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CLINICAL CASE REPORT After a few days, the final restorations were completed at the lab and the two screw-retained BruxZir Solid Zirconia crowns were delivered to the office (Fig. 30). After removing the provisional crowns and screw-retained abutments, the implant fixtures and soft tissue were examined and deemed to be acceptable for crown delivery (Fig. 31). Each respective screw-retained BruxZir crown was secured with a titanium retention screw and torqued to a value of 35 Ncm (Fig. 32). Teflon tape was placed and the access holes were sealed with light-cured composite resin (Figs. 33, 34). The occlusion was checked and did not require adjustment. The proximal contacts were checked with floss and found to be exceptional. The esthetic final result was deemed excellent for both patient and practitioner (Fig. 35). Figure 29: Inclusive Scanning Abutments in place. Results This case helped validate the high level of restorative success that can be achieved with restorations done from intraoral scans. It also illustrated how this digital scanning technology can be used to plan and create tooth-supported surgical guides. Development of precise surgical guides in a model-less, 100 percent digital environment offers clinicians increased confidence for implant placement. The CAD/ CAM-produced Inclusive Custom Temporary Abutments and BioTemps provisional crowns delivered at the time of implant placement further added to the optimal outcome of this case. The final result was nothing less than stellar, exceeding both patient and provider expectations. Figure 30: The final screw-retained BruxZir Solid Zirconia crowns. Development of precise surgical guides in a model-less, 100 percent digital environment offers clinicians increased confidence for implant placement. Figure 31: Evaluation of soft tissue healing six months post-implant placement. Figure 32: Occlusal view of screw-retained BruxZir crowns in place. 62 – www.inclusivemagazine.com –
Discussion Several types of technology were involved in this case. The iTero digital scanning technology was used to create STL files — representing the surface anatomy of the patient’s teeth — that could be merged with the CBCT DICOM files using file merge software. In this manner, a tooth-supported surgical guide was designed to precisely fit on the patient’s teeth in a clinical scenario. There can be huge differences in the fit of tooth-supported surgical guides, especially when designed using only the DICOM file rendering, as compared to a merged file that gives the occlusal accuracy of a surface digital scan. The surface scan in this case was derived from a direct intraoral scan of the patient’s teeth. The software used to merge files is available from several sources and many third-party planners offer this service. The STL/DICOM file merge is the most critical software manipulation of the design process. This element of the process needs more development in order to ensure consistent spatial positioning of the surface data. The final implant positioning was developed after a conference call with the third-party planning service. The CAD software was used to design the tooth-supported surgical guide. STL files were sent to a 3-D printer for printing of the surgical guide. Three-dimensional printing technology is rapidly becoming an important part of everyday dental practice and is commonly being used in the laboratory industry. It is likely that 3-D printing technology will very soon find its way into the dental office. <strong>Dental</strong> CAD/CAM technology was used to design and mill the provisional screw-retained abutments and crowns. The success of past cases provided confidence that the implant placement could be predicted with accuracy. In this case, the implant placement depth and axial positioning were precise. There was some degree of rotational positioning possible to help secure the final placement once the surgical guide was removed. The provisional fit was so precise in this case that the custom temporary abutments and BioTemps crowns were delivered without using a reline material for fit compensation. Furthermore, there was no adjustment made to the contacts or occlusion. An iTero intraoral scanner was used with Inclusive Scanning Abutments made by <strong>Glidewell</strong> Laboratories. CAD software was used to design the screw-retained BruxZir Solid Zirconia crowns. These crowns were delivered without the need for occlusal or proximal adjustments. Figure 33: Access holes protected with Teflon tape. Figure 34: Occlusal view of BruxZir crowns with access holes sealed with composite resin. Figure 35: Buccal view of the final BruxZir restorations. CAD software was used to design the screw-retained BruxZir Solid Zirconia crowns. These crowns were delivered without the need for occlusal or proximal adjustments. – iTero Digital Scanning Technology and Tooth-Supported Surgical Guides – 63
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Inclusive Restorative Driven Implan
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Contents 9 20 29 36 Implant Q&A: An
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Letter from the Editor This issue o
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■ JACK A. HAHN, DDS Dr. Jack Hahn
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Online Exclusive R&D CORNER “Digi
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Implant& Q A: Go online for in-dept
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Page 23 and 24: Go online for in-depth content Mini
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