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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 As has been reported by various authors, the double-scanning of the radiographic templates allows virtual superimposition of a dental set-up ontothe3-DCBCTreconstruction.15–20,27,28 Theutil- isation of DSD for the creation of an aesthetic wax- up and a personalised radiographic template may improve the prosthetically driven virtual planning, determining the ideal teeth position in the anterior edentulous region. The virtual design can also pro- videthefoundationforthefabricationoftheprovi- sional and definitive restorations. Various authors have described immediate im- plantfunctionalloadingovertime.Today,itappears to be an acceptable treatment modality especially recommended in full-arch reconstructions with a one-piece provisional structure.29 Some of the variables to consider are high implant insertion torques, and the number and distribution of the implants placed.30, 31 Furthermore, high survival rates have been reported when immediate loading is combined with guided flapless implant place- ment.32 Thus, immediate loading with fixed pros- theses in edentulous patients results in similar implant and prosthesis survival and failure rates to early and conventional loading.33 The use of ta- pered implants with a special compressive design allowed for torque values of greater than 50 Ncm for each fixture. Furthermore, the placement of six implants permitted favourable distribution, allow- ing the creation of a polygon to absorb occlusal forces. _Conclusion The use of DSD as a prosthetic and surgical plan- ning tool may help to communicate the proposal treatment to patients and to include their feedback and opinions in the clinical treatment design. The communicationoftheclinicalinformationtoallofthe participantsmayalsoimprovethetreatmentoutcome andoptimisethetimetakentoperformthetreatment. The combination of DSD with guided implant surgery technology may offer an aesthetic and functional prosthetic approach to the design of radiographic templates, providing a guide throughout treatment. However, the conventional functional and aesthetic analysis of oral rehabilitation are still mandatory, and should be a requisite to managing this kind of treat- ment,especiallyinadvancedandcomplexcases. The guided implant placement and loading pro- tocol utilised in this clinical situation appears to be a predictable treatment option for the clinical situ- ationpresentedinthisarticle;however,randomised studies are needed to confirm this. Careful consid- eration must be given to case selection to achieve a successful outcome._ Acknowledgements: The authors received funding from the International Team for Implantology through the ITI Scholarship Program. The authors wish the thank Dr Andrew Barnett from the Department of Periodontics andOralMedicinefromtheUniversityofMichiganforhis collaborationintherevisionofthisarticle. Editorial note: A complete list of references is available fromthepublisher. 28 I cone beam3_2014 AlejandroLanis,DDS,MS, receivedhisDDSfromthe UniversityofValparaísoinChile andperformedhisresidencypro- grammeinOralandMaxillofacial ImplantologyattheUniversityof Chile.TheInternationalTeamfor Implantologyselectedhimas anITIScholarfortheUniversityofMichiganintheUS. HeisamemberoftheAcademyofOsseointegration andInternationalTeamforImplantology,aconstituent memberoftheInternationalCollegeofProsthodontists, andafellowofSociedaddeImplantologíaOraldeChile (Chileansocietyoforalimplantology).Heworksin apracticeinSantiagoinChilespecialisedinimplant dentistry,prosthodonticsandaestheticdentistry. Hecanbecontactedatdr.alejandrolanis@gmail.com. OrlandoÁlvarezdelCanto, DDS,MS,isAssociateProfessor inOralImplantologyatthedental schooloftheUniversidaddel Desarrolloandisinprivate practiceinSantiago.Hereceived hisDDSdegreefromthe UniversityofChileandhisMS degreeinImplantologyandOralRehabilitationfrom theAndrésBelloUniversityinChile.Hehasadiplomate degreeinHealthInstitutionsManagementfromthe UniversityofChileandadiplomatedegreeinExecutive andMarketingManagementfromthePontifical CatholicUniversityofChile.Heisamemberofthe SociedaddePrótesisyRehabilitaciónOraldeChile (Chileanprosthodonticssociety),Sociedadde ImplantologíaOraldeChile,LAAO,InternationalCollege ofProsthodontistsandInternationalTeamfor Implantology.HeworksinapracticeinSantiago specialisedinimplantdentistry,prosthodontics andaestheticdentistry.Hecanbecontactedat dr.alvarez@oseointegracion.cl. DrsAlejandroLanis&OrlandoÁlvarezdelCanto Office601 Av.PresidenteKennedy7100 7650618Santiago,Chile cone beam_about the authors CBE0314_22-28_Lanis 30.09.14 15:11 Seite 7