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CLINICAL CASE REPORT
the maxillary left side. The three implant fixtures that were
placed some 10 years prior were restored with a screwretained,
cast gold framework prosthesis with an acrylic
matrix and prosthetic teeth. The fixed prosthesis spanned
from the second molar area to the midline.
Given recent advancements in the accuracy of implant placement
using merged-file, tooth-supported surgical guides, it
was decided to provide the patient with an optimized provisional
solution. The option of immediate placement of
custom, provisional screw-retained abutments and temporary
full-coverage crowns was presented to the patient. After
a discussion of the alternatives, benefits and possible complications,
the patient was pleased with this treatment plan.
Figure 2: CBCT scan, axial view.
DIAGNOSTIC FINDINGS
Medical history: Normal healthy patient with no contraindications
to dental treatment or implant placement.
Periodontal: The patient’s periodontal health was within
normal limits, with probing depths of 3–4 mm in posterior
areas with generalized bone loss and recession. Radiographic
data confirmed generalized bone loss. Gingival health was
satisfactory; several areas bled when probed.
Restorative: Examination revealed multiple lost teeth and
restorations. The maxillary left side had been restored with
a screw-retained cast bar with an acrylic matrix and acrylic
teeth. There was poor marginal adaptation of several of
the restorations, but the patient expressed his need for a
phased treatment plan to help defray costs.
Figure 3: iTero scan, occlusal view.
TMJ/Muscles of mastication: Evaluation revealed an apparently
healthy TMJ with no limitation of range of motion, and
no joint pain or joint noise. The patient exhibited dental
wear patterns consistent with bruxism or clenching.
Occlusion: Intercuspation was observed to be acceptable,
given the patient’s past wear history. Maximum intercuspation
appeared to coincide with a position of centric
relation as best as could be determined manually. A full
range of mandibular motion was observed, and the patient
reported no areas of discomfort in positions of maximum
intercuspation, protrusive, eccentric movements or maximum
opening.
Figure 4: Merge of DICOM and STL files.
Treatment Objectives
The overall treatment objective was to use digital technology
to scan, plan, place and immediately provisionalize the areas
of the two missing maxillary left bicuspids, tooth #4 and
#5. Upon satisfactory implant integration, final restorations
Figure 5: Virtual wax-up.
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