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CAD/CAM - international magazine of digital dentistry

| opinion 3-D technology 34 CAD/CAM 2 2016 that we were, as promised, the office that could changeherlife,makeherfeelbetterandbehealthier. Her treatment involved careful removal of all re- mainingmaxillaryteeth,extensivesitepreservation and buccal augmentation (Figs. 5–11). These proce- dures were well tolerated. Adequate time passed and we discussed and she accepted the next phase oftreatment,whichwastoevaluatetheresultofthe bone grafting procedures. I made a duplicate den- ture in Bio-Acryl radiopaque acrylic and attached to a Sirona proprietary bite plate used as a scan appliance during the follow up CBCT. The biteplate has fiducial markers that allows the SiCAT lab in Germany to merge data sets from a 3-D scan and opticalscanofthemaxillaryarch(Figs.12a&b).The lab milled out a precise surgical guide which corre- sponded to the planned implant sites. We scanned her arch and then proceeded to evaluate her anat- omy using 3-D skull rendering views, offering her the benefit of visualising the virtual placement of lifelikeactualimplantsspecifictohercase(Figs.13a &b).Baseduponabudgetgivenweinitiallyplanned for a four unit implant retained over-denture. After reviewingthesubstantialgainofbonevolumeafter bone augmentation it became apparent that she wouldbeacandidateforanallonsixscrewretained fixed prosthesis (Figs. 14a–c). It was necessary to precisely plan the four anterior implants in such a way as to never preclude the possibility of a future upgrade to an all on four style case.Theusefulnessof3-Dimagingisunparalleledin the dental office. Her post-op CBCT gave us the op- portunity to offer her a completely flapless guided implant surgery through a carefully designed im- plant plan (Fig. 15). 3-D imaging demonstrated ade- quatebonetoreceivefourtosixNobelActiveregular platform implants. She left the office with a fixed provisional prosthesis. Performing a flap- less guided surgery minimised pain, swelling and improve function, aesthetics and the quality of her life in a single treatment visit. Looking at the possibilities available, overden- ture versus all on six, increased her confidence in our ability to provide the most optimal treatment and prompted her thanks, ‘I want you to be my dentist forever’ [Fig. 16]. And that is the 3-D difference. Case 2: ‘I’m not ready for dentures’ Mary presented in June 2015 with pain in her UL/UR quad- rants and a feeling of loosen- ing teeth. During her initialFig. 18a Fig. 17a Fig. 17b Fig. 16Fig. 15a Fig. 15b 22016

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