Tooth Replacement: A one time visit with modern technologies.

110 Rating(s).


Posted on By armando ponzi In CBCT & CAD/CAM

Innovative dentistry relies on biologic and clinical knowledge, new models based on virtual reality and a 3D digital approach.
New opportunity can arise and new vision:
-the PET defines a new and predictable way of healing maintaining the tissue volumes and architecture in time
-PRF improves the quality and timing of healing.
-3D software can better define the initial situation and generate virtual final result that, if validated by the clinician, can easily be converted on ‘items’
-New instrument like ‘Densah drill’ can provide an initial torque favourable for immediate prostethic finalization and an improvement of socket healing and augment either laterally or vertically.
-Hardware like 3D printing and milling machine allows ‘inhouse’ production enabling a new concept of post production chairside of items like custom abutment
-new way of thinking either in terms of planning and team approach or revaluating surgical procedure, simplified and mininvasive.
Case presented goes in that direction: CBCT, digital impression, case mounted digitally and surgical stent, custom abutment in titanium and crown produced inhouse.
Software allows virtual extraction and socket volume in advance: digital insertion of implant and digiatl planning of abutment on top, respecting anatomical limits and biology concept.
The surgical technique, is rather a prosthetic technique and operator need accuracy in order to be within the range and mount all items.
This is a proof of principle: it can be done all procedures in house at once.

Initial Situation
Inhouse Surgical Stent

PET
Immediate Custom Abutment


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11 Comments

Bravo Armando!you have done it!
Why haven't you used hybrid screw-retained crown ?


Reply

Antony, thanks for your valuable words. I'm not so sure about hybrid solution in the long period of time, but I will try and have some experience shortly. Best regards. Armando


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Some elements of implant planning

implant space over root and shield
implant to bone orient


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The abutment is studied on a 3D way in order have ideal distance from margin and should incorporate the information of healing variation of tissue.

abutment project
abutment project and relation to margin profile


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Armando. Beautifully managed case! I am curious to know if short under contoured crowns are always desired or necessary . This could be an issue in the esthetic zone. Have you considered the possibilty of a modified ridge lap? Another subject to discuss in Madrid. GREAT CASE! my friend . Chuck


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Chuck, I like a lot this case for several reasons. I' ve found on Dental forum an exceptional number of highly skille collegue and new technology introduction, as Densah Drill, that add a lot on my research of a single step procedure. When you are in front of a computer you need to establish 3D dimension & limit of all iems you will produce and use. So, The new way of Learning is to give personal professional opinion at that time(digital planning) and all can be digitally modified to accomplish it: the situation here is WYSYG. Catch you in Madrid, it will be a pleasure meeting you. Armando


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Armando-

I like your command of the process and your execution- Nice

I have a few questions - most obvious is being that you performed PET- why did you decide to finish case-
When planning of abutment margin - what is your criteria for shoulder VS Chamfer- what depth of margins - sub gingival did you use- say buccal vs palatal, and what degree of tissue change did you factor on healing-
As Anton asked about screw retained- if you designed the crown ahead of time as you did- a screw channel can be designed and cemented out of the mouth to abutment and screw everything in- I think this could have been a good call in this respect if you have some dimensional changes in tissue during healing or osseointegration.

I again like your utilization of all aspects of dig technology

Cheers,

Richard


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Armando, as always a step ahead on planification PET!
It´s gonna be a pleasure to discuss at Madrid!
See you on friday night.
Jorge


Reply

Martin, great questions you are asking! It is quite challenging to find on computer the limit of the abutment and establish a profile. The advent of PET improved the predictability of healing on vestibular side while we know, on palatal bone ,gingival complex is much more stable, so I expect less bone loss. The idea here is to FILL the empty volume generated by extraction with a studied and dedicated abutment that can drive inner healing and maintain peripheral tissue as marginal gingiva preventing a collaps and generating a structure NOT ROUND that will give a crown correct profile. On that direction I prefer a 1A1T concept rather then one piece Anthony's solution as I can achieve a 'one time healing concept' being the higher area of the abutment part of the prosthetic. Hope I answered your question. Thanks for kind comment. Armando


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Armando

Sounds like a good plan- I am a big fan of if you have a technique that works in your hands then keep handling it!!

Enjoy Madrid!!!


CHeers,

Richard


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Advancements in new dental technology present better solutions for traditional oral health problems than ever before. The trend in dentistry is utilizing technology to make dentistry more comfortable, durable, efficient and natural-looking for the patient as possible. Patients and their dentists benefit from newer techniques that are less invasive and more dependable than the years of past. Procedures that formerly took multiple trips to the dentist or required multiple health care providers can often be performed in the comfort of one office by one qualified provider.


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