Perfect Implants Take Planning

When managing a thriving dental implant practice, it’s important to keep in mind that it is more a science than an art. The process has to be even more precise than the end result is esthetically pleasing, in order to maintain the integrity of the work and the health of the patient’s mouth for years to come.

Guided implant surgery with strict digital workflows is the key to optimal outcomes. These require digital implant planning strategies, which are now readily available, thanks to the most up-to-date 3D imaging technology. Just a few years ago, 3D imaging seemed too advanced to ever become standard equipment; it was also way out of reach from a cost point of view to most practices around the country. That is no longer the case.

Cone beam computed tomography, or CBCT, with its 3D imaging technology, seems to come down in price every year, and more and more it is used in tandem with the 2D images that have been standard in the profession for decades. It is an approach, a formula if you will, that enables dental professionals to achieve the highest level of quality care quickly and efficiently while maximizing profit in the practice by eliminating wasted chair time. It also greatly reduces the margin of error. Once it is mastered, the process is so easy and seamless, not to mention exacting, many dentists can confidently attest that it is worth the investment.

Map it out

The actual implant part of the procedure should take roughly five minutes, albeit coded for an hour of chair time. That’s if the steps to that outcome are mapped out using all the technology at hand — both hyper-advanced 3D, as well as familiar, reliable 2D, which complement each other.

The first step is setting up a consultation with the patient, which involves a CBCT image and intraoral scans. The CBCT component should be coded for capture and interpretation to make sure all bases are covered. The consultation with the patient should take approximately 30 minutes.

A digital diagnostic wax-up would be step two toward guided implant planning. That is done at the computer, merging the digital models of the patient’s mouth and teeth with the CBCT scan. This provides the information needed to fabricate a surgical guide. If it includes a full diagnostic wax-up, the planning takes up to 30 minutes.

Special software interprets the CBCT scan, which works in tandem with computer-aided design/computer-aided manufacturing (CAD/CAM) software. This is designed for dentistry and restorative diagnostics to do diagnostic wax-ups, in the cases where these are called for.

The surgical guide is printed on a 3D printer, which should take roughly 30 minutes to an hour to complete, depending on the speed of the printer being used.

Use of these tools is particularly important in high stakes cases where the implant position is critical to getting a good restorative result. It might take a wax-up to best see markers like gingival restorative margins in the upper anterior, the prosthetic emergence, the incisal or the occlusal position. Together, these details give the practitioner a look into the future to determine the optimal implant position relative to the adjacent anatomy, implants, teeth, bone and other vital components. All of these factors come into play when devising a plan for implant positioning via guided implant surgery.

It must be decided at some point whether there will be an immediate prosthesis, fabricated or delivered, and whether there should be a temp ready, which might save a great deal of time. Or, whether the implant will be placed in order to possibly scan, fabricate and deliver a 3D-printed or mold restoration at the time of surgery. These decisions are made with a guided surgical system custom-designed for each procedure.

Guaranteed and consistent results are worth the investment

Investment in a full complement of sophisticated equipment is ideal for implementing a digital implant workflow, but it is not always necessary to own it all.  Knowing labs or other practitioners that patients can go to in the area can be just as good, although less efficient than having the equipment under your own roof and always available.

While expensive, the return on investment on the equipment, however, is undisputed. The ability to create a specific plan for every procedure in your office allows you to calculate exactly how much chair time and materials are required to maximize the return on whatever you put into your practice. There is no waiting for lab results or images to come in before proceeding.

It also is a guarantee of consistent quality in the work. The quality of the information you have going in dictates the quality of the results.

The most important component is CBCT capacity. Not only does it allow the practitioner to get a computerized image of where an implant is needed, it allows scans to capture factors that may have gone undiagnosed.

An intraoral scanner is ideally owned by the practice, although there are alternatives. Images can be outsourced to a lab, which will produce physical models that can be digitized. The software for reading and analyzing images is also necessary, as is the 3D printer for making the guides to work with. These have come down markedly in price and will likely continue to do so. The importance is bringing all the elements together, no matter the source.

Conclusion

Most U.S. practitioners believe CBCT technology, 3D printing and static guides using guided implant technology are what deliver the best results, certainly from a time and overhead point of view. They markedly improve clinical outcomes, which has a positive effect on the confidence a practitioner has in those outcomes — increasing speed and profitability. All the sophisticated technology and machinery is coming down in price, which will make purchases more accessible in the near future and help bring the best dental care to every patient. All this bodes well for the future of dentistry, which right now is looking very bright.

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