Dual-arch guided smile treatment

chrome guided surgeryPaul Worskett describes the case of a patient who chose Chrome guided surgery to restore their form and function.

A 61-year-old male patient attended the practice requesting treatment to restore his lower arch, as he was unhappy with the appearance and function of the teeth and felt self-conscious.

Medically, he had a history of heart surgery for a defective valve, which was replaced in 2016, and was on warfarin and a beta blocker. In September 2020, his international normalised ratio (INR) level was 1.9.

Clinical examination

Upon examination, his soft tissues – both intra- and extraorally – were normal with no pathology.

In the upper arch, the lateral incisors were missing, there was caries in the premolars, and other maxillary teeth were heavily restored with poor aesthetics.

As for the lower arch, all the lower anterior teeth had been restored with crowns and apicected. As a result, all the lower teeth had short roots and were mobile.

The occlusion was edge-to-edge in terms of the centric jaw relationship (CJR) but was over-closed due to wear and tooth movement.

  • Figure 1: Preoperative full facial

Preparing for treatment

Following a discussion about treatment options, the agreed plan was to proceed with dual-arch Chrome guided smile treatment.

The following diagnostic records were then taken:

  • Impressions for Denar-mounted study models
  • Full-face photos (smiling and retracted), retracted occlusals (frontal and right/left lateral)
  • CBCT of both arches
  • Bite registration was recorded with vertical dimension of occlusion (OVD) opened by 2mm, with photos of the occlusion taken.

The records were uploaded to Quoris 3D for primary evaluation. Subsequently, the online planning meeting was arranged with ROE Dental Laboratory and attended via Microsoft Teams.

The case was approved for production and the first report sent by ROE Dental laboratory via email.

Performing surgery

The day of surgery was booked for mid-February 2021. In preparation, implants, multi-unit abutments (MUAs) and temporary copings were ordered from the suppliers (Neodent).

The Chrome box arrived from Quoris 3D, which contained everything needed to complete the case. This including guides, and a Surgimat, which organises and guides the surgery protocol.

During the surgery, five implants were placed in the maxilla and four in the mandible, with full-arch bridge restorations constructed chairside and fitted. The patient’s occlusion was checked and adjusted to achieve even contact bilaterally.

Follow-up was arranged for two weeks postoperative, at which time the bridges and sutures were removed. The bridges were then refitted, and the occlusion refined. The final bridge is planned for construction in three months’ time.

So far, the patient is very happy with the results and is looking forward to the final outcome. For the dental team, all has gone very well, with the Chrome implant system enabling us to expand our treatment options and provide a better service, which very much fits in with our practice ethos.

  • Figure 7: Postoperative full facial

Shine on

Chrome offers pioneering full-arch stackable guide technology. It was developed for dentists who desire a pre-planned, predictable guided ‘all-on-X’ type of surgery.

In its entirety, the Chrome service delivers anchored bite verification, anchored bone reduction, anchored site drilling, accurate anchored provisionalisation, and a method of transferring all surgical and restorative information for the final restorative conversion phase.

If you would like to try Chrome for yourself, for a limited period the Quoris 3D team is inviting dentists to take up its offer of a free case evaluation. Simply send a CBCT and retracted side-on and face-on photos and the team will evaluate the case with you.

For more information, contact sales managers Orla Sheehy (sales manager Ireland and Scotland) on +353 874512000 or Amanda Williams (sales manager England and Wales), on 07769 353598. Alternatively, visit quoris3d.com or email [email protected].

This article first appeared in Implant Dentistry Today magazine. You can read the latest issue here. 

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