The Collaboration Between the Dentist and Laboratory in the Digital Age

Following previous extractions of non-restorable teeth Nos. 3 and 4, a healthy, 66-year-old male presented for implant placement. NobelParallel Conical Connection RP implants (Nobel Biocare; nobelbiocare.com) were placed for No. 3 at 5 mm x 8.5 mm and No. 4 at 4.3 mm x 11.5 mm under local anesthesia. They were torqued down to >35 Ncm at the time of placement. Healing abutments were immediately placed. The patient tolerated the procedure well (Figure 1).

The patient presented 4 months later to begin the restorative phase of treatment. Using the Planmeca Emerald^TM Intraoral Scanner (Planmeca; planmecausa.com), the maxillary and mandibular arches—as well as two buccal bite registrations—were scanned for digital impressions. The Planmeca Emerald Intraoral Scanner easily and accurately captured the dentition within a few minutes. Using the “time saver” feature, the healing abutments were digitally erased from the maxillary arch scan to be used for the implant impression. Elos Accurate Scanbodies (Elos Medtech Dental; elosdental.com) were placed and full seating was confirmed via a periapical radiograph. The scanbodies were then scanned using the Planmeca Emerald Intraoral Scanner to capture the exact position, angle, and rotation of the dental implants (Figure 2 and Figure 3). Following completion of the intraoral scan, the scanbodies were removed and replaced with the healing abutments. The case was photographed, and a custom shade was taken by the dental technician using the VITA classical Shade Guide (Figure 4).

Using the Planmeca Romexis software, the 3D images were sent to the New York Center for Digital Restorative Solutions via a direct Internet connection. There, the technician was able to upload the files to the laboratory's 3D imaging software and examine the digital impression with a fine level of detail. This process allowed for almost instant collaboration while retaining the highest level of accuracy. Using their software, the laboratory technician could examine the placement of the implant scanbodies and other included digital information such as occlusal clearance (Figure 5). The custom shade determined by the dental technician was used to precisely match the implant crowns to the desired esthetic. Once these processes were complete, the design was sent to a milling machine for production and the resulting implant crowns were then sent to await insertion.

The patient returned for the insertion of two screw-retained monolithic zirconia implant crowns. The healing abutments were removed and the implant crowns were tried in. The contacts and occlusion were marked with articulating paper and required very minimal adjustments. A periapical and bitewing radiograph was taken to confirm full seating of the abutments prior to torquing. The implant crowns were torqued down to 35 Ncm using the Nobel Biocare Manual Prosthetic Torque Wrench (Figure 6). Teflon thread sealant tape and 3M Filtek Supreme Ultra Universal Restorative composite (3M; 3m.com) were placed into the access and light cured. The occlusion was reconfirmed and polished. The patient was satisfied with the fit and esthetics of the restorations and tolerated the procedure well.

The digital workflow utilized in this case, including the Planmeca Emerald Intraoral Scanner, allowed for a faster, easier, and more efficient process. Using the conventional method would have required a PVS impression, opposing counter-model, and bite registration. In addition, impression and models would have required transportation to the laboratory, delaying productivity. In the present case, a digital impression was taken within a few minutes and could be closely examined and trimmed with a simple click. The laboratory technician was able to directly review the scan and provide any necessary feedback that was pertinent to the case. The laboratory and other team members maintained open communication throughout the design process in order to create an ideal restoration.

The aforementioned case highlights the relationship between the dentist and laboratory throughout the restoration of two implant crowns. With the utilization of advanced dental technology and close communication with the laboratory throughout treatment, the patient was pleased with his functional and highly esthetic restorations.

About the Authors

Gary Kaye, DDS
Founder
Kaye Dentistry, PLLC
New York, NY

Mark Hartslief, BSc, RDT
CEO
New York Center For Digital Restorative Solutions
New York, NY

Matthew Goldstein, DDS
Kaye Dentistry, PLLC
New York, NY