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reduced cost of impression materials, almost zero re-impression rates and absolute predictability. Of course, there are steep learning curves with the techniques, but once a clinician has learnt the work- flow, there really is no looking back. We have three different scanners in the practice: the iTero (Align Technology), the CEREC 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 abutments. For truly aesthetic results, we, of course, still have a very close working relationship with our laboratory, 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) fitting the definitive restora- tion is a game changer. Patients also love watching the production process as they see their tooth being milled from an IPS e.max block. Figures 15–19 show the production process, in- cluding the exposure of the implant, the abutment seating, the scan flag on top of the abutment, the healing abutment during fabrication and the delivery of the final prosthesis. However, for more than single units or aesthetic 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 restorations, the need to apply a scanning powder is a limitation, owing to a lack of moisture control contaminating the pow- der. The technology, however, is superb, as is the open- ness of the system, which provides the advantage of being able to export files into planning software. A colleague of mine even uses it for his orthodontic cases now instead of wet impressions. We invested in the iTero scanner five years ago and have used it for everything, from simple conventional crowns and bridges to scanning for full-mouth reha- bilitations. When fabricating definitive bridgework, we use Createch Medical frameworks for screw- retained CAD/CAM-milled titanium and cobalt–chro- mium frameworks. Even though intraoral scanning appears extremely reproducible and accurate, I still use verification jigs where needed to ensure our frameworks are as accurate as possible. There are many intricacies that we consider and tips and tech- niques that we employ to make the scans more accu- rate that we have developed over time. The closer the scanbodies are together, the more accurate the scan is. Also, the more anatomical detail, such as palatal rugae or mucosal folds, the better the scans can be stitched together. digitalisation in dentistry practice management | Fig. 25 Fig. 26 Fig. 27 Fig. 28 Figure 20 shows a CBCT volume to aid in planning for mandibular implant placement (Fig. 21) and realis- ing the implant placement. We exposed the fixtures and placed Straumann Mono Scanbodies (Fig. 22). Then, we took an iTero scan of the fixtures in situ (Fig. 23) and made a verification jig from this (Fig. 24) to ensure passive implant positioning. The iTero mod- els were made (Fig. 25) and a Createch titanium frame- work was used to support porcelain in a screw- retained design (Fig. 26). The last two figures show the excellent outcome and accurate framework seating (Figs. 27 & 28). Choosing your workflow There are many different systems on the market now, each offering a one-stop shop. If you are consid- ering 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 digital impression data into different software. We extract our files into CT planning software, model production software, chairside milling for stents, temporaries and defini- tive restorations, and now orthodontic planning soft- ware. 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 developments 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 implant planning software coDiagnostiX. Furthermore, while it offers 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?_ contact Dr Ross Cutts is the principal dentist at Cirencester Dental Practice in Cirencester in the UK. He can be contacted at cuttsrg@aol.com. CAD/CAM 3 2017 11