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ePaper created 2015-11-12, 17:51:05 | version 1.38.0
industry report _ 3-D prosthetic-driven implant planning I As demonstration of the importance of careful planning, the successful outcome of this case was accomplished through the use of NobelClinician, 3-D prosthetic-driven treatment planning soft- ware. The full 3-D case planning approach was streamlined using the online collaboration tool NobelConnect. It involved the surgeons, prostho- dontist and prosthetic technicians, who used NobelProcera to make this graftless solution (which could be delivered to the patient in a primary care environment) possible. Dr Banks carried out the All-on-4 treatment sur- gery in the mandibular arch with a fixed temporary acrylic prosthesis and provided the patient with im- mediate function on the day of the surgery at the clinicinBillinghamintheUK.Themaxillaryarchtreat- mentwasthencarriedoutoveraperiodofsixmonths to allow implant placement and healing in a severely atrophic alveolar ridge. During this six-month period, we took a staged implant placement approach. Owing to the 3-D diagnosticfeatures,theplacementoftheimplants into the available bone in this manner avoided sinus graftingorextensiveblockgrafting.Bothpterygoidand anteriorimplantplacementtookplacepriortodelivery of the immediate temporary prosthesis. This cautious approachwasadoptedowingtothepoorbonequality. The final prostheses were carefully designed after a phase of temporisation to correct the arch asym- metry. This was made possible by using some of the techniques we had learnt for managing complex oc- clusalschemesandfacialsymmetryfromDrJohnKois, a prominent prosthodontist and educator._ Editorial note: For more information on the All-on-4 treat- mentconcept,visitwww.nobelbiocare.com/all-on-4. The All-on-4 treatment concept is a registered trademark ofNobelBiocare. Fig. 3_Pre-op status: progressive tooth loss and addition to an existing prosthesis yielded significant arch asymmetry. Fig. 4_Significant arch asymmetry: hard-andsoft-tissueridgemodification was an essential component of planning to improve arch alignment. Fig. 5_Severely atrophic maxilla: after 30 years of the left maxillary region being edentulous, the remaining alveolar ridge was severely atrophic. Figs. 6a–c_Three views of the final restoration: left (a), centre (b) and right (c). In order to achieve the correct alignment of both arches, we had to move from the provisional prostheses and their associated asymmetry to something much more aesthetic. The sharing of 3-D planning and the diagnostic set-up between dentist, surgeon and laboratory was streamlined by using NobelClinician and NobelConnect. Fig. 7_The satisfied patient was very happy with the results of her oral rehabilitation, despite the complexity of the case. Dr Ian Lane is a managing partner at Queensway Dental Clinic in the UK. cone beam_author I 29cone beam4_2015 Fig. 3 Fig. 4 Fig. 5 Fig. 6a Fig. 6b Fig. 6c Fig. 7