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One day smile makeover

One day smile makeover

RO: Evolutia tehnologiei 3D in domeniul medicinii dentare pune la dispozitia practicienilor toate "uneltele" necesare pentru rezolvarea variatelor situatii clinice folosind un workflow complet digital.
Avantajele tehnologiei digitale sunt numeroase, atat pentru medic cat si pentru pacient. Unul din cele mai importante este reprezentat de posibilitatea implementarii conceptului de "one session dentistry" chiar si pentru cazurile mai complexe.
Pe de alta parte traim Intr- o perioada in care stomatologia estetica se orienteaza din ce in ce mai mult spre abordari de tipul "no prep" sau "minimally invasive" iar accentul se pune pe colaborarea interdisciplinara (in special cu ortodontia) care va asigura pregatirea cazului de estetica pentru o abordare minim invaziva
Exista insa situatii speciale, cazuri clinice, in care suntem solicitati sa rezolvam situatii de estetica dentara in care trebuie sa lasam deoparte uneori total, uneori partial principiile "minim invazivitatii".
In cele ce urmeaza doresc sa va prezint povestea unei paciente la care am reusit sa transformam un zambet in mai putin de 24 de ore cu ajutorul tehnologiei 3D si a unui workflow complet digital.

EN: The evolution of 3D technology in the field of dental medicine provides practitioners with all the "tools" needed to solve various clinical situations using a fully digital workflow.
The benefits of digital technology are numerous, for both the physician and the patient. One of the most important is the possibility of implementing the concept of "one session dentistry" even for more complex cases.
On the other hand, we live in a time when aesthetic dentist is increasingly focusing on "no prep" or "minimally invasive" approaches, the emphasis is on interdisciplinary collaboration (especially with orthodontics) that will ensure preparing the aesthetic case for a minimally invasive approach
However, there are special situations, clinical cases, where we are asked to solve situations of dental aesthetics in which we must leave aside sometimes totally, sometimes partially the principles of "minimal invasiveness".
In the following, I want to introduce you to a story of a patient in which we managed to turn a smile into less than 24 hours with 3D technology and a fully digital workflow.

RO: Diana a venit in clinica noastra cu speranta si nu prea legat de posibilitatea remodelarii zambetului ei. Desigur ca daca privim cu atentie imaginile cu situatia initiala gandul ne fuge rapid la colaborarea cu medicul ortodont pentru o solutie estetica si non invaziva. Vestea proasta este ca pacienta a beneficiat deja de 2 ani de tratament ortodontic fix ( inclusiv extractia in scop ortodontic a 4 premolari) si nici prin gand nu-i trece sa mai treaca inca odata prin "durerile purtarii aparatului ortodontic" (exprimarea pacientei).

EN: Diana came to our clinic with and without hope, regarding the possibility of remodeling her smile. Of course, if we look carefully at the images with the initial situation, our first thought goes to the collaboration with the orthodontist for an aesthetic and non-invasive solution.
The bad news is that the patient has already received 2 years of fixed orthodontic treatment (including the orthodontic extraction of 4 premolars) and doesn't even consider going through the "pains of the orthodontic device" again (patient's expression).

RO: In acelasi timp presiunea este mare deoarece pe de o parte timpul pe care il avem la dispozitie este scurt ( nu locuieste in Romania) iar pe de alta parte calitatea vietii ei este afectata de nemultumirea legata de aspectul zambetului. In timpul interviului ne-a marturisit ca nu zambeste niciodata si ca "se viseaza" ( la propriu) cu dinti aliniati. Ne-a spus ca acesta este visul frumos dar si cosmarul multor nopti din ultimii anii.
Analizand pozele ei personale constatam ca intr-adevar, pentru ea lipsa de aliniere a dintilor reprezinta un adevarat obstacol psihologic si, practic, nu exista imagini cu ea zambind , nici chiar in cele mai frumoase momente ale vietii (nunta).

EN: At the same time the pressure is high because on the one hand the time we have at our disposal is short (she does not live in Romania) and on the other hand the quality of her life is affected by the dissatisfaction with the appearance of the smile. During the interview, she confessed that she never smiles and that she "dreams" (literally) about herself having aligned teeth. She told us that this is a beautiful dream, but also the nightmare of the last few years. By analiyzing her personal pictures we find that, for her, the lack of alignment of the teeth is a real psychological obstacle, and there are practically no pictures of her smiling even in the most beautiful moments of her life (the wedding).

RO: O situatie de acest gen ne pune greu la incercare deoarece schimbarile necesare pentru remodelarea zambetului implica prepararea destul de agresiva a celor doi incisivi centrali iar utilizarea wax upului si mockupului pentru planificarea si validarea rezultatului final dorit nu este posibila. Asa ca trebuie gasita o solutie alternativa de planificare si vizualizare a solutiei posibile si propuse inainte de a trece la prepararea dintilor care , desigur este un act ireversibil.

Avand la dispozitie intreaga tehnologie digitala am decis sa incercam o abordare diferita a situatiei urmand urmatorii pasi:
1. scanarea situatiei initiale cu sistemul CEREC OMNICAM.
2. printarea modelelor cu situatia intiala folosind imprimanta Formlabs2.
3. prepararea diagnostica a dintilor pe modelul printat.
4. amprenta optica a modelului cu dintii preparati.
5. proiectarea noului zambet in softul CEREC SW 4.5
6. prezentarea rezultatului virtual pacientei si obtinerea acordului acesteia pentru inceperea tratamentului.
Asa ca hai sa trecem la treaba.....


EN: A situation of this kind makes it difficult for us because the changes necessary to remodel the smile involve a rather aggressive preparation of the two central incisors and the use of wax up and mockup for planning and validating the desired end result is not possible. So we need to find an alternative solution to plan and vizualize the possible and proposed solution before proceeding to the preparation of the teeth which, of course, is an irreversible act.

Having all the digital technology we have decided to try a different approach to the situation by following the next steps:
1. scanning the initial situation with the CEREC OMNICAM system.
2. print models with the original situation using the Formlabs2 printer.
3. diagnostic preparation of the teeth on the printed model.
4. optical impression of the model with prepared teeth.
5. designing the new smile in the software CEREC SW 4.5
6. presenting the patient's virtual result and obtaining his / her agreement to start the treatment.
So let's get busy.....

RO: Dupa ce Diana ne-a validat proiectul virtual si s-a declarat de acord cu forma si alinierea dintilor in viitorul ei zambet, am continuat cu:
- scanarea modelului preparat in Sirona Connect SW 4.4.4 si exportul lui in Inlab 15;
- realizarea unui wax up digital in Inlab 15. Cum? Am definit restaurarile pe care le dorim a fi realizate, le-am finalizat designul in concordanta cu ceea ce s-a proiectat in CEREC SW 4.5 iar apoi folosind functia "Seat Layer" le-am fixat virtual pe modelul cu dintii preparati, obtinand astfel un nou model pe care apoi l-am salvat ca fisier .stl si l-am printat cu imprimanta Formlabs 2.

EN: After Diana validated our virtual project and agreed to the shape and alignment of her teeth in her future smile, I continued with:
- scanning the model prepared in Sirona Connect SW 4.4.4 and exporting it to Inlab 15;
- designing a digital wax up in Inlab 15. How? We have defined the restorations that we want to achieve, have completed their design according to what was designed in CEREC SW 4.5 and then using the "Seat Layer" function we virtually fixed them on the prepared teeth model, thus obtaining a new Model that I then saved as a .stl file and printed it with the Formlabs 2 printer.

RO: Acum, in sfarist ne gasim in situatia unui caz clasic si putem trece la treaba. Pasii care urmeaza de acum inainte sunt cei clasici. Am inceput cu o usoara reconturare a zeniturilor gingivale la nivelul premolarilor pentru obtinerea unei inaltimi coronare armonioase.

EN: Now, in the end, we find ourselves in the situation of a classic case and we can get to work. The steps that follow now are the classic ones. We started with a slight remodelling of the gingival zeniths at the premolars to achieve a harmonious coronary height.

RO: Am inceput cu prepararea incisivilor centrali folosind kitul de freze si tehnica P.A.G. create de dr. Jaques Raynal, dar cu o schimbare a etapelor intre ele, datorita situatiei particulare.
Primul pas a fost prepararea fetelor meziale ale celor doi centrali care s-a facut cu freza 998-0286M-FG din kit si care a permis obtinerea paralelismului dintre cele doua fete si praguri simetrice la acest nivel. Aceasta este o conditie foarte importanta pentru a "ajuta" softul sa creeze o propunere cat mai perfecta si care sa necesite interventii minime de design.

EN: I started with the preparation of the central incisors using the P.A.G. kit created by Dr. Jaques Raynal, but with a change of the steps between them due to the particular clinical situation.
The first step was to prepare the mesial surfaces of the two central incisors which was made with the 998-0286M-FG bur from the the kit and which allowed the parallelization between the two faces and the symmetrical shoulder at this level. This is a very important condition for "helping" the software to create a perfect proposal that requires minimal design interventions.

RO: Dupa prepararea fetelor meziale si reducerea din fetele vestibulare s-a trecut la reducerea inaltimii bonturilor dintilor folosind, de asemenea freze calibrate din kitul PAG.

EN: After the preparation of the mesial and buccal surfaces , the height of the teeth was reduced by also using calibrated burs from the PAG kit.

RO: S-a trecut apoi la prepararea fetei palatinale.

EN: The next step was the preparation of the palatal surface.

RO: Finisarea pragurilor s-a facut folosind inserturile speciale diamantate de la piesa de mana KAvo SonicFlex.

EN: The shoulders were finished by using the diamond inserts of the KaVo SonicFlex handpiece.

RO: Dupa ce s-a finalizat pepararea celor doi incisivi centrali s-a putut realiza primul mock up real care ne-a servit ca ghidaj la finalizarea prepararii celorlalti 6 dinti.

EN: After the finishing of the two central incisors was completed, the first real mock up could be done, which served as a guide to the preparation of the other 6 teeth.

RO: Aspectul final al celor 8 dinti preparati.

EN: The final aspect of the 8 prepared teeth.

RO: S-a realizat apoi al doilea ( si ultimul) mock up care a fost scanat in catalogul "Biocopy upper".

EN: Now, the second and final mockup was realised and after it was finished it was scanned in the "Biocopy upper catalogue".

RO: S-a finalizat amprenta optica si s-a trecut la faza de design a celor 6 fatete si 2 coroane partiale utlizand toate instrumentele avute la dispozitie in SW 4.5

EN: The optical impression was finalized and the 6 veneers and 2 partial crowns were designed using all the tools available in SW 4.5

RO: Apoi piesele proiectate au fost frezate din cuburi Empress Multi A1 C14, probate, finisate, lustruite si apoi glazurate. Aceasta etapa a fost realizata de colaboratoarea noastra MTD Cristina VASIU.

EN: Then the designed pieces were milled from Empress Multi A1 C14 blocks, checked, finished, polished and then glazed. This stage was made by our collaborating MTD Cristina VASIU.

RO: In imaginea de jos avem fatetele finalizate si pregatite pentru colaj.

EN: In the following images we can see the finished veneers ready to be applied.

RO: Rezultatul final.

EN: The final result.

RO:Concluzii:
Utilizarea tehnologiei CEREC ne permite sa includem in conceptul de "one session dentistry" chiar si cazurile mai complexe.
A fost nevoie de o prima sedinta in care am realizat consultatia si scanarea situatiei initiale. Pana a doua zi am realizat toate etapele descrise pana la momentul prepararii.
Prima anestezie a fost facuta la ora 10,30 a.m. iar seara la ora 20,30 pacienta a plecat cu noul zambet.
Desi raminem fideli conceptelor de "minim invaziv" trebuie sa fim deschisi la o preparare mai accentuata pentru cazurile in care aceste concepte nu pot fi aplicate. Chiar si asa, vitalitatea celor doi centrali a fost pastrata.
Corelarea tehnologiei CEREC cu alte tehnologii 3D conexe ( cum este imprimanta 3D Formlabs2) ne permite sa gasim solutii si pentru cazurile care nu pot fi incluse in workflowul clasic.
Nu doar ca avem la dispozitie aceste solutii, dar ele sunt si extrem de rapide, permitandu-ne sa eliminam lungile perioade de asteptare dupa etapele de laborator.
Cu toate acestea, utilizarea tehnologiei CEREC nu exclude colaborarea cu tehnicianul dentar, acesta gasindu-si locul perfect in workflowul digital al crearii unui zambet.

EN:Conclusions:
Using CEREC technology allows us to include in the concept of "one session dentistry" even the most complex cases.
In this particular case we needed a first session where we conducted the consultation and scanned the initial situation. By the next day, I did all the steps described until the time of preparation.
The first anesthesia was done at 10.30 am and in the evening at 20.30 the patient left with the new smile.
Although we remain faithful to the "minimally invasive" concepts, we must be open to more intense preparation for those instances where these concepts can not be applied. Even so, the vitality of the two centrals was preserved.
The correlation of CEREC technology with other 3D related technologies (such as the 3D Formlabs2 printer) allows us to find solutions for cases that can not be included in the classic workflow.
Not only do we have these solutions available, but they are also extremely fast, allowing us to eliminate the long waiting times after the lab stages.
However, the use of CEREC technology does not exclude collaboration with the dental technician, finding him the perfect place in the digital workflow of creating a smile.