Implanting success: The state of dental implants
New technologies, workflows and techniques mean exciting things for dental implant treatments.
Dental implants are nothing new. While they have been around in one crude form or another for thousands of years, the breakthrough that led to modern day implants didn't occur until Per-Ingvar Brånemark's mid-1960s work with dental osseointegration. And it wasn't until the 1980s that implants became a widely available option.
Now, however, thanks to technologies such as CAD/CAM and cone beam scans, precision-made hardware, and surgical techniques, implants can be done with positive, predictable outcomes and speedy patient recovery times.
Because of technologies like CAD/CAM, crafting the implant is much easier, faster and of consistent quality.
"Labs have gone wholeheartedly toward CAD/CAM in every way—designing frameworks, even provisionals, and more," says Dr. Allan Pollack, DDS, president of the Academy of Osseointegration. "And more doctors are incorporating it into their practices as well, whether they have an in-house unit where they are doing their own milling, or they are using CAD/CAM technology to design restorations."
Dr. Neal Patel, DDS, of Infinite Smiles in Powell, Ohio is one such clinician who has embraced technology for improved implant cases.
"The new philosophy that we've all pretty much adopted is restoratively driven implant planning and the concept of the guided surgery for accuracy, and then the use of CAD/CAM technology for precision in the fabrication of the prosthetics," Dr. Patel says. "That process starts with having the ability to design a restoration, virtually, using digital technology like CAD/CAM. That virtual tooth is something that can happen in two locations: There are labs that can do it routinely, but there are some doctors who actually have CAD/CAM in the office, and that's our scenario here."
Dr. Patel is somewhat unique in that he has an in-house lab technician who manufactures most of his cases.
"When a patient comes in and they're missing a tooth or multiple teeth, we can actually take a digital intraoral scan and I can either send that to my [dental technician], Marina, and she can virtually design the teeth in software that's perfectly matched to the patient's esthetics and send that virtual plan back to my office," Dr. Patel says. "Or if I have time, I can do that process myself. We have a virtual wax-up done in the CAD/CAM software."
Manufacturing implants chairside is not right for every case, but when it can be done, it's a welcome solution for both doctor and patient.
"It's pretty awesome," says Dr. Kaveh Ghaboussi, DDS, of Madison Smile Solutions in Madison, Wisc. "You can't do it all the time. There are situations where it's better to either scan the implant or take an impression and have the lab do it, but a lot of times when the implant is ready to restore, we can take a stock abutment, and we can scan it in the patient's mouth and mill a crown right there, which is pretty great. And we have even placed an implant and milled a crown and put it on all in one appointment, which is a pretty advanced thing to do. It cuts out a lot of time and a lot of visits for the patient when you can do it."
Overall, technological advances have dramatically improved the quality of care patients receive.
"All of this technology can speed up treatment times while also resulting in higher-quality outcomes," says Dr. Robert Gottlander, VP, Global Prosthetic Solutions at Henry Schein. "You can take digital impressions with an intraoral scanner, design the position of the teeth, and then take that design file from the cone beam and to do the implant planning. There are so many things that you can do today that you could not do five or 10 years ago. And while the technology itself is very impressive, it's what the technology can do for your patients and your practice that enhances its value. And besides saving time and increasing accuracy, an integrated digital solution that includes plan management software, such as Dentrix, can make insurance reporting and reimbursement easier, increase profit per patient, and lead to a steady flow of new patients either through referrals or by using social media to advertise the convenience of digital dentistry."
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