Dental Tribune U.S. Edition

A12 Industry News Dental Tribune U.S. Edition | February 2014 By Tarun Agarwal, DDS, PA Today’s digital im- pression technology en- ables dentists to create a virtual, computer gener- ated replica of the hard and soft tissues in the mouth quickly and accurately using their choice of optical scanning device. As an ardent supporter of digital impressions, I make every at- tempt to digitize our restorative work- flow. There are numerous benefits to a digital impression: • Efficiency: It takes less time to take a digital impression than a traditional im- pression. • Quicker turnaround time: Clinicians often forget or fail to realize the true value of this. Getting restorations back faster is better for the patient, the prac- tice and the overall case outcome. • Cost savings: Have you ever calculat- ed the cost of taking a traditional impres- sion for a final restoration? If you add up what your office spends on impression materials, chair time and case shipping fees, you will be amazed at how much is spent on traditional methods. Case presentation The female featured in this article has been a patient in our practice for nearly eight years. She has a porcelain-fused- to-metal bridge from tooth #5 to #12 replacing missing #7 to #10. She is not terribly unhappy with the look and feel of the bridge, but the bridge has been no stranger to the big issue facing PFM res- torations: the chipping of porcelain from the metal substructure. During the past eight years, we have patched various cor- ners and lingual surfaces. Recently, the patient agreed to re- place her long-span PFM bridge with an implant-supported bridge on #7 to #10 and individual crowns on the abutment teeth. However, she was adamant about not going a day without teeth. We ad- vised her that this would not be an issue. Because of the complexity of her im- plant surgery, immediate loading was not possible. This meant we needed a long-term esthetic provisional that would last the duration of the treatment, could be removed for surgery and was adjustable for post-surgical contouring. A BioTemps® provisional bridge (Glide- well Laboratories; Newport Beach, Calif.) was the quick and easy answer. Traditionally, BioTemps are made prior to preparation and relined chairside. In this case, I wanted to have the BioTemps made to fit the final preparations of the abutment teeth, which would later be converted to individual restorations. As an advocate of digital impressions, I chose to follow a digital workflow. The provisional BioTemps bridge offers the following important advantages in this case: 1) Trial smile: The patient gets a “trial” of the new contours. Any modifications to length or contour can be made chair- side, avoiding costly remakes and un- happy patients. 2) Long-term durability: Because of the complexity of this case, full treatment will take well over 12 months. An acrylic provisional fabricated chairside simply won’t hold up this long. 3) Removability: For implant surgery, the specialist will need the ability to remove and re-cement the provisional with relative ease. 4) Adjustability: The necks of teeth #7 to #10 will need to be adjusted after sur- gery to remove any pressure to the surgi- cal sites. BioTemps are easily adjusted. 5) Surgical assistance: The contours and esthetics of the BioTemps will serve as a “guide” to the surgeon for grafting and placement of the implants. As this case illustrates, digital impres- sions are not just limited to final resto- rations, and certainly not just to single units. It’s time for you to take a closer look at digital restorative technologies and see how they can benefit your prac- tice and your patients. Fig. 1: Preoperative photograph of the patient’s existing longspan PFM bridge. Note the bulky and gray margins, unesthetic contours and ‘patch’ composites used to repair areas of chipped porcelain. Utilizing a digital workflow for provisionalization with BioTemps Chicago BOOTH NO. 4420 Fig. 2: The original abutment preps are cleaned and reduced to the appropriate margin thickness. Photos/Provided by Glidewell Laboratories Fig. 3: A digital impression is taken using the CEREC Omnicam (Sirona Dental Systems Inc., Charlotte, N.C.). This occlusal view illustrates how precisely the Omnicam captures a full-color digital impression. Fig. 4: Labial view of the abutment teeth preparations captured with the CEREC Omnicam. An added benefit of digital impressions is that changes don’t require an entire new impression — only a new digital capture of the changed area. Fig. 5: The BioTemps bridge at delivery, seated with provisional cement. About the author Dr. Tarun Agarwal maintains a full-time private practice emphasizing esthetic, restorative and im- plant dentistry in Raleigh, N.C. You can contact him via e-mail at dra@raleighdentalarts.com or visit www.raleighdentalarts.com. Case illustrates that digital impressions aren’t limited to final restorations and single units