Dental Asia November/December 2021

User Report
The diagnostic panoramic radiograph
revealed a mandibular arch presenting
moderate atrophy of Class III to IV, with a fair
volume of relatively dense cortical bone of
type I - II present in the interforaminal area
(Fig. 1).
The patient both had well-controlled type
II diabetes and hypertension. No systemic
and local risk factors or contraindications
that would have excluded the patient from
implant treatment were identified. After a
thorough discussion on various treatment
options with their advantages and
limitations, the patient opted for an implantsupported
mandibular restoration combined
with a new conventional full upper denture.
TREATMENT PLANNING
The treatment strategy included the
determination of the maxillomandibular
relationship, occlusal vertical dimension, and
teeth position using conventional complete
denture techniques (Figs. 2a-c). The findings
were used as prosthetic references for the
delivery of the fixed mandibular restoration 11
(Figs. 3a-b, 4a-b).
Data acquisition for the generation of the
virtual patient model was based on dual
cone beam computed tomography (CBCT)
scans using a radiographic template of the
new conventional dentures 12 (Figs. 5a-b).
Equidistant radiopaque fiducial markers
(gutta-percha) were positioned along the
vestibular rim of the template, allowing for
precise matching of the individual DICOM
data sets from patient scans wearing the
radiographic template and the template
alone.
Conversion of the lower mandibular
conventional denture into a fixed implantsupported
restoration was accomplished
using Straumann ® Smile in a Box. DICOM
data sets from dual CBCT scans were used by
the Smile in the Box team to establish the
virtual patient model. Based on this model,
the team explored possible concepts for the
implant restoration and associated surgical
protocols and guides using coDiagnostiX ®
surgical planning software.
Fig. 3a Fig. 3b Fig. 4a
Fig. 4b
Fig. 5a
Fig. 5b
Fig.6a
Fig. 6b
Fig. 6c
Fig. 7a
Fig. 7b
Figs. 3a-b: Maxillomandibular occlusal records
and final wax-up on master casts
Figs. 4a-b: New set of acrylic dentures on the
master casts and in close-up
Figs. 5a-b: (a) Transparent radiographic template
on master cast (b) After the modification of
template with radiopaque fiducial markers in
preparation for the dual scan CBCT
Figs. 6a-c: Implant restoration planned in
coDiagnostiX ® (a) 2D projection (b-c) 3D
representations of the planned implant and
prosthetic restorations
Figs. 7a-b: (a) Pin guides for pin fixation (b)
surgical guide for implant placement designed
in coDiagnostiX ®
DENTAL ASIA NOVEMBER / DECEMBER 2021 55