IMPLANT-PROSTHETIC REHABILITATION FROM DIGITAL WORKFLOWS MADE WITH SINGLE MASS COMPOSITE TORONTO BRIDGE AND WOLRD’S FIRST 3D PRINTED CONTINUOUS GLASS FIBER DENTAL SUBSTRUCTURE TECHNOLOGY
AIM OF THE WORK
implant-prosthetic techniques, digital planning as the starting point of the treatment
plan and finalization with the toronto single mass composite work protocol
MATERIALS AND METHODS
Implants, intraoral scanner, digital previsualization software, 3D
printed continuous glass fiber reinforced substructure and Toronto single mass
composite prostheses were used.
The definitive prostheses on 3D printed continuous fiberglass bars are
delivered in the last appointment. The retentive screws are tightened to 25ncm
according to the manufacturer's indications and the through holes are closed
with PTFE and composite. The occlusion is rechecked with articulating paper and
adjustments are made as the last stage of delivery. The first oral hygiene
instructions at home are provided to the patient.
techniques described in this case report demonstrate how digital planning, digital
work protocol and digital reinforcement technology allow for a complete
restoration and functional procedure.
rehabilitation, digital workflow, partial edentulism, substructure
A female patient comes to the office with partial upper and lower edentulism. In the upper arch there are root remnants of elements 11, 13, 16 and an incongruous bridge from 24 to 26. In the lower arch the edentulism is posterior and there are elements from 33 to 43 and a root remnant of 34.
Rehabilitation is proposed to the patient via Overdenture or Toronto Bridge-type fixed prosthesis and, in accordance with the requests of the same, an upper and lower fixed rehabilitation is opted for.
Alginate impressions are then taken for the creation of surgical templates for immediate loading and pre-surgical total prostheses for both arches in order to decide during the operation which temporary rehabilitation to use. (fig. 0-15)
On the day of the intervention, the upper and lower reclamation is carried out. Subsequently, 2 distal inclined implants were inserted in the maxilla in area 25 and 15 (size 3.7*11.5) and 2 implants positioned orthogonal to the bone crest in area 22 and 12 (size 3.7*10). In the mandible, 2 distal inclined implants were inserted in area 44 and 34 (size 3.7*13) and 2 implants positioned orthogonal to the bone crest in area 32 and 42 (size 3.7*13). The insertion torque of the eight implants did not exceed 25Ncm. Covering screws were then placed and the flaps sutured with 5/0 absorbable sutures, the provisional total prostheses were delivered and the patient was discharged.
MATERIALS AND METHODS
Implants, intraoral scanner, digital previsualization software, 3D printed continuous glass fiber reinforced substructure and toronto single mass composite prostheses were used.
RESULTS After 15 days the sutures were removed and 4 months after implant insertion surgery the 8 implants were uncovered with positioning of compatible MUA height 2.5 according to the positioning inclination of the implants.
The prosthetic phase begins with the relining of the provisional prostheses to reveal the correct anatomy of the ridge. Then the impressions obtained outside the oral cavity are scanned with the intraoral scanner, then the relined temporary prostheses relocated in the oral cavity and finally their occlusion. Finally, the edentulous crests are scanned after having positioned the scan bodies for the digital technique to detect the position of the implants. For planning, intraoral and extraoral photographs are taken to define the perimeter limits of the face in order to be able to program the case using the digital previsualization software. The scans thus obtained are then sent to the laboratory for the creation of a prototype of the prostheses under test.
During the second session of the prosthetic phase, the screwed polymethylmethacrylate (PMMA) prototypes are tested to verify the smile line, occlusion, shape of the teeth and vertical dimension. Although already very precise, the prototypes are relined with soft silicone to allow the laboratory to obtain a perfect fit and maximum adhesion between the mucous membranes and the prosthesis.
In the last meeting before finalizing the prostheses, the passivity and correct prosthetic coupling of the cobalt chrome laser melted bars is verified, on the basis of which the 3D printed continuous glass fiber bars are subsequently made. (fig. 16-21)
The definitive prostheses on 3D printed fiberglass bars are delivered in the last appointment. The retentive screws are tightened to 25ncm according to the manufacturer’s indications and the through holes are closed with PTFE and composite. The occlusion is rechecked with articulating paper and adjustments are made as the last stage of delivery. The first oral hygiene instructions at home are provided to the patient. (fig. 22-28)
After about 20 days, the occlusion is checked again and an oral hygiene session is scheduled which, according to protocol, must be repeated at least every six months.
DISCUSSIONS AND CONCLUSIONS
The implant-prosthetic techniques described in this case report demonstrate how digital planning, digital protocol and digital reinforcement solutions allow for a complete restoration
and functional procedure. This digital workflow for prosthetic rehabilitation offers numerous benefits for the patient and practitioner. The first benefit is the precision in treatment planning; the possibility of using digital scanners and previsualization software allows accurate representation of the clinical situation and a planned intervention in a precise and targeted way in comparison to analog workflows. Furthermore, the use of a protocol based on the
employment of 3D printed continuous glass fiber reinforcement structures allows to efficiently integrate digital manufacturing into a faster, more predictable workflow, which is less likely to be subject to potential variability that might be introduced by human error. Lastly, the use of these technologies allows for high efficiency and timeliness in treatment, one that can guarantee high safety and denture quality.
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"Special thanks to the Artitec laboratory in Osnago (MB) and Hi-Fiber for the realization of these prosthetic artifacts.
The digital workflow, the use of increasingly high-performance, lightweight and aesthetic materials as well as the daily exchange with collaborators are the ingredients to achieve the realism of our prostheses and the satisfaction of our patients.
Dr Daverio Dental Practice is a specialized center of Implantology and cosmetic dentistry. INVISALIGN certified."
- Dental Office of Dr. Luigi Daverio