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ePaper created 2017-01-24, 10:47:27 | version 1.38.0
I 07 CAD/CAM 3_2016 clinical_ single-visit solution I factortoconsider(Fig.1).Secondly,thepatientmust have the stamina to partner in what may become a five-hour creative process. Inthissinglecase,the70-year-oldfemalepatient presentedwithconcernsabouthermaxillaryanterior teeth #6-10. Specifically, she did not like the overall color, form and spaces between the teeth where the papillae had receded. Considering the health of the periodontium, there was no evidence of active dis- easeandnopatientawarenessorconcernsaboutthe asymmetry in the position of the gingival margins. However, in the esthetic zone there did exist generalized, mild loss of interdental papillae, mul- tiple failing and/or unesthetic composite restora- tions, wear and stains (Fig. 2). The evaluation of the clinical and radiographic size of these restorations reinforced the plan for complete coverage restora- tions(Fig.3).Theseobservationswereinlinewiththe patient’s concerns. Clinical findings and proposed treatment options were discussed and digitally il- lustrated. The patient agreed to restore teeth #6-10 with full contour crowns (Fig. 4). _Treatment considerations and digital workflow Whenbeginningthesingle-visitCAD/CAMproce- dureformultiplerestorations,anorganizedworkflow willreducetreatmenttimeandincreasethepatient’s satisfaction with the experience. An intimate knowl- edge of the intraoral scanner, design software and millcapabilitiesisrequired.2 Apre-treatmentscanof theexistingteethand/oradiagnosticwax-up(analog or digital) will save time in the design phase (Fig. 5). Inthiscase,thelargecompositeresinrestorations onthefacialcervicalsurfaceof#6-10weresupragin- gival,andtherewasnovisiblesignofrecurrentcaries extending beneath the gingival crest to necessitate the placement of preparation margins deep within the sulcus. Fig. 3_Pre-treatment radiographs of maxillary anterior teeth. Note the large composite restorations, the root taper and the distance from the contact areas to the crest of bone as it relates to the loss of the gingival papilla. Fig. 4_A digital treatment plan analysis serves to identify and document all of the patient’s concerns and document the specific goals of treatment. Fig. 5 _Pre-treatment intra-oral digital impression scan. Fig. 3 Fig. 4 Fig. 5