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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
I opinion _ 3-D technology A custom Atlantis abutment was digitally produced and restored with a crown that was cemented on the 26th of April 2011 with premier’s implant cement. The entire process went smooth- ly without any complication,s and the result was an aesthetic and functional restoration that sat- isfied all of the patient’s desires. You can see how well the actual placement followed the virtual plan in a post-operative scan (Figs. 24 & 25). This case is illustrative of how important the 3-D difference is when treatment planning in the aesthetic zone and becoming fully aware of the anatomy you are dealing with, prior to ever surgerising the patient, which led to a successful treatment outcome. It is a good example of how a challenging case becomes routine and manage- able (Figs. 26–30). _Case 3—3-D imaging reveals hopeless teeth The next two cases have become commonplace inmyoffice.Apatientwillpresentwithachiefcom- plaint of discomfort requiring a focused exam and periapicalX-ray.The2-DX-rayislimitedindefining the extent of the periapical or periodontal lesion as compared to a 3-D image. I will present to you the periapical,and3-Dimages,whichwillchroniclethe before and after treatment rendered to remove the extensivediseasedtissueandreplaceanyextracted teeth. A patient came to my office after being under the care of another dentist who provided routine hygienevisitsoverthepast12years.Shehadachief complaintofdiscomfortuponchewinginherlower right jaw, which had been bothering her for a num- berofmonths.Herpreviousdentistdidnotfindany problem and continued with her routine hygiene visits. I examined her and located a food trap be- tween teeth #30 and #31. Schick 33 digital peri- apical image did reveal distal decay in tooth #30 (Fig.31). Both #30 and 31 were treated endodon- tically over 15 years ago and the periapical region appeared unremarkable. During the periodontal exam, I discovered a 6 mm pocket distal to #31, which I treated with localisedantibiotics.Irestoredthedistaloftooth#30 and dismissed the patient. The real problem, how- ever,wastooth#31;shereturnedafteraweekwith little relief, which prompted me to recommend an enhanced radiographic CBCT. She agreed and I ob- tained theCBCTscan,whichwereviewedtogether. I was surprised to discover a huge periodontal lesion that encapsulated nearly the entire circum- ference of tooth #31 (Figs. 32 & 33). The indistinct periapical was replaced by the remarkable 3-D im- age and there was nothing ambiguous about the originofherdiscomfortandtheextentofthelesion associated with tooth #31. My recommendation was to extract and bone graft this area in preparation for an eventual implant if so desired. After seeking a second opinion at a periodontists’ office, she returned to my office for the necessary treatment. The hopeless tooth was sectioned and removed along with the extensive lesion—most of which was attached to the distal root as seen in the photo- graph documenting the extraction and bone graft (Figs. 34–36). 14 I CAD/CAM 1_2016 Fig. 34 Fig. 35 Fig. 36 Fig. 31 Fig. 32 Fig. 33 CAD0116_06-18_Ramirez 21.01.16 11:03 Seite 8 CAD0116_06-18_Ramirez 21.01.1611:03 Seite 8