Originally posted - 14 December 2017

Our client Sinead McEnhill BDS MSc (Imp Dent) MFGDP ADV DIP IMP DENT RCS (ENG) and director of Belmore Dental Implant Clinic had a 64-year-old patient who was having difficulty wearing his dentures and finding eating and speech a particular problem as his dentures were constantly moving. Also as he was due to retire, he wanted to do something to secure his future quality of life and felt strongly that his smile was something he should be more confident with.

This patient had 12 teeth remaining, all in various states of active decay. All teeth were asymptomatic, but he was embarrassed that his smile was ugly, his dentures were moving on chewing, and his ability to function and speak were greatly diminished.

His main hope at consultation was that it wasn’t too late to have implants placed and that his years of neglect wouldn’t have undermined his chances of being a suitable candidate. Using the digital workflow helped speed up the ability to get the go ahead with the treatment as the dentist and patient worked virtually with the dental lab.

The use of mainstream, everyday digital technology in treatment planning

Smartphones can be used as part of treatment planning as long as digital smile design protocol is followed. Photos of a retracted smile, full facial smile and in this case videos, are useful to a digital laboratory technician to capture important information such as dynamic smile and accurately chart the lips, smile, tooth position, buccal corridors in association with the eyes and the midline of the face. (DSD or presentation software can be used or 3Shape if you aren’t doing the full DSD protocol) DSLR images were also taken.

How Digital Smile Design helps dentists show their patients how they will look after treatment

DSLR images, CBCT and intraoral scans at this point can be sent to your digital laboratory, in this case Ambridge Ceramics. To help the dentist show both graphically and aesthetically how their patient could look post-treatment, we designed a new, highly aesthetic and achievable smile using the digital smile design principles and proportions. This is then sent back to our client via WeTransfer securely in a presentation format of choice. Our clients can then show their patients the presentation of how they could look post-treatment which really helps in treatment uptake.

In this case, and with the help of the key visuals from the digital smile design, it was decided to go with the ‘teeth in a day’ protocol – the first in the UK to be completed with Camlogs’ Conelog Implants.

How the different digital technologies are layered to provide precision and aesthetics

To allow for implant planning both CBCT and intraoral STL. scans were taken and transferred to the lab to show the upper and lower hard and soft tissues. These different files allow us as a digital laboratory to build a multi-layered picture of the patient as they present before surgery enabling us to plan the best treatment outcome possible.
This is done through:

1. Photos and videos of the patient as they present before surgery.
2. Obtaining information of the underlying bone and of the existing teeth in the maxilla and mandible through CBCT (3D X-ray)
3. An STL scan of the mouth or an existing model is taken to show current hard and soft tissues.
4. Images of how the patient will look post surgery created using Digital Smile Design protocol (DSD)
5. This helps the implant dentist and laboratory determine the ideal placement of the implants

With this information we then planned the optimum implant fixture placement from a purely aesthetic point of view, while at the same time collaborated with the dentist to choose the ideal osteomy/implant placement sites. With all this agreed, we then have all the information required for the planning, virtual extractions, designing and printing of the implant surgical guides.