Implant Tribune Italian Edition

17Implant Tribune Italian Edition - Maggio 2013 Letteratura Internazionale << page 16 While survey estimates vary greatly on the percentage of general dental practitioners who are actually pla- cing their own implants1-3 , it is safe to say and readily acknowledged that nearly all general practitioners and their teams discuss and offer implant therapy as an option in tre- atment plans dealing with edentu- lous areas. In fact, there continues to be a high annual growth rate predicted, not only for implants and their accom- panying parts and procedures4 , but also for single crown restorations — with a much slower growth in fixed partial restorations (bridges)5 . In fact, according to the ADA Key Facts, full coverage restoration is the third most common procedure a general practice completes behind prophylaxis and oral exams6 . So the future direction is clear: more sin- gle tooth implants and more single tooth restorations. Software solutions The software that typically accom- panies or is suggested for use with the actual cone-beam system (e.g. Invivo (Anatomage) Cliniview (In- strumentarium), SimPlant (Mate- rialise) is typically feature-rich with levels upon levels of diagnostic fields, measurement capabilities and visual markers. The intent of the E4D Compass sof- tware is to combine the accuracy and the simplicity associated with its chairside restorative counter- part (E4D DentaLogic) in a format understood and valuable to the re- storative clinician educating (and selling) their patients on the option of implant therapy. But most important is the ability to plan the restorative placement first, as the ideal, providing guidelines for the surgical team — whether it is the practice itself or if the proce- dure is referred out. There are numerous associated companies and dental laborato- ries that provide support, cone- beam readings and associated sur- gical guides (e.g. 3-D Diagnostics, 360imaging) in order for the final treatment to be completed, but E4D Compass provides the resto- rative clinician, the capability to preliminarily plan, educate, com- municate and then collaborate through the restorative cycle — providing a clear concise and con- fident plan for the surgical team/ referral. Fig. 5 - Two data sets confirmed within E4D Compass. Fig. 6 - Drawing of mandibular nerve with the E4D Compass Software. Fig. 7 - Final screen with abutment, bone density, implant and restoration. The planning process Patients don’t regularly enter a prac- tice with a demand for placement of a dental implant, instead, more commonly; the complaint is lost function or the presence of a food trap in an edentulous area. It is up to the dental professional to gather the relevant data and then suggest the options for treatment, based on a number of clinical pa- rameters that could include one or more of the following: fixed partial bridge, removable partial bridge (partial), implant therapy, ortho- dontic movement or nothing at all. Only when the restorative clinician has more information via study mo- dels (either stone or virtual), 2-D or 3-D data (X-rays or cone-beam scan), clinical observation and functional requirements can he/she properly recommend or treatment plan the functional restorative options. Having a digital scanner that can proceed directly to a restorative outcome (i.e., Function First) allows the clinician or clinical team to scan the edentulous (Fig. 3) and functio- nal area and then design the ideal restoration, regardless of the man- ner that will eventually hold it in place (Fig. 4). Another consideration is if the di- gital scanner selected uses techno- logy that doesn’t require a contrast agent (i.e., powders or sprays) scans of the oral environment can take place at any stage pre- or postsurgi- cal without the concern of residual powder or disturbance of the hea- ling process. The E4D Dentist system uses a la- ser to capture the 3-D environment whether soft tissue, hard tissue, im- pressions or models and without the use of a contrast agent. By using digital scanning one is able to show the patient immediately the restorative plan, which means the process can continue through to the next steps more smoothly, which if implant therapy is being considered, could include a work authorization for a cone-beam scan. Once you have a compatible cone- beam scan, (iCAT, Gendex, Instru- mentarium, Soredex) you can sim- ply import the cone beam scan and through proprietary visualization within the E4D Compass software you can align the two data sets (Fig. 5). Then the treatment planning and education can begin. After confir- ming the proper data sets by seeing the intraoral scan data and the co- ne-beam data, nerve identification can begin if it is a mandibular case. With a click of a mouse, data sets are moved to arch form and visualize the area of interest. Once the mandibular canal in the surgical area is identified, and the areas can be viewed in all planes, the nerve is visually depicted simi- larly to the method use to draw the margin on a restoration, clicking the mouse and following the line. Once the nerve has been drawn, it can be enlarged to provide a visual safety factor, and even carried out through the mental foramen (Fig. 6). Alignment of the data sets Unlike other software alignment procedures, E4D Compass allows the operator full control – although initially the alignment is proposed along the best possible case, with E4D Compass the operator has vi- sual clues and complete control to adjust the alignment of the two data sets. Again, intuitive controls and visualization within E4D Com- pass make this an easy task. Once the nerve(s) are marked and the mo- dels are aligned, the clinician can go through placement procedures of the preferred implant (manufactu- rer, type and size), location as well as the measurement details of a stan- dard abutment selection, including angled abutments. The abutment view provides the cli- nical team the ability to adjust seve- ral parameters of the abutment, the wall height, the collar radius, collar height and even an angled parame- ter showing 5, 10 and 15 degrees of angulation. Each pane of the E4D Compass software can be expanded to full view for better visualization or realization. The density of the surrounding bone (in contact with the implant and/or within 1 to 2 mm of the im- plant) is depicted visually in a color- coded scale matched to Hounsfield units for representation of proper bone quality (Fig. 7). All of this pro- vides the clinician and the patient with confidence, more information and a better case acceptance expe- rience knowing that the procedure has been planned and correctly pre- dicted prior to any surgical or resto- rative procedure or expense (other than diagnostic) has been comple- ted. Once the general plan has been approved, E4D Compass provides an easy method to communicate the intended plan to the surgical team. Clicking on the report icon will pro- duce an html file consisting of the images of the last screen, the details of the implant selected as well as the outline of the intended restora- tive solution. This can all aid the surgical team in placing the implant according to the intended restorative position. As always, the surgical guidelines/ quality of the bone may dictate the final location and placement, howe- ver, providing a blueprint of sorts through the use of planning softwa- re will certainly set forth an ideal target area and eliminate restorati- ve complications and surprises (as well as minimize expenses) should it be followed (Fig. 8). Synergy amongst various dental technologies will continue to im- prove the communication between dental professionals and patients as well as the teamwork and collabora- tion involved when providing excel- lence in dentistry. Fig. 8 - Report providing details of the planned treatment. 1. Dental Implants facts and figures; Ame- rican Academy of Implant Dentistry (10 percent). 2. The Wealthy Dentist Survey (53 percent) www.thewealthydentist.com. 3. DentalTown Survey (30 percent in 2006, 34 percent in 2008 and 2010; 46 percent in 2011), www. dentaltown.com. 4. Millennium research, 2010. 5. DATA research 2010. 6. ADA Key Dental Facts. references