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ePaper created 2017-08-25, 17:58:13 | version 1.38.0
full mouth reconstruction case report | Fig. 9: Virtual plan of Zenostar restorations. Fig. 10: Milled restorations on Stratos 100 articulator from Ivoclar Vivadent. Fig. 11: Seated maxillary and mandibular restorations on teeth. Fig. 12: Extended healing caps on implants creating an emergence profile. Fig. 9 Fig. 10 Fig. 11 Fig. 12 Surgery and provisionalisation A tooth-supported surgical guide (3D Diagnostix) and Guided Surgery Kit (OCO Biomedical) was used during the osteotomies (Figs. 3 & 4) followed by den- tal implant placement of dental implants (Engage, OCO Biomedical; Fig. 5). Tooth #12 was atraumatically extracted using Physics Forceps from GoldenDent and the socket grafted with a putty blend of cortical mineralised and demineralised bone grafting material, followed by a pericardium membrane and primary closure by suturing the tissue with 3.0 mm silk sutures; and the remaining teeth prepared for crown restora- tions. Any old amalgam restorations or indications of recurrent decay were removed and cored, and any necessary endodontic therapy was performed (Fig. 6). At the time, the laboratory provided the 3-D White Wax-Up, a clear reduction guide was also delivered and then used to ensure adequate reduction for the definitive zirconia crown restorations. Full arch im- pressions were taken (Fig. 7) using polyvinylsiloxane impression material (Panasil, Kettenbach), along with a bite relation using a jig fabricated on the 3-D White Wax-Up models. A shade was also taken, pho- tographed, and later transferred to the laboratory. Then, using a matrix impression (Sil-Tech, Ivoclar Vivadent) of the 3-D White Wax-Up, a provisional restoration, which would aid in determining the best size, shape, colour, and position for the defini- tive restorations, was made using a bleach shade of temporary material (Fig. 8). After the patient re- turned a few weeks later for evaluation of aesthe- tics, phonetics, and bite, the dental laboratory was instructed to replicate the 3-D White Wax-Up when fabricating the definitive restorations. Laboratory design and manufacturing The 3-D White Wax-Ups, colour photographs, im- pressions, and bite relations were forwarded to the dental lab (Arrowhead Dental Lab), along with spe- cific instructions regarding the size, shape, and col- our of the restorations. The laboratory technician scanned the 3-D White Wax-Ups in order to select the appropriate arch form, tooth size, and occlusion from the digital options available in the treatment planning software. Fig. 13: Capturing an ISQ reading with Osstell. Fig. 13 CAD/CAM 3 2017 23