today what I'd like to do is to talk about utilizing digital dentistry and CAD CAM
prosthetics to optimize treatment outcomes this will be part three which will we have already
done part one in part two this will be part three the final restoration fabrication and
delivery before exploring the fabrication of the final restoration it is instructive to revisit
the prosthetic lis driven treatment plan the first article illustrated how precise tooth movement was
accomplished with digitally fabricated Invisalign aligners hence improving the position of the lower
teeth while establishing the correct occlusion for the planned restoration composite resin was
used to restore the incisal edges and return the mandibular anterior teeth to their original
incisal gingival height optimal excess overjet was created with tooth movement to allow proper
room for the maxillary screw retained implant bridge in part two we focused on the digital
workflow used for CB CT and interval scanning virtual determination of implant positioning
guided surgical implant placement and design and fabrication of the provisional implant prosthesis
DICOM data files were merged with the STL digital impression files to create a virtual planning
platform facilitating design and fabrication of the surgical guide used for implant placement
as well as the creation of a pre-made bio temps provisional implant prosthesis after placing the
implants in the exact position called for by the digital treatment planning the screw retained PMMA
provisional restoration was immediately loaded and won by the patient to confirm the fit aesthetics
and occlusion of the proposed restorative design after completion of healing and successful
integration of the inclusive tapered implants the stage was set for a smooth predictable transition
to the final restoration by the time the final restoration was delivered healthy
aesthetic emergence profiles were evident around the implants and in the areas of the politics this
would contribute significantly to the lifelike final restoration our requirements for the six
units crew retained implant bridge included excellent aesthetics acceptable functional
occlusion high strength and wear resistance retrieve ability and reasonable cost Brooke
sir full strength solid zirconia was chosen as it best met the desired criteria flexural strengths
of up to one thousand four hundred and sixty five mega Pascal's and the material superior resistance
to wear and fracture were particularly beneficial in this case because of the patient's history of
bruxing clenching and grinding continuing the 100% digital workflow additional scans were
taken to finalize the restorative design we were so pleased with the form function and aesthetics
of the original PMMA provisional that we wanted to duplicate its surface morphology as well as
the slight alterations made to the cusp tips in the final restoration the Attero element interval
digital scanner was used to generate a digital impression of the bio temps provisional implant
bridge so the lab could incorporate the minor modifications into the final prosthetic design
the patient was referred for CB CT scans for radiographic documentation of implant integration
inclusive scanning abutments were connected to the four maxillary anterior implants and
the interaural scans were taken with the I Tarot element generating a digital impression of the
spinal soft tissues surface anatomy this provided the lab with the information needed to ensure the
final prosthesis emerged from the soft tissue with the most aesthetic manner possible using
digital CAD software the intraoral scan of the original PMMA provisional was merged with the M
plant level digital impression the CAD design for the final six units crew retained implant
bridge was fine-tuned to match the patient's final digital Anatomy and incorporate the slight
modifications made to the cusp tips of the PMMA provisional note the digital comparison of the
PMMA provisional CAD design and the final Brooks er design showed that the screw access holes were
in perfect alignment verifying that the integrated implants were situated in precise alignment with
their virtually planned positions the final CAD design was digitally prepared for fabrication
and the six unit Brooks ER implant bridge was milled from a block of Brooks er full-strength
solid zirconia following milling the lab bonded gold-tone titanium bases into the screw access
holes of the prosthesis as the final delivery appointment the six unit screw retained Brooks
abridge was seated on the for inclusive tapered implants teflon tape was condensed
into the screw access holes to help protect the heads of the retention screws and allow
future retrieval of the prosthesis the teflon tape was then covered with a composite resin
completing delivery of the final restoration the esthetics occlusion and function of the
final restoration were excellent and precisely duplicated those of the patient approved PMMA
provisional restoration due to the restorative space and tooth positioning established by the
pre implant orthodontic treatment the Brooks ER implant bridge established ideal occlusion with
the opposing mandibular incisors the patient was very pleased with the final result which restored
her smile and corrected several dental problems present at the time of the initial consultation
the 100% digital workflow utilized to achieve the predictable final result illustrates why the
future is now for clinicians who are ready to embrace these technological advances thank you
you