Why your implant workflow needs to be digital

Interview with Dr. Peter Hunt, owner Dental Implants Philadelphia

I have been doing implants since 1989. But it is only in the last eight or ten years that we have seen this tremendous transformation to digital.

The idea that we are now getting support from 3D x-ray systems and the various ways of superimposing the implant in the site, this has helped a great deal.

For us, the next step forward became taking this data, and turning it into a surgical guide system.

Creating guides used to be exhausting. We used to have to take a scan and assess the situation. The workflow meant creating a complicated set of models, and a radiographic guide and then, that became the surgical guide. It really was exhausting.  It would take a month or six weeks until we could get to work on the case.

This has all changed in the last five years because we are now able to superimpose a scan of the mouth and merge it with the 3D imagery. It’s been transformative. Now we have got this process down to where we produce a surgical guide in about a day and a half.

There have been lots of technical aspects that have contributed to that. We now have a Formlabs 3D printer in the office.  So we can produce a model and the surgical guide. We can put the rings in quickly and really move forward with the whole process.

And about three years ago, we started working with 3Shape Implant Studio. We worked with the first version and were able to collaborate with 3Shape to contribute to moving the process forward a little bit on the software’s development. Now, it is a smooth and even workflow. It is just tremendous!

I think we will see it take another big step forward soon. We’re trying to get a hold of the new 3Shape scan bodies because I think they are a giant step forward in scan body design and technology. The workflow will be even faster and smoother.

What does digital bring to your implant workflow?

With Implant Studio and scanning, the whole process is becoming so predictable. It’s contributing to a much more effective workflow, much more predictable, more precise and it feels safer and more comfortable.

The other benefit is that we can have the lab working at the same time. We can have the temporary crown ready-made beforehand.

Everyone is always going on about the big cases, the all-on-fours, and they are special, but the main aspect is the person that comes in with the broken tooth. A person who has a tooth broken off at gum level, you want to be able to replace it for them as quickly as possible. With our technology, we can do that in a day and a half and that is an amazing change.

Faster restorations are a much better procedure, because you are not losing the gingival structures in the region of the tooth, and the soft tissue in the bone is retained better by this process.

How would you compare guided surgery to freehand?

First, we should look at the legal aspect. It has become standard in the last few years for people placing implants to want to have a 3D scan to assess where the bone is, and whether you can place the implant there…

When you go into a court of law after having a problem with a case, the first question from the lawyer is, did you do a 3D scan of the situation? If you say yes, then that helps. The obvious extension to that question is, well did you do the case guided? And for many doctors, this is not the case.   

Presently, only 5% of implants are placed surgically-guided. That needs to grow to a much higher percentage. Because medically and legally, you are not going to be able to stand strong on your feet if you do not have a surgically-guided approach. Or at least, have considered it for the case that you are doing.

Guided surgery is more predictable in many ways. It’s more predictable in terms of positioning and placement, so you get a better esthetic and functional restorative option. In terms of a surgical procedure, it makes it much easier for the operator.  It turns a rather complicated almost dangerous procedure into something that is entirely predictable.

That’s nice. It becomes routine, it’s more comfortable and you can spend your time doing other things that will enhance the case.

For example, you can consider doing immediate restorative dentistry if there is enough stability in the implant.

There is no question that with surgically guided protocols you are not free-handing it. You are not relying upon eye-balling it. You are not relying upon a certain belief in a system. You have worked out your procedure beforehand in the planning software.

As long as that whole process is being done accurately and precisely enough, then you will get to that position. There maybe a little variation, but nothing like the variation that you are getting by placing an implant freehand.

How has 3Shape Implant Studio changed your work?

Implant Studio has transformed it. I am able to function and do better work than I have ever done before. It’s more precise. It’s simpler. It’s easier, safer, and it’s faster.

The patients see this, and they appreciate it.        

As I am getting to the end stage of my career, software like Implant Studio is keeping me at the forefront. I am not slacking off at all in that respect.

One of things for dentists is that they feel like they have to take on and do everything themselves.

That is not the case at my practice. In our office, we have an operation setup where essentially all the processes are done by team members. Our team is setup so that they are responsible for a great deal of the implant workflow. Assistants and hygienists can plan with Implant Studio and other tools very simply and very easily.

We have a small office. I have one dental chair in the office. But we have lots of computers around the place. We have a small laboratory. We can manage all of this without too much trouble.

The team approach makes it much less stressful and much more predictable. Because of this, we can do more interesting and complicated cases without too much pressure. 

How does your staff like working with 3Shape TRIOS intraoral scanner?

The team loves working with 3Shape TRIOS. The reaction after getting over the learning curve, is remarkable. Now it has become very simple, which is how it came about with the Philadelphia Eagle’s bite guard case. That entire session took us about ten minutes to scan and send it to Albuquerque for manufacturing. 

How has going digital helped you grow you practice?

Patients sense the transition and progress very easily. So much so that the traditional analog process has disappeared.  It’s very rare that we take an impression these days.  Digital is just so much smoother, faster and more predictable. 

For example, with a crown preparation, we used to allow a considerable amount of time for adjustment, when we inserted the crown. That’s why it was nice to have a technician on the premises ready to add porcelain or whatever may be. These days the precision of the work going in is much better. The fit is incredible compared to the traditional ways we used before.

That means we can cut down our insertion time and again, it’s much more predictable. It’s transformed the whole process.

The patients see this right away. They are excited by seeing the scans. It’s revolutionary for them and they get it!

Dr. Peter Hunt, owner Dental Implants Philadelphia

Dr Hunt is a fourth-generation dentist trained originally in Great Britain at Guy’s Hospital Dental School in the University of London. After graduation he spent a year in residencies in Maxillo-Facial surgery before obtaining a Master’s in Advanced Restorative Dentistry at the Eastman Dental Center in London. He then received the first Annenberg Fellowship  to the University of Pennsylvania where he obtained Specialty certificates in Periodontics and Periodontal Prosthesis.

Besides being in private practice he has always taught dentistry, first at Penn, where he was Director of Continuing Education and later Clinical Professor of Periodontics. Later, he was Professor of Restorative Dentistry, Post-Graduate Director and Director of Periodontal Prosthesis and Implant Dentistry at Nova Southeastern University in Fort Lauderdale. He has provided and participated in many continuing education programs in the US and overseas.

Dr Hunt has been placing and restoring dental implants for over thirty years. His practice in recent years has become more and more centered around implant and dental rehabilitation. Peter is the Publisher and Editor of ImplantsConnect.com, a website devoted to Implantology : Regeneration : Technology : Rehabilitation.

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