One of the strongest arguments for digital dentistry is its obvious benefits for long-term and total rehabilitation cases. The patient story I would like to share is a great example of how digital technology can improve patients’ lives and significantly support year-long treatments.
Our patient’s name is Malvina and she lost a few teeth when she was a little girl. As a result, her dentition was deformed and she had functional problems, including crunching sounds in the joint when chewing or yawning.
Initial situation (gypsum models scanned with Medit’s tabletop scanner)
The orthodontic treatment began with the use of brackets. The patient was wearing them for one year, which resulted in positive changes regarding aesthetics. After analyzing the changes in her bite, our team decided to move the lower premolars distally to prepare for implants. After another six months, the patient was scanned again using the Medit i500.
Medit i500 scan data after 1.5 years of treatment
The intraoral scans taken with the i500 and a CBCT showing the state of the jaw formed the base for the navigational surgical guide for the implants. We then designed the teeth in exocad DentalCAD to prepare for screw retained crowns, as discussed with the dentist and the orthodontist. Afterwards, a surgical guide for planning the implant placement was prepared. This was done in accordance with the teeth design, the intraoral scan data, as well as the acquired CBCT.
Surgical guide for implant placement
As a next step, the surgical guide was manufactured with our 3D printer, which ensured precise geometry and the exact size of the sleeves positioning retentions. With this, preparations for the operation were completed – only a day after the initial intraoral scan used to create the guide was taken.
On the day of the operation the guide fit perfectly which was crucial in guaranteeing great results. After fixing the guide, the implants were integrated in areas with small bone volume and an autoplastic operation was performed, drilling the implant channel.
Fit-checked holes in surgical guide and integrated implants
After three months of osteointegration, we were able to proceed with manufacturing temporary constructions. Traditional impressions would have been very uncomfortable for the patient at this stage, so digital impressions were highly preferable in a situation that additionally involved brackets and a non-typical occlusion due to the teeth still being moved.
Perfect alignment of the virtual scanmarker & screw retained crowns
The emergency profile was an especially important aspect for this case involving temporary prosthetic implants. The orthodontic process hadn’t been completed yet and for the design of the crowns we had to keep the planned movement of the teeth in mind. As the dentist was pleased with the sub-gingival profile and anatomy and the orthodontist with the positioning of the crowns, the crowns were milled. Our lab team polished the final crowns carefully to ensure that the approximate contact was not damaged before sending the final pieces to the clinic.
Fixing of the crowns
The clinical treatment that followed to fix the crowns was a routine procedure (unscrewing, tightening, articulating foil, sealing screw canals with composite).
What proved crucial for completing this treatment seamlessly was communication between the lab and clinic. This is one of the strengths of the digital workflow as it ensures simplicity. With digital technology the job profile of dental technicians such as myself keeps evolving. Overall, I have to emphasize how impressive its value is for our work and I would like to recommend to my fellow dental technicians to transition to the digital workflow.
Andrey Bachmago works as a dental technician and CAD/CAM consultant for Articon and is a specialist for bite splints.
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