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Utilizing a Digital Workflow for Provisionalization with BioTemps®

January 16, 2014
Author
image
Tarun Agarwal, DDS, PA
Tablet computer with shiny background

Today’s digital impression technology allows dentists to create a virtual, computer-generated replica of the hard and soft tissues in the mouth quickly and accurately using their choice of optical scanning device. As an ardent supporter of digital impressions, I make every attempt to digitize our restorative workflow. There are numerous benefits to a digital impression:

  • Efficiency: It takes less time to take a digital impression than a traditional impression.
  • Quicker Turnaround Time: Clinicians often forget or fail to realize the true value of this. Getting restorations back faster is better for the patient, the practice and the overall case outcome.
  • Cost Savings: Have you ever calculated the cost of taking a traditional impression for a final restoration? If you add up what your office spends on impression materials, chair time and case shipping fees, you will be amazed at how much is spent on traditional methods.

CASE PRESENTATION

The female featured in this article has been a patient in our practice for nearly eight years. She has an existing PFM bridge from teeth #5 to #12 replacing missing #7 to #10. She is not terribly unhappy with the look and feel of the bridge, but the bridge has been no stranger to the big issue facing PFM restorations: the chipping of porcelain from the metal substructure. Over the past eight years, we have patched various corners and lingual surfaces.

Recently, the patient agreed to replace her long-span PFM bridge with an implant-supported bridge on #7 to #10 and individual crowns on the abutment teeth. However, she was adamant about not going a day without teeth. We advised her that this would not be an issue.

Figure 1

Figure 1: Preoperative photograph of the patient’s existing long-span PFM bridge. Note the bulky and gray margins, unesthetic contours and “patch” composites used to repair areas of chipped porcelain.

Figure 2

Figure 2: Prior to anesthetization and preparation, a photograph is taken with several shade tabs. It is important to capture shade photographs prior to dehydration of the dentition.

Figure 3a
Figure 3b

Figures 3a, 3b: The abutment teeth are sectioned the length of the buccal and occlusal table. Diamond burs are used to section the porcelain, and then carbide burs are used to section the metal.

Due to the complexity of her implant surgery, immediate loading was not possible. This meant we needed a long-term esthetic provisional that would last the duration of the treatment, could be removed for surgery and was adjustable for post-surgical contouring. A BioTemps® provisional bridge (Glidewell Laboratories; Newport Beach, Calif.) was the quick and easy answer.

Traditionally, BioTemps are made prior to preparation and relined chairside. In this case, I wanted to have the BioTemps made to fit the final preparations of the abutment teeth, which would later be converted to individual restorations. As an advocate of digital impressions, I chose to follow a digital workflow.

 We needed a long-term esthetic provisional that would last the duration of the treatment, could be removed for surgery and was adjustable for post-surgical contouring.
Figure 4

Figure 4: The PFM bridge after removal. The bridge will be preserved for metal refining.

Figure 5

Figure 5: The original abutment preps are cleaned and reduced to the appropriate margin thickness.

Figure 6

Figure 6: A digital impression is taken using the CEREC® Omnicam (Sirona Dental Systems, Inc.; Charlotte, N.C.). This occlusal view illustrates how precisely the Omnicam captures a full-color digital impression.

Figure 7

Figure 7: Labial view of the abutment teeth preparations captured with the CEREC Omnicam. An added benefit of digital impressions is that changes don’t require an entire new impression; only a new digital capture of the changed area.

Figure 8

Figure 8: Model fabricated from the digital impression. This is an optional step, but on long-span cases, it is my preference to have a model backup for path of draw and contact verification.

Figure 9

Figure 9: The lab-fabricated, 8-unit BioTemps provisional bridge. BioTemps are proven long-term esthetic provisionals. They are easily modified, allowing esthetic changes and bite adjustments to be made chairside.

The provisional BioTemps bridge offers the following important advantages in this case:

  1. Trial Smile: The patient gets a "trial" of the new contours. Any modifications to length or contour can be made chairside, avoiding costly remakes and unhappy patients.
  2. Long-Term Durability: Due to the complexity of this case, full treatment will take well over 12 months. An acrylic provisional fabricated chairside simply won’t hold up this long.
  3. Removability: For implant surgery, the specialist will need the ability to remove and re-cement the provisional with relative ease.
  4. Adjustability: The necks of teeth #7 to #10 will need to be adjusted post-surgery to remove any pressure to the surgical sites. BioTemps are easily adjusted.
  5. Surgical Assistance: The contours and esthetics of the BioTemps will serve as a “guide” to the surgeon for grafting and placement of the implants.
Figure 10

Figure 10: The final BioTemps provisional on the digitally fabricated model. Note the less bulky contours.

Figure 11

Figure 11: The BioTemps bridge at delivery, seated with provisional cement.

As this case illustrates, digital impressions are not just limited to final restorations, and certainly not just to single units. It’s time for you to take a closer look at digital restorative technologies and see how they can benefit your practice and your patients.

Dr. Tarun Agarwal maintains a full-time private practice emphasizing esthetic, restorative and implant dentistry in Raleigh, North Carolina. Contact him via email at dra@raleighdentalarts.com or visit raleighdentalarts.com.