Digital Implant Impression

Fig. 1

Digital impression taking of implants with an intraoral scanner (Fig.1) is now possible with Cadent™ iTero®, Lava C.O.S./3M™True Def and Sirona CEREC scanners. Scanner manufacturers cooperate with select implant manufacturers to facilitate this process. The scan process is different from implant system to implant system and scan system to scan system. Biomet 3i™ utilizes the already existing Encode® healing abutment while Straumann® utilizes special scanbodys for example.

Cadent iTero®

Biomet 3i™

Fig. 2

Already installed Encode® healing abutments (Fig.2) are simply scanned with the Cadent™ iTero® intra oral scanner and the scan data is transmitted to a participating dental laboratory. The laboratory then forwards the scan file to Biomet 3i™ Bella Tek™ with attached electronic work order where the abutment will be designed and milled. At the same time Biomet 3i™ forwards a copy of the abutment design file to Cadent™ where a physical model of the dentition and the designed abutment is milled out of polyurethane. Both Biomet 3i™ and Cadent™ send the finished abutment and milled models respectively to the laboratory originally submitting the scan data. The Laboratory merges the outsourced production streams in to a single patient case to produce the actual final restoration. iTero®/Encode® digital workflow

Glidewell Laboratories Inc.

Fig. 3

Glidewell Laboratories Inc. offers proprietary scan pegs (Fig.3) through the Inclusive® house brand. The healing abutment is removed from the implant and the appropriate scan peg is installed (Fig.4) on to the implant. Scanning commences once proper seating of the scan peg is verified. Choose Glidewell from within the iTero® electronic Rx and send the file.

Fig. 4

Nine different implant/abutment interface designs may be serviced with the complete Inclusive® Scanning Abutment Kit. Individual scan pegs may also be purchased for Astra Tech, Biomet 3i™, Brånemark, Keystone PrimaConnex®, Neoss, NobelActive™, NobelReplace™, Straumann® and Zimmer. Due to the compatibility of the implant/abutment interface of some of the above listed implant brands with other implant brands a wide array of implants may be digitally impressed through Inclusive® scan abutments.

Straumann®

Fig. 5

Both, tissue level and bone level implants can be "impressed" with this technique. Straumann® utilizes three component scan pegs for the scan procedure. The three components are a scan cylinder (Fig.5, A), fixation screw (Fig.5, B) and scan cap (Fig.5, C). To prepare for the intraoral scan the healing abutment is removed from the implant and the scan cylinder is installed on to the implant, ensuring proper engagement and seating of the indexing feature (quadrigon). Hand tighten the fixation screw and snap the scan cap on to the cylinder. The scan cylinder is machined with two opposing inside flat sides corresponding to two flat sides on the scan cap. Both flat sides have to be aligned correctly while pressing the scan cap on to the scan cylinder. After the scanbody (Fig.5, D) is installed and completely assembled, the scan may commence.

Fig. 6

The resulting scan file (Fig.6) is then electronically sent to a dental laboratory that is part of the iTero®/Cadent™ network. Here the file can simply be forwarded to Cadent™ where a model with a symmetrical receptacle for special, reusable push in type analogs is milled. Stock or custom abutments may then be produced on the Cadent™ model. Laboratories with a CS2 scanner and software can at the same time the model is milled at Cadent™ design a virtual custom abutment to be milled exclusively through the Straumann® etkon central milling facility.

D4D, E4D

No major implant manufacturer has announced a partnership with D4D/E4D to facilitate intraoral scanning of implants at this time.

3shape Trios®

The Trios® powder less intraoral scanner integrates seamlessly through 3shape's cloud based Communicate™ file interchange service. Laboratories with 3shape's popular laboratory scanning system on the premises may take full advantage of the Trios® connectivity. No major implant manufacturer has announced a partnership with 3shape to facilitate intraoral scanning of implants at this time. Due to the open nature of 3shape® scanners dentists and laboratories must develop their own digital work flow and manufacturing processes.

Lava™ Chair side Oral Scanner (C.O.S.)

Biomet 3i™

Already installed Encode® healing abutments are simply scanned with the Lava™ intra oral scanner and the scan data is transmitted to Biomet 3i™ Bella Tek™. There a technician designs a virtual custom abutment within the 3D digital scan model and forwards the complete design file to a designated dental laboratory with 3M™ ESPE™ Lava™ C.O.S. software capabilities. The laboratory reviews the abutment design, orders the abutment to be milled, marks the margin of the abutment and creates virtual die cuts.

Now the design file work up is uploaded to 3M™ ESPE™ to create a physical model through stereolithographic printing, including a copy of the approved custom abutment. The dental laboratory may design and mill the final restoration for the custom abutment through CAD-CAM technology from the virtual design file or wait for the arrival of the physical model to produce a restoration through conventional methods. Biomet 3i™ Bella Tek™ ships the milled custom abutment to the dental laboratory where it will be packaged with the stereolithography model and the final restoration for delivery to the dental office.

Sirona CEREC

Biomet 3i®

Already installed Encode® healing abutments, surrounding tissue and dentition are sprayed with a antireflective medium (CEREC Optispray) and scanned with the CEREC intra oral scanner. The scan data is transmitted through the CEREC Connect portal to Biomet 3i™ Bella Tek™ where a custom abutment is designed and milled out of titanium or zirconia. Biomet 3i™ sends the finished abutment directly to the submitting dentist and the abutment is then installed on to the implant and rescanned to produce the definitive restoration. CEREC/Encode® digital workflow, Biomet 3i® electronic work order

Straumann®

Fig. 7

Straumann® utilizes special scan pegs (Fig.7) for the scan process. Healing abutments are removed from the implant in the patients mouth and implant platform diameter specific scan pegs are installed on to the implant. The scan procedure is initiated once the seating of the scan pegs is verified. Only tissue level  implants can be "impressed" with this technique. The resulting scan file is then electronically sent to a participating laboratory.

Image "Fig.1" courtesy of Dr. Osvaldo Z. Mayoral, DMD, Pinecrest Florida, Pinecrest Dental.

Images "Fig.3" and "Fig.4" courtesy of Dr. Perry E. Jones D.D.S, FAGD, Richmond Virginia, drperryjones.com

Images "Fig.5", "Fig.6" and "Fig.7" courtesy of Straumann USA, LLC, its parents, affiliates or subsidiaries. © Straumann USA LLC, all rights reserved.