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Compendium
July/August 2021
Volume 42, Issue 7

Smile in a Box Helps Clinicians Treatment Plan With the “End in Mind”

Growing up in a dental family, E. Armand Bedrossian, DDS, MSD, FACP, says he has always been drawn to dentistry, especially implant dentistry.

"I was fortunate to attend my father's alma mater, the University of Pacific Arthur A. Dugoni School of Dentistry, where I was exposed to the ‘Complex Care' curriculum and worked closely with the prosthodontic faculty," says Bedrossian, a prosthodontist who practices in his hometown of San Francisco. "My dental school experience, as well as my father's emphasis on understanding comprehensive treatment planning, led me to the advanced prosthodontic residency at the University of Washington, where interdisciplinary treatment planning with other specialties helped foster both my academic and clinical growth. My career path and dental education instilled fundamental knowledge and understanding in analog principles, which has allowed me to adapt and adopt digital workflows in my practice."

One such workflow is the Smile in a Box® digital treatment planning and manufacturing service from Straumann. "Smile in a Box allows me to effectively communicate to both my colleagues and patients," Bedrossian says. "As a prosthodontist, I strive to treatment plan with the ‘end in mind.' After gathering the diagnostic data necessary for treatment planning, such as an intraoral scan, CBCT, and photographs, we incorporate them into an implant-planning software, such as coDiagnostiX®. Within the software and the Smile in a Box process, I can communicate the prosthetic plan and its relation to the prospective implant positions with my surgical colleagues."

In short, Bedrossian says, "Smile in a Box lets clinicians basically perform the surgery and conversion virtually, allowing us to prepare for potential limitations and problems we may encounter prior to the actual clinical procedure."

Bedrossian emphasizes that the fundamentals of treatment planning have not changed, even with digital technology. Using a service such as Smile in a Box, however, enables a more efficient and predictable way to plan and prepare implant placement and immediate-load prosthetics.

"Treatment planning is an algorithmic sequential evaluation of each patient utilizing facially generated treatment planning principles and diagnoses to aid in providing the appropriate treatment," he explains. "The combination of photographs, radiographs, and diagnostic records allows for the diagnostic work-up. This is all still necessary, but digital technology has made it less labor intensive compared to using an analog approach."

For example, "The traditional approach for a smile design would include alginate impressions and analog wax-ups, requiring that both the clinician and lab technician have an artistic understanding of tooth proportions and occlusion. In the more contemporary workflow, you still need to know how to treatment plan, but it's done through less labor-intensive procedures like intraoral scanning and digital wax-ups. It is still imperative to understand fundamental analog principles in all aspects of dental procedures before integrating digital workflows into a practice."

Bedrossian notes that the use of Smile in a Box, which supports guided surgery, has enhanced his communication with his patients. "For instance, I can explain my rationale for the treatment plan and surgical procedures by way of the visual aids Smile in a Box provides and STL scans of the proposed denture in relation to the implant placement within the alveolar ridge on the CBCT. It allows me to build rapport with patients, gives them confidence in me, and calms them knowing that they are in a contemporary office utilizing modern technology."

Smile in a Box, Bedrossian adds, has been well accepted by both his clinical team and surgeon's team. "It has helped improve the interdisciplinary communication necessary to treatment plan and execute complete-arch implant therapy from the most routine cases to the most complex."

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