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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
case report _ digital workflow with guided surgery I digestion that is an aggravating factor in the dental condition (Fig. 1). The molars in sector 3 were missing, tooth 26 had to be restored and the occlu- sion curves adjusted. Teeth 13, 14 and 15 had a mobility classification of 3 accord- ing to Lindhe and Muehlmann. The roots were decayed and fractured, with the gum suffering from inflammation in 14 and 15 without abscess and sinusitis. Tooth 47 underwent an eruption, and bridge from 47 to 43 seemed to follow this new curve of occlusion. This situation does not allow for sufficient interarch height in order to have number 16 as an antagonist. To prevent an over-infection as well as foraestheticandcomfort-relatedreasons, the urgency consisted in the treatment of sector 1. The overall health condition and drug treatment reinforced our decision to use a non-invasive surgical approach. The treatment plan was as follows: _#47and#43:recreatingsector4withtwoin- dividual implant-borne restorations (Straumann Soft Tissue Level Implant RN, Roxolid material, SLActivesurface)respectingtheocclusioncurves. _#26: root treatment with a tooth-borne restoration in the occlusal plane. _#35# 36, placing of two individual implant- borne restorations (Straumann Soft Tissue Level Implant WN, Roxolid material, SLActive surface). _From #13 to #16: implant-borne restorationaftertoothextractionof13,14 and15(StraumannBoneLevelImplantRC, Roxolid material, SLActive surface). The patient will have a reduced arch. However, the occlusion will be balanced and provide a good masticatory coeffi- cient. The current situation forced us to compromise (Fig. 2) and to place three implants in place of three teeth: canine, premolar and molar. The aim was to extract atraumatically the three decayed teeth and to perform an immediate implant placement after extraction with flapless surgery in con- junction with immediate loading enabling restoration of the other sectors. In order to maximise accuracy and to reduce the number ofsteps,afullydigitalapproachusingguidedsur- gery was selected, allowing us to preoperatively produce a screw-retained CAD/CAM provisional restoration. _Planning After detailed three-dimensional diagnostics, teeth 13, 14 and 15 were virtually extracted in the implant planning software (coDiagnostiX, Dentalwings). The prosthetic design was created with Straumann CARES Visual (Fig. 3). I 25CAD/CAM 1_2016 Fig. 7 Fig. 5 Fig. 11 Fig. 9 Fig. 10 Fig. 8 Fig. 6 Fig. 4 CAD0116_24-28_Zarrine 21.01.16 10:50 Seite 2 CAD0116_24-28_Zarrine 21.01.1610:50 Seite 2