Dr. Beat R. Kurt
• Dr. Kurt received his Master’s degree in Dental Medicine in 1990 from the University of Bern and completed his postgraduate education in oral surgery at the clinic of dento-maxillo surgery at the Central Hospital of Lucerne.
• He specialises in implantology, guided implant surgery, soft tissue management and bone augmentation. He is a referral for oral surgery, complex reconstructive dentistry and synoptic dentistry.
• Dr. Kurt has been in private practice for over 25 years in Lucerne, Switzerland. He has over 17 years of experience working with various guided surgery systems and has used a complete digital workflow for several years.
the clinical case
the clinical case
A 62-year-old male patient was referred to my practice for implant planning and treatment in the maxillary anterior region. The teeth in the maxillary anterior region (4×4) all had undergone endodontic therapy, and teeth #11, #21 and #22 had received crowns due to a previous accident that occurred 30 years ago. The patient reported pain and was conscious that tooth #21 was mobile (Fig. 1A-B)
The first step was to obtain a Cone Beam Computer Tomography (CBCT) scan of the maxillary arch which revealed periapical pathology in all of the patient’s four front teeth. Furthermore, tooth #21 exhibited significant loss of buccal bone (Fig. 2A, B) and also a small piece of amalgam was identified in the bone near tooth #21.
After a thorough analysis of the x-ray findings, a treatment plan was established to extract the incisors (teeth #12 through #22) and perform a socket ridge preservation to reduce bone loss to the extraction site.
As routine protocol in my dental practice, we captured a digital impression of the maxillary and mandibular arches with the DEXIS™ IS 3800 intraoral scanner (Fig. 3A, B), along with intraoral photographs to document the initial oral condition. These digital models were used for the fabrication of the temporary removable prothesis.
Upon receiving approval from the insurance company for the proposed treatment plan, all four teeth were extracted. Following the extractions, the alveoli sockets were meticulously debrided with EthOss degranulation burs and filled with EthOss to promote primary closure and healing of the wound (Fig. 4).
To preserve both the aesthetic and functional aspects for the patient during the time between extraction of the teeth and the new bridgework, a provisional removable prosthesis was fabricated (Fig. 5). The patient’s general dentist has also been working fully digitally for years and the temporary restoration was made with a digital impression and printed models.
Two months post-extraction, we obtained a CBCT scan (Fig. 6) of the maxilla and captured digital impressions using our DEXIS IS 3800 intraoral scanner (Fig. 7A, B). These scans were essential for commencing the implant planning process and creating the surgical template.
During the implant planning phase, we created a preliminary plan using 3D imaging software with a prosthetic-driven implant planning approach (Fig. 8A), which was exported into surgical guide planning software for final planning and construction of the surgical drilling template (Fig. 9A, B, C).
The implants were planned in all four positions with the object of identifying the two most optimal and accessible sites for the placement of two implants and the corresponding bridge restoration (Fig. 8B).
After the completion of the planning and drilling reconstruction, the surgical template was 3D printed with a Stratasys printer using MED610.
“The buccal bone was again thickened with EthOss, and the wound was closed with a semi-submerged technique.”
The two implants (Straumann™ BLT RC 4.1mm, 12mm SLActive Roxolid) were then placed utilizing the Straumann guide kit for precise guidance. The remaining piece of amalgam in the bone region of tooth #21 was carefully removed — only a small piece in the gingiva was remaining (Fig. 10).
The buccal bone was again thickened with EthOss and the wound was closed with a semi- submerged technique, facilitating proper healing and integration of the implants (Fig. 11A, B).
After a 10 week osseointegration and healing period, the patient returns for a final assessment of the implant stability using the Implant Stability Quotient (ISQ) measurement.
The subsequent step involves the completion of the final prosthetic reconstruction, that will be performed by the patient’s general dentist at his regular practice. To create the screw-retained monolithic bridge a digital impression will be obtained using an intraoral scanner and the dental technician will also work fully digitally — as far as possible — for the final restoration.
SOURCES
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2) Mangano F, Lerner H, Margiani B, Solop I, Latuta N, Admakin O. Congruence between Meshes and Library Files of Implant Scanbodies: An In Vitro Study Comparing Five Intraoral Scanners. J Clin Med. 2020 Jul 9;9(7):2174. doi: 10.3390/jcm9072174.
3) Lerner H, Mouhyi J, Admakin O, Mangano F. Artificial intelligence in fixed implant prosthodontics: a retrospective study of 106 implant- supported monolithic zirconia crowns inserted in the posterior jaws of 90 patients. BMC Oral Health. 2020 Mar 19;20(1):80. doi: 10.1186/s12903-020-1062-4.
4) Revilla-León M, Supaphakorn A, Barmak AB, Rutkunas V, Kois JC. Influence of print orientation on the intaglio surface accuracy (trueness and precision) of tilting stereolithography definitive resin-ceramic crowns. J Prosthet Dent. 2023 Apr 25:S0022-3913(23)00186-5. doi: 10.1016/j.prosdent.2023.03.020. Online ahead of print.
5) Corbani K, Hardan L, Eid R, Skienhe H, Alharbi N, Ozcan M, Salameh Z. Fracture Resistance of Three-unit Fixed Dental Prostheses Fabricated with Milled and 3D Printed Composite-based Materials. J Contemp Dent Pract. 2021 Sep 1;22(9):985-990.