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ePaper created 2018-03-26, 09:23:37 | version 1.38.0
Dental Tribune Asia Pacifi c Edition | 1+2/2018 TRENDS & APPLICATIONS 15 8 9 10 11 12 13 14 15 Fig. 8: Postoperative radiograph of implant placement. Fig. 9: Surgical placement of LL67 implants. Fig. 10: Tissue-level implants. Fig. 11: Scanbodies. Fig. 12: Crowns on printed model. Fig. 13: Crowns in situ. Fig. 14: Composite fl ow material used to increase scanning reference points. Fig. 15: Verifi cation jig locked in situ to verify passive implant positioning. Fig. 16: Createch framework showing the fi t surface. Fig. 17: Final metal-ceramic bridge in situ. 16 17 Prosthetic reconstruction Once the implants are placed in situ and fully integrated we then have the option to choose between conventional wet-im- pression techniques and digital intraoral scanning devices. For the majority of cases intraoral scanning is extremely predicta- ble and reliable—more so than conventional techniques—with milled (and lately printed) mod- els having excellent properties and fewer accumulation of pro- cessing errors. However deeply placed to adjacent teeth with deep contact points, are very diffi cult to scan and pick up. Straumann tissue-level implants offer a very straightforward restorative plat- form to scan from (Figs. 10–13). implants, relative With greater numbers of im- plants and fewer teeth to act as reference points intraoral scan- ning becomes less reliable, par- ticularly across the arch. There- fore, we need to act with caution and be aware of its limitations. We have used composite fl ow stuck to the soft tissues to in- crease reference points for our scanners increasing their ability to stitch images more accurately together. With this in mind we cannot assume the scan to be ac- curate and any framework fabri- cated would be non-passive, we therefore are obliged to use other methods to verify the scans accu- racy. We have found locking tem- porary abutments within a com- posite framework intraorally the easiest and most reproducible way to do so. It then allows us to design and mill a truly pas- sive framework by Createch and a acrylic bridge (Figs. 14–17). temporary Conclusion There are many opportuni- ties to opt in and out of using technology regarding the digital implant workfl ow. For anyone considering capital investment, the most important question to ask is, how will or can this im- prove the outcomes I provide to my patients and then deter- mine whether that warrants the expenditure. Too often we are subjected to sales pitches of the next biggest thing by company sales representatives and gadgets and gizmos end up by the way- side. Acknowledgements to Andy Mor- ton and Ian Murch, the fantas- tic technicians at Borough Crown and Bridge, that I work closely with. laboratory 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. AD register for FREE – education everywhere – no time away from and anytime the practice – live and interactive – interaction with webinars colleagues and experts – more than 1,000 archived across the globe courses – a focused discussion forum – a growing database (cid:82)(cid:73)(cid:3)(cid:86)(cid:70)(cid:76)(cid:72)(cid:81)(cid:87)(cid:76)(cid:715)(cid:3)(cid:70)(cid:3)(cid:68)(cid:85)(cid:87)(cid:76)(cid:70)(cid:79)(cid:72)(cid:86)(cid:3) and case reports – free membership – ADA CERP-recognized no travel costs credit administration Dental Tribune Study Club Join the largest educational network in dentistry! www.DTStudyClub.com ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.