How to increase success with implants through a digital workflow

Today’s dental labs exist in an ever-changing digital environment. Lab scanners are more common, and are being used for an increasing range of indications. Only a few years ago, this technology was only used in certain labs for a specific purpose (mostly zirconia production).

Today, its use in both materials and indications is growing. The next wave of digital is already upon us: the ability for doctors to intra-orally scan implant sites for abutments and crowns. The navigation of this new technology includes a new set of twists and turns for the laboratory technician. 

Related Article: 5 Ways to Go Digital the RIGHT Way

I look at the digital workflow as a circle-starting and ending with the doctor and the patient. How the case goes around this circle is different based on many factors. These factors include what type of intraoral scanner the dentist uses, the type of design software the lab has access to and the manufacturing of the completed restoration.

When everyone involved with the case (dentist, lab and milling center) are on the same page, fabrication is as easy as drawing a circle. When communication fails, the workflow is anything but smooth. Several factors can cause changes in the workflow. None of these alone messes up the circle, just how the circle is drawn.

The importance of the implant library

The first of these factors is the implant library. A common misconception we encounter is that implant libraries are generic and any manufacturer can mill from any library, or that a doctor can get an implant scan body and send the case to any lab or any manufacturer. This is not the case.

The exacting measurement of implant prostheses require exacting data to be put into the design file. This starts with the proper scan body being connected with the correct implant library. The measurements for this are what are visible in the design software, but also in the data that lies just beneath the surface of the case.

The most important of these is the zero point (see the image above) of the implant connections. The timing of the implant restoration and the height of the designed part is dependent on this zero point. The accuracy of a case moving from a digital environment back to reality becomes intertwined with how accurate the data is.

Next page: Choosing the right design software and digital partner.

Choosing the right design software

The next way the digital workflow changes is the lab’s design software, level of digital knowledge and capabilities. Monolithic model-less dentistry is available today, which includes implant-retained restorations. However, if a model is needed, the implant library and the design station must have the capability to create it; they must be able to insert a lab analog into it and add thickness to the scan data in order to print the model. The implant library holds many keys to success.

Proper training on how to design these cases is also important. We as technicians need to educate ourselves on what is best for the patients’ health. Taking into account the biologic width, tissue support and margin placement are paramount in these types of cases. A team effort from all can ensure a healthy outcome.

The last step of successful digital implant cases is the abutment manufacturer. Knowledge to mill accurate implant interfaces is different from the milling of a zirconia coping. The accuracy and consistency of this part can make or break a case.

For ultimate accuracy, the type of machine used to machine implant interfaces differs from what is used to mill parts in a dental lab. It isn’t that an interface can’t be milled on the dental machines, just that these machines are not ideal. Choosing a trusted partner that is experienced in this area does reflect on the final product. 

Picking the right partners

With many different libraries available, labs must choose who they partner with. These decisions are related to the scanner the doctor chooses, and how the lab will use the data. Sometimes labs need to purchase additional software to work with some intraoral scanners, while other scanners are capable to of exporting clean STL files.

At Core3dcentres, we have the capabilities to fill in any part of the restorative circle that the team needs. We can accept the digital files from doctors, design and fabricate the restorations and models, send the scan data to the lab or educate technicians on the workflow to give the lab control of the case.

Q&A: Emily Bradley, Director of Education, Core3dcentres

We can also educate team members through our Core3daCADemy courses and on-site programs. Core3dcentres’ implant library has more than 100 different connections (with more in development), each scan body is measured for accuracy within three microns multiple times, and we ensure we use scanners of impeccable accuracy and design software whose limitations are only in the imagination of the technicians.