02/26/2021
**READ THE WHOLE POST FOR A GIVEAWAY @ THE END**
Fullarch friday in full effect. My favorite days at work and its not even close. Got to sleep in, hug my kids and then change a life. There was more laughing, chatter and positive attitude today from all parties than the normal days where you're running from patient to patient and can't focus attention on really anything. Everyone feels the stress and pressure those days, patients included. These cases deserve undivided attention and laser focus.
76 year old patient drives 6 hours roundtrip to see me. During his most recent check up during COVID, he said, "doc, gimme some chompers to eat what the heck I want while I'm still here". Half the battle is convincing patients of the 30k+ fees associated with treatment of this magnitude. Once he said let's roll, the REAL work started on his case. But the case was nearly a disaster from the get-go, so if i can help one person, its worth the time of this post...
Fully edentulous maxilla for decades. Very little bony ridge, and no desire to augment hard tissue, from the patient's perspective-- we call this a "butt pucker" full arch case, but digital sure eases the stress level. My dad had fabricated a metal-reinforced full upper denture some time ago. So unable to use it as a dual scan prosthesis. Didn't scan/3d print due to time constraints, so denture duplicated, CBCT acquired of duplicate (w composite markers attached), then CBCT of duplicate in patients mouth. He was dismissed for the day, and drove home.
Fast forward a week when i began planning and noticed that patient had been forced into malocclusion with the cotton rolls he was biting on. CBCT dual scan technique was amiss, and we had to get him back for a better scan. See screenshots below so you know what you're looking at if you ever get in the same predicament. You need a WELL FITTING DENTURE to make this process work and it has to be SEATED PROPERLY in the scan. This proper seating must be replicated during surgery to ensure consistency of virtual plan and live placement.
We teamed with TruAbutment, Inc. and the openness of Planmeca Romexis allows exportation of the implant elements, along with virtual scan bodies, implant extensions and the model stl's. Truabutment designs the All on T multi unit abutments and the prosthesis design. I 3d printed the surgical guide and temp full arch prosthesis on the SprintRay Pro printer with Dentca Denture tooth resin and finished by my team with Ivoclar Vivadent Nexco paste.
Fast forward to surgery today. As clean a surgery as I could have asked for. Barely had to adjust the temp hybrid to fit over the temp cylinders, added some chairside for fl**ge coverage. I did punt the anchor pins (poor retention with them, my fault from a guide design standpoint), and utilized the URIS Implants pylon anchor kit that screws directly into an already placed implant to really anchor down the guide. She wasn't moving from there! Loaded him up and equilibrated occlusion. He'll make the 6 hour trek in a few weeks to start the lower rehabilitation.
We will scan with All on T MUA scan bodies at Stage II and will also scan the prosthesis intraorally, communicating a few prosthetic changes to Truabutment for the final zirc prosthesis. These cases take communication, attention to detail and teamwork. They are the pinnacle of what I can offer a patient dentally, and I will never stop enjoying the feeling of torqueing in that full arch of teeth, nothing like it.
If you've read this far, I'm shipping a new Are You Numb Yet? Dental Education lid to the first person who responds as to why the photo with the torque wrench and implant carrier in it could have spelled even more potential disaster if I hadn't caught my error. Happy weekend, everyone!
