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ePaper created 2014-12-05, 15:38:45 | version 1.33.01
I 23 industry report _ use of CBCT and CAD/CAM I cone beam4_2014 Etiology of Tooth Loss, refers to a similar trau- matic injury in which CBCT images revealed not onlyarootfracturewithinthebone,butafracture of the lingual plate.2 A limited field three-dimensional (3-D) scan 5 cm x 5 cm 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 3-D 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, realising that this would have a questionable long-term prognosis due to the size of the frac- ture;3)restorewithaCAD/CAMmilledcrown.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 beyond the initial trauma. In some cases, this condition may be treated by endodontic treat- ment and crown restorations but in other cases root resorption may take place, precipitating the loss of the teeth. These teeth will be monitored every six months over several years with periapi- cal radiographs. Every appropriate effort was made to maintain the tooth in place and avoid the need of an implant until the patient reaches maturity. Dental implants in adolescent patients may affect the vertical 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 summarised that jaw growth in a young adolescent patient may compromise the out- come of the oral rehabilitation using an implant- supported prosthesis even if implants were suc- cessfully integrated. After presentation of the treatment plan and discussion of risks, benefits, options, and alternatives, the parents and patient elected to restore tooth 21 with a CAD/CAM crown. The parents understand this crown will likely need to be replaced once she reaches adulthood for the best cosmetic appearance, as her teeth and face will change with further growth and development. Treatment Tooth 21 was anaesthetised and prepared for a ceramic crown. I utilised the CS 3500 intraoral scanner to scan the prepared maxillary anterior quadrant and the opposing mandibular anterior quadrant, as well as obtain a bite registration (Figs. 3 & 4). CS Restore software was then utilised to design the anterior crown (Figs. 5–7). The CS 3000 milled the crown from an Ivoclar Vivadent e.max shade A1 size 12 ceramic block. We tried in the crown and took a digital PA radiograph to verify the margination, and made a slight occlusal adjustment on the lingual surface. The patient and parents were pleased with the appearance of the unglazed product. We polished, glazed, and added a slight white line on the buccal of 21 to mimic natural tooth 11. The crown was fired in the Ivoclar Programat Fig. 6Fig. 5 Fig. 7 CBE0414_22-24_Pauley 28.11.14 11:37 Seite 2 CBE0414_22-24_Pauley 28.11.1411:37 Seite 2