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BURBANK DENTAL LAB / BLOG / Fully Digital Workflow: An All On 4 Case Study

Fully Digital Workflow: An All On 4 Case Study

mm Written by Andrew Sedler

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COMING SOON

Dental treatments have the potential to ease oral pain, restore bites, and improve smiles, as well as to improve a patient’s self-esteem.

Oral esthetics can directly impact a person’s perceived quality of life. Tooth loss, in particular, can have a profound impact on esthetics and, thus, be a significant contributor to low self-esteem.

One of the most rewarding parts of dentistry is finding solutions that help patients improve their facial esthetics while simultaneously improving their function.

All On 4 dental implant restorations offer exceptional treatment options for patients suffering from tooth loss.

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The All On X Digital Workflow with Dr. Husam Elias, MD, DMD, FACS - Southern California Center of Surgical Arts

Case Study

This case was sent to Burbank Dental Lab by Dr. August de Oliveira. The patient presented as having lost most of her teeth in her 20s.

After an exam, it was determined that this patient would be an excellent candidate for the All On 4 dental implant technique.

The patient had implants placed. At the time of the surgery, her dentures were converted, and she was able to wear them for a year.

Fully Digital Workflow: All On 4 Case Study

The treatment plan, however, was to provide the patient with a stronger, more resilient solution. As with any All On 4 treatment, having an accurate record of the patient’s current dentition is important. This helps with determining the midline and aids in tooth placement. The patient’s converted denture provided this necessary information.

Fully Digital Workflow: All On 4 Case Study
Why I Trust and Use Burbank Dental Lab - by Dr. Mike Golpa, DDS

Digital Scans

This case was done using a completely digital workflow. The first step in gathering the necessary data was to scan the implant sites to measure their exact orientation and position. This was done using the Imetric 4D ICam 4d extraoral scanner, which is an excellent option for multi-implant scans.

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STEP 1

Burbank Dental Lab implant scan specialist provides the special scan bodies for insertion in the patient’s newly placed implant sites.

STEP 2

Scan Bodies are removed and special healing abutments are placed on the implant sites. Soft tissue can now be scanned with an intra-oral scanner.

STEP 3

The data from both scans are then sent to the laboratory. The ICam4d data and soft tissue scans are aligned to become a high-precision dental model.

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The iCam4d system uses special scan bodies to record the implant position.

iCam4D - Special scan bodies

The scan bodies (iCambodies) are inserted into the patient’s implant sites. They should not be torqued down but hand-tightened.

These scan bodies contain unique 3D coding that provides the implant’s location data in a digital format. This data is captured using the iCam4d systems extraoral scanner. The accuracy of these scans is within 10 to 15 microns.

Next, the scan bodies were removed. The soft tissue and bites were then recorded. These scans were done using the 3Shape scanner.

Fully Digital Workflow: All On 4 Case Study

The data from both the abutment scan and the soft tissue scan was then sent to the digital portal at Burbank Dental Lab. You can access the portal from the home page at https://burbankdental.com. These scans were then aligned to become the digital representation of the patient’s mouth.

Dr. August de Oliveira sent an additional bit of digital data in the form of a 3D face scan. This was used as a visual aide to relate the face to the digital model. This helped provide another bit of data to help ensure a correct midline.

Fully Digital Workflow: All On 4 Case Study
Fully Digital Workflow: All On 4 Case Study
IMETRIC Digital Scan In-Office Service - LOS ANGELES AREA ONLY

DuraTemp Provisionals

A Polymethyl Methacrylate (PMMA) DuraTemp provisional was milled from the uploaded digital data provided from the various scans.

Titanium cylinders were used over the implant sites. This gave the patient a prototype to wear and evaluate before the final restorations were fabricated.

The provisionals were evaluated for the following:

  • Overall fit and patient comfort
  • Proper bite and occlusion (close-up)
  • Evaluate esthetics, including tissue esthetics

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ZIRMAX M

ZIRMAX ME - Burbank Dental Lab CA

The final restorations were fabricated with zirconia.

Specifically, the material was the ZIRMAX M hybrid prosthesis from Burbank Dental Lab. This material was chosen because it is both strong (1200 MPa) and highly esthetic.

Fully Digital Workflow: All On 4 Case Study

Its ability to withstand heavy occlusal loads makes it one of the best material choices for All On 4 treatments.

In addition, ZIRMAX M has the following attributes:

  • It is highly durable and does not chip.
  • Feels like natural dentition.
  • Provides life-like natural results.
  • Used successfully for over 10 years.
Master FirstFit in a Day! - Event - Burbank Dental Lab - Burbank, CA

Try-in

The final step, in this case, was the final seat. A passive fit is crucial for an All On 4 restoration.

In multi-unit cases that have a poor fit, the overall function of the case will be compromised, putting the framework and the implants under stress. This also will result in poor bone resorption.

The case was first tied in by using a single screw in one of the abutments. Once the screw is in place, the opposite side of the restoration is evaluated for proper fit. To ensure a passive fit has been achieved, it is evaluated clinically and by radiograph.

Fully Digital Workflow: All On 4 Case Study
How To Avoid A Dental Prosthesis Remake Due To Fit - by Vincent Nalbandian, Implant Department Manager

The Multi-Unit Digital Workflow

Burbank Dental Lab has provided the complete steps for their multi-unit digital workflow:

  1. Patients must have an accurate record of their existing dentition. This can be a study model or denture.
  2. If you are not currently using this technology in your office, a Burbank Dental Lab implant specialist can be scheduled to come to your office and place the iCambodies (scan bodies). Call or click here for a complete list of current service areas.
  3. Record the position of the implants using an iCam4D scanner.
  4. Using an intraoral scanner, scan the soft tissue.
  5. A digital dental model is created from the uploaded scans.
  6. Create a DuraTemp PMMA provisional.
  7. Evaluate the provisional.
  8. Fabricate the final prosthesis.
  9. Try-in the prosthesis to ensure a passive fit.

Using proper planning and appropriate steps, the final prosthesis had an amazing fit, and the patient loved her new smile. This case brought this young patient comfort, convenience, and overall improved health, but perhaps most importantly, it gave her back a beautiful smile.

Fully Digital Workflow: All On 4 Case Study
Fully Digital Workflow: All On 4 Case Study

Call Burbank Dental Lab today to learn more about our fully digital workflows.

The Dental Office of Dr. August de Oliveira

Burbank Dental Lab would like to thank Dr. August de Oliveira for sending this case and providing the photos and notes.

Dr. August de Oliveira, DDS

Dr. August de Oliveira, DDS

Front Desk Pro with Sandy Pardue - Burbank Dental Lab - Burbank, CA

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Slide 1

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