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September 2009 | Dental Lab Products
Forward trends: treatment precision

New twists on implants

Laboratory owners expand services through technology to position themselves strategically as indispensable partners in end-to-end implant planning.

by Richard Palmer

 

Ask anyone in dentistry today, and they are likely to express that while dental implant treatment has been around for nearly 30 years, it is on the verge of becoming the standard for restorative care involving edentulism in any degree. Add into this mix a consumer patient base savvy to the benefits afforded by implants through mass-market and targeted marketing, and dental professionals are seeing the potential to grow their businesses along the entire treatment spectrum—from planning to placement to final restoration—through an expanded menu of services to accommodate this trend.

From the beginning

There are many places along the implant treatment workflow where laboratories can position themselves as part of the implant team, focusing on one specific aspect of care such as designing and milling patient-specific CAD/CAM zirconia abutments. Or, they could broaden their attention all along this path and establish their business as specializing in implants. Most laboratory owners would agree that the sooner they can become involved in the total implant treatment plan, the better the outcome. Mark Jackson, RDT, Vice President and co-owner of Precision Ceramics Dental Laboratory, said involvement early on in implant treatment drives it in a new direction from the get-go, essentially flipping it into a “crown-down” perspective. “Today, our implant cases are prosthetically driven, whereas before, they were surgically driven,” he said. “Now, we can figure out where the prosthetics are going to be, and then build the implant surgery around the prosthetics.”

Jackson made the business decision recently to position his Montclair, California-based PCDL at the very start of implant treatment by incorporating a cone beam computed tomography (CBCT) digital radiography unit into his lab, one of just a handful of dental laboratories with the advanced 3D imaging equipment. Although there were a small number of dental imaging centers or CBCT-equipped dental practices in his general area, Jackson saw a number of distinct advantages to having the technology in-house.

“I want to be involved with the planning forward” Jackson said. “If I can get into the doctor’s office with my scanning and planning services, I have the inside track to get to that prosthetic case.” PCDL is adjoined by a dental practice, which will be the exclusive client of the CBCT imaging services before expanding out additional practices in the area.

“It also gives us a great deal of credibility in terms of implant planning because we now go from scanning to planning to surgery and restoration successfully in-house every day,” Jackson said.

Working up to the CBCT scan during the initial preplanning stages, Jackson makes a diagnostic waxup to help the implant team and the patient plan restorative goals, then he makes a radiographic template from the waxup that has radiopaque markers such as gutta-percha or barium sulfate intaglios to establish important landmarks used in the 3D CBCT image for positioning. The patient comes to the facility and is fitted with the guide to check for precision, then a board-certified oral and maxillofacial radiologist at PCDL captures the 3D data in DICOM (Digital Imaging and Communications in Medicine) format and imports the files into the appropriate implant planning software based on the initial treatment plan. At this point, the implant team works together to locate the ideal placement and angle for the implants.

In a growing number of cases, a surgical guide is fabricated using the CBCT data to help the surgeon or GP with exact implant placement and to reduce the risk of surgical errors. The guide can be manually fabricated by the laboratory or outsourced for CAD/CAM fabrication through services such as Nobel Biocare’s NobelGuide and Simplant’s SurgiGuide.

“As more GPs start placing implants, they are the ones who are really going to benefit from these surgical guides,” Jackson said, adding the guides are “prohibitively expensive for just a single tooth,” which is where most GPs begin implant placement.

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