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ePaper created 2017-09-22, 22:09:32 | version 1.38.0
digital_3-D technology visit, we performed all conventional diag- nostic procedures, clinical examination, full mouth series of periapical X-rays, periodon- tal examination and photographs (Figs. 17a & b). She had avoided visiting the dentist for many years due to a bad experience with past periodontal treatment. Examination re- vealed maxillary incisors with class II mobil- ity, pocketing 8 mm or more throughout her maxillary arch, spacing of her incisors, hy- per-erupted molars nearly exfoliated and missing teeth #18, #19, #30, and #31. Gen- eralised plaque, calculus and oedematous gingival tissue was evident. No medical con- traindications for dental treatment existed but she was very anxious about undergoing any dental treatment. We recommended and she agreed to an enhanced CBCT 3-D radiographic evaluation. Reviewing these images confirmed my belief that all maxillary teeth were designated with a poor to hopeless prognosis. The 3-D images of her dentition gave her a clear understanding of the problems she faced. We dis- cussed what options were available to improve her condition (Figs. 18a–c). Gaining her trust made it possible for me to provide emergency care during this initial visit with extractions of teeth #2 and #15. This treatment resolved her pain and Mary was convinced that she could handle the treatment plan outlined during our Co-Diagnostic evaluation. The definitive treatment plan possibilities were con- structed, defined and presented during her second visit. This patient was confident that we could im- prove the quality of her life with advanced dental techniques and technologies. Once again the benefit of my in-office CBCT was instru- mental in gaining a clear understanding of this patients’ problems and she was encour- aged to accept treatment. The preparatory phase of treatment called for strategically removing certain teeth while retaining others to retain a fixed pro- visional prosthesis. Bone grafting and site preservation precipitated the second 3-D Fig. 18b Fig. 18c scan to plan for fabrication of her surgical guide. In this case, 6 months passed and the #5, and #12 sites were re-evaluated for healing. Adequate bone was present to receive dental implants and the ground- work was prepared to carefully extract #7, and #10 and immediately implant these sites if the buccal plate was not damaged during the extractions. Reiterated after reviewing this CBCT scan was the absolute necessity for the buccal plate to remain in- tact, otherwise bone grafting would be performed. This would set back the timing of this case by at least 4 months, but as long as the remaining natural teeth are maintained then this would not be a big issue. Mary's surgical template was created as a SiCAT classic guide, utilising a proprietary biteplate that contained fiducials and was secured to the remain- ing natural dentition with a futar bite registration. The SiCAT lab merged the 3-D data and a scanned diagnostic cast to complete the fabrication of this four unit surgical guide. Safe guarding and pro- Fig. 19 Fig. 20 Fig. 21 Fig. 22 Fig. 23 digital 3_2017 4747