Implant Tribune Middle East & Africa No. 2, 2024
Periodontitis increases risk of stroke among young people, study finds / Fully digital full arch? Continued advancements in full-arch implant restoration
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DTMEA_No.3. Vol.14_IT.indd
PUBLISHED IN DUBAI
www.dental-tribune.me
Vol. 14, No. 3
Periodontitis increases risk of stroke
among young people, study finds
By Dental Tribune
International
KUOPIO, Finland: Stroke is the
second leading cause of death globally, and periodontitis has been
shown to be associated with an increased risk of ischemic stroke.
Building on their research on links
between poor periodontal health
and various cognitive problems, reported on by Dental Tribune International, a team at the University of
Eastern Finland have investigated
the relationship between periodontitis and stroke among individuals
under the age of 50 and confirmed
the link in a case–control study.
The study examined 146 people
aged between 18 and 49 who had
suffered a cryptogenic ischemic
stroke—one not explained by established risk factors—and 146 ageand sex-matched controls. Based on
thorough radiographic and clinical
examination, as well as patient variables, such as obesity, alcohol consumption, smoking status and education, and measures of bacteraemia, the study concluded that a clear
correlation exists between individuals under the age of 50 with periodontitis and a heightened risk of
cryptogenic ischemic stroke. Putting
this in context, study co-author Dr
Pirkko Pussinen, professor of transAD
Already linked to cognitive decline, periodontitis has now been connected to a risk of stroke among young people. (Image: zinkevych/freepik)
lational dentistry at the university’s
Institute of Dentistry, said on the
university’s website: “People suffering from periodontitis have a two to
2.5 times higher risk of stroke while
they’re still of working age.”
Additional findings made by the
study include that stroke severity increased with the severity of periodontitis and that the onset of
stroke was related to having recently
undergone invasive dental treatments or having persisting dental
infections requiring acute dental
treatment. Prof. Pussinen expanded
on this: “The risk of stroke also increased after invasive dental treatments, such as root canal treatment
and tooth extraction, especially in
individuals with patent foramen
ovale, PFO, a hole in the septum of
the heart.”
The study suggested that both
PFO and oral bacteria entering the
bloodstream as a result of periodontal disease may contribute to
the formation of a blood clot, leading to stroke, but cautioned on the
role played by bacteria. The researchers said: “We were able to obtain blood samples from patients
only a few days after their stroke, at
which point no biomarkers of bacteria could be found in their blood.”
The new study, titled “Periodontitis, dental procedures, and
young-onset cryptogenic stroke”,
was published in the May 2024 issue
of Journal of Dental Research.
[2] =>
DTMEA_No.3. Vol.14_IT.indd
IMPLANT TRIBUNE
C2
Implant Tribune Middle East & Africa Edition | 03/2024
Fully digital full arch?
Continued advancements in
full-arch implant restoration
1a
1b
1c
Figs. 1a–c: Rubber bands (a & b) or composite applied directly to the tissue (c) to aid intra-oral scanners in acquiring accurate data.
2a
2b
2c
Figs. 2a–c: Photogrammetry. Manufacturer-specific scan bodies (a). Extra-oral light source (iCam4D; b). Photogrammetry software (iMetric 4D; c).
By Drs Isaac D. Tawil & Scott
D. Ganz, US
Introduction
Full-arch implant-supported reconstruction continues to provide
viable solutions to restore and improve function, enhance aesthetics
and change quality of life for our patients. All-on-X implant reconstruction has benefited from new advancements and technical innovations. In this article, we continue the
journey of navigating through new
developments which impact on the
full-arch analogue and digital workflows.
Our previous articles introduced
several elements to aid the clinician
in both the surgical and restorative
phases of full-arch replacement, including the use of CBCT-guided surgical apps1 and how CBCT has
greatly improved the assessment for
3a
implant placement relative to the
desired restorative position for provisional and final restorations while
reducing implant complications.
We have previously described
an ancillary surgical protocol utilising extracted teeth as an autologous solution for bone grafting,
which has greatly enhanced healing
and long-term alveolar stability,
providing ample graft volume while
significantly reducing biomaterial
costs. 2 Subsequent publications also
reported on improving the restorative time and treatment outcome
utilising iJIG technology3 and employing small hole technology (C2F)
to enhance the physical integrity
and anatomy of milled or 3D-printed
provisional restorations4 and to improve inter-arch alignment and occlusion.
The goal of these articles was to
improve time, efficiency, costs and
long-term results for the benefit of
clinicians, laboratory technicians
and patients. This latest article endeavours to provide updates on the
acquisition of data necessary to
complete the restorations and addresses improvements in full-arch
screw-retained monolithic restorations which incorporate multi-unit
abutments (MUAs).
Data acquisition
As the dental industry continues
to strive for fully digital solutions,
the development and improvement
of intra-oral data devices and acquisition technology has continued to
evolve. Intra-oral scanning (IOS)
speeds and accuracies have made
intra-oral scanners a viable replacement for direct analogue impressions. Native IOS software apps now
provide several impressive features
which enhance and streamline com-
plete digital protocols. However,
owing to inherent logistical limitations, using IOS technology for fullarch dental implant restorations has
presented difficulties and inaccuracies, requiring additional apps to
achieve fully digital solutions.
All-on-X surgical and restorative
protocols require the placement of
four or more implants with a favourable anterior–posterior spread to
achieve the necessary long-term
support. Capturing the positions of
these implants with accurate crossarch IOS, especially in the mandible,
has been one of the major struggles
for clinicians and dental laboratory
technicians to overcome.
IOS technology requires a stable
environment for data to be stitched
and captured accurately. Several techniques have emerged to aid the clinician in scanning these difficult environments, characterised by improper
3b
Figs. 3a & b: Grammetry components for splinting for increased accuracy and stability (a). Completed Grammetry intra-oral structure secured to MUAs
with conventional screws (b).
retraction, salivary flow, lack of stable
keratinised soft tissue and large distances between scanned objects. The
splinting of scan bodies with elastic
bands or wires (Figs. 1a & b), for example, has facilitated the ability of scanners to continue a scan without interruption by creating a linear path for
data capture.5 Innovative techniques
such as the sigma composite curve
(Fig. 1c) and fiducial markers fixated to
the bone have also helped improve
the scanning flow.6 While these processes work for some and not for others, developers have created alternative workflows to aid in the acquisition
of accurate intra-oral data.
Photogrammetry in dentistry is
a relatively new development that
has revolutionised capture and positional analysis.7 Photogrammetry is
a diagnostic and research method
that uses an extra-oral capture device with specific photogrammetry
scan bodies to acquire measurements from 2D digital images
(Figs. 2a & b). Photogrammetry
scans allow dental clinicians to acquire precise measurements of the
individual scan bodies (Fig. 2c) secured to the dental implants either
at the time of surgical placement or
after the implants have been uncovered.8 While extremely accurate for
recording the positioning of the implants, photogrammetry does not
acquire the topography of the soft
tissue. Therefore, a second scan is
required with an intra-oral scanner.
The IOS data can then be used to
► Page C3
[3] =>
DTMEA_No.3. Vol.14_IT.indd
IMPLANT TRIBUNE
C3
Implant Tribune Middle East & Africa Edition | 03/2024
◄ Page C2
4
Fig. 4: Grammetry scan body with vertical and horizontal extensions to aid in
bonding to the mesh frame. IOS = intra-oral scanning; OEM = original equipment
manufacturer.
such as Dr Jonathan Abenaim’s XCell
process to facilitate and streamline
data acquisitions, avoiding the need
for photogrammetry.10 This proprietary workflow protocol requires
education therein and the use of
proprietary scan bodies. To maintain consistency and accuracy, the
protocol recommends a specific
intra-oral scanner and CAM unit.
Additionally, the workflow recommends use of Dr Abenaim’s Powerball screw to complete the production of the final restoration. Although
the recommendations are not mandatory, there is limited support
the use of an expensive device and
expensive scan bodies, Grammetry
allows the use of the dentist’s existing intra-oral scanner along with
special components provided to the
clinician for each case. The
analogue–digital process utilises
MUA-compatible
scan
bodies
(OptiSplint) designed to incorporate
an aluminium mesh frame (Fig. 3a)
that can be customised chairside
(with the snipping tool included) as
required by the intra-oral location of
the implants. This mesh frame
comes in small and large sizes to accommodate various mouth sizes
5a
5b
5c
5d
5e
5f
5g
5h
5i
5j
5k
5l
sional prosthesis, a calibration device is included in the Grammetry
kit. This device will ensure that the
specific printer settings based on the
resin used will achieve a passive fit.
Ti base or not Ti base? That is
the question
The desire for screw retention
over cementation for fixed prostheses has been debated for some
time.11 As restorative components
have evolved and CAM software
and hardware capabilities have improved dramatically, screw retention
utilising MUAs has become the pre-
Figs. 5a–l: Chrome osteotomy drilling guide used for full-template guidance (a). Multi-unit abutments seated on to the implants (b). Provisional PMMA restoration with holes to pick up the titanium cylinders (c).
Provisional restoration placed over the graft and platelet-rich fibrin after suturing (d). Intra-oral view of healed maxilla (e). OptiSplint after intra-oral luting (f). The scan of the provisional with the analogues attached (g). Virtual design of the Misch classification FP-1 restoration in exocad (h & i). Model fabricated to test the fit of the OptiSplint and final restoration (j). Final metal-free monolithic zirconia restoration secured with Powerball screws (k). Panoramic radiograph verifying the fit of the restoration and direct sealing with no gaps (l).
6a
6b
6c
Figs. 6a–c: Three methods of attaching zirconia restorations to implants. Conventional multi-unit abutment (a). Titanium bar (b).
Titanium base (c).
fabricate a virtual 3D model used to
measure various parameters of the
implant analogues.9 The software
correlation of these measurements
can be used to assess and validate
the correct positioning of implants
and the alignment of the patient’s
occlusion, regarding tooth size, distance and angle.
The combination of IOS and
photogrammetry data provides the
CAD software with all the necessary
information to virtually create a provisional prosthesis or a final resto-
ration to be 3D-printed or milled.
The advanced capability of this
highly accurate technology generates a fully digital workflow. There is
little need for an analogue model
for production or verification purposes. Although these impressive
devices are extremely accurate, the
initial purchase costs and availability
of sensitive component materials
has been an issue of concern.
To obviate the expense of photogrammetry, alternative fully digital workflows have been developed,
when not utilising the components
indicated. The proven XCell process
is extremely efficient and paved the
way for continued development of
other intra-oral imaging technology.
Another very recent option,
called Grammetry (ROE Dental Laboratory), has been developed as an
open comprehensive surgical and
restorative solution that offers a very
similar and straightforward process
at a significantly reduced cost.
Whereas photogrammetry requires
and MUA–implant positions. The
workflow involves inserting the scan
bodies on to the MUAs intra-orally
(Fig. 3b). The proprietary scan bodies have extensions (Fig. 4) to allow
the mesh to seat and rotate in close
proximity to the extensions, which
facilitate luting using a resin base
material (STELLAR DC Acrylic, Taub
Products). The structure can then be
digitised by scanning intra-orally
with an intra-oral scanner and
extra-orally with an intra-oral scanner or desktop scanner. The bonded
splinting of the scan bodies to the
mesh frame allows for a simple
uninterrupted scan path. The Grammetry process provides the clinician
with the fully digital benefits of photogrammetry while providing the
capability to fabricate analogue
models that can be articulated as
part of the prosthetic design process represented by the clinical
workflow (Fig. 5). Additionally, the
Grammetry splint can be used as a
model verification jig. The fully digital Grammetry process communicates to the dental laboratory the
necessary records workflow to design and fabricate a full-arch prosthesis at a significantly reduced cost.
For those who have 3D printers and
wish to design and print the provi-
ferred choice for most full-arch restorations owing to the passivity required for monolithic zirconia prostheses. The success of full-arch
screw-retained cross-splinted restorations can be attributed to the
elimination of subgingival cement
and the passivity of prosthesis seating.12
Screw-retained fixed implant
prostheses have undergone many
iterations over the past several decades.13 PMMA denture conversions
proved too weak to withstand occlusal forces long term. To improve
strength, metal frame reinforcement
was added to the acrylic, but the end
results still yielded a high level of
long-term prosthetic failures. Improvements in metal–ceramic restorations yielded improved long-term
aesthetics and longevity; however,
the associated costs became a factor and fractures continued to occur.
Owing to the improving strength
and diversity of materials and the
continued development of CAD/
CAM technology, other material
choices have become more viable.
Monolithic zirconia has become the
most widely used material for full► Page C4
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7a
7b
7c
Figs. 7a–c: Dimensions of a standard multi-unit abutment screw head and the available zirconia (a & b), leading to fracture (c).
8a
8b
8c
9
Figs. 8a–c: Straight screw access hole (a). Angled screw access hole of up to 15° (b). Straight vs angled screw access holes and variation in access
hole positions for improved strength and aesthetics in multi-unit abutments (c).
10
Fig. 10: New and innovative screw technology features and benefits with design and torque information.
arch implant-supported restorations.14,15 The milled and sintered
zirconia structure can be fabricated
with a standard MUA coping, a
custom-milled titanium bar or a titanium base (Fig. 6). These metal substructures are chemically luted to
the zirconia structure. Initially, while
costs were significantly reduced,
fractures were still evident, most notably from poor design. The fractures tended to occur in distal
extensions, attributed to poor
anterior–posterior spread, and in locations of screw access holes. Screw
access fractures can be attributed to
insufficient zirconia thickness at the
crown–abutment interface. Conventional prosthesis-retaining screws
secured to MUAs have a screw head
that is 2.00 mm in diameter, only allowing for 0.25 mm of screw surface
to engage the crown portion (Fig. 7).
This leaves only 0.4 mm between the
head of a conventional screw and
the titanium base. Screw loosening,
screw fracture and debonding of titanium bases from the zirconia
structure have become a source of
difficulty and concern.16 As these
complications and avoidable remakes continue to persist, develop-
ers have searched for alternative
solutions.
To counter the effects of screw
loosing, titanium base debonding
and screw access hole fracture, several new screws have been developed. Over the past few years, the
continued refinement of these
screws has led to the evolution of
metal-free full-arch monolithic zirconia restorations. As a result, in
many cases, the need for excessive
bone reduction to accommodate
the metallic portion has been eliminated, allowing for increased potential for Misch classification FP-1 com-
Fig. 9: Grammetry Vortex LA VIS screw attached directly to
the multi-unit abutment, allowing for increased thickness of
zirconia dependent on the available interocclusal space.
(Image ©Dr Danny Domingue)
pared with FP-3 restorations.17 Some
of these screws allow for increased
thickness of zirconia between the
MUA and screw head. Allowing increased thickness in this susceptible region further reduces the risks
of zirconia fracture of the area of the
screw access hole. Additionally, the
newer screws typically have a tapered or rounded screw head, allowing for improved retention by
applying pressure to the lateral walls
in the apical direction, reducing incidences of screw loosening.
A few of these newer screw designs can accommodate angled
screw access holes. Angled screw
access hole correction has become
widely incorporated in single-tooth
implant restorations.18 Previously,
correcting angulations for full-arch
restorations on MUAs required
using an MUA with an increased degree of angulation. When an MUA is
secured to the implant and the scan
data has been captured, altering the
screw access hole requires removing
and replacing the MUA with one
with an increased angle. This becomes problematic when provisional or final restorations have already been designed, and a positional tooth change is requested.
Often, these changes can leave access holes in aesthetic or potentially vulnerable areas (Fig. 8). Additionally, there are angular limitations
of MUAs, varying according to each
component manufacturer. Rather
than changing the MUA and dealing
with the difficulties of temporisation,
some of the newer MUA screw technologies allow for the MUA to remain
in place and for angulation of the
screw access hole to as much as 25°.
One screw in particular that is
uniquely designed in this regard is
the Grammetry Vortex LA VIS screw
(Fig. 9). This screw can accommodate various vertical positional
depths. This feature allows for ac-
commodation directly on the MUA,
titanium base or titanium bar simply
by adjusting the height position of
the screw. The adjustable vertical
position allows for more or less zirconia if desired, depending on the
available interocclusal space. In addition to accommodating angled
screw access holes, the ideal screw
access position and depth can be
achieved.
Therefore, utilising the innovative methods of data capture and
validation described in this article
combined with the newer screw
technology, it is possible to accomplish increased efficiency and accuracy of the fabrication process. Additionally, it has been illustrated that
screws which can accommodate an
angled screw access hole will result
in improved aesthetics (Fig. 10).
Case presentation
The following case exhibits the
features and benefits of utilising
Grammetry in combination with innovative screw technology. The
63-year-old male patient with a
noncontributory medical history
presented with failing dentition in
both arches. Diagnostic records
were collected, including full-mouth
digital radiographs (RVG 6200,
Carestream Dental; Fig. 11a),
intra-oral scans (Medit i700 wireless;
Figs. 11b & c), a large field of view
CBCT scan (Carestream 9600;
Fig. 11d), and intra-oral and extra-oral photographs (Fig. 11e). The
mandible contained an im- pacted
canine as well as several mobile and
painful teeth.
The maxilla was in a similar condition, having deteriorating, painfully mobile teeth, as well as extensive caries. While the bone loss was
significant in the mandible, the ver► Page C5
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12a
11a
12b
11b
11c
12c
11e
11d
Figs. 11a–e: Full-mouth radiograph series revealing caries and periodontal defects (a). Maxillary and mandibular intra-oral
scans (b & c). CBCT scan for diagnosis and treatment planning (d). Pre-op photograph showing a reverse curve of the mandibular teeth and poor aesthetics (e).
14c
14a
14b
14d
14e
13
Figs. 14a–e: Retracted view of the provisional restorations (a) fabricated with C2F small hole technology (b). Two-week post-op smile (c). Two-week post-op panoramic
radiograph and intra-oral photograph showing excellent healing (d & e).
tical dimension of occlusion (VDO)
allowed for both arches to be treated
with an FP-1 prosthesis.
Based on the assessment of the
acquired data, several treatment
plans were developed and presented
to the patient. Treatment concepts
that were considered included salvaging those teeth deemed stable
enough to be utilised to retain removable restorations, implant stabil-
isation with a combination of fixed
and removable prostheses, implantsupported overdentures and fullmouth reconstruction with implant
therapy. After reviewing the various
treatment proposals, the patient
elected the last option.
The collected data, along with
preliminary plans for potential implant receptor sites (Blue Sky Plan,
Blue Sky Bio), was submitted to the
laboratory (ROE Dental Laboratory)
for review. The 3D data from the
CBCT scan was then merged with
the IOS data set to aid in determining a restoratively driven solution
for both arches. The laboratory then
designed
provisional
full-arch
screw-retained restorations utilising
CAD software at the designated
VDO required for the prostheses.
The desired tooth position as visualised with the 3D reconstructed volume of bone helped to determine
the most favourable implant receptor sites. A virtual remote planning
session was held with the laboratory
to finalise the full-template guided
surgical plan (CHROME GuidedSMILE, ROE Dental Laboratory),
which incorporated a 2 mm increase
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15a
15b
15c
15d
15e
15f
15g
15h
Figs. 15a–h: Facial scan for smile evaluation and midline assessment (a). Intra-oral scanning Grammetry workflow for transfer
to the dental laboratory (b). Photogrammetry scan bodies used to validate and confirm the Grammetry implant positions
(c & d). 3D-printed maxillary and mandibular restorations on verification casts (e & f). Grammetry OptiSplint used to capture
implant positions for model fabrication (g & h).
16a
16b
Figs. 16a & b: Panoramic radiograph showing printed restorations secured with Grammetry Vortex LA VIS screws (a).
Retracted intra-oral view (b).
17a
17b
17c
Figs.17a–c: Final panoramic radiograph confirming seating of the zirconia restorations (a). Retracted intra-oral view (b). Final
patient smile showing excellent aesthetics and a happy patient (c).
in the VDO, and the case was sent for
production. The CHROME GuidedSMILE protocol consists of several
component parts, which provide a
stackable solution with metallic scaffolding to control the bone reduction, the preparation of the osteotomies, full-template guidance of the
implants into the bone, control of
implant depth, trajectory and rotational indexing, the positioning of
the MUAs, and the delivery of the
provisional restorations.1
The surgery for both arches was
completed in a single visit under intravenous sedation. All the remaining teeth were extracted, and selected teeth were then pulverised
utilising the Smart Dentin Grinder
(KometaBio) and sterilised to be
used as autografting bone substitute2 (Fig. 12). A biologically driven
drilling system for anatomical alveolar sculpting (Universal Shapers) was
employed (Fig. 13). The alveolar
bone was scalloped utilising the diamond shaper drills for both implant
and pontic sites to promote emergence profiles for enhanced aesthetics according to the basic tooth
size requirements assessed from the
initial data collection. The surgery
was uneventful except for a mild
complication during the extraction
of the impacted mandibular canine.
Implant stability was measured with
resonance frequency analysis (implant stability quotient) to validate
loading. MUAs were secured to each
implant based on the rotational positions predetermined by the surgical planning. Deficient sites and residual tooth sockets were then
grafted with the ground dentine autograft, covered with platelet-rich fibrin membranes and sutured around
the healing abutments. Provisional
restorations were fabricated using
the C2F protocol (Figs. 14a & b).4
After customisation and polishing,
the provisional restorations were inserted and allowed to heal
(Figs. 14c–e).
During the subsequent postoperative visits, the patient described
being extremely happy with his
newly rehabilitated mouth. As the
preliminary provisional restorations
had been designed based on the
desired virtual result, it was possible
to make changes as necessary for
the final restorations. A slight discrepancy was observed in initial
tooth size and midline position, and
this was noted in order to be corrected during finalisation of the
monolithic zirconia restorations. The
patient tolerated the 2 mm increase
in VDO, and minimal adjustments to
the occlusion were accomplished
through digital articulation (OccluSense, Dr. Jean Bausch). Tissue healing was unremarkable apart from
minor loss in alveolar height and
soft tissue in the impacted canine
extraction site.
After four months, the patient
returned to complete the process of
finalising the prostheses. Final records were taken, including new
digital scans and photographs. Photographs included the patient profile
when smiling and not smiling as well
as intra-oral occlusion. The digital
scans included a facial scan acquired
from the CBCT device, maxillary and
mandibular soft-tissue scans using
scan bodies (DESS), bite registration,
an iJIG scan of the provisional restorations for tooth positions,3 photo-
grammetry (iCam4D, iMetric 4D)
and Grammetry scans (Fig. 15). The
Grammetry scans were scanned
extra-orally with both the intra-oral
scanner and an extra-oral desktop
scanner (Medit T710) for comparison.
The data collected was sent
through a scanning software portal
(Medit Scan for Clinics) to the dental
laboratory with requested changes
for correction of the desired smile
design. Utilising advanced planning
features in the design software
(exocad), the midline and tooth size
changes were corrected. 3D-printed
maxillary and mandibular PMMA
restorations were used for try-in
using the direct-to-MUA screws
(Vortex LA VIS; Fig. 16a). Fit, phonetics, aesthetics and occlusion were
evaluated and confirmed using digital articulation (OccluSense; Fig. 16b).
The patient was extremely satisfied
with the printed try-ins. Since no adjustments were required, the patient
was allowed to leave with the printed
try-ins as new provisional restorations made from extra-strong
resin. The new provisional restorations were worn for ten days to
confirm form and function. The final
shade was chosen, and metal-free
monolithic zirconia restorations
were then fabricated by the laboratory.
The final restorations were passively and accurately seated ten
days later uneventfully using Vortex
LA VIS screws. Confirmation records
were taken with photographs, radiographs and digital articulation to
recheck fit, function, phonetics and
occlusion (Fig. 17a). The patient was
extremely satisfied with his final restorations, describing the process as
life-changing and surprisingly fast in
comparison with what he had heard
about full-mouth implant therapy.
He was especially pleased with the
speed at which the final process was
able to be completed (Figs. 17b & c).
Conclusion
With proper diagnosis and treatment planning, single-arch or fullmouth implant reconstruction can
be completed in a timely manner
under ideal circumstances. The implementation of restoratively driven
guided surgery can improve accuracy and ensure proper implant
placement, including depth and angulation. Data collection at either
the time of surgery or postoperatively can improve the accuracy and
speed at which finalisation can be
completed.
The present case described digital and analogue protocols for capturing soft-tissue topography as well
as the use of iJIG provisional restorations essential to aligning and validating the intra-oral position of restorations, as well as the use of Grammetry and photogrammetry. Voids
can be shown with accuracy and adjusted to be filled in using design
software. With incorporation of a 2D
profile photograph or, better yet, a
3D facial scan, tooth position, size
and shape can be easily managed
for an improved try-in or final restoration.
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In this case, three methods were
utilised to capture data to provide a
basis of comparison. The first, photogrammetry, has been acknowledged as the gold standard for implant position accuracy. The second,
Grammetry, utilised the new Opti
Splint analogue luting protocols.
The third, digital capture, utilised the
Grammetry OptiSplint, in which the
intra-oral scanner and extra-oral
desktop captures were analysed and
compared. The extra-oral desktop
capture
of
the
Grammetry
OptiSplint was almost identical to
the photogrammetry capture when
both data sets were superimposed.
The extra-oral desktop capture of
the Grammetry splint yielded marginally better results than the intraoral scan captured extra-orally. Although the results may be slightly
less accurate due to the human error
associated with intra-oral scanners,
they were more than acceptable, as
CAD/CAM unit tolerances prevent
milling beyond the results obtained.
An added benefit of using the Grammetry process is the possibility of
producing a physical model, allow-
ing for an analogue try-in for producing both printed try-in and final
milled restorations.
In summary, there are various
existing digital workflows which can
be successfully utilised to achieve
consistent and accurate results for
full-arch implant-supported restorations. Currently, owing to supply
chain shortages and limitations,
photogrammetry devices are on
back order and in short supply.
Grammetry protocol components
are both available and less expensive. For the purposes of this case
presentation, it was found that the
analogue–digital protocol of Grammetry can be used as an effective,
affordable and equally accurate alternative to photogrammetry. In
combination with the necessary records, Grammetry can provide a
fully digital capture of implant positions while providing analogue
models if desired for articulation
and restoration fabrication. Capturing data either on the day of surgery
or later on can greatly improve dental laboratory communication and
reduce final prosthesis production
time while supporting a high level of
accuracy, enhancing the overall clinical and patient experience. Future
research on the protocols and materials utilised for this case presentation is recommended, as the search
for the most economical and accurate digital workflows continues to
evolve.
Editorial note: This article originally appeared in Dentistry Today in May 2023,
and an edited version is provided here
with permission from Dentistry Today.
Please scan this QR code
for the list of references.
Dr Isaac D.
Tawil received
his DDS from
the New York
University College of Dentistry and
has a master’s degree in biology from
Long Island University, both in the US.
He is a fellow of the International Congress of Oral Implantologists and the
Advanced Dental Implant Academy,
a diplomate of the International Academy of Dental Implantology and
a co-director of Advanced Implant
Education. He has received recognition for outstanding achievement in
dental implants treatment from the
Advanced Dental Implant Academy,
as well as the President’s Volunteer
Service Award for his volunteer work
in places such as Honduras, Mexico,
the Dominican Republic, China and
Peru. Dr Tawil lectures internationally
on advanced dental implant procedures using the latest technology and
teaches live surgery seminars in his
office and abroad, as well as handson courses globally. He maintains a
general private practice in New York,
where he focuses on implant therapy.
He can be reached at tawildental@
gmail.com.
Dr Scott D.
Ganz completed a 3-year
specialty
in
maxillofacial prosthetics at the University of Texas MD Anderson Cancer Center in Houston, in the US, and
this led to his focus on the surgical
and restorative phases of implant
dentistry. He has contributed to 22
textbooks and over 150 publications,
lectures globally, is a diplomate of
the Academy of Osseointegration,
a fellow of the International College
of Dentists, and co-director of Advanced Implant Education. He maintains private practices in Fort Lee, in
New Jersey, and Manhattan, in New
York. He can be reached at drganz@
drganz.com.
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