Dental Tribune Nordic Edition No. 3, 2016

12 Dental Tribune Nordic Edition | 3/2016 TRENDS & APPLICATIONS Possibilities and risks of digital techniques in implant dentistry An interview with Dr Margareta Hultin, Sweden By Anne Faulmann, DTI Implant dentistry is constantly advancing. New research results, the rapid development of digital technologies and increasing expe- rience in clinical practice change the way implantologists work. This may lead to a rethinking of already established treatment approaches. At the 2016 European Associa- tion for Osseointegration congress, which took place in Paris in France from 29 September to 1 October, Dental Tribune spoke to presenter Dr Margareta Hultin about her dis- cussion topic of immediate CAD/ CAM restoration and recent devel- opments in implant dentistry. Dental Tribune: Dr Hultin, how has implant dentistry developed in re- cent years, and what new insights have changed the way implantolo- gists work? Dr Margareta Hultin: Implant dentistry has developed in several areas in recent years, such as graft- ing and augmentation procedures, as well as treatments for optimis- ing and predicting the aesthetic result after rehabilitation. On the one hand, improvements in im- plant treatment can be attributed to a better understanding of how both the hard- and soft-tissue anatomy—for example, the role of thickness, width and positioning of keratinised tissue—influence the long-term outcome and aesthetic result. On the other hand, 3-D radi- ographic imaging techniques have greatly improved individual as- sessment of hard tissue with regard to jaw anatomy and bone volume in treatment planning. Digital dentistry is increasingly rel- evant in dental practice nowadays. Howhasdigitaltechnologychanged implant dentistry, and what are its main advantages? Digital technology can support dentists in several steps of restora- tive treatment, from cone beam computed tomography and the virtual planning of implant posi- tions through to prosthesis manu- facture for immediate function. Also,virtualplanningcanbetrans- ferred to the actual clinical setting by fabricating surgical guides for flapless implant placement. The main advantage of digital techniques is the ability to plan and optimise the positioning of implants in a prosthetically driven manner. Moreover, computer- guided techniques can help de- crease postoperative discomfort and allow immediate function, as they enable implant placement with minimal surgical trauma. In addition, these techniques can offer a useful alternative to bone augmentation in severely re- sorbed jawbone, as they facilitate optimal positioning of implants in the available bone. In your lecture at this year’s EAO con- gress in the “Things we stopped in our practice due to failures” session, you have discussed immediate CAD/ CAM restoration. What are potential complications of immediate CAD/ CAM restoration, and why is this treatment approach prone to failure? Although computer-guided techniques for implant placement can offer advantages for both the dentist and the patient, guided implant surgery is technically de- manding and not free of specific procedure-related complications. For example, the drilling template may fracture or there may be com- plications related to limited access and visibility when using a flapless approach. This can lead to devia- tions in implant positioning and ultimately a poorly fitting pros- thesis. Moreover, high aesthetic demands may be difficult to com- pletely foresee, since computer- guided implant positioning carries the risk of overlooking the ideal lo- cation of an implant with regard to the soft tissue. Therefore, the skills and experience of a clinician who wants to use these techniques need to go far beyond those necessary for regular implant surgery. What alternative treatment proto- col do you recommend for less ex- perienced clinicians? A good option is to use digital techniques for implant placement in combination with traditional protocols for prosthesis manu- facture. For example, a template- guided flapless surgery for implant placement can be combined with a traditional protocol for unloaded healing and the fabrication of a permanent prosthesis. “3-D radiographic imaging techniques have greatly improved individual assessment of hard tissue with regard to jaw anatomy and bone volume in treatment planning.” “...guided implant surgery is technically demanding and not free of specific procedure-related complications.” © Anne Faulmann/DTI Dr Margareta Hultin at the EAO congress in Paris in September. Hultin is a senior lecturer at the Department of Dental Medicine at Karolinska Institutet in Stockholm and has more than 15 years of experience in research and education in implantology. © Alex Mit/Shutterstock.com

Dental Tribune Nordic Edition No. 3, 2016

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