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Full mouth rehabilitation with implant-supported fixed prosthesis via dental CAD-CAM system

Dental CAD-CAM system을 통한 고정성 전악 임플란트 수복 증례

  • Hong, Jeong-Min (Department of Prosthodontics, School of Dentistry, Seoul National University) ;
  • Han, Jung-Suk (Department of Prosthodontics, School of Dentistry, Seoul National University) ;
  • Yoon, Hyung-In (Department of Prosthodontics, School of Dentistry, Seoul National University) ;
  • Yeo, In-Sung Luke (Department of Prosthodontics, School of Dentistry, Seoul National University)
  • 홍정민 (서울대학교 치의학대학원 치과보철학교실) ;
  • 한중석 (서울대학교 치의학대학원 치과보철학교실) ;
  • 윤형인 (서울대학교 치의학대학원 치과보철학교실) ;
  • 여인성 (서울대학교 치의학대학원 치과보철학교실)
  • Received : 2020.09.10
  • Accepted : 2020.10.13
  • Published : 2021.01.29

Abstract

Dental implants should be placed at ideal sites for implant-supported restorations. For a patient with insufficient residual ridge, mouth preparation including surgical intervention can be indicated to establish a soft and hard tissue environment favorable for a definitive prosthesis. Prosthodontic design based on computer-guided surgery and computer-aided design-computer-aided manufacturing (CAD-CAM) provides a visual blueprint allowing a clinician to assess the necessity of such a surgical intervention beforehand. In this case, a definitive restoration was planned and made via a CAD-CAM system according to the patient's oral status before treatment, simulated surgical interventions and serial provisional restorations. Based on the planning, a guided template was made and the implants were installed with bone augmentation using the template. Customized abutments, the first and the second provisional restorations were designed and fabricated by CAD-CAM. The definitive restorations were digitally made following the shape of the second provisional prostheses, which were confirmed in the patient's mouth. The patient was satisfied with the masticatory, phonetic and aesthetic functions of these definitive prostheses.

임플란트를 사용한 수복치료에서는 보철물을 위한 이상적인 위치에 임플란트가 식립되어야 한다. 치조골이 부족한 환자의 경우에는 최종 보철물을 위한 적절한 연조직 및 경조직 지지를 얻기 위해서 수술적인 처치를 포함한 구강내 처치를 필요로 하게 된다. CAD-CAM 기술을 활용한 보철물 설계는 위와 같은 수술적 처치의 필요성에 대해 임상가가 사전적으로 평가해볼 수 있는 청사진을 제시해준다. 본 증례에서는 CAD-CAM system을 통해 환자의 치료 전 구내상황, 수술적 처치에 대한 예상, 일련의 임시 보철물을 반영하여 최종 보철물을 계획하고 제작하였다. 최종 보철물을 반영하여 제작한 수술용 가이드를 사용하여 임플란트를 식립함과 동시에 치조골 증대술을 시행하였다. 이후 CAD-CAM을 활용하여, 맞춤형 지대주와 1차 및 2차 잠정 수복물을 디자인하고 제작하였으며, 환자의 구내에서 평가를 거친 2차 잠정 보철물과 동일한 형태의 최종 보철물을 제작하였다. 저작, 발음, 심미 기능에 있어서 환자와 술자 모두 만족할만한 결과를 얻을 수 있었다.

Keywords

References

  1. Misch CE. Contemporary implant dentistry. 3rd ed. St. Louis: Mosby; 2008.
  2. Pozidi G, Lamprinoudi A, Papavasileiou G, Kamposiora P, Pallis D. Implant rehabilitation of the edentulous maxilla. A case series of different treatment options. Clin Oral Impl Res 2016;27:389. https://doi.org/10.1111/clr.387_12958
  3. Joda T, Bragger U. Digital vs. conventional implant prosthetic workflows: a cost/time analysis. Clin Oral Implants Res 2015;26:1430-5. https://doi.org/10.1111/clr.12476
  4. Kapos T, Ashy LM, Gallucci GO, Weber HP, Wismeijer D. Computer-aided design and computer-assisted manufacturing in prosthetic implant dentistry. Int J Oral Maxillofac Implants 2009;24:110-7.
  5. Becker CM, Kaiser DA. Surgical guide for dental implant placement. J Prosthet Dent 2000;83:248-51. https://doi.org/10.1016/S0022-3913(00)80018-9
  6. Raico Gallardo YN, da Silva-Olivio IRT, Mukai E, Morimoto S, Sesma N, Cordaro L. Accuracy comparison of guided surgery for dental implants according to the tissue of support: a systematic review and meta-analysis. Clin Oral Implants Res 2017;28:602-12. https://doi.org/10.1111/clr.12841
  7. Azari A, Nikzad S. Computer-assisted implantology: historical background and potential outcomes-a review. Int J Med Robot 2008;4:95-104. https://doi.org/10.1002/rcs.188
  8. Garber DA, Belser UC. Restoration-driven implant placement with restoration-generated site development. Compend Contin Educ Dent 1995;16:796, 798-802, 804.
  9. Kwon KR. The prosthetic approach for collapsed vertical dimensions of occlusion. J Dent Rehabil Appl Sci 2004;20:169-81.
  10. Morton D, Gallucci G, Lin WS, Pjetursson B, Polido W, Roehling S, Sailer I, Aghaloo T, Albera H, Bohner L, Braut V, Buser D, Chen S, Dawson A, Eckert S, Gahlert M, Hamilton A, Jaffin R, Jarry C, Karayazgan B, Laine J, Martin W, Rahman L, Schlegel A, Shiota M, Stilwell C, Vorster C, Zembic A, Zhou W. Group 2 ITI consensus report: Prosthodontics and implant dentistry. Clin Oral Implants Res 2018;29:215-23.
  11. Vigolo P, Fonzi F, Majzoub Z, Cordioli G. An evaluation of impression techniques for multiple internal connection implant prostheses. J Prosthet Dent 2004;92:470-6. https://doi.org/10.1016/j.prosdent.2004.08.015
  12. Zitzmann NU, Marinello CP. Treatment plan for restoring the edentulous maxilla with implant-supported restorations: removable overdenture versus fixed partial denture design. J Prosthet Dent 1999; 82:188-96. https://doi.org/10.1016/S0022-3913(99)70155-1
  13. Schweiger J, Guth JF, Edelhoff D, Stumbaum J. Virtual evaluation for CAD-CAM-fabricated complete dentures. J Prosthet Dent 2017;117:28-33. https://doi.org/10.1016/j.prosdent.2016.05.015
  14. Lee JH, Kim SH, Han JS, Yeo IL, Yoon HI. Contemporary full-mouth rehabilitation using a digital smile design in combination with conventional and computer-aided design/manufacturing restorative materials in a patient with bruxism: A case report. Medicine (Baltimore) 2019;98:e18164. https://doi.org/10.1097/md.0000000000018164
  15. Sun Y, Luebbers HT, Agbaje JO, Schepers S, Politis C, Van Slycke S, Vrielinck L. Accuracy of dental implant placement using CBCT-derived mucosa-supported stereolithographic template. Clin Implant Dent Relat Res 2015;17:862-70. https://doi.org/10.1111/cid.12189
  16. Poli PP, Muktadar AK, Souza FA, Maiorana C, Beretta M. Computer-guided implant placement associated with computer-aided bone regeneration in the treatment of atrophied partially edentulous alveolar ridges: A proof-of-concept study. J Dent Sci 2020 [in press].
  17. Wittneben JG, Buser D, Salvi GE, Burgin W, Hicklin S, Bragger U. Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study. Clin Implant Dent Relat Res 2014;16:356-64. https://doi.org/10.1111/cid.12066