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Another Digital Update

Colin Campbell
by Colin Campbell on 19/07/17 18:00

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From time to time in these pages (because I am a dentist and because we do the digital thing) we do an update of where we are. Interestingly it always attracts some comments and some interaction. I hope also it might encourage or inspire other people to take a look at some of these tools, as they are becoming more and more available in dental practices, not only to improve the experience and outcomes for your patients but also for your team. So what has happened since the last time?

Well a few weeks ago we took delivery of a Straumann lab scanner, known as the Cares scanner. Yes, for those of you who have read this before we already had the Sirona lab scanner, but the Straumann lab scanner opens further doors for us. As a (nearly) 20 years Straumann customer it seemed to make sense to close up the workflow from implant placement to implant restoration with the ability to use original components.

This opens the opportunity for us to use the whole Straumann Cares catalogue and order direct from the practice. We can also now dial in directly with Createch, the Spanish company who provide high level milling for much of the Straumann components.

The Createch Titanium Bar system is incredible.

You can access the system through your Straumann registered laboratory who has a Care scanner just by sending your impressions or your models to them, but for us to have the direct hook up through the laboratory in the practice makes things much easier and also financially better. As a result of this we will be doing much of our restorative work on implants using the Straumann scanner system but we still have full access to the Sirona in-lab system and use Atlantis from Dentsply for specific indications and for comparison!
This is quite a powerful thing, we are a dental practice who is manufacturing and who has their own lab arm so we can now openly and honestly compare the systems. So watch this space!

The next new piece of kit that will arrive within 2-3 weeks time is the first of our 3D printers. We have researched this quite heavily and in the end we have gone for a larger 3D printer model provided by Straumann. The question I guess for lots of people is why a 3D printer?
We can already mill our surgical guides using a five axis-milling machine so what will we use a printer for? Well for us there are two benefits.

1. We can free up the milling machine to mill much more high value things and can print surgical guides over night (we are now printing between 100-200 surgical guides a year)
2. We can print digital diagnostics and models if required. This allows us to digitally mock up a system on screen and also print a copy for the patient to look at and take away. We can also work with those mock-ups for various reasons across the clinical spectrum (it’s £6 a model to print)

Finally though and much more exciting than either of the above for me is our new found ability to print Dicom files, therefore print upper and lower jaws prior to surgery. Imagine the advantage for us prior to an immediate full arch reconstruction to have an in house printed model available. Imagine someone new to implant dentistry planning to do an upper central incisor case being able to visualise the ridge after the flap has been raised. You could also use the model to test your guide! The printing of jaws in the next 6 months will become one of the biggest and most exciting things going on in the practice as we nail down the protocol for this. We’ll also be able to use the models for teaching.

So two new pieces of kit (I don’t think we have room for any more at the moment) we can continue to work on with our little digital revolution.
A word of warning though and a heads up from what discussion is yet to come, we have had significant issues with zirconia restorations in larger sections and fractures of large zirconia bridges. Zirconia is a very taxing material and it is not as a result of negligence that this difficulty has arisen. There are three issues with zirconia full arch bridges, particularly in implants that must be considered.

1. They must fit. The process of verification of fit is onerous, time consuming and technical
2. The connectors must be thick. Take the manufacturers recommended guidelines for connectors and increase it by 50%. For more information on that email me and I’ll put you in touch with Mark Melbourne
3. The span between implants must be significantly considered and if in any doubt it is titanium not zirconia.

More of some of the issues we had with the zirconia bridges I will talk about later because I have always promised to be open and honest about the things that go both right and wrong. I wonder why we went all zirconia because for many years I was pro porcelain bonded to metal and the results were staggeringly reliable. I hope I am not sat here in 5 years time complaining that zirconia bridges were just a ‘shiny bright object’ as we return to full arch bridges of porcelain fused to metal. If I felt that was the right thing to do believe you me I would.

For those of you that paid any attention to what we did at the Digital Symposium, the case is heading towards reconstruction. I will do a full debrief of that case overall for anybody who was there as a promise to you, so that is the next thing to look at in the next digital update.

Blog Post Number - 1346

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Colin Campbell
Written by Colin Campbell
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