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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
case report _ restorative dentistry I Fig. 2_Panoramic radiograph further illustrates the extensive tooth decay the patient had suffered, which had caused a major infection as evidenced by the radiolucent lesions visible at the tips of several roots. Also note the periodontal lesions visible in the lower arch. Fig. 3_Following extraction of the patient’s dentition, immediate dentures were delivered to provide the patient with a minimum level of function and aesthetics during the healing phase. Figs. 4a & b_Occlusal views of patient’s maxillary and mandibular ridges exhibit healthy tissue at the extraction sites. Figs. 5a & b_Surgical guides were 3-D printed to help ensure placement of the implants in accordance with the digital treatment plan. I 31CAD/CAM 1_2016 traditional complete dentures vs. implant-supported restorations before making a decision with such life- changingpotential.Thepresentationthatfollowsdoc- umentsacaseinwhichapatientwithseverelydecayed dentition undergoes a complete oral reconstruction. Atreatmentplanisdevelopedthatharnessestheclas- sic principles of implant placement, the versatility of modernrestorativematerials,andtheprecisionofdig- italdiagnosticsandCAD/CAMfabricationtoachievea predictable,aestheticrestorationforacasethatwould seem hopeless to many. The case illustrates how im- planttherapycanaffordpatientseveninthemostex- tremeofdentalcircumstancesanexcellentlong-term prognosis, restoring not just the teeth, but also the bone,softtissue,self-esteem,andqualityoflife. _Case Report A 36-year-old male patient presented for treat- mentwithadvanced,extensivecariesandlocalizedpe- riodontaldisease(Figs.1a–c).Inadditiontonothaving seen a dentist in more than 20 years, the patient was recovering from an addiction to methamphetamine, which had caused excessive clenching and grinding that had substantially worn down the patient’s teeth. Themanyyearsofdentalneglectcombinedwiththese parafunctional habits to render the patient’s severely decayeddentitionuntreatable(Fig.2).Further,thede- teriorationofthepatient’steethwasaccompaniedby significantsoft-tissuerecessionandboneresorption. Althoughthepatienthadbeenquiteapprehensive about seeking treatment, pain and discomfort even- tually compelled him to take action. The patient had sought treatment from a practice where he could receive all of the necessary treatment from a single provider in the fewest appointments possible. After locatingmypractice,thepatientfoundthecourageto presentforevaluation.Itwasapparentfromtheinitial visitthathewasashamedofhiscondition. Thegoalwastoofferhimthebesttreatmentavail- able in order to restore the patient’s smile, form and function. Without presuming the appropriate stan- dard of care for the patient based on his condition, it was explained to the patient that his natural teeth couldnotbesavedandafullrangeoftreatmentalter- natives was presented, from complete dentures to fixedfull-archimplantrestorations.Before-and-after photos of similar cases were shown to the patient to assist his evaluation of the restorative options. The patient chose full-mouth reconstruction consisting of fixed prostheses delivered over dental implants. A treatment plan was developed that included ex- traction of the patient’s non-restorable dentition, the placement of eight implants in each arch, de- livery of Inclusive® Titanium Custom Abutments and BioTemps® restorations (Glidewell Europe GmbH; Frankfurt/Main, Germany), and final restoration with fixed PFM prostheses. The latest tools in digital den- tistry would be utilised to maximize the precision of bothimplantplacementandprostheticfabrication. Because of the patient’s relatively youthful age and his continued bruxing habit, eight implants were proposedforeacharchinordertomaximisethedistri- bution of occlusal load, the preservation of his ridges, andthelong-termprognosisoftherestoration.There- sorbedstateofthepatient’smaxillaryandmandibular ridgesnecessitatedagraftingproceduretocreatethe foundation needed for implant placement. Custom abutments would be used to position the prostheses for optimal aesthetics. Although BruxZir® Solid Zir- conia Full-Arch Implant Prostheses (Glidewell Europe Fig. 4b Fig. 5bFig. 5a Fig. 2 Fig. 4aFig. 3 CAD0116_30-36_Nazarian 21.01.16 10:51 Seite 2 CAD0116_30-36_Nazarian 21.01.1610:51 Seite 2