Clinical
Fig 8 Fig 5 Pre-surgery image post-extraction
Image of the temporary prosthesis in the mouth
Fig 11
Image of the milled structure placed in the 3D-printed model
Fig 6
View of the tooth-supported guide in position and detail of the placement of the implant
Fig 9
Scanning abutments in the patient’s mouth while taking the definitive impression
Fig 12
View of the tissues and of the gingival emergence using the temporary prosthesis
Fig 10 Fig 7
Detail of the making of the temporary prosthesis
Continued »
superimpose the DICOM files obtained using CBCT (cone-beam computerized tomography) and the stl-format files produced by intraoral scanning with the TRIOS scanner (from 3Shape), thereby making guided surgery much more precise than conventional systems in which only CAT (computerised axial tomography) is used. The surgical splint guide designed by the doctor was made at the Core3dcentres milling centre, ensuring excellent stability and fit and giving the clinician greater confidence of success at the time of treatment. During surgery, once the four
teeth were extracted, the surgical guide was correctly fitted to the adjacent teeth in order to proceed with the placement of the two Ocean implants, measuring 4mm in diam- eter and 13mm long from platform 4.0 of the Avinent Implant System. The type of surgery used in this
case was pilot guided. The surgical splint is used to initiate surgery by marking with the first drill the direction and depth at which the
66 Scottish Dental magazine
Screenshot of the intraoral impres- sion and the scanning of the im- plants using the scanning abutments
implant is to be placed. Afterwards, the surgical guide is removed and the drilling sequence continues in the conventional manner, following the marked direction until the diameter of the selected implant is reached. All of this can be done in a minimally invasive manner without the need to make a flap, improving the patient’s post-oper- ative recovery. Fully guided drilling and implant placement is also an option available to the clinician. Once the implants were placed in position, they demonstrated satis- factory primary stability and so two AVINENT straight transepithelial abutments measuring 4mm were placed to reach the height of the gum and to position the prosthetic connection at the gingival level. The temporary prosthesis was made in a conventional manner using titanium temporary abutments retained by the transepithelial abutments. A fixed acrylic partial prosthesis screwed to two temporary abutments was placed and the occlusion was adjusted, leaving it load-free during lateral and protrusive movements. Twelve weeks later, once the implants had been shown to have
good stability, the definitive digital impression was taken using the TRIOS intraoral scanner so that the permanent prosthesis could be made using CAD/CAM design. 3D-printed models were made to
check the precision of the fit and to send the work to the laboratory for the final loading with ceramic.
Conclusion The partial or complete restoration of teeth using dental implants has a very high success rate as a treatment method today. The latest technological advances
enable us to plan the surgical placement of guided implants in accordance with the final resto- ration, giving an even more predictable outcome. Using the new design software programs, we can make extremely precise surgical guides for more challenging cases, speeding up surgery and shortening patient recovery times. In addition, CAD/CAM tech-
nology applied to the design of prostheses and the making of milled structures gives improved fit with outstanding reliability and excellent long-term results.
ABOUT THE AUTHOR
Dr Jesús López Vilagran graduated from the University of Barcelona in 2001 with a degree in dentistry. He has a masters degree in occlusion and oral restoration and a qualification in reconstruction in multidisciplinary treatments on implant materials from the University of Barcelona. He is currently a director of the odontology and prosthodontics area at the Maxilofacial Institute at the Teknon Medical Centre in Barcelona and is a director of Clinica Dental Vilagran in Badalona.
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