Looking for help documenting a case.

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Posted on By Paul Mikhli In CBCT & CAD/CAM

Hi guys. Posting for the first time and I'm really excited to work on this case! Dr Garber and Klien presented a full day course on implant placement and restoring a single tooth this past Thursday using 3 Shape. I want to present something similar using Sirona.
I had a patient come in on Monday with fractured lingual cusp #12 below the gum line. At this point there is no pain and she is heading out of town. I was able to bond the mobile cusp to the rest of the tooth and will be taking a CT when she returns. (Just ordered the Orthophos SL on Feb 1st so it will hopefully come in this month). I scaned the tooth with the Cerec so I have a record of her original tooth morphology and position. My plan is to take the CT, merge the info with the optical surface scan, plan the implant position exactly where it needs to be, mill a surgical guide with the Cerec, extract the tooth (maybe socket shield technique?), and place the implant. Ultimately, I plan to mill her final restoration to the exact specs of where her current tooth is. I feel this case can teach both the evolving digital world of dentistry and also demonstrate careful extraction and implant placement techniques.
I have never documented a case like this before so all help is appreciated. Here are a few pictures I've taken so far.

Fractured Lingual Cusp #12
Placing Bond

Bonded tooth
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Paul; Welcome....great case and post. You can always post up to 6 images per post and add more later via comments (2 images per comment). Your idea here is excellent. Truly DIGITAL and with a good basis. Please keep us posted. Thanks Maurice


Hi Paul, welcome to the forum. This seems to be an ideal case for discussion and feed-back as we have many members who are really leaders in this exciting digital arena. Just for a start, since the case is somewhat like yours, take a look at Armando Ponzi's post some time back. Here is the link:
<a href="http://forum.dentalxp.com/case/details/ss-image-guided-planning-single-step-im/3306" target="_blank">Click Here </a>


Paul, the interesting thing about the technique you used is that it can last for some time if the patient is pain free. Some of the ones I have done are still there!


Paul, welcome indeed. I would be interested in how you plan to export the Cerec scan. To my knowledge, Cerec stores its scan files in SSI format and not STL. Please let me know how you will circumvent this format issue. Thanks.


Welcome . . .
- as we showed in the course, you have selected the correct type of case type to begin with.
Your sequential planning is good but Sirona is a closed system, so you need to find out the specifics of just how the different aspects of the system interface most effectively - - and what are your limits in exchanging certain files beyond the immediacy of Sirona.
I'm not sure if you're also asking about process of documentation so you can show it and use it to demonstrate the power of digital.
If so, that info is on DentalXP and easily accessed.- - see Stephen Goldstein, Shannon Pace Brinker, Ron Goldstein and Glenn Krieger for some great ideas and teaching on documentation and great photography made easy - essentially for clear photos you may need a mirror to focus on just what you're demonstrating . A high resolution intra-oral cam may at times be adequate-
Looking forward to seeing it all


you may find some information on the clinical case you presented from this personal case I shared on dentalxp:
Great to see your flow chart planning and actual clinical execution.
PET is a real add on these case as it improves margin predictability in time.


Paul, great case to begin with Socket Shield to prevent buccal wall lost. Ask Armando the way a digitall SS can be done.
Regards and keep us posted.