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ePaper created 2015-09-29, 13:02:58 | version 1.38.0
special _ digital technologies I Itismostimportanttogetthepatientexpectations inalignmentwiththedentistbeforestartingdetailed treatmentplanning.Weneedtoknowwhatthepatient wantsinordertodeliverittothepatient.Tobeableto communicateeffectivelywiththepatient,weneedto knowourselvesandweneedtoknowourclinicalabil- ities and limitations before applying our work. In my opinion, the patient experience is essential in case presentation. Clinicalphotosbothextraorallyandintraorallyare the first step in the treatment planning process. We recommend that you start with the protocol from AACD (American Academy of Cosmetic Dentistry) or DSD (Digital Smile Design by Christian Coachman). These are well documented protocols and contain all the basic photos needed. The photos will be used following the DSD proto- col to visualise the end result to the patient and in communicationswithspecialistsandthedentallab(if needed).TheDSDprotocolenablesamultidisciplinary treatment planning process without seeing the pa- tient in the practice. Every step is done through a free cloud-based service. It is inexpensive, flexible and easy to do. The data from the DSD is transferred to a model of the patient (Figs. 1a–d). This can be done on a stone model or a digital model. With the models aligned, it is possible to make an additive wax-up with the exact propor- tions of the DSD. With a stone model, we make a silicone stent that is carefully trimmed. We fill it with a bis-acrylic material and position it in the mouth of the patient. With a digi- tal wax-up we need to make a composite shellthatiseithermilledorprintedona3-Dprinter. Theshellcanbegluedintopositionwithbis-acrylics or flowable composite. Withthetry-insmilewetakeaseriesofphotos.The photos will be used to verify with the patient that we are on the right track. If needed, the try-in smile can be adjusted until the wanted result is achieved. If we make any corrections, a new impression is taken for our final treatment plan. Oncethepatienthasacceptedthetreatmentplan, we proceed with a functional wax-up. The functional wax-up will guide the treatment of the patient. It will enable us to visualise the final restorations. At this pointwecandecideexactlywhatwillbe:theidealim- plant position; the ideal abutment; the ideal restora- tive material; the ideal shape of the restoration; the need for grafting (hard and soft tissue). The easiest way to achieve the most precise func- tionalsetupisbyusingtheArcusDigma(KaVo;Fig.2). It is the only system that enables you to make a very Fig. 1c Fig. 1d Fig. 2 I 13cone beam3_2015