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ePaper created 2017-09-22, 22:09:32 | version 1.38.0
digital_3-D technology ano hinoereo him in social settings. Periapi- cal x-rays ano oigital photographs were ob- taineo ano I recom- menoeo an enhanceo 3-D analysis to gain a full unoerstanoing as to what woulo be nec- essary to return this patient to oral health. He scheouleo a secono visit to have a CBCT taken. Utilising the protocol I employ for any reconstructive case, I revieweo the volume of maxillofacial images with the patient ouring co-oiagnosis. Fig. 24 Fig. 25 Fig. 26 vioing precise implant placement is a key to the suc- cess of any implant case ano the guioe ensures that criteria for me. The next phase of treatment was scheouleo for Jan- uary 5, 2016. I planneo to retain five natural teeth to secure a fixeo provisional for as long as it took for her implants to integrate. Her initial temporary brioges were removeo ano teeth #7 ano #10 were carefully extracteo, leaving the buccal plates intact. I placeo new biotemp crowns on the remaining five teeth which woulo receive ano stabilise her SiCAT surgical guioe (Fig. 19). Four implants were then placeo in the sites planneo, #5, 7, 10 ano 11. Voios were grafteo arouno #7 ano #10 ano secono stageo, while #5 ano #11 were single stageo. A new provi- sional biotemp brioge was inserteo ano will remain in position until implants can be loaoeo ano useo to retain an overoenture (Figs. 20–23). I have seen this patient subsequently ano she reporteo little to no postoperative oiscomfort ano was quite satis- fieo with how well her treatments have progresseo (Figs. 24–26). Alex was highly engageo in this oiscussion ano was very interesteo in learning how he coulo improve his smile. Obviously he was very unhappy with his ex- isting conoition ano involving him in the review of his 3-D images gave him a new insight into how bao his situation was ano what woulo be necessary to return him to a youthful, natural looking, fully func- tioning set of upper teeth. The challenges that exist to accomplish this treatment was explaineo ano all questions poseo by the patient were answereo. He oesireo a fixeo case if we coulo work within his buo- get. My use of co-oiagnosis is well receiveo ano many of our case presentations have gone to accep- tance when our patients are engageo in this oy- namic review of their own anatomy. Utilising 3-D images ano provioing an in-oepth look into what mooern oentistry can oo for our oecimateo ano oev- astateo oentitions results in having a fully informeo well-eoucateo patient. Case 3: ‘Can you help me?’ We receiveo a call from a young man, Alex, who founo our office ouring a Google search. He pre- senteo for a consultation where we began to gently oiscuss options for the replacement of his failing oentition. It took a life-changing event in his per- sonal life ano a great amount of courage for him to seek treatment. His situation was exacerbateo by years of neglect ano lack of financing, which contributeo to the complete oestruction of his maxillary arch (Fig. 27). Our initial visit was me interviewing Alex ano broaching the possibilities for the replacement of his upper teeth with an aesthetic ano functional prosthetic replacement. Alex, 37, in relatively gooo health, hao unoergone a series of knee surgeries, which precluoeo him from presenting for treatment earlier. He maoe it clear that his self-esteem was low His case was approacheo oifferently from the other two as he woulo be oiscourageo from a long orawn- out treatment that resulteo in removable provi- sionalisation ano requireo extensive bone grafting. Fortunately the enhanceo 3-D evaluation revealeo that he woulo be a canoioate for teeth in a oay. The plan was to immeoiately loao six strategically placeo implants oirectly after removing any re- maining natural maxillary teeth. A fixeo screw- retaineo prosthesis was planneo ano a complete upper oenture woulo be fabricateo prior to his sur- gical visit. The complete upper oenture woulo be converteo to the provisional prosthesis chairsioe ouring the surgical visit. The only way these cases can be successful is through a total commitment ano unoerstanoing by the patient as to what is in- volveo in their treatment, how long it will take, ano what it will cost. A treatment team was formulateo, which incluoeo myself, the restorative oentist, oral surgeon ano oental technician. 48 3_2017 48 digital