today EAO Madrid October 05, 2017

science & practice speed provide a viable alternative to conventional 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 qual- ity of your tooth preparations. The scan can then be sent directly to the laboratory for processing. While we do not think of intra- oral scanners as being any more ac- curate than good-quality conven- tional impressions, there are many benefits of scanning, such as no more postage to be paid for impres- sions, vastly reduced cost of impres- sion materials, almost zero re-im- pression rates and absolute predict- ability. We have three Of course, there are steep learn- ing curves with the techniques, but once a clinician has learnt the work- flow, there really is no looking back. different scanners in the practice: the iTero (Align Technology), the CEREC Omnicam (Dentsply Sirona) and the Straumann CARES Intraoral Scan- ner (Dental Wings; Fig. 14). The CEREC Omnicam is fantastic for sim- ple chairside CAD/CAM restora- tions, such as IPS e.max all-ceramic Digitising your implant practice (cid:132) Undoubtedly, digital dentistry is the current topic. Over the last five years, the entire digital workflow has progressed in leaps and bounds. There are so many different digital applications that it is sometimes dif- ficult 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 workflow justifies the expense. I have many times heard the ar- gument that there is no need to try to fix something that is not broken. It is so true that impressions have their place and there are certainly limitations to the digital workflow that anyone using the technology should be aware of. For me, how- ever, the benefits of digital far out- weigh the disadvantages. In fact, the disadvantages are the same as with conventional techniques. Chairside CAD/CAM single-visit restorations have been possible for over 20 years, but it was only re- cently that we became able to mill chairside implant crown restora- tions after the release of Variobase (Straumann) and similar abutments. I made my first CEREC crown (Dentsply Sirona) back in 2003 with a powdered scanner, and the differ- ence 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 regarding the use of CAD/CAM technology were published online in the British Dental Journal on 18 November 2016. Over a thousand dentists were ap- proached online to take part in the survey and the 385 who replied gave very interesting responses. The ma- jority did not use CAD/CAM technol- ogy, and the main barriers were ini- tial cost and a lack of perceived ad- vantage 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 fix; 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- By Dr Ross Cutts, UK 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 conven- tional techniques. What is digital implant dentistry? Many implant clinicians have probably been using CAD/CAM workflows without even realising it, as many laboratories were early adopters, substituting the lost-wax technique and the expense of gold for fully customised cobalt–chro- mium milled abutments (Fig. 1). One of my most important goals in seeking to be a successful implan- tologist is to provide a dental im- plant solution that is durable. We have seen a massive rise in the inci- dent of peri-implantitis and have found that a large proportion of these cases can be attributed to ce- ment inclusion from poorly designed cement-retained restorations (Fig. 2). Even well-designed fully customised abutments and crowns can have ce- ment inclusion if the restoration is not carefully fitted (Fig. 3). This has led to a massive rise in retrievability of implant restorations, with screw- retained crowns and bridges now be- ing the goal. However, making screw-retained prostheses places even greater emphasis on treatment planning and correct implant angu- lation. With laboratories as early adop- ters, we have been milling titanium or zirconia customised abutments for over ten years (Fig. 4). What has changed recently in the digital revo- lution is the rise of the intraoral scanner. We now have a workflow in which we can take a preoperative intraoral 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 placement, have a temporary crown prefabricated for the planned im- plant position and then take a final scan of the precise implant position for the final prosthesis. Accuracy of intraoral scanners Figures 4 to 13 show the work- flow for preoperative scanning, which includes the implant design, guide fabrication and surgical place- ment of two fixtures. Intraoral scan- ners have improved over the last few years, and their accuracy and Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 8 Fig. 5 Fig. 6 Fig. 7 Fig. 9 Fig. 10 12 Fig. 11 Fig. 12 Fig. 13 26th EAO Annual Scientific Meeting

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