Eliminating the Guesswork: The Complete Digital Workflow in Implant Dentistry
Markus B. Blatz, DMD, PhD; and Christian Coachman, DDS, CDT
Current diagnostic and treatment planning tools support a complete digital workflow that takes the guesswork out of implant dentistry and facilitates asynchronous collaboration between all involved specialties, from the restorative dentist to the surgeon to the dental laboratory. Long gone are the days of freehanded implant placement as guided as well as navigated surgery and now even robots provide unprecedented precision and predictability in implant placement based on the individual medical, morphologic, and anatomic situation of each patient.
In the past, clinicians relied almost exclusively on their subjective and sometimes incorrect clinical evaluation and judgment. Limited knowledge and understanding of facial and dental esthetics and the inaccuracies and distortions of analogue procedures, such as impression making, facebow transfer, interocclusal record taking, and use of analogue articulators, often compromised clinical outcomes, especially in implant dentistry, which requires an interdisciplinary approach. In contrast, digital tools and software can greatly improve visualization, evaluation, diagnosis, and decision making as well as interdisciplinary treatment planning and execution.
The complete digital workflow begins with the patient digitalization, obtained by the scanning of hard and soft tissues. This is facilitated through the use of intraoral scanners, cone-beam computed tomography, and additional digital tools, such as digital smile design software, virtual articulators, and jaw tracking devices. An advantage of this approach is that many of the diagnostic and planning steps can be carried out on the computer, even without the patient being present, saving valuable chairtime. More recently, several digital diagnostic and treatment planning tools have been powered by artificial intelligence to speed up the process and provide improved accuracy and calibration, most notably in the area of automated radiographic evaluation. The obtained files can be immediately stored in a dental cloud platform and shared with the professional team. An interdisciplinary treatment plan is designed through asynchronous communication with input from all team members, including the restorative dentist, surgeon, and technician. Other specialties, such as periodontics, orthodontics, or endodontics for example, can be easily consulted as needed.
Next, the planned treatment is simulated in a 3D software. These treatment options along with the desired outcome are presented to the patient on the computer and, if possible, with an intraoral mock-up. These simulations not only help the clinician make better decisions but also serve as a tool for patient education, motivation, and case acceptance.
The process is then completed with so-called guided dentistry, which implies that surgical guides, appliances, and restorations can be printed or milled to transfer the digital plan to the patient's mouth. Especially in implant dentistry, surgical guides have become indispensable for optimal clinical care, ensuring precise implant placement for all types of cases, from single-unit restorations to full-mouth reconstructions. Proper implant position is critical for any type of prosthetic reconstruction and its esthetic and functional long-term success.
In the dental laboratory, the design, material selection, and fabrication of the definitive restoration have long been aided by digital technologies and are constantly undergoing improvements. It's now up to clinicians to embrace a comprehensive digital approach, not just to be "cutting-edge," but to provide patients with more precise, predictable, and, ultimately, better care.
Coachman C, Sesma N, Blatz MB. The complete digital workflow in interdisciplinary dentistry. Int J Esthet Dent. 2021;16(1):34-49.
About the Authors
Markus B. Blatz, DMD, PhD
Professor of Restorative Dentistry, Chair, Department of Preventive and Restorative Sciences, and Assistant Dean, Digital Innovation and Professional Development, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
Christian Coachman, DDS, CDT
Adjunct Professor, Department of Preventive and Restorative Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania;
Founder and Chief Executive Officer, DSD-Digital