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Show Tribune United Kingdom Edition | 1/2018 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 flow material used to increase scanning reference points.—Fig. 15: Verification jig locked in situ to verify passive implant positioning.—Fig. 16: Createch framework showing the fit surface.—Fig. 17: Final metal-ceramic bridge in situ. AD With this in mind we cannot assume the scan to be accurate and any framework fabricated would be non­passive, we therefore are obliged to use other methods to verify the scans ac­ curacy. We have found locking temporary abut­ ments within a com­ posite framework in­ traorally the easiest and most reproducible way to do so. It then allows us to design and mill a truly passive framework by Createch and a temporary acrylic bridge (Figs. 14–17). Conclusion There are many opportuni­ ties to opt in and out of using technology regarding the digital implant workflow. 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 determine whether that warrants the ex­ penditure. Too often we are sub­ jected to sales pitches of the next biggest thing by company sales representatives and gadgets and gizmos end up by the wayside. Acknowledgements to Andy Mor- ton and Ian Murch, the fan - tastic laboratory technicians at Borough Crown and Bridge, that I work closely with. Dr Ross Cutts is the princi- pal dentist at Cirencester Den- in tal Practice Cirencester in the UK. He can be contacted at cuttsrg@aol.com. 16 17 Prosthetic reconstruction Once the implants are placed in situ and fully integrated we then have the option to choose between conventional wet­im­ 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 difficult to scan and pick up. Straumann tissue­level 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 flow stuck to the soft tissues to increase ref­ erence points for our scanners increasing their ability to stitch images more accurately together.

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