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22 Dental Tribune Middle East & Africa Edition | November-December 2014clinical CBCT and CAD/CAM allow for one-day restoration of Tooth #9 © Carestream Health, Inc. 2013. WELCOME TO THE NEW REALITY In the new reality, the CS 3500 intraoral scanner creates highly accurate, true color 2D images and 3D models of teeth without conventional impressions. • Truly handheld, portable with no trolley and plug and play • Powder-free with slim scanner head for comfortable, custom-fit restorations • Unique light guidance system for more patient-focused scanning • Part of a flexible and open system, allowing you to choose between in-house or lab milling Enter the new reality at carestreamdental.com/cs3500 DESIGN MILL CS3500 SCAN ALL YOU NEED FOR THE PERFECT RESTORATION, AND NOTHING YOU DON’T NO trolley NO impression material NO focusing on the screen NO limitations NO powder Visit us at: 6th Dental Facial Cosmetic Int’l Conference Jumeirah Beach Hotel Dubai 14-15 November 2014 CS3500 A4 advert:Layout 1 06/08/2014 10:49 Page 1 > Page 34 Figure 1 Figure 2 By Robert Pauley, USA C ase Overview Our office received a fran- tic phone call from the mother of one of our twelve- year-old patients, who stated that her daughter fell while in P.E. class and broke a front tooth. We advised her to bring her daughter to the office as soon as possible. Immediately after her arrival a periapical radiograph of tooth #9 and extraoral photo- graphs were obtained (Fig. 1). Upon clinical examination and review of the digital radiograph, I saw tooth #9 was horizontally fractured at the middle third. There was no pulp exposure evident, but the tooth did have a pinkish tint on the lingual. No mobility was noted and no peri- apical changes or root fractures were obvious at this time. The new American Association of Endodontists guidelines recom- mend taking one occlusal and two periapical radiographs with different lateral angulations for all dental injuries, including crown fractures. If cone beam- computed tomography is avail- able, it should be considered to reveal the extension and direc- tion of the fracture.1 Dr. Edward Mills in his presen- tation on Site Development and Implant Protocol Based on Etiol- ogy of Tooth Loss refers to a sim- ilar traumatic injury in which CT images revealed not only a root fracture within the bone but a fracture of the lingual plate.2 A limited field 3D scan 5cm x 5cm at 300 voxels was taken with the CS 8100 3D to rule out buccal or palatal plate fractures (Fig. 2). None were evident on the scan. While her parents were upset that she had been injured, the ability to view a 3D image reassured them that the damage appeared to be limited to the tooth’s coronal structure. Treatment Plan The patient’s treatment options were: 1) do nothing; 2) restore with a composite restoration, realizing that this would have a questionable long-term prog- nosis due to size of fracture; 3) restore with a CAD/ CAM milled crown. The patient and her parents were advised that cases where teeth have been injured traumatically such as in this case, one might experience a post traumatic irreversible pulpitis at a period of time be- yond the initial trauma. In some cases, this condition may be treated by endodontic treatment and crown restorations but in other cases root resorption may take place precipitating the loss of the teeth. These teeth will be monitored every 6 months over several years with periapical radiographs. Every appropriate effort to maintain the tooth in place and avoid the need of an implant until the patient reaches maturity. Dental implants in ad- olescent patients may affect ver- tical growth and development of the alveolar ridge because the osseointegrated implant acts as an ankylosed tooth. At a focus conference on Advanced Dental Implant Studies, Dr. Mills sum- marized that jaw growth in a young adolescent patient may compromise the outcome of the oral rehabilitation using an im- plant supported prosthesis even if implants successfully inte- grated. After presentation of the treatment plan and discussion of risks, benefits, options, and alternatives; the parents and pa- tient elected to restore tooth #9 with a CAD/CAM crown. The parents understand this crown will likely need to be re- placed once she reaches adult- hood for the best cosmetic ap- pearance, as her teeth and face will change with further growth and development. Tooth # 9 was anesthetized and prepared for a ceramic crown. I utilized the CS 3500 intraoral scanner to scan the prepared maxillary anterior quadrant and the opposing mandibular ante- rior quadrant as well as obtain a bite registration (Figs 3, 4). CS Restore software was then utilized to design the anterior crown (Figs. 5-7). The CS 3000 milled the crown from an Ivo-