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today EAO Madrid October 05, 2017

science & practice Fig. 15 Fig. 16 Fig. 14 Fig. 17 Fig. 18 Fig. 19 Fig. 20 Fig. 21 Fig. 22 Fig. 23 Fig. 24 Fig. 25 Fig. 26 Fig. 27 Fig. 28 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) fit- ting the definitive 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. Figures 15 to 19 show the pro- duction process, including the expo- sure 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 pow- dered system at the moment, this is due to change this month. Particu- larly with implant restorations, the need to apply a scanning powder is a limitation, owing to a lack of mois- ture control contaminating the pow- der. The technology, however, is su- perb, as is the openness of the sys- tem, 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 impres- sions. We invested in the iTero scanner five years ago and have used it for everything, from simple conven- tional crowns and bridges to scan- ning for full-mouth rehabilitations. When fabricating definitive bridge- work, we use Createch Medical frameworks screw-retained CAD/CAM-milled titanium and co- balt–chromium frameworks. Even for though intraoral scanning appears extremely reproducible and accu- rate, I still use verification jigs where needed to ensure our frame- works are as accurate as possible. There are many intricacies that we consider and tips and techniques that we employ to make the scans more accurate that we have devel- oped over time. The closer the scan- bodies are together, the more accu- rate the scan is. Also, the more ana- tomical detail, such as palatal rugae or mucosal folds, the better the scans can be stitched together. Figure 20 shows a CBCT volume to aid in planning for mandibular implant placement and realising the implant placement (Fig. 21). We ex- posed the fixtures and placed Strau- mann 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 models were made (Fig. 25) and a Createch titanium framework was used to support por- celain in a screw-retained design (Fig. 26). The last two figures show the excellent outcome and accurate framework seating (Figs. 27 and 28). Choosing your workflow There are many different sys- tems on the market now, each offer- ing a one-stop shop. If you are con- sidering investing in a digital scan- ner, then take some advice from col- leagues. 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 ex- tract our files into CT planning soft- ware, model production software, chairside milling for stents, tempo- raries and definitive 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 synchro- nises perfectly with coDiagnostiX implant planning software. Further- more, while it offers a chairside milling unit, it also synchronises perfectly with my laboratory for larger cases. To conclude, digital implant den- tistry is the future and so why not take advantage of it and help im- prove your clinical outcomes? (cid:26) Author Dr Ross Cutts is the principal dentist at Cirencester Dental Practice in Cirencester in the UK. He can be contacted at cuttsrg@aol.com. 26th EAO Annual Scientific Meeting 13

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