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gone, but — no fear — the software has
been enhanced to allow us to modify
our virtual models in ways we couldn’t
before. We are able to do some of the
modifications in the Acquisition phase,
prior to the buccal bite stitching, and
thus simplifying the buccal-bite process.
Also, manipulating our virtual models
allows us to get restorations to the
milling chamber as quickly as possible
while still continuing to work in the
quadrant and leveraging milling time
(
a benefit of the SArmen technique).
Now, it is more powerful and more
flexible, increasing efficiency for the
complex cases.
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Case Study
Our patient is a 73-year-old male who has
had a healthy life and an assortment of
treatment to his mouth over the years. His
chief complaint was that he didn’t like his
smile any more. You can see in the pre-op
pictures (Figs. 2-4) he has somewear, accel-
erated due to rough ceramic restorations
abrading his lower natural dentition. Study
models were taken and a case worked up.
Patient declined to have a complete rehabil-
itationbutwanted to improvehis smile. The
limitations were explained and the patient
accepted. Wax-up was done so I could get
an idea of how the preparations had to be
to get the desired outcome. The patient was
happy with the color of his teeth, so it was
decided that we would restore the maxil-
lary incisors and the left mandibular cuspid
and incisors. Due tofinances, patient agreed
to ceramic on the maxillary teeth and the
mandibular canine with Lava Ultimate
being used for the remainder. With real-
life dentistry, sometimes concessions are
required in order to allowa case to proceed.
The patient didn’t think he could do it all
in one sitting, sowe decide to do themaxil-
lary anterior followed by mandibular.
Patient was seated and anesthetized. We
used theOmnicamfor this case. The buccal
bite and the mandibular arch were imaged
while the septocaine started to work. The
crown on #10 was removed; decay was
present on the core so that was removed,
the decay excavated and core replaced. Old
restorations were removed, and prepara-
tions were completed. In this case, cord
was placed to help prevent bleeding during
the preparation. The prepared maxillary
teeth can be seen in Figure 5. The patient
was taking blood thinners, so we wanted
to prevent any bleeding from commencing,
which could have interfered with imaging
and bonding. Due to the detail of the
Omnicam, the cord packing step often
is omitted since the detail of the image
allows one to pick up the un-powdered
margin very easily. The prepared arch
was captured and can be seen in Figures 6
and 7. When you look closely, you can see
the detail of the full-color virtual model,
dentin, enamel, soft tissue, composite,
porcelain and metal. All are easily discern-
ible not only to the dentist but to the patient
as well. When this is up on themonitor and
if the patient is able to see, be prepared for
their questions (Fig. 8).
Fig. 2: Photo of the pre-existing condition
of the teeth.
Fig. 3: Occlusal view of the maxillary
anteriors.
Fig. 4: Occlusal view of the incisal edges
of the lower teeth.
Fig. 5: Incisal view of the preparations.
Fig. 6: Omicam scan of the maxillary
prepared teeth.
Fig. 7: Initial proposal from the 4.0
Omnicam software.
Fig. 8: Omnicam proposals of the
maxillary teeth.