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ePaper created 2017-03-17, 11:21:45 | version 1.38.0
full mouth restoration case report | Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 6: Hiossen guided kit. Fig. 7: Fixed implant provisional restoration pick-up. Fig. 8: Fixed implant provisional restorations. Fig. 9: Clear duplicates of provisionals used for relations. Fig. 10: 3Shape view of the proposed treatment. Fig. 11: Monolithic zirconia restorations. and waterproof, it also is very effective and clear in taking close-up photos as well as full face shots. Ad- ditionally, I will always offer my patients a third party payment option like the Lending Club (San Francisco, CA) for their treatment. Lending Club Patient Solu- tions provides patients great funding flexibility with very low rates and high approvals. Most of all, the support from their staff has been very professional. Planning A CBCT scan was taken to accurately treatment plan this case to make certain that no complications would arise from doing all the procedures (extract, graft and implant placement) within one visit. Since her entire dentition had rampant caries present, her treatment would require extracting teeth #2–15 and #18–31, as well as the impacted third molars (teeth #1, 16, 17, 32) to avoid any further complications in the future. To further develop a treatment plan, diagnostic mod- els were forwarded to the dental lab and mounted on the articulator for further analysis in order to meet the patient’s aesthetic and functional needs. Instruc- tions for a virtual wax-up were prescribed for increas- ing the patient’s vertical dimension due to a collapse in her bite from the severe wear in her dentition. As a result of the information gathered from merging the CBCT information with the STML files of the vir- tual wax-up, it was determined that aesthetics and function could be enhanced by restoring the patient’s entire maxillary and mandibular arches with implant supported restorations. All risks, benefits and alter- natives of various treatment options were reviewed with the patient including dentures, over dentures and fixed restorations. Her treatment plan of choice would consist of screw retained fixed zirconia resto- rations in the upper and lower arches supported by six implants each. With the combination of their corkscrew thread, built-in platform switching and apical design, the ET III SA (Hiossen) implant system was utilised in this particular case. According to the manufacturer, the enhanced SA (sand blasted and acid etched) surface of this implant has shown a substantial quickening of gene expression, cell differentiation and proliferation that are essential to osseointegration meaning faster bone healing and earlier loading times. Other dental implant systems in the market with high initial stabil- ity may include but are not limited to; Biomedical En- gage (OCO), Nobel Active (Nobel Biocare), Seven (MIS), I5 (AB Dental USA), Conus 12 (Blue Sky Bio) and Any- Ridge (Megagen). Not only was the type and size of the implant selected because of CBCT planning, but also its relationship to the planned restoration and its proximity to vital structures determined before performing the sur- gery. Guided bone leveling, as well as immediate implant placement, would be accomplished at the surgical appointment by using CT-based bone level- ing and implant drilling guides. Additionally, prefab- ricated screw-retained fixed provisional restorations would be directly picked up with acrylic over dental implants in the maxilla and mandible in the key im- plant positions if adequate fixation was acquired. When performing this many procedures in one visit, I will utilise IV sedation to make the procedure more efficient and comfortable for the patient as well as CAD/CAM 1 2017 21