The Award contest 2015/ 21 October 2015/

Case 45 | Prosthodontic Award 2015 | Italy

Dr. Michele Rossini | DT Angelo Zorloni

Immediate load application in full digital and model free implant dentistry

Key words:

Full digital
Model free
Immediate load
Transition Denture

A patient arrives with an old denture not suitable nor stable. There are no functional dysfunctions nor pain. The patient does not report any problem and sustains that’s completely asymptomatic.

During the first appointment, a scan of the mouth is made with and without the old denture and the occlusal position is recorded using the old denture.

The digital model obtained is placed in the digital (virtual) articulator (average value) thanks to the patient front and lateral pictures. A diagnostic digital wax up is made using the parameters clinically recorded during the first appointment. A (diagnostic) Transition Denture can be built using the diagnostic digital wax up. This transferring denture allows the passage of information between the digital environment and the patient’s mouth.

After that, the try in of the Transition Denture provides an incredible amount of both aesthetic and functional information. When a satisfying result is obtained, the Transition Denture is scanned and the patient will undergo a TC exam.

A DICOM file is obtained from the TC (purple in the picture), which includes all the information required about the shape and the position of the bone structure. These information are matched with the stl file obtained from the scan of the patient’s mouth (green line) and the stl file of the Transition Denture (orange line), so that the surgeon can start the surgical planning. In the meantime, the lab technician digitally creates the final shape of the teeth. Thanks to a connection software, it is possible to interconnect both surgical planning and design software. In this way, it is possible to get a combined surgical/prosthetic design without using traditional physical model. As a result, surgical milled or 3D printed template is obtained. This template includes both the information about the implants positioning (dicom file) and about soft tessues (stl file). It is also possible to find the design of every single tooth that will be milled.

After the surgery, a scan of the scan bodies is done directly in patient’s mouth. Immediately after that, the file is sent to the laboratory where the titanium framework is designed and milled. In this case the lab technician, who works at the milling centre, follows the indications and the information given by the clinician and the technician who plan the workflow. In this case the design of the framework originates directly from the shape and the position of the teeth previously established. Through the multiple matching, it is possible to control all the passages and produce the framework of the final denture and the milled teeth.

At the end of the work, it is possible to notice the astonishing conformity amongst the design, theTtransition Denture modified in the mouth of the patient and the final result.

During the matching step it is possible to control the result: the exceptional precision of the whole design is noticeable using surgical implants softwares with file DICOM combined with prosthetic design software with stl file. The whole workflow is completed without using any physical models and in a timesaving procedure involving only four clinical appointments: