J Dent Rehabil Appl Sci.  2022 Dec;38(4):249-256. 10.14368/jdras.2022.38.4.249.

Digital technique in diagnosis and restoration of maxillary anterior implant: a case report

• Bang H
• Jang W
• Park C
• Yun KD
• Lim HP
• Park S

• KMID: 2538523
• DOI: http://doi.org/10.14368/jdras.2022.38.4.249

Abstract

The implant prosthesis of anterior maxilla requires careful consideration in planning. In order to satisfy both esthetic and functional needs of a patient, fusion of intra-oral scan in Cone-beam computed tomography (CBCT) and facial scan can be considered. Bony structures and soft tissues captured in CBCT and occlusal surfaces of intra oral scan were incorporated into personal characteristics from facial scan. The patient had insufficient buccal bone on maxillary anterior area. The maxillary implants could not be placed on the most ideal position. However, the “top down” approach completed by computer-generated arranging of teeth in implant planning and surgery with surgical guide resulted in esthetically and functionally satisfying result regardless of the limitation. Careful diagnosis with digital technique and the usage of surgical guide resulted in successful surgery and esthetic restoration. The temporary fixed prostheses were designed, restored and evaluated. The patient was not satisfied with the first design of temporary prosthesis, which showed uneven space distribution between teeth due to the position of maxillary implant. The design was modified by changing proximal emergence contours and line angle to alter the perceived since of incisors. The patient was satisfied with the new design of provisional restoration. A digital occlusion analyzer (Arcus Digma II, KaVo, Leutkirch, Germany) was used to measure inherent condylar guidance and anterior guidance of a patient to provide a definitive prosthesis.

Keyword

implant; CAD; CAM; virtual patient; dental esthetic; intraoral scan

Figure

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  Fig. 1 Initial panoramic radiograph.

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  Fig. 2 Initial intraoral photographs. (A) Right lateral view, (B) Frontal view, (C) Left lateral view, (D) Maxillary occlusal view, (E) Mandibular occlusal view.

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  Fig. 3 Digital facebow transfer. (A) Digital facebow: right view, (B) Digital facebow: front view, (C) Digital facebow: left view.

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  Fig. 4 Extra-oral photographs for esthetic analysis. (A) Front view, showing hairline, glabella, subnasale, lip line, and menton, (B) Front view with lip retractor, (C) Lateral view.

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  Fig. 5 Design of Surgical Guide with facial scan, CBCT (Dicom file), and intra oral scan. (A) Digital wax up on CAD software and virtual implant placement, (B) Front view: Superimposition of wax up, intra oral scan, CBCT (dicom file), and facial scan, (C) Digital wax up of maxillary anterior area and placement of implant fixture, (D) Lateral view: superimposition of surgical guide, intra oral scan, CBCT (dicom file), a facial scan.

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  Fig. 6 Impression taking with intraoral scan. (A) Digital impression taking with scanbody, (B) Intra oral scan of mandible.

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  Fig. 7 Provisional restoration. (A) CAD design of provisional restoration, (B) Superimposition of Provisional restoration, intra oral scan and CBCT (dicom file), (C) Virtual patient with Provisional restoration, (D) Superimposition of Provisional restoration, intra oral scan, CBCT (dicom file), and facial scan, (E) Intraoral photo of provisional restoration, (F) Extraoral photo of a patient with provisional restoration.

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  Fig. 8 A digital occlusion analyzer (Arcus Digma II, KaVo, Leutkirch, Germany). (A) A patient with Arcus digma II, (B) Arcus digma II result.

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  Fig. 9 Final restoration. (A) Intraoral photo: Front view, (B) Intraoral photo: Occlusal view.

Reference

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