NobelClinician and digital workflow
- Digital Workflow.
- Smart Fusion: NobelProcera® 2G scanner and CBCT.
- NobelGuide implant placement.
- Model-Based prosthetic planning approach.
NobelClinician software provides digital treatment planning by combining the information of two sources: A CBCT scan of the patient with a scan of the model and wax-up from a NobelProcera 2G scanner (Nobel Biocare AG). This special function and technique of merging these two scans in NobelClinician is termed “Smart Fusion”. This technique requires only a single CT scan of the patient.
Prosthetic-driven treatment planning
This approach to digital treatment planning encourages so-called “backward planning” - beginning with the ideal position of the implant crowns determined by the prosthodontist or dental laboratory technician. This facilitates prosthetically driven and optimized implant positioning and placement.
The CT scan procedure needs some prerequisites to be paid attention to such as the full scan of all tooth crowns of the same jaw as well as limited amounts of artifacts due to adjacent metal or alloy-made restorations. The use of cotton rolls to separate both jaws during the scan is of utmost importance in order to allow correct identification of dental structures later in the smart fusion process. There must be at least 6 remaining teeth to ensure proper registration of the CT and NobelProcera scans (Smart Fusion).
Figure 1: Panoramic x-ray: the patient’s desire was a complete rehabilitation of the upper jaw, teeth #16 (#3 UNIV) and #13 (#6 UNIV) supporting the bridge abutment were indicated for extraction due to furcation involvement (#16) and advanced periodontal bone loss (#13)
Figure 2: Anterior view (left): Cast model with wax-up in region 12-16 (7-3 UNIV). Lateral view (right): Wax-up indicating the prosthetic space of the later implant restorations
Figure 3: The cast was mounted in the Nobel Procera 2G scanner (with scanning spray applied) Figure 4: Screenshot from the first (of two) Nobel Procera 2G scan with the wax-up in place
Figure 5: After reconstruction of the scan Figure 6: After production in the dental lab: Tracing the outline of the teeth for segmentation
Figure 7: Aspect of the second cast model NobelProcera scan alone without the wax-up Figure 8: Data set of the NobelProcera scan of the model and the wax up overlayed, followed by identification of the wax-up, the teeth are then numbered according to the original position
Figure 9: Intraoral situation before surgery (note: at the time of surgery. Tooth #16 (#3 UNIV) was still in situ Figure 10: : Intraoral situation: NobelGuide in situ (and tooth #16 extracted) with sufficient soft tissue and periodontal support of the template
Figure 11 Figure 12 Removal of soft tissue with a guided tissue punch
Figure 13: Clinical situation right before osteotomy Figure 14: Fixation of the guide after the fully guided insertion of the first 2 implants
Figure 15: (Left) Final situation after implant placement of the last implant fully guided (immediate guided implant placement). Note: Two regular and one wide platform implant inserted (in region 16 a cover screw was mounted instead of a healing abutment due to reduced primary stability)
(Right) The remaining area of the extraction site was covered with solcoseryl paste
Figure 16: Postoperative panoramic x-ray control
Figure 17: (Left) Final prosthetic restoration. (Right) Intraoral situation after insertion of the conventional cemented and screw-retained implant bridges Figure 18: Patient with the final restorations in situ