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CAD/CAM - international magazine of digital dentistry

3-D technology opinion | 33CAD/CAM 2 2016 movable over-denture. I elected to retain a number of natural teeth while bone regenerated and im- plants were placed as bone volume allowed. The natural teeth would retain a fixed provisional as long as possible. The third case would be treated with ‘teeth in a day’ approach. All maxillary teeth would be extracted and six immediate implants would be placed and restored with a fixed screw- retained prosthesis during the same visit. These three case reports will illustrate what is possible when advanced technologies are implemented in the modern dental practice. The 3-D difference was employed to assess each case on a tooth-by- tooth basis. The diagnosis that each tooth had a poor to hopeless prognosis made it clear that ‘HERODONTICS’ would be uncalled for. Case 1: ‘I want to smile again’ Christina,37,whowasseekingtoimprovehersmile and improve her confidence. She had been treated previously at another dental office with little suc- cessanditwasobviousthatcriticalcarewasneces- sary to improve the current state of her maxillary arch. The initial visit was to decide upon a course of action to remove her discomfort and provide a fully functioning arch of teeth. Christina presented with extensive decay in all of the remaining maxillary natural teeth (Figs.1a & b). All conventional diag- nostic, clinical and radiographic procedures were completed and reviewed during the first fifteen minutes. I recommended and she accepted an en- hanced 3-D CBCT scan which would be used to per- form a complete dental examination (Figs. 2a–c). During co-diagnosis she made it clear that she would accept extraction of all the remaining maxil- laryteethandreplacementwithanimmediateCUD. Thiswouldserveasaninterimprosthesisthatwould allow her to begin to feel better about her smile and give her confidence to socialise and eat without discomfort.Optionsforamoredefinitivetreatment were formulated between us and facilitated by the virtual 3-D imaging and 3-D analysis and review of the maxillofacial anatomy that existed. There is no such thing as a cookie-cutter approach to diagnosis and treatment planning in complex dentistry. The clinician must be a good listener, be respectful of the patients’ desires and be decisive in providing solutions to their problems. We have to manage the entire patient from start to finish and manage and exceed their expectations. Her treatment began with extraction and bone grafting the UR/UL molars #15 and #2 (Figs. 3 & 4). SheacceptedanimmediateCUDasaninterimpros- thesis. This would provide her with a beautiful nat- ural smile as fast as possible and commit her to the development of a more definitive treatment plan. Extraction of all maxillary teeth would remove the causeofherembarrassmentandgivehertheconfi- dence to eat more comfortably and socialise more readily.Iimpressedthemaxillaryarchafteracouple of weeks of healing so the posterior portion of the denture could seat on a firm base. Christina devel- oped a trust in us and was grateful to smile again. With this came a decreased level of anxiety and she wasgivenanemotionalliftwhenshecametorealise Fig. 13a Fig. 13b Fig. 14a Fig. 14b Fig. 14c 22016

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