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Resident, Jonathan and Maxine Ferencz Advanced Program in Prosthodontics, New York University College of Dentistry, New York, NY; and Prosthodontist, Department of Prosthodontics, Implantology Institute, Lisbon, Portugal
Resident, Department of Periodontics, University of Southern California, Herman Ostrow School of Dentistry, Los Angeles, Calif.; and Periodontist, Department of Periodontology and Implant Dentistry, Implantology Institute, Lisbon, Portugal
Patient education is one of the many responsibilities of clinicians. Various authors have highlighted the importance of patient prosthodontic education at various phases of treatment and even attribute the success or failure of treatment to the education provided to patients regarding the services to be rendered.
Patient education should take place before treatment (that is, after clinical examination and diagnosis, which includes presentation and explanation of possible treatment limitations), during treatment (that is, restating the original diagnosis and treatment prognosis), and after treatment (that is, providing home care instructions for long-term maintenance of the treatment).
Traditional methods of patient education include pamphlets, photographs, and casts. These provide visual aids that help the patient understand the clinician’s explanations.
In 1967, Schabel described the use of acrylic resin diagnostic casts to explain the influence of structural abnormalities versus ideal conditions in complete denture rehabilitation.
With the advent of implant dentistry and prosthetically driven implant placement, new techniques and technologies have been developed and improved to provide presurgical information. Among these, presurgical cone-beam computed tomography (CBCT) scans in combination with radiographic guides provide valuable 3-dimensional (3D) information with diagnostic value for the clinician and educational value for the patient.
The ability to print the 3D images generated by the CBCT scan examination allows the clinician to show the patient an anatomic cast and explain its relationship with the envisioned restorative plan. Physical casts provide a better way for clinicians to explain treatment limitations to the patient,
and printing an otherwise 3D virtual reconstruction can be an inexpensive tool for patient education.
The present article illustrates and describes the diagnostic workflow for a patient presenting with congenitally missing lateral incisors (Fig. 1). The diagnostic waxing and fabrication of intraoral trial restorations were later used as a radiographic template for implant placement and ultimately printed in 3D to explain the need for adjunctive guided-bone regeneration surgery to the patient.
Fabricate an index of the diagnostic cast by combining light-body (Reprosil Impression Material Light Body VPS; Dentsply Sirona) and heavy-body (Reprosil VPS Impression Material Putty; Dentsply Sirona) polyvinyl siloxane impression materials.
3.
Inject autopolymerizing resin (Luxatemp Ultra; DMG America) and seat the index intraorally applying moderate pressure (Fig. 3).
Export the obtained data in digital imaging and communications in medicine (DICOM) format.
7.
Upload the DICOM file into 3D edition software (3D Slicer, v4.6, MacOS; slicer.org), ensure that the appropriate Hounsfield unit range includes the alveolus and tooth structure but excludes scatter from the metal-ceramic restorations, and export the resulting information in standard tessellation language (STL) file format.
8.
Import the obtained STL file into 3D printing software (Cura, v2.3.1; Ulimaker B.V.) and print a 3D cast (Ulimaker 2+; Ulimaker B.V.) that can be used to help explain treatment to the patient (Fig. 5).
Figure 5Three-dimensional printed cast from cone-beam computed tomography scan.
The described technique presents a straightforward and relatively inexpensive step in a prosthetically driven implant plan. It allows the clinician to obtain a physical 3D printed cast of a diagnostic CBCT scan after image optimization and file conversion with a software platform that is freely available and does not require specialized equipment.
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