CASE PRESENTATION
Collaborative Care for Successful Single-Tooth Replacement
Even seemingly straightforward cases require open communication among the clinical team members, precise diagnostic imaging, and detailed treatment planning to ensure a good outcome for the patient. As a prosthodontist who doesn’t place implants, I work closely with a periodontist who does all of the surgeries. In addition, I have a dental lab in my office staffed with experienced technicians. By combining the expertise of these 3 professionals with intraoral scans, CBCT images, and treatment planning software, we’re able to proceed with treatment fully prepared with all of the information we need to deliver the best results possible.
In this case, documented in the images on the following pages, a patient presented with a congenitally missing tooth No. 12, which he wanted replaced. We started by capturing the images we needed to treatment plan the case— intraoral scans (Figures 1–3) taken in my office using 3Shape TRIOS and CBCT images taken in the periodontist’s office. We then integrated these images using 3Shape Implant Studio software (Figure 4), which supports 70 different implants from a variety of manufacturers. We identified key landmarks in the CBCT images and paired them with the intraoral scan. When we merged the two data sets, we had a view of the patient’s teeth, gingiva, and bone.
The treatment planning process included a meeting between me (the prosthodontist), the periodontist, and the dental lab technician. Sometimes these meetings are held remotely, but in this case we met in person. The dialogue began with an explanation of the tooth being replaced and its optimal position. The surgeon explained that given the position, and the fact that the ridge was extremely narrow, the bone would need to be leveled to create a better platform for implant placement. Also, because the roots were close together, the surgeon chose the narrowest implant (Straumann Narrow Platform Implants).
In discussing the removal of some soft and hard tissue, it was noted that we would create a disparity in the gingival margin of the implant for tooth No. 12 and tooth No. 11 (Figure 5). However, I pointed out that there also was a big disparity between teeth Nos. 11 and 13. The replacement tooth No. 12 would serve as a transition from the high margin on the canine to the low margin on tooth No. 13. The surgeon, technician, and I agreed.
To transfer the information about implant position to the mouth, we used the data captured with the intraoral scans and the CBCT with the Implant Studio Software to create a surgical guide (Figure 6). Then, with a two-stage surgical approach, the surgeon used the guide to place the implant, and the site was sutured. We did not uncover the implants for 4 to 6 months after surgery (Figure 7).
Using state-of-the-art technology and providing opportunities for open communication among all of the dental professionals involved in the case, we identified challenges, developed solutions, and provided the patient with an excellent outcome (Figure 8).
GO-TO PRODUCT USED IN THIS CASE
3SHAPE TRIOS
3Shape TRIOS is recognized for its speed, documented accuracy, digital color impressions, and ease of use. Supporting the widest range of treatment workflows, TRIOS delivers both open STL and DCM fi les. The wireless intraoral scanner comes with an integrated intraoral camera, automated shade measurement, HD photos, and more, all in one device. TRIOS freely connects to thousands of 3Shape labs and other labs for the fabrication of crowns, bridges, inlays/onlays, full and partial dentures, abutments, implant bridges, and bars, as well as sleep appliances and clear aligners. TRIOS includes an autoclavable tip and is available in a pen and handle grip version.
3Shape TRIOS is recognized for its speed, documented accuracy, digital color impressions, and ease of use. Supporting the widest range of treatment workflows, TRIOS delivers both open STL and DCM fi les. The wireless intraoral scanner comes with an integrated intraoral camera, automated shade measurement, HD photos, and more, all in one device. TRIOS freely connects to thousands of 3Shape labs and other labs for the fabrication of crowns, bridges, inlays/onlays, full and partial dentures, abutments, implant bridges, and bars, as well as sleep appliances and clear aligners. TRIOS includes an autoclavable tip and is available in a pen and handle grip version.
Figure 1—Intraoral scan with 3Shape TRIOS.
Figure 2—Intraoral scan, buccal view.
Figure 3—Intraoral scan showing replacement tooth.
In discussing the removal of some soft and hard tissue, it was noted that we would create a disparity in the gingival margin of the implant for tooth No. 12 and tooth No. 11 (Figure 5). However, I pointed out that there also was a big disparity between teeth Nos. 11 and 13. The replacement tooth No. 12 would serve as a transition from the high margin on the canine to the low margin on tooth No. 13. The surgeon, technician, and I agreed.
Figure 4—Integration of CBCT with intraoral scan in the 3Shape Implant Studio software
Figure 5—Merged data shows a disparity in the gingival margin between the implant position (tooth No. 12) and tooth No. 13 after removing hard and soft tissue.
Figure 6—Using 3Shape Implant Studio, we created a 3D-printed surgical guide. The rectangular opening on the first molar allows the surgeon to tell if the guide is fully seated. The raised letters on the buccal aspect are the patient’s name, which helps eliminate using the wrong guide. The circle is where the implant will be placed.
Using state-of-the-art technology and providing opportunities for open communication among all of the dental professionals involved in the case, we identified challenges, developed solutions, and provided the patient with an excellent outcome (Figure 8).
Figure 7—Implant placement after healing.
Figure 8—The final restoration (left) is the exact shape of the planned restoration (right).
JONATHAN FERENCZ, DDS, FACP
Dr. Ferencz is a Diplomate of the American Board of Prosthodontics and Clinical Professor of Prosthodontics and Occlusion in the Department of Advanced Education in Prosthodontics at the New York University College of Dentistry, where he has taught since 1972. He has also served as Adjunct Professor of Restorative Dentistry at the University of Pennsylvania School of Dental Medicine since 2014. As a founding member of the International Academy of Digital Dental Medicine, Dr. Ferencz has given over 400 invited lectures and presentations to dentists and postgraduate dental students around the world.
Dr. Ferencz is a Diplomate of the American Board of Prosthodontics and Clinical Professor of Prosthodontics and Occlusion in the Department of Advanced Education in Prosthodontics at the New York University College of Dentistry, where he has taught since 1972. He has also served as Adjunct Professor of Restorative Dentistry at the University of Pennsylvania School of Dental Medicine since 2014. As a founding member of the International Academy of Digital Dental Medicine, Dr. Ferencz has given over 400 invited lectures and presentations to dentists and postgraduate dental students around the world.
