Utilising a digital workflow for prosthetically-driven implant treatment

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Posted by: Dental Design 9th April 2021

An 84-year-old female patient presented in the practice looking for a solution to her missing upper teeth. She expressed the desire for a permanent fix as she was a keen cyclist and needed a comfortable and stable solution. She also had a failing UL1 that had previously been heavily restored and endodontically treated.

From the patient’s medical history, she was generally fit and well except for being asthmatic, for which she was using Ventolin inhalers to manage.

Treatment planning

A comprehensive intraoral assessment was conducted. Digital impressions were taken using an IOS scanner, as well as a full set of clinical photographs (Figures 1-4) and a CT scan to better visualise the anatomy. Digital wax-ups were created using InLab 18 (Figures 5a-d) before the models were 3D printed in-house and then a vacuum formed acrylic splint was made to aid placement in the patient’s mouth.

All possible treatment options were discussed with the patient. These included no treatment, removable dentures and implant-retained prostheses, covering all the advantages, disadvantages, potential consequences and complications of each option. As the patient was interested in a fixed solution, the implant-retained prostheses were her first-choice.

The surgical and restorative procedures were planned in detail, using the restorative ideals to determine the best implant position, angle and size. The entire process was discussed with the patient in detail, highlighting the importance of long-term maintenance for success. Informed consent was obtained.

Treatment provision

The UL1 and UL5 were extracted atraumatically and a Neodent^® Helix^® Grand Morse^® implant placed immediately. Implants were also placed in the sites of the UR5, UR6 and UL6 with indirect sinus lifts on both sides. Densah burs were used in reverse and synthetic materials were used to perform the bone augmentation.

All the implants were torqued between 45/60ncm and healing abutments were placed. I would typically place the final abutment at time of surgery, but in this case decided against it as we were using a denture as the provisional restoration.

The patient left the surgical appointment with all the appropriate oral hygiene instructions and advice, allowing the soft and hard tissues to heal for 3 months. When she returned to the practice for review, the soft tissues were pink and healthy. The healing abutments were removed and a selection of abutments were fitted to the implants, including mini and micro conical abutments for the posterior bridge work and a Grand Morse Exact abutment on the UL1 (Figure 6).

Scan bodies were fitted for impressions to be taken with the CEREC Primescan (Figure 7) and sent to Beever Dental Technology in Leeds for the fabrication of the prostheses (Figures 8-9). These scan bodies from Neodent make the digital workflow even simpler as they are designed specifically to work well with an intraoral scanner.

The restorations were returned to the practice and tried in the mouth. They required no alterations, which is a massive benefit often afforded by utilising an entirely digital workflow for dental implant treatment.

Outcome

A great final outcome was achieved in this case and the patient was very satisfied with her smile (Figures 10-15). Everything healed as expected and there were no complications at any point during treatment – likely thanks to meticulous planning and good patient compliance thusfar. Having the final prosthetic restorations in mind before planning the surgery is very important. The digital wax-ups are therefore imperative in defining both the aesthetics and functionality of the implant-retained prostheses, which can be created in-house or by a dental laboratory.

Using a digital workflow in cases like this makes the restorative phase so much easier. Neodent is always increasing its digital libraries, so most of the abutments available can now be scanned digitally, for greater flexibility.

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