GAP Australasian-Dentist-May June 2019

Category 30 AustrAlAsiAn Dentist this will demonstrate whether there is a vertical component that indicates a lack or abundance of soft tissue (Fig. 8). this can be easily quantified in a metric system if an intraoral reference is measured with a calliper. We can now inform the patient whether an additional procedure like guided bone regeneration (GBr) or a connective tissue graft will be needed, which can be helpful for informed consent and financial planning. Second risk evaluation the intraoral scan is imported into CAD software and transformed into a virtual master model without the tooth to be extracted and a separate stl shape of the ideal CAD-designed tooth (Fig. 9). now there is the opportunity for 3D evaluation of the dimensional relation between the new tooth and the soft tissue before extraction. in the current case, the tooth involved had not been extracted and a CBCt scan was performed (X-Mind trium, ACteOn; 110 x 80mm field of view; 0.15mm voxel size) for further investigation and treatment planning. in the Ais 3D App software that comes with the CBCt X-Mind trium device, stl files can be matched and aligned with the 3D bone volume, thus giving the opportunity to plan the future implant position taking into account the shape and position of the future crown (Figs. 10a & b). in accordance with the prosthetic procedure preferred, cemented versus screw-retained, CAD/CAM-fabricated versus manual layering and the type of material to be used, all the information for the final treatment plan is available, on which decisions can be made regarding GBr, connective tissue graft and timing of implant loading. Case report the female patient, aged 47 and a non- smoker, was in good general health. she performed regular oral hygiene and had good periodontal health. the patient experienced increasing mobility of the maxillary left central incisor and complained about compromised aesthetics due to the extrusion and progressive migration of the tooth in a buccal direction. the incisor had been treated with a crown at a preadolescent age after a violent trauma. the intraoral radiograph showed incomplete root development and evidence of a root canal therapy suggesting a strip perforation though no signs of periapical lesions were present. the shape of the crown was not symmetrical in relation to the triangular shape of the maxillary right central incisor, but had a wider and rectangular profile. Minor general gingival recession had led to the presence of a tiny inter-dental space. the marginal gingiva was reddened, and the central papilla was not symmetrical. Probing depths were within 2mm for both the right and left central incisors and the radiographic mesial and distal bone peaks were of a regular height. the photographic aesthetic evaluation showed that it would be very difficult to obtain symmetry in tooth shape and have good-looking and healthy soft tissue support at the same time. the patient’s maximum smile exposed the gingival contours. in such cases, it may be wise to consider also the possibility of altering the anatomy of the contralateral tooth with, for example, a ceramic veneer and discuss outcomes with the patient before finalising the treatment plan. this can be evaluated by performing the cut/copy/flip/ paste sequence in reverse (Fig. 7). together with the patient, it was decided to start performing the best lInICal Fig 11a Fig 11b Fig 11c