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ePaper created 2018-02-16, 11:06:18 | version 1.38.0
case report _ full mouth reconstruction Fig. 5 Fig. 6 Fig. 7 Fig. 8 followed by dental implant placement of den- tal implants (Engage, OCO Biomedical; Fig. 5). Tooth #12 was atraumatically extracted using Physics Forceps from GoldenDent and the so- cket grafted with a putty blend of cortical mi- neralised and demineralised bone grafting ma- terial, followed by a pericardium membrane and primary closure by suturing the tissue with 3.0 mm silk sutures; and the remaining teeth pre- pared for crown restorations. Any old amalgam restorations or indications of recurrent decay were removed and cored, and any necessary endodontic therapy was performed (Fig. 6). At the time, the laboratory provided the 3-D White Wax-Up, a clear reduction guide was also de- livered and then used to ensure adequate re- duction for the definitive zirconia crown resto- rations. Full arch impressions were taken (Fig. 7) using polyvinylsiloxane impression material (Panasil, Kettenbach), along with a bite relation using a jig fabricated on the 3-D White Wax-Up models. A shade was also taken, photographed, and later transferred to the laboratory. Then, using a matrix impression (Sil-Tech, Ivoclar Vi- vadent) of the 3-D White Wax-Up, a provisional restoration, which would aid in determining the best size, shape, colour, and position for the de- finitive restorations, was made using a bleach shade of temporary material (Fig. 8). After the patient returned a few weeks later for evalua- tion of aesthetics, phonetics, and bite, the den- tal laboratory was instructed to replicate the 3-D White Wax-Up when fabricating the defi- nitive restorations. Laboratory design and manufacturing The 3-D White Wax-Ups, colour photographs, impressions, and bite relations were forwar- ded to the dental lab (Arrowhead Dental Lab), along with specific instructions regarding the size, shape, and colour of the restorations. The laboratory technician scanned the 3-D White Wax-Ups in order to select the appropriate arch form, tooth size, and occlusion from the digi- tal options available in the treatment planning software. Once a virtual model was created, the full-contour restorations were digitally desig- ned, and virtual images of the proposed recon- struction were forwarded through 3Shape Com- municate to the dentist’s e-mail for review and approval (Fig. 9). Any minor adjustments 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 zirconia restorations were completed, the appropriate monolithic Fig. 5_Engage dental implant depicting the thread pattern and auger tip. Fig. 6_Prepared maxillary and mandibular teeth with implants already placed. Fig. 7_Achieving full arch impressions with Panasil from Kettenbach. Fig. 8_Upper and lower provisional restorations. 20 3_2017