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ePaper created 2017-09-22, 22:09:32 | version 1.38.0
digital_3-D technology Fig. 15a Fig. 15b Fig. 16 that we were, as promised, the office that could change her life, make her feel better and be healthier. Her treatment involved careful removal of all re- maining maxillary teeth, extensive site preservation and buccal augmentation (Figs. 5–11). These proce- dures were well tolerated. Adequate time passed and we discussed and she accepted the next phase of treatment, which was to evaluate the result of the bone grafting procedures. I made a duplicate den- ture in Bio-Acryl radiopaque acrylic and attached to a Sirona proprietary bite plate used as a scan appliance during the follow up CBCT. The biteplate has fiducial markers that allows the SiCAT lab in Germany to merge data sets from a 3-D scan and optical scan of the maxillary arch (Figs. 12a & b). The lab milled out a precise surgical guide which corre- sponded to the planned implant sites. We scanned her arch and then proceeded to evaluate her anat- Fig. 17a Fig. 17b Fig. 18a 46 3_2017 46 digital omy using 3-D skull rendering views, offering her the benefit of visualising the virtual placement of lifelike actual implants specific to her case (Figs. 13a & b). Based upon a budget given we initially planned for a four unit implant retained over-denture. After reviewing the substantial gain of bone volume after bone augmentation it became apparent that she would be a candidate for an all on six screw retained fixed prosthesis (Figs. 14a–c). It was necessary to precisely plan the four anterior implants in such a way as to never preclude the possibility of a future upgrade to an all on four style case. The usefulness of 3-D imaging is unparalleled in the dental office. Her post-op CBCT gave us the op- portunity to offer her a completely flapless guided implant surgery through a carefully designed im- plant plan (Fig. 15). 3-D imaging demonstrated ade- quate bone to receive four to six Nobel Active regular platform implants. She left the office with a fixed provisional prosthesis. Performing a flap- less guided surgery minimised pain, swelling and improve function, aesthetics and the quality of her life in a single treatment visit. Looking at the possibilities available, overden- ture versus all on six, increased her confidence in our ability to provide the most optimal treatment and prompted her thanks, ‘I want you to be my dentist forever’ [Fig. 16]. And that is the 3-D difference. Case 2: ‘I’m not ready for dentures’ Mary presented in June 2015 with pain in her UL/UR quad- rants and a feeling of loosen- ing teeth. During her initial