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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
I case report _ digital workflow with guided surgery The prosthetic project was shared with the implant planning software using the integrated online platform Synergy (Dentalwings). The three- dimensional radiographic DICOM data and the prostheticdesignprojectSTLfilewerematchedin coDiagnostiX. The integrated platform allows for real-time collaboration between the dentist and dental technician for finalising the treatment planning from both implant placement and restorative design (Fig. 4). The surgical guide was designed with coDiagnostiX (Fig. 5) and produced using three- dimensional printing technology (Objet Eden260VS Dental Advantage (Stratasys, Minnesota, Fig. 6). The surgical guide was teeth- and mucosa-supported on the palate.Toavoidlateralmovement,fixation screws were added (Straumann Bone Block Fixation). An individualised two- piece splinted three-unit bridge was vir- tually designed (Fig. 7) and CAD/CAM- fabricated from a PMMA-based restora- tionmaterialcementedtoapre-fabricated bonding base (Straumann Variobase for bar and bridges + Polycon ae, Straumann CARES X-Stream, Figs. 8–10). The bridge design and the occlusion were checked on aprintedjawmodel(DreveDentamid,Ger- many, Fig. 11) and finally sealed then sent to the dental practice with the jaw model and the surgical guides. _Surgery On the day of surgery (Figs. 12 & 13), the sur- gical protocol provided by the implant planning software guides the clinician through the sur- gical procedure and supports him in the use of the appropriate instruments from the guided surgery surgical kit (drill heights, drill handles, etc, Figs. 14 & 15). To avoid deformation of soft tissues that could influence the stability of the surgical guide, we performed regional anesthesia: _Vestibular: high tuberosity anaesthe- sia for the alveolar nerve supra-posterior, and high canine anaesthesia that reaches the supra-anterior alveolar branch of the maxillary nerve. _Palatal: analgesia of the nasopalatal nerve in the retro-incisive area and the large palatal nerve in the area of the large palatal foramen. The crowns were removed; the root of tooth #13 was cut and removed in frag- ments. The avulsions were created deli- cately; the alveoli were curetted and debrided under irrigation. Papillae were detached to allow for the regularisation of the bone crest by removing bone that was too thin, anticipating the post-extraction resorption. The surgical guide was placed and the positionwassecuredusing14mmfixation screws in the maxilla at region 17 (Fig. 16). 26 I CAD/CAM 1_2016 Fig. 14 Fig. 15 Fig. 12 Fig. 13 Fig. 18 Fig. 19 Fig. 16 Fig. 17 CAD0116_24-28_Zarrine 21.01.16 10:50 Seite 3 CAD0116_24-28_Zarrine 21.01.1610:50 Seite 3