by Bart W. Silverman, D.M.D., Oral and Maxillofacial Surgery
Download PDF Version With Clinical Case Images
A 61-year-old male presented for evaluation of a failing mandibular right bridge (Fig 1). Options discussed with patient included to remove the bridge and leave the area unrestored; replace with a mandibular removable partial denture; or restoration with implants. The patient elected for removal of the bridge and placement of three endosseous implants for three crowns.
Under intravenous sedation, the mandibular bridge was sectioned anterior to the mandibular right second premolar and teeth #29 and #32 were surgically removed (Figs 1 and 2). In addition, the socket of tooth #29 was debrided and curetted. A mineralized bone graft with a non-resorbable cytoplast membrane was placed in order to reconstruct bone missing secondary to local periodontal bone loss in the area of tooth #29.
After the patient healed, the plan was to perform guided surgical implant placement using an optical scan protocol. A CS 9300 was used to perform a cone beam computed tomography (CBCT) scan and the CS 3500 intraoral scanner was used to obtain digital intraoral impressions (Figs 3-5. Both files were merged into an implant planning software for fabrication of the surgical guide. Under intravenous sedation, three Biohorizon Tapered Internal implants were placed in teeth #29, #30, and #31 areas (Figs 6-8).
After three months, custom abutments were fabricated with the scanning of scanning bodies by the CS 3500 (Figs 9-12). The crowns were fabricated by Digident labs of Orangeburg, NY (Figs 13-15). The restorations were placed (Fig 16), and a post-operative panoramic image was captured (Fig 17).
Performing CBCT and intraoral digital impressions allows me to completely digitize the implant planning process. By placing a scanning body and scanning it with the CS 3500, the custom abutments and crowns are produced via a digital model. The abutment and crown are planned virtually, reducing patient chair time and overall case turnaround time. The learning curve for the CS Solutions product line was minimal, and I have found that patients are extremely impressed with our new technology.