With today’s advanced implant technology enabling a much more digital workflow, my team and I can now help our patients achieve more effective restorations in a quicker, more comfortable manner. As a recent example, a 77-year-old healthy male was referred to my practice for an implant rehabilitation of the maxillary left anterior region. He was recently in an accident and fractured the two pillars of the existing bridge, 21 x 23. As a result, both teeth were not viable for fabrication of a new conventional bridge.
Diagnostic records and prework.
After acquiring the initial photos and radiographs, we captured a digital impression using the CS 3600 intraoral scanner from Carestream Dental. We also acquired a pre-operative CBCT scan. Both of these files — the CBCT and digital impression — were then sent to the dental lab technician for design. The technician imported the files into exocad software and designed a wax-up for the new implant bridge for teeth 21i x 23i. Next, the DICOM data, a modified model (where the fractured roots of 21 and 23 were virtually extracted in Meshmixer software), the opposing arch model and the new wax-up from the lab technician were imported into the SMOP implant planning software from Swissmeda.
Now the implants could be optimally planned to achieve the goal of immediate implantation and placement of a direct screw-retained bridge on teeth 21i x 23i. Two Straumann BLT RC 4.1 mm, 12 mm implants were planned in regions 21 and 23. With a new import of the data into exocad, the lab technician milled a PMMA provisional bridge. The provisional bridge fit was verified using a control model printed by Dreve 3D model printing services. Two temporary cylindrical abutments were modified with Opaquer. Meanwhile, the surgical guide was designed in SMOP and then printed with a Stratasys 260 printer using medically approved M 610 material. The surgical guide fit was also verified using the Dreve control model.