Implant Tribune United Kingdom Edition No. 2, 2017

Implant Tribune United Kingdom Edition | 5+6/2017 IMPLANT TRENDS 17 15 16 14 17 18 19 20 21 22 23 24 25 26 27 28 Omnicam (Dentsply Sirona) and the Straumann CARES Intraoral Scanner (Dental Wings; Fig. 14). The CEREC Omnicam is fantastic for simple chairside CAD/CAM restora- tions, such as IPS e.max all-ceramic restorations on Variobase abut- ments. For truly aesthetic results, we, of course, still have a very close working relationship with our labo- ratory, but, undoubtedly, patients love the option of restoration in a day. Being able to scan an implant abutment and then an hour later (to allow for staining and glazing) ﬁ tting the deﬁ nitive restoration is a game-changer. Patients also love watching the production process as they see their tooth being milled from an IPS e.max block. of the ﬁ nal prosthesis. However, for more than single units or aes- thetic single-unit cases, we use the iTero and Straumann scanners. The latter we have only had at our disposal since February. While it is a powdered system at the moment, this is due to change this month. Particularly with implant restora- tions, the need to apply a scanning powder is a limitation, owing to a lack of moisture control contami- nating the powder. The technology, however, is superb, as is the open- ness of the system, which provides the advantage of being able to ex- port ﬁ les into planning software. A colleague of mine even uses it for his orthodontic cases now instead of wet impressions. tive bridgework, we use Createch Medical frameworks for screw- retained CAD/CAM-milled tita- nium and cobalt–chromium frame- works. Even though intra-oral scanning appears extremely re- producible and accurate, I still use veriﬁ cation jigs where needed to ensure our frameworks are as ac- curate as possible. There are many intricacies that we consider and tips and techniques that we em- ploy to make the scans more accu- rate that we have developed over time. The closer the scan bodies are together, the more accurate the scan is. Also, the more anatom- ical detail, such as palatal rugae or mucosal folds, the better the scans can be stitched together. Figures 15–19 show the produc- tion process, including the expo- sure of the implant, the abutment seating, the scan ﬂ ag on top of the abutment, the healing abutment during fabrication and the delivery We invested in the iTero scan- ner ﬁ ve years ago and have used it for everything, from simple con- ventional crowns and bridges to scanning for full-mouth rehabili- tations. When fabricating deﬁ ni- Figure 20 shows a CBCT vol- ume to aid in planning for man- dibular implant placement and realising the implant placement Fig. 21). We exposed the ﬁ xtures and placed Straumann Mono Scanbodies (Fig. 22). Then, we took an iTero scan of the ﬁ xtures in situ (Fig. 23) and made a veriﬁ cation jig from this (Fig. 24) to ensure pas- sive implant positioning. The iTero models were made (Fig. 25) and a Createch titanium framework was used to support porcelain in a screw-retained design (Fig. 26). The last two ﬁ gures show the excellent outcome and accurate framework seating (Figs. 27 and 28). Choosing your workﬂ ow There are many different sys- tems on the market now, each of- fering a one-stop shop. If you are considering investing in a digital scanner, then take some advice from colleagues. One of the most important things is to ensure the system you opt for is an open one that allows you to extract the digi- tal impression data into different software. We extract our ﬁ les into CT planning software, model pro- duction software, chairside mill- ing for stents, temporaries and de- ﬁ nitive restorations, and now or- thodontic planning software. I am convinced there will be yet more advances with time. The size of the camera is critical—some can be very cumbersome—and it is worth asking the salesperson what devel- opments are underway. Some companies are more on the cutting edge than others. My favourite at the moment is the Straumann scanner. Its design is light and user-friendly and it synchronises perfectly with coDiagnostiX implant planning software. Furthermore, while it of- fers a chairside milling unit, it also synchronises perfectly with my laboratory for larger cases. To conclude, digital implant dentistry is the future and so why not take advantage of it and help improve your clinical outcomes? Dr Ross Cutts is the principal dentist at Cirencester Dental Practice in Cirences- ter in the UK. He can be contacted at cuttsrg@aol.com.

Implant Tribune United Kingdom Edition No. 2, 2017

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