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ePaper created 2015-11-12, 17:51:05 | version 1.38.0
I industry report _ 3-D prosthetic-driven implant planning _In the following case presentation, I take the reader step by step through the treatment of a chal- lenging case, including a mandible treated according to the All-on-4 treatment concept. _Case presentation A 64-year-old female patient presented for treatmentwithanasymmetricarchduetoprogres- sive tooth loss. She had controlled hypertension, but no other significant medical history. She had been wearing maxillary and mandibular partial cobalt–chromium–molybdenum dentures for many years, with individual teeth added when crowns or bridgesfailed.Thepatientpresentedwithaseverely atrophic maxilla and mandible, with a mandibular immediate prosthesis on a shortened dental arch. As a result of the patient’s progressive tooth loss, I approached this case with the All-on-4 treatment concept (Nobel Biocare) in mind. For both 3-D diag- nostics and treatment planning, we used Nobel- ClinicianSoftware(NobelBiocare).Thecase,which presented with some significant arch asymmetry, required a staged approach to ensure that the com- plexity of the planned treatment could be managed successfully. MycolleaguesattheQueenswayDentalClinic(con- sultant oral and maxillofacial surgeon Dr Rob Banks, Queensway Laboratory managing partner Richard Elliot, and prosthodontic manager John Blenkey) and I carried out the prosthetic planning, the All-on-4 surgery, immediate provisionalisation and the labo- ratory work. Managing complex anatomy and correcting arch asymmetry Author_ Dr Ian Lane, UK 28 I cone beam4_2015 Figs. 1a–c_Panoramic radiographs: pre-op (a); post-op depicting implant placement (b); and post-opwithfixedfinalprostheses(c). Figs. 2a & b_Indispensable planning tool: NobelClinician screenshots showing planning images from this case. The long anterior loop of the mental foramen was identified in the image to the right and accommodated in the planning. Fig. 1a Fig. 1b Fig. 1c Fig. 2a Fig. 2b