Dr. Szabela is devoted to three matters in his life: family, professional training, and his dental practice. After completing his formal training and attaining his DDS degree from New York University in 2007, Dr. Szabela returned to his home state of New Jersey to treat families in private practice. In 2012, he opened his stateof-the-art practice, Garden State Dental Design, in Clark, NJ, focusing on esthetic rehabilitation and implant dentistry. His postgraduate certifications include: Master clinician in implant dentistry from Loma Linda University and the Global Institute for Dental Education; the Master Program in Fixed Prosthodontics focusing on Aesthetic and Functional Rehabilitation at the ACE Institute, Italy; advanced bone and soft-tissue grafting procedures from the BTI Institute in Spain; advanced training in the field of cosmetic dentistry at the UCLA School of Dentistry; and advanced training in the field of fixed orthodontics and TMJ/TMD treatments.
The Limitless Possibilities of Modern Dentistry
I invested in CAD/CAM equipment about 5 years ago and, since then, had been designing and milling single-unit restorations and small bridges for my patients, but when it came to the larger cases, I was getting fed up with the labs not being able to perform to my standard or having a long wait time. It got to the point where I decided to bring all my restorative work in-house so I could have greater control over my cases. Last year, I invested in the Planmeca FIT Plus, a sophisticated CAD/CAM system that includes the Planmeca Emerald S intraoral scanner, Planmeca PlanCAD Premium software, and the Planmeca PlanMill 50 S milling unit. Now, I’m able to provide a greater service to my patients with streamlined procedures ranging from individual crowns to hybrid implant bridges to full-mouth reconstructions. In fact, as this case shows, the possibilities are endless.
Case Presentation
A 64-year-old male presented with several old restorations that showed significant deterioration. He was unhappy both with the appearance and function of his dentition. I suggested we remove the old bridges and crowns and start anew, telling him, “We can’t just do 1 or 2 teeth. You have so much dentistry that’s been done that we basically need to re-equilibrate your bite and give you a comprehensive design for a nice, new smile. You’ll look so much younger and brighter.” After creating a smile design and showing him images of what he could look like, he said, “You know what? If you can deliver that type of work, then I’m in.” We decided to move forward with a full-mouth rehabilitation involving 28 single-unit zirconia crowns. For the 5 edentulous sites—3 maxillary and 2 mandibular—where the bridges had been, we would place 5 implants (BTI) with custom abutments and screw-retained crowns. We assessed bone quality using a cone-beam scan and designed both the temporary and permanent restorations using the intuitive Planmeca PlanCAD Premium software. Treatment began with significant prep and refinement, digital impressions with the Planmeca Emerald S, and immediate placement of esthetic PMMA temporaries, which were milled using the Planmeca PlanMill 50 S.
Prosthetic-driven implant planning was completed in Planmeca Romexis software, and the patient returned for implant surgery, followed by a healing period of 3 months. During the final appointment, we placed all 28 individual teeth, which had been milled in the Planmeca PlanMill 50 S using IPS e.max ZirCAD Prime (Ivoclar Vivadent).
Afterward, the patient was very pleased, telling me, “Thank God for modern dentistry, because I never thought this would be possible.” In years past, this would have been a longer process with Figure 3—Preoperative x-ray of patient presenting with several old restorations Figure 4—Treatment was designed using the intuitive Planmeca PlanCAD Premium software. Figure 5—The upper arch provisional milled from PMMA material Figure 6—The patient’s temporary smile following placement of the provisional restorations Figure 7—X-rays following implant placement planned in Planmeca Romexis software Figure 8—The final result. A new smile scanned, designed, and milled with the Planmeca FIT Plus. extensive lab communication, wait time, and myriad potential problems with timeconsuming solutions. This patient wanted everything done in one shot, with as few appointments as possible, and we were able to accommodate him by designing and delivering his new dentition in-house, from start to finish, in 5 months.
Conclusion
This is the future of dentistry, simply because it’s better for the patient. I was able to control the entire workflow throughout and customize the restorations to achieve the outcome that my patient desired. The digital workflow for impressions, design, and milling are the future. There’s no turning back now.
Planmeca FIT Plus
Planmeca FIT Plus comprises the Planmeca PlanMill 50 S 5 axis mill, Planmeca PlanCAD Premium design software for creating dental prosthetics, and the Planmeca Emerald S intraoral scanner. This complete solution allows clinicians to achieve maximum productivity throughout the entire digital dentistry workflow. The wide range of dental applications includes crown and bridge designs, wax-ups, removable partials, and dentures. The unit mills both wet and dry, discs and blocks, using a broad range of materials, including zirconia, glass ceramics, and temporary materials.
