Combining traditional and digital techniques

Kunal Shah presents a recent case study.

A male patient in his mid 30s presented to the practice as a new attender. His main concern was a missing UL2, which he wanted to restore in order to enhance the aesthetics of his smile.

A comprehensive medical, dental and social history was taken. He had no relevant medical issues, was a non-smoker and was generally fit and healthy. The initial intra and extraoral examination revealed no abnormalities, no existing restorations or dental work and good oral hygiene.

All possible treatment options for restoring the missing UL2 were presented to and discussed with the patient. These included no treatment, a denture, a bridge (likely a Maryland Bridge) and an implant-retained restoration. The patient desired a fixed solution and so elected to proceed with a dental implant.

Treatment planning

A CBCT scan was taken with the CS 8100 3D (Carestream Dental) to assess the bone density and identify anatomical landmarks. This is important for accurate planning and therefore for predictable and successful treatment provision. In this case, the CBCT provided two important insights. Some bone resorption was identified in the anterior region, which is crucial to be aware of as it could lead to gingival recession post-implant placement if not planned for and managed effectively. Following the protocols for prosthetically driven implant planning (PDIP), treatment could be tailored in order to minimise the potential impact on the final aesthetic result. We started by determining the ideal implant position and worked backwards to ensure the plan would deliver the desired outcome.