CAD/CAM Tribune U.S. (Archived)
Safety-first implant therapy / Industry
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CAD/CAM TRIBUNE
The World’s Dental CAD/CAM Newspaper · U.S. Edition
May 2011
www.dental-tribune.com
Vol. 1, No. 1
Safety-first implant therapy
By Neal S. Patel, DDS, and Jay B. Reznick, DMD
Cone-beam computerized tomography (CBCT) systems number
amongst the most advanced imaging
devices that are currently available
on the market.
The insight into the third dimension simplifies diagnostic procedures, enhances treatment safety
and reduces radiation doses for
patients. In addition, there are convincing forensic arguments in favor
of CBCT.
With the aid of 3-D CBCT images,
users can interpret the clinical situation with much greater accuracy.
They can evaluate the optimum
drilling angles for various perspectives (saggital, coronal, axial) and
generate transversal slices and panoramic images.
Compared with conventional CTs,
CBCT systems are less sensitive to
metal artefacts. Thanks to the availability of 3-D imaging, dentists are in
a better position to assess the risks of
treating certain cases in-house.
In addition, CBCT users can create digital networks with their colleagues and advertise their services
to referring dentists.
An important reason for purchasing a CBCT system is the time and
effort involved in referring patients
to external radiologists, both for
the patient and the dentist. In some
cases, patients do not return after
being referred. In addition, the diagnostic results are sometimes delayed
and the reports are not directly
assigned to the X-ray images.
Referrals to external radiologists
tend to disrupt the patient counseling
process. Experience has shown that
patients rate the expertise of a dental
practice more highly when all services come from a single source and
when the dentist is directly involved
in the diagnosis of the X-rays.
The higher costs of a CBCT image
compared with a conventional panoramic X-ray can easily be justified
by the clear diagnostic and therapeutic benefits. A convincing argument is that a CBCT contains 300 MB
of information, compared with only 5
MB in the case of a digital panoramic
X-ray.
Implant planning using GALILEOS and CEREC reduces the number of appointments. Less laboratory
work is required. In most cases, it is
not necessary to produce waxed-up
prosthetic reconstructions. The combination of digital imaging and CAD
generates all the necessary information for the dental laboratory, thus
ensuring transparent working procedures.
The decisive factor is that the integration of GALILEOS and CEREC
streamlines the dentist’s workflow
and leads to reliable clinical results.
Enhanced clinical reliability
A very useful feature of the GALILEOS system is the built-in implant
database, which contains the dimensional data of various commonly
used endosseous posts (Astra, Straumann, BIOMET 3i, Bicon, BioHorizons and Z-Look).
By combining the GALILEOS
image, the clinical CEREC scan and
the virtual superstructure design, the
user can dispense with a prosthetic
wax-up model (Fig. 1). Instead, a
template is used that is easily fixated
in the patient’s mouth (Fig. 2). The
prosthetic planning is carried out
fully digitally by using the CEREC
software.
Thereafter, the prosthetic planning data is imported into the CBCT
scan, eliminating both the need to
create an X-ray template and to form
a barium-sulphate prosthetic model.
This leads to results that are more
precise.
Moreover, because no barium sulphate is used, the CBCT image is of
good quality. The positions of the
endosseous drill holes are determined by means of plastic surgery
guides (SICAT/Sirona). Minimally
invasive flapless implantation eliminates the need for the elevation of the
mucoperiosteal flap. This not only
minimizes surgical trauma, but also
permits the immediate placement of
the restoration on the implant.
Fig. 1: The 3-D scan of GALILEOS with imported CEREC crown.
Fig. 2: SICAT surgery guide.
Less laboratory work
The ability to import the CEREC data
into the CBCT image significantly
streamlines the implant planning
workflow. The interaction between
GALILEOS and CEREC means that
only two appointments are required,
at an interval of five to seven days.
Thanks to the surgery guide, the
invasive surgical insertion of the
endosseous post takes only 15 minutes, resulting in greater precision
and reduced stress. Using the conventional method (that is, without a
CBCT scan and surgery guide) each
implant requires up to 45 minutes
and is accompanied by greater risks.
g LT page 2D
Fig. 3: Inserted ZrO2 abutments.
[2] =>
2D Case Study
CAD/CAM Tribune | May 2011
f LT page 1D
Thus far, custom-made angled
abutments with individual emergence profiles have often been
required in order to compensate for
divergences in the insertion angles
between the implants and the superstructures. Thanks to the integrated
implant-planning process, it is now
possible to deploy competitively
priced, industrially prefabricated
abutments (Fig. 3).
The precise planning of the angulation in the CBCT image and the
guided drilling process ensure a better fit between the endosseous post
and the superstructure. If required,
specially shaped abutments can
be created out of zirconium oxide
(ZrO2) using the inLab system.
As a rule, the implants are luted
directly to single-tooth implants. In
order to protect the gingiva, overpressed luting residues must be
carefully removed.
Following the attachment of the
abutment and the closure of the
screw access, it is advisable to place
a retraction cord in order to expose
the tissue and the abutment margin.
The abutment is then conditioned
with titanium powder in preparation for acquiring the intra-oral
impression using the CEREC AC and
designing the final implant crown
(Fig. 4).
AD
CAD/CAM TRIBUNE
The World’s Dental CAD/CAM Newspaper · U.S. Edition
Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com
Fig. 4: Screenshot of CAD
construction for implant crowns.
The crown is then automatically
milled to anatomical dimensions out
of a lithium disilicate (LS2) block
(IPS e.max CAD, Ivoclar Vivadent).
The try-in should be performed prior
to crystallization. This is followed by
crystallization, polishing/glazing and
luting to the abutment (Fig. 5).
If stringent esthetic requirements
have to be fulfilled (for example, in
the anterior region) the LS2 crown
can be cut back and then individually veneered (Fig. 6).
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief
Laura Kelly
l.kelly@dental-tribune.com
Fig. 5: LS2 crowns adhesively
luted to the abutments.
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Account Manager
Gina Davison
g.davison@dental-tribune.com
Conclusion
To a significant extent, GALILEOS
and CEREC simplify implant planning and superstructure fabrication.
The clinical outcomes are predictable. Compared with conventional
methods, treatment is much faster.
The 3-D images and the virtual
prosthetic proposal play a valuable
role in patient counseling. In addition, there is an increased likelihood
Managing Editor/Designer
Implant, Endo & CAD/CAM Tribunes
Sierra Rendon
s.rendon@dental-tribune.com
Account Manager
Humberto Estrada
h.estrada@dental-tribune.com
Fig. 6: Implants with supra-structures
in situ.
that the patient will accept the plausibility of the proposed treatment
and give his or her consent more
quickly. CCT
CCT
About the authors
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com
Marketing & Sales Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia Wehkamp
j.wehkamp@dental-tribune.com
International C.E. Sales Manager
Christiane Ferret
c.ferret@dtstudyclub.com
Dental Tribune America, LLC
116 West 23rd Street, Ste. 500
New York, N.Y. 10011
Phone: (212) 244-7181, Fax: (212) 244-7185
Published by
Dental Tribune America
© 2011 Dental Tribune America
All rights reserved.
Dr. Neal S. Patel operates a dental
practice in Powell, Ohio. He is a CEREC
user, as well as an advanced trainer for
the GALILEOS CBCT system.
Dental Tribune makes every effort to
report clinical information and manufacturer’s product news accurately,
but cannot assume responsibility for
the validity of product claims, or for
typographical errors. The publisher
also does not assume responsibility
for product names or claims or statements made by advertisers. Opinions expressed by authors are their
own and may not reflect those of
Dental Tribune America.
CCT
Corrections
CAD/CAM Tribune strives to maintain the
utmost accuracy in its news and clinical reports. If you find a factual error or
content that requires clarification, please
report the details to Managing Editor Sierra Rendon at s.rendon@dental-tribune.com.
Tell us what you think!
Dr. Jay B. Reznick runs a dental practice in Tarzana, Calif. He specializes in
implantology, as well as in tooth and
skin transplants.
Do you have general comments or
criticism you would like to share? Is
there a particular topic you would like
to see more articles about? Let us know
by e-mailing us at feedback@dentaltribune.com. If you would like to make
any change to your subscription (name,
address or to opt out) please send us an
e-mail at database@dental-tribune.
com and be sure to include which
publication you are referring to. Also,
please note that subscription changes
can take up to six weeks to process.
[3] =>
Industry 3D
CAD/CAM Tribune | May 2011
Astra Tech launches new Atlantis
interface for sloped ridge situations
Astra Tech has expanded its patient-specific
abutment solution for
North American customers to now include Atlantis™ Abutments for Astra
Tech OsseoSpeed™ TX
Profile implants.
This is the latest addition to the rapidly expanding Atlantis patient-specific abutment assortment. A
leading CAD/CAM solution for patient-specific,
cement-retained implant
Atlantis Abutments for
prosthetics is a natural
Astra Tech OsseoSpeed TX
complement to the anaProfile implants. (Photo/
tomically designed implant
Provided by Astra Tech)
for sloped ridge situations,
launched by Astra Tech
earlier this year.
Atlantis Abutments are available ity chart is available at www.atlantis
for all major implant systems such as abutment.com.
Astra Tech, Straumann, Nobel Biocare,
BIOMET 3i and Zimmer Dental. Addi- About Atlantis Abutments
tional interfaces for Atlantis Abutments Atlantis Abutments are designed
are being developed.
and fabricated using Atlantis VAD™
The complete Atlantis compatibil- (virtual abutment design) software,
a patented process that combines
state-of-the-art 3-D optical scanning,
advanced software and manufacturing methods to deliver patient-specific abutments that eliminates the
need for hand modification.
Atlantis Abutments help to expand
the possibilities for cement-retained
implant restorations and are available
for all major implant systems and in
titanium, gold-shaded titanium and
four shades of zirconia.
Atlantis and Atlantis VAD are trademarks of Astra Tech. All other trademarks are the property of their respective owners.
About OsseoSpeed TX Profile
The OsseoSpeed TX Profile is a
uniquely shaped, patented implant
specifically designed for sloped ridge
situations that allows clinicians to
achieve 360-degree bone preservation around the implant, regardless
of the position in the mouth. As with
all Astra Tech implants, OsseoSpeed
TX Profile has all the key features
of the well-documented Astra Tech
BioManagement Complex™.
About Astra Tech
Astra Tech AB, a company in the
Astra Zeneca group, is a global leader in dental, surgical and urological
products, services and support. An
innovation-driven company since the
start in 1948, Astra Tech has continually developed market-leading solutions to meet health-care needs based
on user and medical community input.
Ongoing research and development is
aimed at finding new ways to support
caregivers and improve quality of life
for patients worldwide.
Astra Tech headquarters are located in Mölndal, Sweden, with production facilities in Sweden and North
America. The company is represented
globally by 16 subsidiaries and selected
local distribution partners. Astra Tech
has 2,200 employees worldwide and its
revenue in 2010 was SEK 3.9 billion.
The company invests five percent of its
revenues annually in research. CCT
(Source: Astra Tech)
AD
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