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full mouth restoration case report | their corresponding multi-unit abutments and tem- porary cylinders. Seven days postoperatively the patient returned with very little discomfort, swelling, or bruising. She was very pleased with her fixed provisional resto- rations (Fig. 8). Now that the patient was no longer anaesthetised, the occlusion was checked again to confirm there were no interferences in lateral and protrusive movements. The next step in her treatment would consist of impressions for the definitive upper and lower restorations approximately 4 to 5 months postoperatively. Approximately 16 weeks after implant placement, the patient returned for the prosthetic phase of her treat- ment. The gingival tissue around the implants looked healthy, so the healing caps were removed and the implants evaluated. Each implant was tested with the Osstell ISQ (Osstell, Linthicum, Md.) implant stability meter. Since the ISQ readings were all very high (above 75), impression posts (Hiossen) were inserted on the multi-unit abutments. Since all the dental implants were well integrated, im- pressions were taken for the definitive restorations. For both arches, impressions were taken using Instant Custom C&B Trays (Goodfit) with a heavy and light body vinylpolysiloxane impression material (Take 1 Advanced, Kerr). Bite relations was accomplished by picking up clear duplicates of the provisional restorations (Fig. 9). Instructions for size shape and color for the definitive restorations was forwarded to the dental laboratory and any changes indicated easily communicated to the dental laboratory technician. A FP3 prosthesis would be fabricated for the patient’s upper and lower restorations. The pink gingival areas of this prosthesis type were needed to reconstitute the maxillary and mandibular tissue contours, as substantial bone leveling was required to even out the patient’s smile. With improvements in materials and advancements in CAD/CAM technology (Fig. 10), full-arch pros- theses can now be precisely milled from monolithic zirconia, offering aesthetics and functionality with the added benefit of long-term durability. Exhibiting exceptional fracture toughness and flexural strength, Zenostar zirconia has the ability to withstand the func- tional stresses that full-arch implant restorations are subject to over time. same robust material. The strength and durability offered by Zenostar is comple- mented by lifelike aesthetics and excellent translucency. The teeth of the prosthesis exhibit colour that is very similar to natural dentition, and advanced staining tech- niques are used to establish gingival areas that blend well with the patient’s soft tissue. Within three weeks, the definitive maxil- lary and mandibular restorations were delivered from the dental lab (Fig. 11). Utilising a right angle prosthetic driver, both provisionals were removed and the defini- tive restorations inserted (Figs. 12 & 13). Care was given to torque the retention screws according to the manufacturer’s recommendations. A Panorex X-ray was taken to verify the restorations were completely seated. Once confirmed, a piece of Teflon tape was placed followed by composite material (Figs. 14 & 15). The occlusion was checked and verified with the T-Scan (Tekscan) to make sure that all the proper points of contact were in their ideal positions to en- sure longevity of the reconstruction. The patient no longer experienced pain and was very pleased with her new enhanced ‘whiter’ smile (Fig. 16). Conclusion Computer generated 3-D virtual treatment plans allow the dental provider or team to accurately place dental implants efficiently and effectively. With a variety of different software and associated surgical instrumentation available, dental implant diagnosis and treatment has become more simplified. This de- velopment has created an interdisciplinary environ- ment in which better communication and precise execution leads to better patient care and outcomes._ contact Dr Nazarian maintains a private practice in Troy, Michigan with an emphasis on comprehensive and restorative care. Dr Nazarian is the director of the Reconstructive Dentistry Institute. He has conducted lectures and hands-on workshops on aesthetic materials and dental Unlike hybrid dentures, the entire body of the Zenostar Implant Prosthesis (Arrowhead Dental Lab) including the gingival and tooth areas is constructed from the implants throughout the United States, Europe, New Zealand and Australia. Dr Nazarian is also the creator of the DemoDent patient education model system. He can be reached at www.aranazariandds.com. Fig. 16 Fig. 16: Postoperative full face view. CAD/CAM 1 2017 23