Showing Posts In: digital dentistry

Fully digital design for natural-looking results

1 April 2021 Categories: digital dentistry Tagged with: , , , , , , , , , , , , , ,

This case perfectly portrays a fully digital case and the difference the result can make to a patient’s overall appearance.

This lovely gentleman visited Dr Drew Winstanley wanting to improve the general appearance of his smile. He was unhappy with the brown and discoloured look of his teeth and had been left dissatisfied with the multiple failed attempts by previous practitioners to mask the tooth wear.

Not only is Dr Drew a relatively new client of ours, so was this patient for the practice, so we really needed to pull out all the stops… and we always do!

We started with a digital smile design using 3Shape Dental Designer, which allowed us to show both the dentist and the patient the proposed new smile digitally in 3D by superimposing it over the patient’s existing dentition. This allows an honest and open dialogue to happen between the patient, dentist and us at the lab, meaning that we can make any tweaks and adjustments as required, before any dental work was started or before any tooth structure was cut. This is key for us at Ambridge Ceramics as we believe in building strong relationships with our clients in order to deliver beautiful, functional restorations, every time.

In order to correct the bite and aesthetics of this smile, we created 11 digitally designed and milled porcelain veneers and crowns. For this specific case, two different materials were used: e.max CAD (purple block) and Zirconia Anterior Multi-Layer. Both have different refractive indices and therefore reflect light (shade) in different ways, so there’s always a potential for the end result to appear a different shade when finished or worse, when fitted.

At Ambridge Ceramics, we have found via experimentation, which zirconia works best with which lithium disilicate system (e.max) and how to treat them to enable a shade match with the final restorations.

As you can see from the final outcome, the result was harmonious and natural looking, while being strong and functional. Both Dr Drew and his patient were thrilled with the result.

 

How using a fully digital workflow helps to deliver predictable results, superior aesthetics and delighted patients [Part 1]

6 November 2018 Categories: digital dentistry digital lab digital smile design digital workflow teeth-in-a-day

Originally posted – 14 December 2017

Our client Sinead McEnhill BDS MSc (Imp Dent) MFGDP ADV DIP IMP DENT RCS (ENG) and director of Belmore Dental Implant Clinic had a 64-year-old patient who was having difficulty wearing his dentures and finding eating and speech a particular problem as his dentures were constantly moving. Also as he was due to retire, he wanted to do something to secure his future quality of life and felt strongly that his smile was something he should be more confident with.

This patient had 12 teeth remaining, all in various states of active decay. All teeth were asymptomatic, but he was embarrassed that his smile was ugly, his dentures were moving on chewing, and his ability to function and speak were greatly diminished.

His main hope at consultation was that it wasn’t too late to have implants placed and that his years of neglect wouldn’t have undermined his chances of being a suitable candidate. Using the digital workflow helped speed up the ability to get the go ahead with the treatment as the dentist and patient worked virtually with the dental lab.

The use of mainstream, everyday digital technology in treatment planning

Smartphones can be used as part of treatment planning as long as digital smile design protocol is followed. Photos of a retracted smile, full facial smile and in this case videos, are useful to a digital laboratory technician to capture important information such as dynamic smile and accurately chart the lips, smile, tooth position, buccal corridors in association with the eyes and the midline of the face. (DSD or presentation software can be used or 3Shape if you aren’t doing the full DSD protocol) DSLR images were also taken.

How Digital Smile Design helps dentists show their patients how they will look after treatment

DSLR images, CBCT and intraoral scans at this point can be sent to your digital laboratory, in this case Ambridge Ceramics. To help the dentist show both graphically and aesthetically how their patient could look post-treatment, we designed a new, highly aesthetic and achievable smile using the digital smile design principles and proportions. This is then sent back to our client via WeTransfer securely in a presentation format of choice. Our clients can then show their patients the presentation of how they could look post-treatment which really helps in treatment uptake.

In this case, and with the help of the key visuals from the digital smile design, it was decided to go with the ‘teeth in a day’ protocol – the first in the UK to be completed with Camlogs’ Conelog Implants.

How the different digital technologies are layered to provide precision and aesthetics

To allow for implant planning both CBCT and intraoral STL. scans were taken and transferred to the lab to show the upper and lower hard and soft tissues. These different files allow us as a digital laboratory to build a multi-layered picture of the patient as they present before surgery enabling us to plan the best treatment outcome possible.
This is done through:

  1. Photos and videos of the patient as they present before surgery.
  2. Obtaining information of the underlying bone and of the existing teeth in the maxilla and mandible through CBCT (3D X-ray)
  3. An STL scan of the mouth or an existing model is taken to show current hard and soft tissues.
  4. Images of how the patient will look post surgery created using Digital Smile Design protocol (DSD)
  5. This helps the implant dentist and laboratory determine the ideal placement of the implants

With this information we then planned the optimum implant fixture placement from a purely aesthetic point of view, while at the same time collaborated with the dentist to choose the ideal osteomy/implant placement sites. With all this agreed, we then have all the information required for the planning, virtual extractions, designing and printing of the implant surgical guides.