Using Collaboration and Technology to Deliver
Inside Dental Technology delivers updates on digital workflows, materials, lab techniques, and innovation in dental technology through expert articles and videos.
May 1, 2019
Volume 10, Issue 5, May 2019
Page(s): p. 50
By Victor Castro, CDT, and Wesam Salha, DDS, MSD
A 52-year old male patient had presented to the author, periodontist Wesam Salha, DDS, MSD, several years before he agreed to treatment. He was a very nervous patient and had anxiety about dental treatment. He presented with severe hard and soft tissue loss and a great deal of infection.
The patient was adamant that he would never wear something removable—during the transitional provisional phase or the final outcome—so the restorative team made plans to remove all his maxillary teeth and place six implants that would be immediately loaded with a PMMA temporary prosthesis. Once the healing phase was complete and the esthetics, function, and phonetics were deemed satisfactory, a fixed complete zirconia prosthesis was delivered. For the mandibular arch, the treatment plan included 10 crowns on his natural teeth and a four-unit, implant-supported fixed partial denture. A zirconia base frame with a full layer using VITA VM®9 (VITA North America; vitanorthamerica.com), a biologically natural, feldspar veneer ceramic, was utilized.
The team's up-front planning and communication with the laboratory and all the specialists were key to the successful outcome on this case. The pre-workup evaluation and communication, with regard to the pictures, radiographs, scans, and models, were the most important. They also relied on technology to help communicate by sharing information digitally and planning and visualizing the treatment virtually.
To start, the team took a full set of facials and intraoral pictures that were evaluated with the face-bow articulated models. They put all of it together so they knew what the end result would look like through wax-ups and virtual planning.
They then utilized planning software called nSequence® (NDX nSequence; nsequence.com) that allowed the team to modify the bone structure, place the implants, place the temporary prosthesis, and plan the entire procedure virtually. At that point, they transferred the plan to the milling machine, which milled a certain sequence of guides that were used after removal of the teeth. That gave the team the ability to transfer the information from the software to generate the final milling of the zirconia for the final prosthesis.
The team discussed the final shade, shape, and characterization with the patient, particularly since all the patient's teeth were being restored. For the maxillary prosthesis and the mandibular anterior prosthesis, they used a translucent zirconia framework with VITA VM®9 pink ceramic and white ceramic. For the remaining mandibular single crowns on natural teeth, they used a zirconia substructure and VITA VM®9 as well, and characterized them with a little bit of VITA AKZENT® Plus (VITA North America) in a yellow-to-orange shade around the cervical areas for a more natural look.
The transformation in the patient was life-changing (Figure 1 through Figure 3). He went from being a nervous dental patient with compromised oral health to a confident person in the way he carries himself and interacts with others.
About the Author
Victor Castro, CDT, is the owner/president of Studio-280 in Houston, Texas. Wesam Salha, DDS, MSD, is the owner of Galleria Periodontics & Implants, also in Houston, Texas.
Manufacturer Information
VITA North America
vitanorthamerica.com
800-828-3839
Disclaimer: The statements and opinions contained in the preceding material are not of the editors, publisher, or the Editorial Board of Inside Dental Technology.
