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ePaper created 2017-09-22, 22:09:32 | version 1.38.0
digital_3-D technology Fig. 13a Fig. 13b movable over-denture. I elected to retain a number of natural teeth while bone regenerated and im- plants were placed as bone volume allowed. The natural teeth would retain a fi’ed provisional as long as possible. The third case would be treated with ‘teeth in a day’ approach. All ma’illary teeth would be e’tracted and si’ immediate implants would be placed and restored with a fi’ed screw- retained prosthesis during the same visit. These three case reports will illustrate what is possible when advanced technologies are implemented in the modern dental practice. The 3-D difference was employed to assess each case on a tooth-by- tooth basis. The diagnosis that each tooth had a poor to hopeless prognosis made it clear that ‘HERODONTICS’ would be uncalled for. Case 1: ‘I want to smile again’ During co-diagnosis she made it clear that she would accept e’traction of all the remaining ma’il- lary teeth and replacement with an immediate CUD. This would serve as an interim prosthesis that would allow her to begin to feel better about her smile and give her confidence to socialise and eat without discomfort. Options for a more definitive treatment were formulated between us and facilitated by the virtual 3-D imaging and 3-D analysis and review of the ma’illofacial anatomy that e’isted. There is no such thing as a cookie-cutter approach to diagnosis and treatment planning in comple’ dentistry. The clinician must be a good listener, be respectful of the patients’ desires and be decisive in providing solutions to their problems. We have to manage the entire patient from start to finish and manage and e’ceed their e’pectations. Christina, 37, who was seeking to improve her smile and improve her confidence. She had been treated previously at another dental office with little suc- cess and it was obvious that critical care was neces- sary to improve the current state of her ma’illary arch. The initial visit was to decide upon a course of action to remove her discomfort and provide a fully functioning arch of teeth. Christina presented with e’tensive decay in all of the remaining ma’illary natural teeth (Figs.1a & b). All conventional diag- nostic, clinical and radiographic procedures were completed and reviewed during the first fifteen minutes. I recommended and she accepted an en- hanced 3-D CBCT scan which would be used to per- form a complete dental e’amination (Figs. 2a–c). Her treatment began with e’traction and bone grafting the UR/UL molars #15 and #2 (Figs. 3 & 4). She accepted an immediate CUD as an interim pros- thesis. This would provide her with a beautiful nat- ural smile as fast as possible and commit her to the development of a more definitive treatment plan. E’traction of all ma’illary teeth would remove the cause of her embarrassment and give her the confi- dence to eat more comfortably and socialise more readily. I impressed the ma’illary arch after a couple of weeks of healing so the posterior portion of the denture could seat on a firm base. Christina devel- oped a trust in us and was grateful to smile again. With this came a decreased level of an’iety and she was given an emotional lift when she came to realise Fig. 14a Fig. 14b Fig. 14c digital 3_2017 4545