Fully Digital Workflow: An All On 4 Case Study

Dental treatments not only have the potential to ease oral pain, restore bites and improve smiles, but they also have the potential of improving a patient's self-esteem.

Oral esthetics can have a direct impact on a person's perceived quality of life. Tooth loss, in particular, can have a profound impact on esthetics, thereby a significant contributor to low self-esteem.

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

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

Case Study

This case was sent to Burbank Dental Lab by Dr. August de Oliveira. The patient presented 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 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, it is important to have an accurate record of the patient’s current dentition. This helps with determining the midline as well as aiding in tooth placement. The patient's converted denture provided this necessary information.

Converted Denture - All On 4

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 the exact orientation and position of the implants. This was done using Imetric4D’s ICam4d extraoral scanner. This scanner is an excellent option for multi-implant scans.

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

iCam4D - Special scan bodies

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

These scan bodies contain unique 3D coding that provides the location data of the implant 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.

all-on-4-fully-fully-digital-workflow04
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

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 provided the patient with 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
All On "X" Success Guide Coming Soon

ZIRMAX M

The final restorations were fabricated with zirconia.

Specifically, the material was the ZIRMAX M hybrid prosthesis from Burbank Dental Lab. This material was chosen for being both strong (1200 MPa) as well as highly esthetic.

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 extremely durable and does not chip.
  • Feels like natural dentition.
  • Provides life-like natural results.
  • Used successfully for over 10 years.

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 both clinically and by radiograph.

The Multi-Unit Digital Workflow

Here are Burbank Dental Lab’s complete multi-unit digital workflow steps:

  1. Patients must have an accurate record of their existing dentition. This can be a study model or denture.
  2. If you are not using this technology in your office currently, 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.

By using the proper planning and making the 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 find out more about our fully digital workflows.

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

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Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.