GAP Australasian-Dentist-May June 2019

Category 28 AustrAlAsiAn Dentist t houghmany smile design programmes offer us solutions for rendering of multiple-tooth replacements, very often in our daily practice we encounter major challenges when just a single tooth needs to be substituted. in order to estimate the risk of an unacceptable aesthetic final result of our treatment and to determine the most effective and predictable treatment plan, it is necessary, also in these cases, to perform an analysis of the desired tooth shape, the soft tissue architecture and the bone volume necessary to stabilise an implant in the optimal position and support the soft tissue. this analysis can be done using several means. in the traditional workflows, we asked our dental technician, after taking impressions of the dental arches and registering the occlusion, to perform a wax-up to obtain information about tissue volume available and needed. it was difficult to get from this hard model information about the lip line and gingival exposure, and before the era of 3D scanning, it was impossible to interface the teeth with the deeper anatomy. With the arrival of digital photography, video, intraoral scanners 1 and CBCt scanners, our possibilities have grown enormously, thus raising the accuracy and predictability of our treatments. in the following case report, the author will try to describe how he and his team approach cases in which a single tooth needs to be replaced by an implant- supported crown. Most of the procedures can be applied to more extensive cases, since the basic rules of implant dentistry are universal. After an anamnestic interview in which patient expectations play a fundamental role, we proceed with the intraoral examination. Hygiene and periodontal health are checked, and if required, a session for calculus debridement, motivation and instruction is scheduled. normally, the first radiographic examination performed is an intraoral radiograph for a single tooth (Fig. 1) or a dental panoramic tomogram if the need for a more extensive treatment is suspected. in the same session, both dental arches are scanned with an intraoral scanner and the bite is registered. A simple photographic sequence is followed: 1. Full frontal view intraoral photograph (Fig. 2). 2. Detailed photograph of the single arch, possibly with a black mirror to contrast the teeth (Fig. 3). 3. Photograph of laterolateral detail of the tooth and gingival profile (Fig. 4). 4. Full-face photograph with maximum gingival exposure (Fig. 5). Matching of CBCT and virtual wax-up for single-tooth replacement of a central incisor By Dr Jakob Zwaan, netherlands lInICal Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 Fig 6