GAP Australasian-Dentist-May June 2019

Category 34 AustrAlAsiAn Dentist lInICal was conditioned (Fig. 32) by adding composite to the temporary crown and grinding material where necessary until the prosthodontist and the patient felt an optimal result had been achieved. Transfer of the profile A new intraoral scan sequence was performed. First was the scan of the full arch with the temporary crown in place. the provisional was then removed from the mouth and screwed on to an implant replica fixed to a stable support with wax. the second scan revealed in 360° the modified shape of the temporary crown, including the gingival profile (Fig. 33). these files can be easily matched in the CAD software when the technician designs the definitive crown (Figs. 34–36). if a monolithic material is used, the technician may copy the entire shape of the temporary. When a support is needed that will be layered with ceramic afterwards, at least the gingival profile can be duplicated in a reliable way. Definitive crown the author strongly prefers screw-retained devices. Owing to the angulation of the implant, it was necessary to relocate the screw access hole. in CAD, the design for a cobalt-chromium support that copied the gingival profile of the temporary was prepared, and the screw access was brought to the palatal aspect (Fig. 37). the file was sent to the Arc solutions milling centre in Helsingborg in sweden. High-qualitymaterialandCAMproduction guarantee an excellent outcome in terms of connection and smooth surfaces (Figs. 38–40). the technician layered feldspathic ceramics to obtain the final anatomy and texture. the patient was totally satisfied with the result and did not wish for intervention for the maxillary right central incisor. Minor gingival asymmetries, though evident at high magnification in photography, are not really disturbing when viewed at social distance if all other parameters, like colour, incisal edge, tooth texture, correct proportion of the incisal two-thirds of the tooth and transitions, are respected (Figs. 41–43). Conclusion innovative technologies enable extremely accurate diagnosis and treatment planning. Affordable high-quality CBCt has profoundly changed our profession. in the current case, the detailed X-Mind trium 3D images allowed for planning and performing implant placement in the optimal mesiodistal position. Correct distances to the lateral incisor and the nasopalatine duct were obtained. Final choices will always remain related to the experience, skills and equipment of the performing team. After collecting all of the necessary information and knowing what technology can provide, it is possible that one team will opt for GBr and monolithic crowns, where another might try to minimise the invasiveness of surgery and employ innovative milling strategies to deliver a predictable, beautiful solution. in the actual challenging buccopalatal dimension, the implant was perfectly planned and guided into to the centre of the native bone. Guided bone regeneration was limited to the minimum and minor buccal exposure of the implant was predicted. reviewing the case described above, the fact that bone volume could be matched with the dental preoperative situation and the CAD virtual wax-up made the whole procedure, from extraction to final restoration, highly predictable. Bone volume, bone quality, extent of GBr indicated and the type of prosthodontic solution were all known before starting treatment thanks to the implant planning with the Ais 3D App software. Both the clinician and patient were well informed and prepared, avoiding surprises, improvisations and unnecessary stress. new developments like smart, scannable healing abutments will help to continue creating treatment outcome and comfort improvements. u Editorial note: A list of references is available from the author. He can be contacted at zwaan@dentz.it or zwaan.jakob@libero.it Dr Jakob Zwaan graduated from Utrecht University in the Netherlands in 1987. He is a member of Digital Dentistry Society and Nederlandse Vereniging voor Parodontologie [Dutch society of periodontics] and President of the 3DSimplement Association. He has authored numerous scientific publications and spoken widely at international events. He focuses on implant surgery and digital dentistry, and runs a private practice in Calusco d’Adda in Italy. Fig 38 Fig 39 Fig 42 Fig 41 Fig 40 Fig 43