The introduction of Guided Surgery to implant dentistry has brought multiple benefits to both the planning and surgical aspects of the workflow. Predictable placement, faster patient recovery and less chair time are some of the main advantages to utilizing the new technology. Switching to a top-to-bottom planning approach where aesthetic results are given more priority has opened the door for dentists to take more control of the prosthetic aspect of their implant cases and have CAD/CAM provisional crowns designed and delivered at the time of surgery.
Today, solutions like 3DDX Guided Full Mouth Restorations make it possible for full mouth rehabilitation procedures that allow you to give your edentulous patients implants and teeth in a single visit.
In the following example, a 44 year old female patient presented with a semi edentulous mandible. All remaining teeth had suffered severe attrition. The patient already had an all-on-4 denture in the maxilla.
A diagnostic Vatech CBCT scan (Fig. 1) was acquired and then uploaded to 3DDX to start the planning phase. After filling in the case requirements and uploading the DICOM data through the 3DDX Connect secure portal, Dr. Engel mailed in patient impressions and a bite registration that were digitized at 3DDX via laser scanning to aid in implant planning and the creation of a digital wax up.
3DDX Dentists received the case and prepared it for planning in the 3DDX implant planning software (Fig. 2) then created an all-on-6 Straumann Bone-Level Tapered implant plan according to Dr. Engel’s instructions (Fig.3).
Implants were planned in positions #19 (4.8x10mm), #20 (4.1x10mm), #24 & #25 (3.3x12mm) and finally #29 & #30 (4.1x10mm). All remaining teeth were planned for extraction which was virtually simulated on the software.
The next step was designing the components of 3DDX Guided Full Mouth Restorations by the 3DDX Restorations team. First, the pin-positioning guide (Fig. 6) is designed to make sure the fixation pins on the Base (Bone Reduction Guide) will be accurately positioned during surgery.
After that, the Snap-In Bone Reduction Guide (Fig.7) is designed. This guide has a double purpose, both as a bone leveling guide and the base on which all the following steps are built. The four fixation pins provide additional stability during surgery.
The Snap-In implant Surgical Guide (Fig. 8) is designed to fit securely on top of the Bone Reduction Guide to allow for sub-millimetric accuracy and full control over both the osteotomy and implant placement procedures. The key-locking mechanisms on both sides provide extra stability during surgery and act as indicators that the guide is fitting as planned.
For this case, it was determined that angled abutments will be required. To ensure perfect alignment with the planned Hybrid Denture, an Abutment Guide (Fig. 10) is necessary. The design is also made to fit on top of the Snap-In Bone Reduction Guide and has indented markings for accurate positioning of the angled abutments (Fig. 11).
Finally, a temporary hybrid screw-retained restoration (Fig. 12) was designed by a 3DDX Prosthodontist using the data available from the CBCT, the Implant Plan and the Digital Wax-Up.
Dr. Engel was updated with every planning step and once the phase was completed, he reviewed and confirmed that the plan followed his instructions. All parts were then sent into production and mailed to Dr. Engel in the same week.
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