Case 94 | The Award 2017 | Greece/Germany
Dr. Panagiotis Tsirogiannis / Dt. Paul Tax
Minimal invasive surgical and prosthetic rehabilitation through a complete digital workflow
A 39-year-old male patient with an uncomplicated medical background presented for treatment, with the wish for a complete dental rehabilitation. The clinical examination revealed a chronic localized periodontitis of moderate severity, although without bleeding on probing (BOP); missing first maxillary premolars without diastemas; carious roots at regions 18, 15, 26, 28, 36, 35, and 46; and amalgam fillings at teeth 17, 16, 22, 25, 27, 37, 34, 44, 45, and 47.
The treatment plan included extraction of the remaining roots, replacement of the amalgam fillings with composite resin ones, placement of a single tooth implant in region 15, and rehabilitation of the gaps 25 to 27, 34 to 37, and 45 to47 with monolithic zirconium oxide restorations (ZrO2).
After obtaining the three-dimensional (3D) digital cone beam computed tomography (CBCT) scan (Galileos Comfort Plus, Sirona, Germany), a specially constructed stent with a barium sulfate (BaSO4) radiopaque tooth (SR Ortho TAC, Ivoclar Vivadent, Lichtenstein) was placed compatibly with the patient’s occlusion. The presurgical implant planning was carried out with coDiagnostiX software (Dental Wings, Canada). The limited edentulous available space in the area (7 mm) due to the position of the adjacent teeth and the right sinus indicated the placement of a Straumann NNC implant (Straumann, Basel, Switzerland) with a diameter of 3.3 mm and a length of 8 mm.
The data were transferred to a GonyX device (Straumann), the individual surgical guide was fabricated and the implant was inserted with a minimally invasive procedure.
The implant was immediately loaded with a screw-retained provisional restoration, as the primary stability exceeded 30 Ncm. A month later, the teeth selected for fixed dental prostheses (FDPs) (24, 27, 34, 37, 45, and 47) were prepared with a chamfer margin, and a digital impression of both arches was made using an intraoral optical scanner (iTero, Cadent, USA).
The tooth shade was selected and recorded using a colorimetric device (Shadepilot, DeguDent, Germany). The tooth shade data and the stereolithographic STL (Standard Triangle Language) data were processed by the dental laboratory using Ceramill Artex (Amann Girrbach, Austria) digital articulator software. The design and fabrication of the ZrO2 restorations was accomplished using a CAD/CAM system (Ceramill Mind/Ceramill Motion 2, Amann Girrbach, Austria).
For the implant-supported cement-retained all-ceramic crown, a prefabricated titanium abutment (Straumann NNC Cementable straight, Straumann) was chosen, with the entire procedure being accomplished by means of the CAD/CAM system. After the try-in, the restorations were cemented with a resin cement (PermaCem, DMG, Germany), with the exception of the implant crown, for which a temporary cement (TempBond NE, Kerr, USA) was used. After treatment, the patient was included in a follow-up schedule and 1 year later there is no failure record.’
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