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ePaper created 2014-10-07, 09:31:41 | version 1.30.01
I case report _ smile design combined with guided implantology an aesthetic wax-up and a personalised radio- graphictemplateforflaplessguidedimmediateim- plant placement planning. After the surgical proce- dure, a full-arch provisional structure fabricated based on the DSD analysis was immediately loaded. _Case report Diagnosisandplanning A 39-year-old female patient presented to our clinicwiththerequestforfull-mouthrehabilitation. She was most unsatisfied with her oral health and anaesthetic smile, and was very apprehensive of dental treatment owing previous negative experi- ences in this regard. The extra-oral examination did not establish any significant findings. She had no systemic conditions and did not have a history of smoking,andwasthusclassifiedasASA1(healthy). Comprehensive clinical examination found par- tial edentulism and a failing dentition as a result of moderateperiodontaldiseaseandseverecariesprob- ably induced by mild enamel hypocalcification that could be observed in the remaining dentition. She presentedwithcongenitallymissingmaxillarylateral incisors (teeth 12 and 22). Teeth 17, 16, 15, 24, 25, 26 and 27 had been extracted several years before owingtoseverecaries.Theremainingmaxillaryright premolar presented with severe caries with deficient resin restorations. Both canines presented with moderate carious lesions and Grade I mobility. Teeth 11 and 21 presented with extensive recurrent decay. In the mandible, the periodontal examination provided a diagnosis of gingivitis. Teeth 36 and 46 had been extracted several years before after sus- taining a vertical root fracture. Tooth 44 had been extracted three years before owing to a severe Fig. 8_Final crown design after the DSD analysis. Proposed implant positions over the digital restorative simulation. Fig. 9_DSD: extra-oral digital simulation of the future rehabilitation (colour scale). Fig. 10_A wax-up on one of the study models based on the DSD analysis. Fig. 11_A translucent acrylic template was fabricated for only the palatal region and the edentulous regions of the maxillary model. Acrylic teeth were added in accordance with the DSD plan. Fig. 12_The radiographic template in position over an articulated model. 24 I cone beam3_2014 Fig. 9Fig. 8 Fig. 13Fig. 12 Fig. 10 Fig. 11 CBE0314_22-28_Lanis 30.09.14 15:11 Seite 3