OccluSense® by Bausch
Gewinner des Best of Class Technology Award 2019
Die Dr. Jean Bausch GmbH & Co. KG, der führende Anbieter von Artikulations- und Okklusionsprüfmitteln, wurde mit dem Cellerant Best of Class Technology Award 2019 ausgezeichnet.
"Wir treten in eine neue Ära der Zahnmedizin ein - eine Ära, die die Art und Weise, wie wir unsere Patienten und Praktiken diagnostizieren, behandeln und verwalten, verändern wird", sagte Dr. Lou Shuman, CEO von Cellerant und Gründer der Best of Class Technology Awards. "Dies war ein Durchbruch in der Produkt- und Dienstleistungstechnologie. Das Komitee verbrachte Hunderte von Stunden, um die Unternehmenslandschaft zu überprüfen und zu analysieren. Achten Sie genau auf unsere Gewinner, da sie wirklich führend sind, um Ihnen das Beste aus der heutigen modernen Praxis zu bieten."
Figure 1. A fractured full-arch zirconia restoration. Despite recent improvements in the strength and accuracy of ceramo-metal materials, modern dental materials remain capable of fracture. Note the location of the fracture adjacent to the titanium cylinder, a susceptible area where the material can be thin.
Figure 2. Various types of articulating paper (Bausch; Köln, Germany), ranging from 40 microns to 200 microns in thickness. Most articulating papers are available in strips designed to analyze one side of the mouth, while others are horseshoe-shaped to analyze the entire mouth.
Figure 3. OccluSense® device (Bausch; Köln, Germany), which combines traditional carbon articulation with digital pressure-sensing registration, allowing the recording of masticatory forces over a designated time period. The masticatory pressure is recorded digitally with more than 1000 points of contact in 256 pressure levels and is transmitted wirelessly to an iPad, where the data can be read in 2- and 3-dimensional graphics.
Figure 4. Preoperative panoramic radiograph of the patient. On the failing maxillary arch, implant No. 4 is not integrated, implant No. 13 has crestal bone loss, and natural teeth have gross decay and infection. On the failing mandibular arch, many of the implants demonstrate significant bone loss.
Figure 5. Preoperative photograph showing failing maxillary and mandibular full-arch prostheses.
Figure 6. CHROMETM GuidedSMILE (ROE Dental Laboratory, Independence, Ohio) fully guided surgical guide, with mechanisms for a stackable bone-supported framework. Based on digital planning of the case, this surgical guide was fabricated for the extraction of existing dentition/implants as well as for placement of final implants.
Figure 7. Immediate loading of the maxillary dental implants utilizing the CHROMETM GuidedSMILE (ROE Dental Laboratory, Independence, Ohio) stackable system. The system helped create a prefabricated provisional prosthesis that was luted intraorally to titanium cylinders seated on multi-unit abutments.
Figure 8. The iJIGTM protocol (ROE Dental Dental Laboratory, Independence, Ohio) was used to create a final maxillary prosthesis. The part of the protocol shown here involved luting together a sectioned resin arch, flowing polyvinyl siloxane underneath it to capture the soft tissue form, and flowing Blu Mousse over it to capture the occlusion.
Figure 9. The next step in the iJIGTM protocol (ROE Dental Dental Laboratory, Independence, Ohio), at which a full-arch printed resin try-in was seated onto multi-unit abutments to verify fit, soft tissue adaptation, occlusion, phonetics, and esthetics. The resin try-in was fabricated using the information from the luted, sectioned resin arch that had been produced at the previous appointment. The occlusion and all excursive movements were captured by traditional articulation with carbon paper and foil and were adjusted prior to final prosthesis fabrication.
Figure 10. A final monolithic zirconia prosthetic was milled, sintered, stained, and delivered.
Figure 11. Immediately loaded temporary prosthesis for the mandibular arch, created through the improved CHROMETM GuidedSMILE (ROE Dental Laboratory, Independence, Ohio) protocol with C2F (convert to final) small hole technology. Note the difference in size of the holes in this improved prefabricated provisional prosthesis versus the maxillary one.
Figure 12. To achieve data collection using extraoral photogrammetry iCAM 4D (iMetric4D; Courgenay, Switzerland) scannable analogs that resemble dominoes are placed in the patient's mouth and scanned in addition to traditional intraoral scanning of the patient's arch and temporary prosthesis. This accurate scanning technique allows a final zirconia prosthesis to be delivered without additional verification jigs or printed try-ins.
Figure 13. Final mandibular zirconia prosthesis. The prosthesis was inserted without Ti-bases, which allowed for increased thickness of zirconia to increase strength for the final prosthesis.
Figure 14. Data collected from the OccluSense® pressure measuring system (Bausch; Köln, Germany), showing an initial unbalanced bite, with 72% of the occlusal force concentrated around the lower left posterior region. Following some occlusal adjustments, the patient's occlusion was correctly balanced and evenly distributed.
Figure 15. Follow-up panoramic radiograph of completed treatment with final maxillary and mandibular zirconia prostheses.
Discussion
The unique needs of this particular patient, who required dual-arch treatment, allowed for the comparison of the two articulation methods: digital dental articulation versus traditional articulation. The patient reported that, although the surgical aspects of treatment were similar in both arches, the mandibular restorative process was vastly simpler and significantly more comfortable from the outset of temporization to delivery of the final prosthesis. Anecdotally, the difference in the two experiences can be attributed to improvement in intraoral scanning devices, the use of photogrammetry, and the digital occlusal-pressure articulating system for the mandibular restoration, which were not available at the time of the initial treatment 4 years earlier. The ability to capture all phases of the static and dynamic occlusal and excursive movements in real time significantly reduced chairtime for this patient while providing the clinician with a predictable post-restorative treatment.
Conclusion
While this case demonstrates the usefulness of the OccluSense pressure measuring system for full-mouth implant-supported restorations, in the dental practice of the authors the device also plays an integral role in orthodontics, general dentistry, management of TMD, and even treatment with traditional fixed or removable prosthodontics.
Ensuring functional occlusion is central to the treatment of patients requiring full-arch restorations and to the longevity of the prosthesis. When used in conjunction with traditional articulation, digital occlusal-pressure articulation can provide high levels of accuracy in the measurement of functional occlusion. Using the innovative digital occlusal-pressure measurement system described in this article, both static and dynamic occlusion can be captured to decipher occlusal patterns, which is crucial to facilitating full-arch or full-mouth rehabilitation.
References
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Ganz S, Tawil I. Full arch implant surgical and restorative considerations: innovative digital workflow using a verification jig with teeth. Dentistry Today. January 1, 2020. https://www.dentistrytoday.com/full-arch-implant-surgical-and-restorative-considerations- innovative-digital-workflow-using-a-verification-jig-with-teeth/. Accessed March 14, 2022.
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About the Authors
Isaac Tawil, DDS, MS
Private Practice, Brooklyn, New York
Scott Ganz, DMD;
Private Practice, New York, New York; and Fort Lee, New Jersey
Michael Erdos, DDS
Private Practice, New York, New York