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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
case study _ backward planning I ment planning with the new ASTRA TECH Implant System EV. By eliminating analogue working steps and moving to exclusivelydigitalplanningand production of all prosthetic components, new and greatly simplified technical solutions can be developed prior to the actual implant placement. Preciseandcarefulplanning ofeachindividualimplantposi- tion in light of prosthetic considerations is an es- sential requirement for the surgical and prosthetic successofimplanttherapy.Today,modernimplant- relatedconceptsareonlyregardedsuccessfulwhen the prosthesis satisfies current aesthetic demands. So-called backward planning can be used to deter- mine the implant choice and position. This requires three-dimensional planning and implementation of the obtained information (by means of CBCT/CT, digital set-up) in an implant-planning programme in which all the data can ideally be combined. SIMPLANT from DENTSPLY Implants is one such programme.Notonlydoesitmakeitpossibletoplan the implant position, taking prosthetic guidelines into account, but it also offers an interface for pros- thetic restoration with ATLANTIS. This makes a digi- tal workflow and the resulting advantages possible and feasible in the ordinary practice. Initialsituation The patient wished to restore the tooth that was missing in position 26. Presented with treatment options, he declined a conventional bridge on account of the invasive procedure that would be required on the adjacent teeth. Instead he opted for an implant-supported prosthesis with an ATLANTIS Abutment (DENTSPLY Implants), delivered follow- ing the Immediate Smile concept. After guided placement of the implant and achievement of primary stability, the treatment plan called for im- mediate placement of a custom abutment and tem- porary crown. The patient was therebymanagedadequatelyin only one treatment session. An impression was taken of the initial situation, and the models were digitised using a conventional laboratory scan- ner. Volumetric computerised tomography (CBCT) was also employed. Besides clinical as- sessment of the initial situa- tion, radiographic diagnostics to evaluate bone structure, bone quantity, and the status of neighbouring anatomic structures should be included in such planning. ImplantplanninginSIMPLANT With a few steps, the patient’s case was then entered in SIMPLANT. The CBCT data were imported first. Next the STL data of the model and digital wax-up was loaded. The SIMPLANT software is an open solution that can be used with all DICOM- compatible (CB)CT scanners and conventional STL- compatible laboratory scanners or intraoral scan- ners.Thesuperimposeddatashowsanexactpicture of the anatomic and prosthetic situation. The bone surface was displayed by the software in a different colourfromthesurfaceofthemodel(teethandsoft tissue) (Fig. 1). Prior to implant planning a digital wax-up was created in the 3Shape software. To do this, the corresponding tooth was selected from a tooth library and positioned in the gap. The tooth was adjusted to the available space in a few steps. The implant was virtually positioned in the bone withreferencetotheavailableboneandanticipated occlusal loads and the ideal length, diameter, and position for the implant were defined, taking the specification of the prosthesis into account. More than 100 implant systems are stored in the SIMPLANT software library; in this case it was de- cidedtousethenewASTRATECHImplantSystemEV (DENTSPLY Implants), which meets the demands of Fig. 7_Piercing the soft tissue. Fig. 8_Predrilling with the initial drill, thus reducing the pressure in the bone around the implant shoulder. Fig. 9_Preparation with the EV/GS no. 1 drill. Fig. 10_Extending the preparation with the EV/GS no. 3 drill. I 21CAD/CAM 1_2016 Fig. 10 Fig. 8Fig. 7 Fig. 9 CAD0116_20-23_Mertens 21.01.16 10:48 Seite 2 CAD0116_20-23_Mertens 21.01.1610:48 Seite 2