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CAD/CAM international magazine of digital dentistry No. 4, 2016

CAD/CAM 4 2016 | cone beam supplement treatment planning based on CBCT 42 An indirect method for provisionalisation The team approach in a complete mouth hybrid reconstruction Authors: Dr Robert A. Levine & Dr Harry Randel, USA Initial situation A periodontist and ITI colleague whose office is two hours from our practices referred this patient to our team. Initially, she was seen by the prostho- dontist, Dr Harry Randel, and subsequently referred to the periodontist, Dr Robert Levine, for a team ap- proachtosolveherfailingdentition.Thepatientpre- sented at our office as a 65-year-old non-smoking female (ASA 3: Illnesses under treatment: anxiety/ depression, osteoarthritis, fibromyalgia, hypothy- roidism and history of myofacial pain dysfunction, Figs. 1–3). There was a history of TMJ issues (i.e. clicking and pain with her right side TM joint) which presently is under control and pain-free. Herchiefcomplaintwastoimproveheraesthetics andcomfortwithadesireforapermanentandquick solution to replace her failing dentition. She also desires a reduction of her maxillary anterior gummy smileinthefinalprosthesis.Shearrivedatouroffice for a third surgical consult for an immediate load maxillary and mandibular hybrid restoration using theStraumann®ProArchtreatmentconcept(tilting of the distal implants to avoid anatomic structures ofthemaxillarysinus,mandibularmentalforamina). This treatment concept reduced the need for addi- tional surgeries and number of implants needed to provide a fixed hybrid restoration with a first molar occlusion. A medium to high lip line was noted upon a wide smile with a bi-level plane of occlusion. Also noted was supraeruption of her maxillary and mandibular anterior teeth (FDI: #12, 11, 21, 22 and #41–43,US:#7–10and#25–27)creatingadeepbite of6mm(Fig.2).AClassIcaninerelationshipwasre- corded with 6mm overjet & 6mm overbite. Due to hermedication-relateddrymouthissue,generalised recurrent caries were noted. Periodontal probing depths ranged generally from 4–7mm in the maxil- lary jaw and from 4 to 6 mm in the mandibular jaw with moderate to severe marginal gingival bleeding upon probing in both jaws. Tooth #6 (FDI: #13) was Figs. 1–3: Initial situation. Fig. 2 Fig. 1 Fig. 3 42016

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