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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
I case report _ restorative dentistry 34 I CAD/CAM 1_2016 GmbH; Frankfurt/Main, Germany) would have been the ideal restorations given the need for long-term durability in this case, the product was not yet avail- able at the time of treatment. Thus, PFM prostheses were chosen in order to avoid acrylic and its suscepti- bilitytostaining,wearandfracture.TheproposedPFM restorations included layered pink porcelain to recre- atethepatient’snaturalgingivalcontours.Allaspects of treatment were explained to and accepted by the patient. The first phase of treatment began by atrau- matically extracting the patient’s entire dentition using Physics Forceps (Golden Dental Solutions Inc.; Detroit, USA), which allowed for removal of the teeth withoutcausinganydamagetothesurroundingbone. The extraction sockets were filled with grafting ma- terial in order to preserve the sockets and rebuild the maxillary and mandibular ridges for ideal implant placement. The patient was provided with immediate dentures, which were prefabricated based on impres- sionsthatweretakenatapreviousappointment(Fig.3). After approximately five months of healing, the patientwascalledinsocone-beamcomputedtomog- raphy (CBCT) scanning could be performed. The soft tissue of the patient’s now-edentulous arches exhib- itedexcellenthealth(Figs.4a&b).CBCTscanningcon- firmed that the grafting procedure was successful in increasingthebonevolumeavailabletoaccommodate the planned implants. The CBCT scanning data was used to devise a virtual treatment plan that would place the eight implants for each edentulous ridge in the maximum amount of bone while adhering to the key implant positions as taught by Dr Carl Misch.6 Surgical guides were fabricated to ensure placement of the implants in the precise positions called for by thetreatmentplan(Figs.5a&b). Atthenextappointment,thetissue-supportedsur- gicalguidesweretriedinandfoundtobewell-fitting. Thefixationpinsofeachsurgicalguideweretightened with a surgical index in place to ensure complete, secureseatingoftheappliances(Fig.6).Atissuepunch was used to provide access to the implant sites, facili- tating a flapless surgical procedure that would min- imise gingival trauma. The osteotomies were created through metal inserts placed in the surgical guides, which precisely controlled drilling depth and orienta- tionaccordingtothedigitaltreatmentplan(Fig.7). Eight BioHorizons® Laser-Lok® dental implants (BioHorizons; Birmingham, USA) were placed in each ridge, including 5.7 mm implants in the two distal- most locations of each arch, and 4.5 mm implants in the remaining sites. After placing healing abutments in the implants, a soft reline was performed on the patient’s temporary dentures so they could continue toserveasinterimprosthesesforthedurationofheal- ing and osseointegration. Four months after surgery, thepatientreturnedtotheofficesoimpressionscould be taken. Removal of the healing abutments revealed optimal tissue health surrounding the implant sites (Figs.8a&b).Transferpostswereseatedtocapturethe position of the implants (Fig. 9). Closed-tray impres- sions were taken of the upper and lower arches using Take 1® Advanced™ vinyl polysiloxane material (Kerr Corp.; Orange, USA, Figs. 10a & b). At the same ap- pointment, thermoformed suck-down impressions were made and a bite registration taken with the Figs. 14a & b_The lab digitally produced the custom abutments and verified the design on the soft-tissue models. Fig. 15_A diagnostic wax-up was created to assist in the development of the full-arch reconstructions. Fig. 16_The BioTemps prostheses were fabricated, and the interocclusal relationship was verified on the articulator prior to patient try-in. Fig. 17_Acrylic positioning jigs were used to seat the custom abutments in the patient’s mouth. Fig. 15 Fig. 17Fig. 16 Fig. 14a Fig. 14b CAD0116_30-36_Nazarian 21.01.16 10:52 Seite 4 CAD0116_30-36_Nazarian 21.01.1610:52 Seite 4