today GNYDM 2

exhibitors30 Greater New York Dental Meeting — Nov. 26, 2012 Scannable abutments: digital impressions for dental implants By Carlos A. Boudet, DDS, DICOI n Technological advances are mak- ing it easy to practice dentistry in almost every dental procedure.1 This article aims to increase awareness of a new modality for the restoration of implants by general practitioners and prosthodontists utilizing chairside digital impression systems.2 Taking an implant impression for crowns and bridges requires a stock or custom impression tray loaded with a polyvinyl siloxane or poly- ether material that is placed in the mouth to record the position of a properly seated impression coping. This impression is then used to pour a stone model from which the labora- tory fabricates the final restoration. Digital intraoral impressions were first introduced in 1987 by Siemens with the CEREC 1.3 There are now several systems that offer intraoral scanning and digital impression capa- bilities for the construction of crowns and bridges without the need for impression trays or materials.4,5 For the dentist who needed an implant impression, however, this technology was yet available. In 2004, BIOMET3iintroducedacodedimplant healing abutment that provided all of the necessary implant information without the need for impression cop- ings.6 In 2010, Straumann introduced a scannable abutment called a “scan- body,” which allowed for the taking of a digital implant impression. We needed this option to be available for the most commonly used implant systems, but Straumann only works with iTero™ .5 Axis Dental Design Center has taken the concept further by develop- ingscannableabutmentsthatarecom- patible with implant systems from most of the major implant companies, allowing dentists to submit digital impressions for CAD/CAM design and milling of implant abutments and fixed restorations. However, at the time of this writing, they, too, can use only the iTero scanner.7 In February, Glidewell Laborato- ries introduced intra-oral scanning abutments under its Inclusive® line of implant products for implant systems from Astra Tech, Straumann, Neoss andZimmer,aswellasCertain® ,Prima- Connex® and Brånemark System® , NobelActive™ and NobelReplace™ . These Inclusive Scanning Abutments are also available for the lab’s line of Inclusive Tapered Implants, and they can be used to create digital implant impressions with available, compat- ible intraoral scanners, such as iTero, Lava™ C.O.S.® , CEREC® , FastScan® and the soon-to-be-compatible E4D® Den- tist. Heraeus projects to have a new intraoral scanner, the cara TRIOS® , available this year. The following case example dem- onstrates the simplicity of capturing a digital implant impression using an Inclusive Scanning Abutment and CEREC Redcam acquisition unit with version 3.8 CEREC Connect software to restore a Zimmer Screw-Vent® implant. However, any of the pre- viously mentioned chairside digital impression systems available today are compatible and can be used for this technique. Case presentation A62-year-oldmaleneededtherestora- tion of a Zimmer Screw-Vent 4.7 wide implant in the area of the right man- dibular first molar (Fig. 1). The gingiva healed around the healing abutment and was ready for the implant impres- sion. After removing the healing abut- ment, I placed the Inclusive Scan- ning Abutment and finger tightened it over the implant. If tissue shaping is required for proper emergence of the final abutment because you did not use a custom healing abutment, you can do it now. You will need good hemostasis, as bleeding will interfere with the impression. Next, we powdered the scanning abutment and adjacent teeth and took the scans for the digital impression (Fig. 2). I then took the buccal bite and correlated the models before replac- ing the scanning abutment with the healing abutment. Lastly, we selected Glidewell Labo- ratories as the dental laboratory in the CEREC Connect software and completed the detailed prescription for the simultaneous fabrication of the CAD/CAM custom abutment and crown. I selected a titanium abutment and BruxZir® Solid Zirconia crown. Before the lab began the milling process, the technician called as I had requested, and we fine-tuned the design (Fig. 3). The case arrived, I tried in and verified the fit of the CAD/CAM abut- ment, torqued it to the recommended specifications and then cemented the BruxZir crown with very minimal adjustment (Fig. 4). Conclusion I could have handled this case in- office with good results using soft-tis- sue models, a prefabricated titanium abutment prepared extraorally and an IPS e.max® crown, but why would I want to spend more time doing labo- ratory work when I can be more pro- ductive and deliver state-of-the-art dentistry to my patients? When you compare the simple steps involved in capturingdigitalimplantimpressions using scannable abutments to conven- tional impression systems, the digital method is easier and makes you a bet- ter and more productive dentist.8 References are available upon re- quest from the publisher. 5 Fig. 3 5 Fig. 4 5 Fig. 25 Fig. 1 (Photos/Provided by Glidewell Laboratories) Here at the GNYDM For more information on Glidewell Laboratories’ intra-oral scanning abut- ments, stop by the booth, No. 4400. About the author Carlos A. Boudet, DDS, DICOI, graduated from Medi- cal College of Virginia in 1980 with a DDS. He established his dental practice in West Palm Beach, Fla., in 1983 and has been there for 26 years. He is a diplo- mate of the ICOI, a member of the Central Palm Beach County Dental Society and sits on the board of di- rectors of the Atlantic Coast Dental Research Clinic. Contact him at www. boudetdds.com or (561) 968-6022.