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Inside Dentistry
July 2024
Volume 20, Issue 7

Fully Digital Implant Workflow Benefits Patients

Dentsply Sirona’s Astra Tech Implant System® EV, Atlantis® patient-specific prosthetic solutions, and other innovations facilitate accurate and predictable implant therapy

Jeremy Ueno, DMD

Jeremy Ueno, DMD, prides himself on having taken a completely grassroots, relationship-based approach to building his practice, the Ueno Center in Campbell, California. Lacking mentorship during his years as an associate, Ueno took a leap of faith and trusted his ability to do things his own way and to build his own connections. "My first job as an associate was to cover another dentist's practice while he was out of the office for 6 weeks dealing with a health issue, and my second involved taking over another dentist's practice for about a year while she was also out dealing with health concerns," he says. "So, in both of those circumstances, the practice owners that I was working for were unfortunately not able to provide any mentorship. I had completed a periodontics residency at Columbia University and knew that, as a specialist, I would need to build a referral base. Therefore, during the first few years, I just did a ton of outreach."

Ueno's approach paid off, and he has since grown his practice into a multispecialty dental surgery center with three associates, including two more periodontists and an oral and maxillofacial surgeon. One of the major ways that Ueno was able to build his practice was by facilitating study clubs out of his office. Ueno's laboratory technician, Sean Han, CDT, who now owns a specialty full-arch dental laboratory, Master's Arch, in Phoenix, Arizona, attended some of the study club meetings at Ueno's office in the past and credits them with inspiring him to learn CAD/CAM and really focus more on digital dentistry and full-arch cases. When Han left California to start Master's Arch in Arizona, Ueno continued to work with him as one of his main clients. "Everything we do is 100% patient centric," Ueno says, "and in order to create the best possible patient experience, we have to invest in our ongoing education and training as well as in developing new and better systems, developing our team and our leadership, and adopting the most effective technologies."

As a result, Ueno and Han were able to work closely together to create a new, fully digital implant workflow after having already gone from an analog one to a semi-digital one utilizing stackable guides. Innovative implant technology from Dentsply Sirona and support from Ueno's Dentsply Sirona representative played a key role in the new workflow's development. "We started using Dentsply Sirona's Astra Tech Implant System® EV along with their Atlantis® patient-specific prosthetic solutions," Ueno says. "From a clinical perspective, the design of the Astra Tech Implant System's implants allows for better primary stability. Being able to consistently achieve well over the 25 Ncm of torque that we need when we place implants has been a godsend for me surgically."

According to Han, Dentsply Sirona's SmartFix® treatment concept and components also help to improve stability. "We do a lot of cases with angulated multi-unit abutments," he says. "These abutments are great because they come with two pieces that are uniquely designed to help eliminate screw loosening. It has been a game changer to see almost none of the patients in our cases experience screw loosening or prosthetic loosening, which can be an issue with other multi-unit abutments."

Ueno notes that he has also adopted Dentsply Sirona's line of regenerative products, including OSSIX® Plus collagen membranes and Symbios® PerioDerm® acellular dermal allografts. However, the real benefit of their new workflow has been the chair time that it has saved. Using the Primescan® intraoral scanner and photogrammetry, Ueno and Han are able to precisely plan implant positions and send records back and forth completely digitally. According to Ueno, their new method of only acquiring digital records cuts the hour or more of chair time that would be needed for a traditional pickup impression down to just 15 to 20 minutes of digital record taking by a dental assistant. He then just has to wait to receive Han's digital design, which is sent to his in-office 3D printer. Without the need for any analog impressions or conversions, the efficiency of the entire process and the communication between the providers is improved, creating an optimal patient experience and benefiting any dentist, surgeon, or laboratory technician involved in the case.

"It typically takes about half an hour for the design, and then we can print a temporary restoration in-office in about 23 minutes. We then wash, cure, stain, and glaze the temporary restoration and can deliver it into the patient's mouth the same day," Ueno says. "Another advantage of the Astra Tech Implant System EV is that now we don't need retention copings, which can be $90 each, so we have eliminated that cost. We're seeing less breakage of temporary restorations as well because the precise implant location means that our screw access channels can be very small when compared with the larger holes that you have to create in your temporary when you do a traditional pickup."

Once patients have healed, they return to the Ueno Center for a torquing test, and digital records are acquired, including intraoral scans and photogrammetry scans, which are then sent to the restorative dentist. With photogrammetry, Han is able to submit records that are accurate to less than 10 µm to the Atlantis manufacturing facility, which then creates the custom titanium bar while he creates the zirconia restoration. Atlantis is able to match that accuracy and guarantee a passive fit for its patient-specific, customized restorative solutions, which are tailored to the laboratory's preferences for anything from a single tooth to a full-arch fixed or removable restoration.

The Astra Tech Implant System EVprovides a versatile assortment of implants and restorative components, a flexible drilling protocol, and restorative flexibility.

Atlantisoffers patient-specific prosthetic solutions that are optimally designed and based on your preferences.

The SmartFix treatment concept enables full-arch restorations to be supported by four implants by placing the distal implants at an angle, which optimizes the available bone and increases the anterior-posterior spread while avoiding anatomical structures.

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