Implant Tribune United Kingdom Edition No. 2, 2017

16 IMPLANT TRENDS Implant Tribune United Kingdom Edition | 5+6/2017 Digitising your implant practice By Dr Ross Cutts, UK Undoubtedly, digital dentistry is the current topic. Over the last ﬁ ve years, the entire digital workﬂ ow has progressed in leaps and bounds. There are so many different digital applications that it is sometimes difﬁ cult to keep up with all the ad- vances. Many dentists are excited about the advantages of new tech- nologies, but there are an equal number who doubt that the im- proved clinical workﬂ ow justiﬁ es the expense. I have many times heard the ar- gument that there is no need to try to ﬁ x something that is not broken. It is so true that impressions have their place and there are certainly limitations to the digital workﬂ ow that anyone using the technology should be aware of. For me, how- ever, the beneﬁ ts of digital far out- weigh the disadvantages. In fact, the disadvantages are the same as with conventional techniques. Chairside CAD/CAM sin- gle-visit restorations have been possible for over 20 years, but it was only recently that we became able to mill chairside implant crown restorations after the re- lease of Variobase (Straumann) and similar abutments. I made my ﬁ rst CEREC (Dentsply Sirona) back in 2003 with a pow- crown dered scanner, and the difference from what I remember then to how we can make IPS e-max stained and glazed restorations (Ivoclar Vivadent) now is amazing. An investment not an expense The results of a survey regard- ing the use of CAD/CAM technol- ogy were published online in the British Dental Journal on 18 No- vember 2016. Over a thousand dentists were approached online to take part in the survey and the 385 who replied gave very inter- esting responses. The majority did not use CAD/CAM technology, and the main barriers were initial lack of perceived cost and a advantage over conventional methods. Thirty per cent of the respond- ents reported being concerned about the quality of the chairside CAD/CAM restorations. This is a valid point. We must not let our- selves lose focus that our aim should always be to provide the best level of dentistry possible. For me, digital dentistry is not about a quick ﬁ x; it is about raising our performance and improving predictability levels by reducing human error. In the survey, 89 per cent also said they believed CAD/CAM tech- nology had a major role to play in the future of dentistry. I really can- not imagine that once a dentist has begun using digital processes that he or she would revert to con- ventional techniques. What is digital implant dentistry? Many implant clinicians have probably been using CAD/CAM workﬂ ows without even realising it, as many laboratories were early adopters, substituting the lost-wax technique expense of gold for fully customised cobalt– chromium milled abutments (Fig. 1). and the in the One of my most important goals in seeking to be a successful implantologist is to provide a dental implant solution that is durable. We have seen a massive incident of peri- rise implantitis and have found large proportion of that a these cases can be attributed to cement inclusion from poorly de- signed cement-retained restora- tions (Fig. 2). Even well-designed fully customised abutments and crowns can have cement inclu- sion if the restoration is not care- fully ﬁ tted (Fig. 3). This has led to a massive rise in retrievability of implant restorations, with screw- retained crowns and bridges now being the goal. However, making screw-retained prostheses places even greater emphasis on treat- ment planning and correct im- plant angulation. With laboratories as early adopters, we have been milling titanium or zirconia customised abutments for over ten years (Fig. 4). What has changed recently in the digital revolution is the rise of the intra-oral scanner. We now have a workﬂ ow in which we can take a preoperative intra-oral scan and combine this with a CT scan using coDiagnostiX (Dental Wings) in order to plan an implant placement accurately and safely. We can also create a surgical guide to aid in accurate implant place- ment, have a temporary crown prefabricated for the planned im- plant position and then take a ﬁ - nal scan of the precise implant po- sition for the ﬁ nal prosthesis. Accuracy of intra-oral scanners Figures 4–13 show the workﬂ ow for preoperative scanning, which includes the implant design, guide fabrication and surgical placement of two ﬁ xtures. Intra-oral scanners have improved over the last few years, and their accuracy and speed provide a viable alternative to con- ventional impression taking. The digital scan image comes up in real time and you can evaluate your preparation and quality of the scan on the screen immediately. Seeing the preparation blown up in size no doubt improves the technical quality of your tooth preparations. The scan can then be sent directly to the laboratory for processing. While we do not think of in- tra-oral scanners as being any more accurate than good-quality conventional impressions, there are many beneﬁ ts of scanning, such as no more postage to be paid for impressions, vastly reduced cost of impression materials, al- most zero re-impression rates and absolute predictability. Of course, there are steep learning curves with the tech- niques, but once a clinician has learnt the workﬂ ow, there really is no looking back. We have three different scanners in the practice: the iTero (Align Technology), the CEREC 1 4 5 2 3 8 9 6 7 10 11 12 13

Implant Tribune United Kingdom Edition No. 2, 2017

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