Dentist: Dr. Shane Patel
Location: Quality Dental Group, London.
Patient: Female with failing lower dentition and existing upper arch implants
Background
A female patient presented with a failing lower dentition. She had previously undergone full arch implant placement, including zygomatic implants, in the upper arch, which was currently fitted with a temporary bridge, which both the patient and clinician were not happy with. Dr. Shane Patel aimed to restore the lower arch using the CHROME GuidedSMILE protocol, but also wished to improve the upper temporary bridge. He approached Quoris3D for assistance in finding a solution to replace the upper bridge concurrently with the lower arch restoration.
Challenges
- The need to replace the upper temporary bridge before designing the lower arch restoration, if using a conventional method.
- A wish to minimise patient inconvenience and chair time.
- A desire to improve and streamline the treatment process using a digital protocol
Innovative Approach
Dr. Patel consulted with the Quoris3D team to find an efficient solution. Quoris3D's CAD department recommended using the Grammetry protocol developed by its partner company, ROE Dental Laboratory. This advanced digital protocol allows for precise and rapid digital record collection, enabling a straight-forward, two-step restoration process. It delivers all the benefits of photogrammetry, but with the use of an Intraoral Scanner rather than a photogrammetry device. This option would allow the Quoris3D team to include the information collected in a single pre-surgery records appointment, for both the upper and lower arches, into the design and case planning for the lower CHROME GuidedSMILE treatment, and so complete the surgery in the lower arch, and provide the new upper and lower immediate provisional bridges, in a single visit.
Procedure
Step 1: Digital Record Collection
- Tools Used: Intraoral Scanner (IOS) and Optisplint kit.
- Process: Dr. Patel captured the upper implant positions using the Optisplint followed by a series of IOS scans. This data was combined with key information from the existing temporary bridge to design a new upper temporary bridge, which could be included in the design and planning for the lower CHROME GuidedSMILE treatment.
Step 2: Concurrent Immediate Restoration
- Upper Arch: The new 3D printed temporary bridge was designed to fit directly to the multi-unit abutments (MUA) using Vortex screws.
- Lower Arch:The CHROME GuidedSMILE system facilitated guided bone reduction, expertly accurate, predictable, and efficient implant placement, and a straight-forward bridge conversion.
Outcome
In a single, morning clinical session, Dr. Patel successfully:
- Transitioned the patient from an unsatisfactory upper temporary bridge and failing lower dentition to a fully, provisionally restored upper and lower arch.
- Utilised the CHROME GuidedSMILE system for precise, lower arch implant placement and provisionalisation.
- Employed Grammetry and Vortex screws for direct MUA attachment of the new upper temporary bridge.
Highlights
This case beautifully illustrates:
- Digital Design Expertise: The Quoris3D team’s capability in creating precise digital designs.
- Efficient Digital Protocols: The ability to take accurate digital records quickly using the Grammetry protocol, reducing restorations to a predictable, two-step process.
- Fully Digital Workflow: How seamless, fully digital case management brings efficiency and accuracy.
- Advanced Fixation Techniques: The use of the innovative Vortex screws for secure MUA attachment in the upper arch.
- CHROME GuidedSMILE Efficiency: Expertly accurate, safe, and efficient implant placement in the lower arch, combined with straightforward bridge conversion.
Summary
By combining these advanced approaches, Dr. Patel was able to provide his patient with an excellent standard of care. He could minimise their time in the dental chair and their discomfort, while also enhancing their overall treatment experience and outcomes. He achieved a level of efficiency, accuracy and predictability which would be difficult to achieve using conventional methods. He can also look forward to providing a similarly efficient two-step treatment process when the patient is ready to move forward to their final bridgework.
With a wider lens, the case showcases the effectiveness of integrating cutting-edge dental technologies in full arch restoration.
Clinician's View
Dr. Shane Patel’s review:
‘We had already provisionalised the upper with zygomatic implants, and the challenge was to re-do the upper provisional bridge and also carry out a CHROME procedure on the lower arch. We used Grammetry on the upper, which was straight forward and simple. No impression, just everything digitally scanned. The result was fantastic! Literally no adjustment whatsoever! Definitely a happy patient. Grammetry is really, really easy. I will definitely use it again. Just one appointment and then straight to fit.’
James Hamill, CEO Quoris3D:
‘I was able to be with Shane for this appointment, and I left feeling very pleased for both Shane and his patient, and incredibly proud of our team at Quoris3D. Their expertise and knowledge took this challenge and turned it into a seamless, straight-forward treatment experience for both the patient and Shane, and it was all designed and planned using a fully digital process; their skills and talent really shone.
Our partnership with ROE Dental Laboratory, one of the most established and largest dental laboratories in the US, is a huge asset to our ability to offer our customers the most advanced treatment options. ROE’s position as industry leaders, pioneering in the development of guided surgery and digital workflows, which culminates in systems like GuidedSMILE and Grammetry, means our customers can benefit from access to an extensive foundation of knowledge and experience which can only come with the large number of cases and years a company like that has under its’ belt. Their collaborative role in the development of the innovative Vortex screw, for straight to MUA fixture, is another perfect example.
ROE’s Grammetry protocol has been an excellent complement to our full-arch service range. It puts all the benefits of Photogrammetry into your IOS and reduces restoration to just two short appointments. In my own clinical work I have found it particularly useful for patients who have attended with existing full arch implant restorations, seeking a replacement bridge, or to transition from removable to fixed prosthesis. The feedback on Grammetry from customers looking for a solution for cases like these has been overwhelmingly positive. And Shane’s case is a perfect example of how we can support clinical success in all types of situations, bringing the capability and efficiency of digital workflows to your work in multiple ways. Our goal at Quoris3D is to support dentists wherever they are in their full-arch skill level, technological experience, and the direction they want to go in."
