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ePaper created 2016-06-17, 10:57:49 | version 1.38.0
3-D technology opinion | 35CAD/CAM 2 2016 visit, we performed all conventional diag- nostic procedures, clinical examination, full mouth series of periapical X-rays, periodon- tal examination and photographs (Figs. 17a & b). She had avoided visiting the dentist for many years due to a bad experience with pastperiodontaltreatment.Examinationre- vealed maxillary incisors with class II mobil- ity, pocketing 8 mm or more throughout her maxillary arch, spacing of her incisors, hy- per-erupted molars nearly exfoliated and missing teeth #18, #19, #30, and #31. Gen- eralised plaque, calculus and oedematous gingivaltissuewasevident.Nomedicalcon- traindications for dental treatment existed but she was very anxious about undergoing any dental treatment. We recommended and she agreed to an enhanced CBCT3-Dradiographicevaluation.Reviewingthese images confirmed my belief that all maxillary teeth were designated with a poor to hopeless prognosis. The 3-D images of her dentition gave her a clear understanding of the problems she faced. We dis- cussed what options were available to improve her condition (Figs. 18a–c). Gaining her trust made it possible for me to provide emergency care during thisinitialvisitwithextractionsofteeth#2and#15. This treatment resolved her pain and Mary was convinced that she could handle the treatment plan outlined during our Co-Diagnostic evaluation. Thedefinitivetreatmentplanpossibilitieswerecon- structed, defined and presented during her second visit. This patient was confident that we could im- prove the quality of her life with advanced dental techniques and technologies. Once again the benefit of my in-office CBCT was instru- mental in gaining a clear understanding of thispatients’problemsandshewasencour- aged to accept treatment. The preparatory phase of treatment called for strategically removing certain teeth while retaining others to retain a fixed pro- visional prosthesis. Bone grafting and site preservation precipitated the second 3-D scan to plan for fabrication of her surgical guide. In thiscase,6monthspassedandthe#5,and#12sites were re-evaluated for healing. Adequate bone was present to receive dental implants and the ground- work was prepared to carefully extract #7, and #10 and immediately implant these sites if the buccal plate was not damaged during the extractions. Reiterated after reviewing this CBCT scan was the absolutenecessityforthebuccalplatetoremainin- tact, otherwise bone grafting would be performed. Thiswouldsetbackthetimingofthiscasebyatleast 4months,butaslongastheremainingnaturalteeth are maintained then this would not be a big issue. Mary's surgical template was created as a SiCAT classic guide, utilising a proprietary biteplate that contained fiducials and was secured to the remain- ing natural dentition with a futar bite registration. The SiCAT lab merged the 3-D data and a scanned diagnostic cast to complete the fabrication of this four unit surgical guide. Safe guarding and pro- Fig. 18b Fig. 18c Fig. 19 Fig. 20 Fig. 21 Fig. 22 Fig. 23 22016