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educing treatment time with digital dentistry
all leveraged digital dentistry technologies.
The convergence of these
technologies is enabling simpler, more
convenient and more affordable restorative
protocols.
Diagnosis
The patient had no medical contraindications
for implant surgery. She
was on blood thinners, which were
discontinued for a period of four days
before and two days after the surgery
to mitigate the amount of bleeding
during and after implant placement.
Her periodontal tissues were generally
healthy and free from irritation
because of a recent reline and adjustment
of the lower denture to relieve
sore spots. Her occlusion with the relined
dentures was good, and she had
been functioning in these dentures
for years without any TMJ issues. Her
lower denture’s lack of retention was
her primary motivation for considering
implant therapy.
Figure 1: Though scan appliances must often be
fabricated for CBCT scanning, the patient’s existing
denture was functionally and esthetically sufficient to
serve as the radiographic guide.
Figure 2: Gutta-percha markers were placed in the
patient’s lower denture to serve as radiographic reference
points for the CBCT scans.
Treatment Objectives
The objective of the treatment plan
was to improve patient comfort and
chewing function by replacing the
patient’s existing mandibular denture
with a screw-retained fixed implant
bridge. With sufficient primary stability,
the patient could receive a fixed
provisional at the time of surgery, providing
her with a stable lower denture.
The provisional denture would be
designed with dental CAD software,
using the setup from the existing denture.
The final restoration would also
be produced digitally, beginning with
the CAD/CAM provisional design and
incorporating any adjustments made
to the provisional post-surgery.
Figure 3: A CBCT scan was taken of the scan appliance (in this case, the patient’s existing denture) in the
patient’s mouth.
4
Treatment Planning
Because the occlusion, esthetics and
VDO of the patient’s existing denture
were correct, it was modified to serve
as the CBCT scan appliance (Fig. 1).
Prior to the imaging appointment, six
5
Figures 4, 5: Following dual-scan protocol, in addition
to scanning the patient with the scan appliance
in place, the patient’s existing maxillary denture and
lower denture were scanned outside of the patient’s
mouth.
Figure 6: The scan of the bite registration was used
to digitally articulate the lower and upper dentures.
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