outcomes by virtual analysis. The calibration and superimposition ofintra-andextra-oralphotographsandtheapplica- tionoffundamentalaestheticandfunctionalocclusal concepts allows the creation of a customised virtual restorative design and allows this information to be shared with laboratory technicians and patients for theirfeedback.3–5 Theconceptwasdevelopedtoassist the dentist in three major aspects: (a) planning and designing an aesthetic smile; (b) communication between all participants involved in the clinical case; and(c)communicationwiththepatient,increasinghis orherparticipationandmotivatingandeducatinghim or her about the benefits of the treatment.6, 7 This de- signconceptisapplicabletothe restorative field and has been shown to be useful in surgical planning.5 In suitable clinical scenarios, DSD can be utilised to determinate the ideal teeth position to obtain the best aes- theticandfunctionalresult. It is well known that visuali- sation of the surgical field with flap elevation may reduce the risk of occurrence of bone fen- estrationanddehiscenceduring implant placement. However, flap elevation is always associated with some degree of morbidity and dis- comfort, and requires suturing to close the surgical wound.8 The use of non-invasive surgical techniques like flapless implant placement may provide several clinicaladvantages,whilemaintainingsimilarsurvival ratestoconventionalimplantplacementprocedures.9 The concept of computer-guided implant surgery wasdevelopedtoovercomethelimitationsassociated with conventional surgical templates10, 11 and to im- provetheaccuracyofsurgicalimplantplacementwith a flapless approach.12, 13 More importantly, the com- puter-generated surgical guide provides a link be- tweenthevirtualprostheticallydriventreatmentplan and the actual surgery by transferring the simulated interventionaccuratelytothesurgicalsite.14 In this article, we present a clinical case in which DSD was utilised to guide treatment and combined with guided implant surgical software to achieve theproposeddigitalrestorativesimulation.Thedig- ital restorative simulation was used in fabricating Figs. 3a–c_Lateral view of the right interocclusal relation (a). Frontal view of the interocclusal relation (b). Lateral view of the left interocclusal relation (c). Fig. 4a & b_Lateral extra-oral photographs of the anterior region. Left side (a). Right side (b). Fig. 5_Articulated models. Fig. 6_Intra-oral frontal view over a black background. Fig. 7_DSD: the central tooth proportion utilised was 84 per cent. Note the measurements performed with the calibrated rulers. I 23cone beam3_2014 Fig. 5Fig. 4 Fig. 7Fig. 6 Fig. 3a–c CBE0314_22-28_Lanis 30.09.14 15:11 Seite 2