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CAD/CAM - international magazine of digital dentistry

vidingpreciseimplantplacementisakeytothesuc- cess of any implant case and the guide ensures that criteria for me. ThenextphaseoftreatmentwasscheduledforJan- uary5,2016.Iplannedtoretainfivenaturalteethto secure a fixed provisional for as long as it took for her implants to integrate. Her initial temporary bridges were removed and teeth #7 and #10 were carefully extracted, leaving the buccal plates intact. I placed new biotemp crowns on the remaining five teeth which would receive and stabilise her SiCAT surgical guide (Fig. 19). Four implants were then placed in the sites planned, #5, 7, 10 and 11. Voids weregraftedaround#7and#10andsecondstaged, while #5 and #11 were single staged. A new provi- sional biotemp bridge was inserted and will remain in position until implants can be loaded and used to retain an overdenture (Figs. 20–23). I have seen this patient subsequently and she reported little to no postoperative discomfort and was quite satis- fied with how well her treatments have progressed (Figs. 24–26). Case 3: ‘Can you help me?’ We received a call from a young man, Alex, who found our office during a Google search. He pre- sented for a consultation where we began to gently discuss options for the replacement of his failing dentition. It took a life-changing event in his per- sonal life and a great amount of courage for him to seek treatment. His situation was exacerbated by years of neglect and lack of financing, which contributed to the complete destruction of his maxillary arch (Fig. 27). Our initial visit was me interviewing Alex and broaching the possibilities for the replacement of his upper teeth with an aesthetic and functional prosthetic replacement. Alex, 37, in relatively good health, had undergone a series of knee surgeries, whichprecludedhimfrompresentingfortreatment earlier.Hemadeitclearthathisself-esteemwaslow and hindered him in socialsettings.Periapi- cal x-rays and digital photographs were ob- tained and I recom- mended an enhanced 3-D analysis to gain a full understanding as to what would be nec- essary to return this patient to oral health. He scheduled a second visit to have a CBCT taken. Utilising the protocol I employ for any reconstructive case, I reviewed the volume of maxillofacial images with the patient during co-diagnosis. Alex was highly engaged in this discussion and was veryinterestedinlearninghowhecouldimprovehis smile. Obviously he was very unhappy with his ex- isting condition and involving him in the review of his3-Dimagesgavehimanewinsightintohowbad his situation was and what would be necessary to returnhimtoayouthful,naturallooking,fullyfunc- tioning set of upper teeth. The challenges that exist to accomplish this treatment was explained and all questions posed by the patient were answered. He desiredafixedcaseifwecouldworkwithinhisbud- get. My use of co-diagnosis is well received and manyofourcasepresentationshavegonetoaccep- tance when our patients are engaged in this dy- namic review of their own anatomy. Utilising 3-D images and providing an in-depth look into what moderndentistrycandoforourdecimatedanddev- astateddentitionsresultsinhavingafullyinformed well-educated patient. His case was approached differently from the other twoashewouldbediscouragedfromalongdrawn- out treatment that resulted in removable provi- sionalisation and required extensive bone grafting. Fortunately the enhanced 3-D evaluation revealed that he would be a candidate for teeth in a day. The plan was to immediately load six strategically placed implants directly after removing any re- maining natural maxillary teeth. A fixed screw- retained prosthesis was planned and a complete upper denture would be fabricated prior to his sur- gical visit. The complete upper denture would be converted to the provisional prosthesis chairside during the surgical visit. The only way these cases can be successful is through a total commitment and understanding by the patient as to what is in- volved in their treatment, how long it will take, and what it will cost. A treatment team was formulated, which included myself, the restorative dentist, oral surgeon and dental technician. | opinion 3-D technology 36 CAD/CAM 2 2016 Fig. 24 Fig. 25 Fig. 26 22016

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