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ePaper created 2017-08-25, 17:58:13 | version 1.38.0
| case report full mouth reconstruction Fig. 15 Once a virtual model was created, the full-contour restorations were digitally designed, and virtual im- ages of the proposed reconstruction were forwarded through 3Shape Communicate to the dentist’s e-mail for review and approval (Fig. 9). Any minor adjust- ments in tooth shape and contour were sent back to the dental technician so that the most ideal aesthetic and form could be achieved. Once the final design and adjustments to the zirco- nia restorations were completed, the appropriate monolithic zirconia block(s) were selected and milled. After milling, minor adjustments were made while the restorations were in the green state, using only grind- ing instruments. Little or no pressure was applied dur- ing this process, but water was used to prevent exces- sive frictional heat from fracturing the zirconia. The internal aspects of the restorations were sand- blasted with 50 µm alumina at 50 psi to enhance ad- hesion and cementation, after which contaminants were removed using steam or ultrasonic cleaning for 15 minutes. Zirconia surfaces must be free of dirt, milling dust/residue, and oily-greasy elements. After the restorations’ surfaces were cleaned, they were sintered appropriately, and then any character- isation with stains and glazes was performed. The contact Dr Ara Nazarian maintains a private practice in Troy, Michigan (US) with an emphasis on comprehensive and restorative care. He is a Diplomate in the International Congress of Oral Implantol- ogists (ICOI). His articles have been published in many of today’s popular dental publications. Dr Nazarian is the director of the Ascend Dental Academy. He has conducted lectures and hands-on workshops on aesthetic materials and dental implants throughout the United States, Europe, New Zealand and Australia. He can be reached at aranazariandds@gmail.com. 24 CAD/CAM 3 2017 Fig. 14 Fig. 16 restorations were hand polished, evaluated (Fig. 10), and returned to the dentist for cementation (Fig. 11). Abutments and remaining crown restorations Four months later, the healing caps were removed from the implants in the #4 and #13 areas (Fig. 12) and ISQ values tested using the Osstell unit. Since the readings were very favourable (Fig. 13), impression posts were inserted (Fig. 14) and full arch impressions captured for use by the laboratory in fabricating the final crown restorations and custom abutments. The laboratory was able to scan the impressions, use dig- ital file splitting to simultaneously design the custom abutments and crowns, and then precisely mill each component to the required parameters (Fig. 15). Ultimately, the custom abutments were placed and torqued two weeks later and the crown restorations were seated to complete the case (Fig. 16). Conclusion A systematic method for treatment planning, ma- terial selection, tooth preparation, and cementation enables dentists and laboratories to effectively and efficiently address patient needs. In the case described here, the patient was very pleased with her smile re- habilitation, in addition to being able to receive all of the necessary treatment procedures at the same practice. With a technology-driven and digitally sup- ported collaborative relationship, laboratories and dentists can achieve such outcomes more routinely, predictably, aesthetically, and functionally._ Special thanks to Chris Barnes and his team at Arrowhead Dental Lab for the abutments and restorations and 3DDX for the implant planning and surgical guide. Editorial note: A list of references is available from the publisher.