Australasian Dentist Magazine Sept-Oct 2021

Category 64 Australasian Dentist clinical Figure 22 Figure 25 Figure 19 Figure 23 Figure 26 Figure 20 Figure 24 Figure 27 Figure 21 placement was designed and the corresponding STL file was sent to the dental laboratory for printing (Figs. 28-30). The next step was to prepare the temporary bridge for immediate loading. This is the preliminary phase prior to milling, and involves replicating the shape of the dental set-up in a resin disk. (Figs. 31-33). Once obtained, the temporary bridge was seated and adapted on the master model with implant analogs and the corresponding SRA abutments (Fig. 34). In the final step, occlusion was carefully adjusted (Fig. 35). Surgical procedure In the first phase, the hopeless teeth located on the planned implant sites were strategically extracted, and the soft tissue removed with a punch for a flapless approach. The remaining teeth were used to stabilize the guide with the aid of surgical pins as anchorage. Following the optimal stabilization of the guide, the implants were placed using the dedicated surgical kit, and the screw- retained abutments (SRA) were placed on the implants. The remaining teeth on the arch were then extracted and temporary abutments were placed on the SRAs. The temporary bridge was screwed onto the copings and bonded with flowable resin. Once the occlusion was adjusted, the chimneys were filled with Teflon and covered with temporary composite. The patient was very satisfied with the functional and aesthetic outcome (Fig. 36). X-ray images taken at the one-month (Fig. 37) and at the three-month follow- up visit showed a favorable outcome and the patient reported no mechanical or biological. Prosthetic procedure At the 3-month follow-up visit, the patient reported no mechanical or biological complications. Moreover, the clinical examination showed uneventful healing with a complete soft tissue maturation (Fig. 38-41). At this point, the treatment already met the patient’s expectations providing the desired aesthetic and functional clinical outcomes (Fig. 39-40). To prepare the final restoration, the temporary bridge was removed, and the soft tissues were evaluated (Fig. 42). An optical impression with Straumann® Virtuo Vivo™ intraoral scanner was taken, and a digital model was obtained and guided into occlusion with the lower jaw (Figs. 43-45). Then, the initial dental set-up (represented in blue in Fig. 46) was matched with the digital model, and minor adjustments were made (shown in white in Fig. 46) for the final dental display (Fig. 47). Before milling the zirconia framework, it is important to ensure optimal dental optimal dental alignment. Therefore, a “test drive” was performed through a rough milled resin bridge with the exact shape of the designed restoration that was then checked in the patient’s mouth (Figs. 48-50). The overall aesthetic outcome, smile line, emergence profiles of the teeth, lip support, and occlusion were carefully verified. The zirconia bridge was then created accordingly (Figs. 51-55). For this, a full- contour zirconia bridge was milled onto which Variobase® copings were cemented (Fig. 56). The model was slightly adjusted and refined before delivery (Fig. 57). Responsibility for the outstanding restorations is by dental technician AlessandroGiacometti, who has supported me in this case, and provided a state of the art bridges during the treatment. Treatment outcomes Finally, the bridge was screwed in the patient’s mouth. The treatment outcome fulfilledthepatient’saestheticexpectations in terms of natural appearance, harmony, and beauty. Furthermore, she reported an improvement in her quality of life due to the recovery of her masticatory function and self-esteem (Figs 58-62). u