Top 10 Q&A about digital implantology

As Product Director for Implantology at 3Shape, I attend many events on the subject. 3Shape usually conducts seminars and trainings as well as having a stand at most implant related conferences. The great thing about going to these shows is meeting face-to-face with doctors and surgeons.

Visitors always ask me why they should go digital, when should they make the jump, or is the technology ready? From the professionals who have never used an intraoral scanner to the ones that are already using digital technology for implant planning and guide production they've got tons of questions.

I created a top 10 list of the most popular questions I get asked, in hopes that it will provide you with some answers on when and why go digital with your implant treatments.

I realize that I might be a bit bias regarding the benefits of digital implantology. But I am not alone. The doctors that have adopted digital workflows are an extremely passionate bunch. They are very enthusiastic about the advantages of digital implantology like reduced chair-time and faster, more predictable procedures as well as their patients walking out of the office the same day with a new tooth and experiencing less pain and blood. There are, by the way, a number of studies supporting their passion.1

In the words of renowned prosthodontist, Dr. Jonathan L. Ferencz: “The difference digital dentistry has made to making a crown is tremendous. But the difference it has made in implant dentistry is night and day!” That's a pretty big difference, wouldn't you say?

My list of the year's top ten questions and answers on digital implantology:

1. Does it work?

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Doctors usually have one simple question: Does it work? To cite Dr. Alan Jurim, a New York doctor that is really pushing the envelope in digital implantology, he says, "3Shape provides that innovation. And I love being able to implement it! And it works. It works great!"

With the digital workflow and guided prosthetics, your procedure is based on esthetics and the overall clinical situation. Your planning is top to bottom so to speak, because you have already decided on the final outcome or what the restoration will look like before you begin the implant treatment. Moreover, because you are merging CT and intraoral scans you are basing these decisions on available bone, adjusting teeth as well as soft tissue conditions. Working this way provides you with so many advantages in terms of esthetics, fit and function, and in creating the corresponding surgical guide.

Now aside from the clinical advantages of prosthetic driven guided surgery, which include increased predictability, faster implant surgery and more patient comfort, you or your partners can now also deliver complete implant treatment packages to the patient at the day of surgery. Complete treatment packages that include the surgical guide and prosthetic components like customized or screw-retained abutment plus a temporary crown.

And because you are working digitally, onscreen, it makes communications between the entire team, from surgeon, prosthodontist to whoever is designing and manufacturing the temporary crowns, customized healing abutments or even the final prosthetic, so much more efficient with a reduced lead-time.

As an aside, if you are not working with an intraoral scanner or digital impressions, you can still have your analog impression scanned and brought into the software for planning and design of cases. Intraoral scanning just makes the procedure more precise and time efficient but is not a dire necessity with guided prosthetics.

So if you're still wondering if it really works, it certainly does!

2. What's my first step in going digital?

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Many surgeons and doctors already use 3D scans from CBCT scanners in their clinical-decision process for implant placements. I believe though, to really get the full picture and create your "digital patient," you need to integrate intraoral scans matched with CBCT images.

So to get started, if you have never used digital technology, I always recommend doctors begin with an intraoral scanner like TRIOS. It makes the planning much simpler, more efficient and predictable as well as optimizing the workflow between doctor, surgeon and lab. It also gets you quickly into the digital mindset.

What's nice about TRIOS is, you don't have to get 3Shape involved in the production as a middle man. When you scan with TRIOS, you don't send your scans to 3Shape to validate. You connect directly with your partner lab and push the send button. That's it. The scan is on its way. TRIOS has its own built in scan validation tools, so you know already that your scan is approved.

Once you get comfortable working digitally, you can then move on to using software like Implant Studio for planning and production.

And why do you move on to using software like Implant Studio? Dr. Luis Cuadrado de Vincente says, "Implant Studio not only allows the dental team to make things better, quicker and cheaper, it enables more patients to receive this treatment. And it allows you to do new treatments, guided prostheses, with a high success."

3. What's the learning curve with intraoral scanners?

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We always have a TRIOS intraoral scanner on our stand at implantology events. I usually hand the dentist the scanner and let them try it. TRIOS is just like any other gadget. Like your smartphone, you need to get to know it, but the learning curve is fast. And speaking of smartphones, Dr. Barbara Jurim says, if you can use one then you can scan with TRIOS.

Our research shows that the more you use an intraoral scanner, the more likely you are going to end up using it all the time. Once you start scanning with TRIOS, it becomes part of your routine. You can't imagine ever being without it.

4. How can my practice start providing implant treatments?

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As a dentist or prosthodontist, you should start by using an intraoral scanner and sharing the scans with your surgeon and lab team, so they can take over and do their thing. This makes the workflow and communications amongst team members much more efficient. Members of the team can contribute their specialty knowledge and skills more easily. It just provides an amazing way to communicate and improve treatment results and time.

So get an intraoral scanner and make sure it can scan for implant indications.

5. As a surgeon, should I use an intraoral scanner?

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According to Texas surgeon, Dr. Richard Martin, more specialists are starting to come around to using intraoral scanners. He believes however, that, "as surgeons, we need to recognize the benefits of digital technology as well as its benefits to our business. Dentists are really getting into the digital workflow, and as oral surgeons, we risk getting left behind. So in terms of referral retention, I believe, going digital, is a must for surgeons."

California-based surgeon, Dr. Peter M. Scheer, agrees with the team-building benefits in using an intraoral scanner, saying, "We plan to incorporate the restorative dentist into the design process of surgical guides and provisional restorations to again reinforce confidence and build value. We hope this will instill positive curiosity and establish new professional relationships."

So going digital for surgeons is not solely about the clinical and restorative insight, but it's also a matter of keeping up with the times and building cooperation amongst the implant team and referring dentists. Digital imaging just makes communications and collaboration so much more effective.

In terms of the clinical benefits though, Dr. Sonia Leziy, a Canadian surgeon, puts it nicely, saying, "what got me back into using guides was that I started intraoral scanning using TRIOS. The surgical guides being generated from the TRIOS scans fit beautifully – all of them. Because of this, I have jumped back into guided surgery in a significant way."

Denmark-based surgeon, Dr. Simon Kold echoes the benefits saying that after going digital, he has "reduced surgery time from 90 to 30 minutes."

The long and short of it is, as a surgeon, digital technology is certainly creating both clinical and business advantages.

6. What about using different implant systems?

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This is where intraoral scanners and software begin to differentiate from one another. Some digital impression solutions are only compatible with a limited number of implant systems and/or scan flags. Likewise, some implant planning software only work with certain implant systems or do not connect to a lab solution. So as a doctor, you need to do your research and see which scanner and software give you the most options or is compatible with your preferred implant system and the intended restoration work.

A hint to save you time, TRIOS and Implant Studio have by far the largest selection of integrated implant systems (close to 50 and counting). Implant Studio works with the most popular implant systems using their original components and workflows.

Check out the Implant & Sleeve libraries available for 3Shape Implant Studio.

7. Is it possible to do edentulous cases?

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Yes. Implant Studio 2015 and later versions enable you to do edentulous cases by applying the dual CT-scan protocol. For a look at the workflow for edentulous cases, 3Shape created a series of free training videos and webinars that you can check out. Likewise, the aforementioned Dr. Alan Jurim has shared a very cool edentulous case and several implant cases with us.

In partially edentulous cases, you can also use TRIOS in a tooth-supported workflow. TRIOS enables you, with its RealColor, to validate the information available in the soft tissue. Up until TRIOS, soft tissue had always been a stumbling block for intraoral scanner-makers.

8. Can I make my own surgical guides?

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Many surgeons complain that the price of surgical guides is blocking their wider use. There's also a lot of talk about how the manufacturing of guides is time consuming, complicated as well as inaccurate. These are all valid challenges that TRIOS and Implant Studio have addressed.

Citing Dr. Luis Cuadrado de Vincente again, he says that, "TRIOS' extreme accuracy is at the heart of my success." And that the guides being produced using the TRIOS intraoral scan are much more accurate than those made from CBCT files or conventional impressions. In Dr. Cuadrado's words, "Now you can offer your patients a guided treatment that really works."

If you have, for example, TRIOS and Implant Studio, you can start making your own guides. You can create the .STL file in Implant Studio and then send it to a partner lab or manufacture the guide yourself locally. With the software, you can customize the guide to your own preferences or type of guide. Implant Studio even has pre-sets for select manufacturing machines, so it's nearly plug and play when producing the guide.

This makes guide production and use not only more convenient for the team and patient, it is cheaper and more accurate – a huge cost-saver. You no longer need to go to centralized implant system makers to create guides. They are affordable and available for every surgery and their cost offset the time you save in surgery.

9. Does digital allow me to choose what type of restoration and treatment I offer?

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The answer here is similar to question number five regarding implant software's openness and compatibility with various implant systems. It really depends on the intraoral scanner and software manufacturer you choose. Some scanners are just not powerful enough for certain types of restorations. Likewise, some implant software is only geared for certain types of implant indications and implant systems.

TRIOS is approved for scanning the widest range of restorative indications of any IO scanner on the market. With it, you can scan and then design abutments, implant bridges and bars as well as capture implant positions with scan bodies and add a scan of surrounding soft tissue/emergence profile.

Similarly, using Implant Studio and 3Shape restorative design software like Dental System you are free to create any restoration or treatment you need.

10. What kind of support should I expect?

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In terms of TRIOS and Implant Studio, 3Shape bundles customer support services under its CLINIcare™ umbrella. 3Shape provides training by certified experts, educational seminars and training courses, online training webinars built-directly in the TRIOS system and the TRIOS Master Program, which includes videos and tutorials.

3Shape also has a global support network featuring certified 3Shape representatives, multi-language second line support by 3Shape's experts for special cases, and 3Shape support and service centers around the world.

Discover more about our 3Shape implant solutions here.

Studies supporting digital implantology

Fortin T, Bosson JL, Isidori M, Blanchet E. Effect of flapless surgery on pain experienced in implant placement using an image-guided system. Int J Oral Maxillofac Implants. 2006;21(2):298-304.

Scherer U, Stoetzer M, Ruecker M, Gellrich NC, von See C. Template-guided vs. non-guided drilling in site preparation of dental implants. Clin Oral Investig. 2015;19(6):1339-1346.

Block MS, Emery RW, Lank K RJ. Accuracy using dynamic navigation. Int J Oral Maxillofac. In press.

Birk Ploennigs, Product Director Implantology, 3Shape

Birk has a Masters in both Physics from TU Dresden and in Business Administration from CDI in Paris. He brings ten years of experience in the consumer electronics and the automotive industries as well as Key Account Manager for Carl Zeiss, Samsung and General Manager for Jenoptik in the U.K.

Birk joined 3Shape in 2009. Over the past four years he has led its Implant Studio software team. Birk works extensively with professionals from around the world in developing the implant solution. Whether it is with surgeons, doctors, labs or implant system manufacturers, Birk has effectively brought together the needs of stakeholders to create an industry leading digital implant software solution. Since its initial launch two and a half years ago, 3Shape Implant Studio has experienced tremendous growth and is one of the fastest growing business areas for the company.

Birk Ploennigs

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