July/August 2018
Volume 39, Issue 7

Precise, Efficient Implant Placement Utilizing CAD/CAM and Digital Software

Younger practitioners entering the profession are coming into an industry that has and will always include digital dentistry. Such was the case for Alex Touchstone, DDS, who began using CAD/CAM and digital technologies almost immediately after opening his practice in Hattiesburg, Mississippi. "My practice has been shaped by the application of dental digital technologies for the benefit of the patient since day one," he says.

His office utilizes a variety of CAD/CAM and digital solutions offered by Planmeca. These range from Planmeca Romexis® software, to the Planmeca PlanCAD® Easy, to the most recent release, the Planmeca Emerald intraoral scanner. Touchstone's process begins by capturing a cone-beam CT (CBCT) and a digital, full-arch impression. The CBCT is captured utilizing the Planmeca ProMax®, which is a dedicated 3D imaging device that produces all required volume sizes for diagnosing the maxillofacial region. The digital impression is captured with the Planmeca Emerald.

Between the patient's first and second appointments, that information is accessed from within the same software that was used to capture the data, Planmeca Romexis. This software supports different workflows, from high patient turnover 2D imaging to advanced specialist 3D treatment planning, implant planning, and guided surgery.

"Inside of Romexis, I'll plan the position of the implant and then fabricate a digital surgical guide, which will then be exported out of Romexis and either printed or milled in my on-site lab," Touchstone explains. This software allows him to do a digital impression in his main restorative operatory, capture a CBCT in his main imaging operatory, and walk back to his lab to pull up all of the data. "Because the information is sitting there on the lab computer workstation terminal, it doesn't have to be imported/exported or pulled from one place to the next," he says, adding that this increases efficiency.

Oftentimes, Touchstone and his team will also utilize PlanCAD Easy, a CAD/CAM design module that is fully integrated within Planmeca Romexis, to design the final tooth position and then use that information when planning implant positioning. "This allows me to consider the position of the implant relative to not only the bone but the crown itself. That software can then be used to make the provisional crown prior to implant placement," he states.

When the patient comes back for the second appointment, Touchstone uses the surgical guide to place the implant and may or may not place a provisional crown. "Oftentimes, the use of the surgical guide and the precision of the implant placement itself will allow for a more conservative surgery that can include a flapless technique if there is sufficient keratinized tissue," he explains, emphasizing how beneficial this is for patients, as they will feel less discomfort later on and enjoy a shorter healing time.

Practitioners also benefit from a shortened workflow; in the past, Touchstone had to allot an hour or more for the placement of a single implant when working freehand. With surgical guides and the potential for minimal or no flap, implant placement now takes about 20 to 30 minutes.

Touchstone can tell that patients sense the precision with which he is performing the procedure and the comfort they experience during it. "I hear comments like, ‘Wow, dentistry has come a long way!'" he notes.

For Touchstone, the bottom line with patients is that on one level, dental practitioners provide a service that is technical in nature; however, on a deeper level he sees the dynamic between dentist and patient as a relationship whose foundation is based on trust. "They see the 3D rendering of their CBCT, and that I go through the process step by step and show them what I'm seeing," he continues. "With the intraoral scanner and intraoral camera from Planmeca, patients are able to fully see and understand why I am recommending what I am. They then are more willing to accept the treatment, because they trust me," he concludes.

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