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    The state of dental implants in 2017

    Our annual look at innovations in the implant workflow.

    Over half of the 500,000 dental implants placed in the U.S. every year are placed by general dentists—and that number is growing, according to the American Academy of Implant Dentistry. Thanks to the digital workflow, specifically CAD/CAM technology, more general dentists are gaining the tools and confidence needed to offer implants to their patients. 


    “There are many dental professionals who, understandably, are wary of new ways of working and prefer to continue using the processes they were originally trained in,” says Dr. Pascal Kunz, vice president of product management for digital dentistry at Nobel Biocare. “The number of early adopters in dentistry remains relatively small, but those that embrace emerging technologies stand to benefit.” 

    Technology should help dentists become better, not force them to leave their traditional education and skills untapped. “We have to create even better synergies within the treatment teams,” he says. “I think overall
    the industry leaders have realized that digital dentistry has arrived and are beginning to embrace the change that is happening.”

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    How CAD software is impacting the implant workflow 

    Computer-aided design and milling have revolutionized the implant workflow, according to David Rice, DDS.  

    “Our ability to diagnostically work up a patient where we can digitally create the final restoration prior to any surgical procedure is amazing,” he says. “We can design and then mill or 3D-print surgical guides, which will give us the exact location for where that implant should go before we begin. When we get to the healed portion and actual placement of the restorative phase, we already know that our final restoration will be in a perfect position, safe from the vasculature and any nerve issues and built for a perfect occlusion and perfect esthetics.”   This  kind of technology also ensures that labs get more accurate information in regards to timing and relative location of the implant to adjacent teeth. “The laboratory doesn’t have to worry about taking the impression post, manually inserting an analog into it, and putting it back into the impression to then fabricate a custom abutment and crown for the patient,” says Paresh Patel, DDS. “Everything will just be totally in the digital world and not have to go into a tabletop laboratory scanner to then turn it into something that the doctor can give to the patient.” 

    MillingThat ensures a more accurate and streamlined process, increasing communication between members of the treatment team and creating a better patient experience, says Priya Menon, director of marketing, North America at Dentsply Sirona Implants. “It’s also a key contributor to the rapidly growing trend of integrating a more flexible and complete digital workflow,” she says. 

    “We have certainly seen a very strong uptake of Nobel Biocare digital solutions for dental implant treatment,” Dr. Kunz says. “We are seeing significantly more software installations and more cases planned digitally. The option for guided pilot drilling only has also proved popular, with clinicians understanding the importance of achieving the desired position, depth and angulation of the first drill, but then appreciating the flexibility of a freehand approach. 

    “The importance of fully understanding the clinical situation, including prosthetic requirements prior to treatment, is greatly valued by clinicians. [...] It’s about looking at the bigger picture to help ensure the best possible approach to treatment.” 

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    The role of CAD/CAM in implant dentistry also plays a huge role in creating custom abutments

    “We are able to create a custom abutment, just like we used to with a laboratory, and send it,” Dr. Rice says. “Except now, we have total control chairside to design or move a margin on a custom abutment. The number-one reason implants fail today is because dentists are leaving cement. The custom abutment is so impressive because not only can we esthetically design how we’d like our implant placed and positioned, but we can move the finish line where a crown and that custom abutment will interface. That process is super simple. Between zirconia and e.max, we have two very durable and highly esthetic materials to mill our custom abutments out of, from a CAD perspective.” 

    Dentists also have the benefit of printing surgical guides

    “Using the 3D imaging data, digital treatment planning software enables the clinician to virtually plan their implant case prior to surgery, taking into account vital anatomical structures, bone quality and prosthetic requirements,” Menon says. “From the plan, surgical guides can be produced that allow for the exact replication of the plan to be carried out during surgery.”  

    According to an October 2012 literature review in the Journal of Oral Implantology (“Types of Implant Surgical Guides in Dentistry: A Review,” by Kathleen Manuela D’Souza, Meena Ajay Aras) implant software cannot override human error, so it is imperative that dentists have the education to understand what goes into placing a long-lasting, esthetic restoration. 

    “The various complications recorded were related to inaccurate planning, radiographic stent error, intrinsic errors during scanning, software planning, the rapid prototyping of the guide stent, and the transfer of information for the prosthetics,” the authors write. “However, if the clinician recognizes these sources of inaccuracy, efforts can be made to minimize the error and optimize patient treatment.” 

    Still, companies continue trying to compensate for human error. 

    “Dentsply Sirona Implants’ VAD (Virtual Atlantis Design) software takes the specific edentulous space, surrounding teeth and soft tissue anatomy into consideration, providing prosthetic solutions that mimic true natural tooth function and appearance,” Menon says. “Engineering principles are built into the software to ensure the requirements for manufacturing precision and integrity of the design are maintained, thus eliminating the errors that can occur with human designs using computers.” 


    Next: How can you ensure implant success—and patient satisfaction?


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