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Renewing a Smile with the glidewell.io™ In-Office Solution

October 1, 2024
Author
Jonathan Vo image
Jonathan Vo, DMD
Renewing a Smile with the glidewell.io™ In-Office Solution

The introduction of in-office milling was a rewarding experience for my practice. I began with posterior cases and enjoyed the ability to offer same-day crowns while controlling the quality of the restoration.

After about a year, I was ready to take the next step and begin milling anterior cases. To this end, I took Dr. Justin Chi’s hands-on advanced anterior course at Glidewell. The course covered the finer points of crown design and characterization, which served me well when this patient sought a remake of his smile.

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Figures 1a–1c: The patient came to my practice to address the shade and alignment of his teeth.

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Figures 2a–2c: Because the patient had crowding that needed to be addressed before restorative treatment, we initiated aligner therapy, which lasted for two years.

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Figures 3a–3d: Aligner therapy alleviated the crowding and improved the tooth positioning for the planned veneers and crowns. During aligner therapy I extracted teeth #12 and #15 due to endododontic infections. I placed two implants that integrated during the orthodontic treatment.

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Figures 4a–4c: A pre-op scan is shown in Figure 4a. Figure 4b shows a screenshot of a digital wax-up for #7–10, and Figure 4c depicts an overlay of the digital wax-up. This digital wax-up was completely additive, allowing me to be conservative with the preparations. Using a 3D-printed model of the digital wax-up, I made a PVS matrix for #6–11 provisionals. Using Luxatemp® Ultra temporary crown and bridge material (DMG America; Ridgefield Park, NJ) in the PVS matrix, I fabricated the provisionals intraorally.

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Figures 5a–5c: The patient is shown in provisionals a week after placement. I give patients several days to live in their provisionals so they can decide if they approve the design. At follow-up appointments, I solicited the patient’s feedback on the provisionals. We then selected the final shades and made any requested changes.

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Figures 6a, 6b: I reviewed shading with the patient before choosing an A2 shade.

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Figures 7a–7c: Following tooth preparation, I scanned with an iTero Element™ 5D imaging system and imported directly to the Glidewell fastdesign.io™ Software and Design Station. Teeth #6, #8 and #11 are crowns, while #7, #9 and #10 are veneer preps. Note that #12 and #15 have custom implant abutments already seated.

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Figures 8a–8c: Here is the model view from the same scans shown in Figures 7a–7c.

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Figures 9a–9d: The preparations are shown beneath the designed crowns and veneers. I used the fastdesign.io software’s design as a service function to get assistance with the design process from the glidewell.io support team. This was very helpful, as I was able to use the scans of the provisionals as a guide for the final crown design.

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Figures 10a, 10b: The support team at Glidewell provided the final design of the restorations, as shown here. I was pleased that it closely mirrored the provisionals. The new restorative design arrived overnight, ready for me to mill in my office.

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Figures 11a–11c: I used Obsidian® Milling Blocks, which I like for the natural esthetics. Obsidian restorations bond well to the teeth and are easily monitored with radiographs. I 3D-printed the final scan of the preparations. A solid model worked well for adjusting contacts as needed.

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Figure 12: I milled crowns #12 and #15, with plans for screw-retained final restorations. I drilled holes on the occlusals of the implant crowns and cemented them extraorally, allowing me to thoroughly polish and contour the margins.

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Figures 13a–13c: The patient was happy with the results. At two days post-cementation, the gingiva was healing nicely. Our next phase of treatment will be the mandibular arch.

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Figures 14a, 14b: I was pleased with how the surface anatomy and texture of the restorations provided a natural look.

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Figures 15a–15g: Here are the post-op X-rays. I am pleased with the accuracy and marginal adaptation coming out of the fastmill.io™ In-Office Mill.

CONCLUSION

The glidewell.io system helped me turn around a case efficiently and to a standard that satisfied me and the patient. The design process and milling were completed in a day, even with a full clinical schedule. I was able to stain and glaze the crowns between patients while my assistants helped with milling. I was especially pleased with the surface anatomy and texture, which gave the restorations a natural look.

Adding the skills necessary to provide anterior restorations with my mill made a rewarding experience even more gratifying, as I could provide the patient with a high-quality result in a timely manner. Whether you want to start doing anterior cases or stay with the more straightforward posteriors, I recommend glidewell.io In-Office Solution milling to any dentist looking to add another dimension to their practice.