CHAPTER 13
The Digital Workflow in Implant Dentistry
13.1 INTRODUCTION
There are two primary approaches to dental implant treatment workflows, the traditional analogue method and the digital implant workflow. Comprehensive and precise treatment planning procedures form the basis for fixed restorations supported by dental implants. These typically encompass the following steps:
- Generating articulated study models based on diagnostic impressions.
- Creating diagnostic wax‐ups, intraoral wax‐ups or diagnostic appliances to assess aesthetics and phonetics.
- Utilising radiographs, including peri‐apical and cone beam computed tomography (CBCT) scans, to assess the bone support for dental implants.
- Developing a radiographic guide and adapting it into a surgical guide.
Analog systems have traditionally relied on conventional impression techniques to produce a plaster model. Subsequent procedures, from the diagnostic wax‐up to prosthesis fabrication, are manually fabricated by dental laboratory technicians.
On the other hand, a complete digital workflow eliminates the drawbacks and challenges commonly associated with conventional analogue methods. Some of these common limitations include:
- discomfort, often linked to the impression procedure
- the potential for distortion of impression materials and inaccuracies in subsequent manufacturing steps
- the risk of damaging the dental cast
- delays due to logistical issues in sending laboratory work between the dental practice and the laboratory.
These disadvantages of the analogue system are not present in a full digital workflow. In this approach, an intraoral scanner captures the impression, and the prosthesis is designed using computer‐aided design software. The data from the digital impression are easily transmitted over the web, significantly reducing the time required for manufacturing wax‐ups and prostheses.
One of the primary advantages offered by the complete digital workflow lies in its ability to accurately diagnose and virtually plan implant placement using digital intraoral scans and CBCT data. This streamlined approach facilitates the creation of a precise surgical implant guide, simplifying and ensuring the predictability of the implant fixture placement.
Full digital workflows in implant treatment planning and surgical procedures provide several benefits:
- Reduction in the number of patient visits required for the procedure.
- Establishment of a simplified and predictable workflow for implant treatment planning and guided surgery.
- Enhanced precision and accuracy in the angulation and placement of single and multiple implants.
- A more straightforward and efficient prosthetic design process.
- Reduction in the number of patient visits required for the procedure.
13.2 COMPONENTS AND STEPS OF THE DIGITAL IMPLANT WORKFLOW
13.2.1 Digital Diagnostic Impression
The digital implant workflow commences with the intraoral scanning of the pre‐surgical area. Current digital scanners have demonstrated a noteworthy level of accuracy, falling within a range of 6.9–45.2 μm according to the literature [1]. These scanners efficiently capture and produce three‐dimensional (3D) models, ensuring rapidity, and are proficient in generating digital models that exhibit the same reliability as traditional plaster cast models.
However, it is important to note that there is varying evidence in the literature concerning the accuracy and suitability of complete arch digital impressions, particularly in cases involving edentulous individuals where implant fixtures are positioned in a cross‐arch configuration. It is worth mentioning, however, that the latest generation of digital impression systems demonstrates greater accuracy for full arches and improved speed compared to their predecessors [1]. Furthermore, apart from being more efficient and convenient than traditional impression techniques, studies have also indicated that patients often express a preference for the intraoral scanning approach over the conventional impression method.
13.2.2 Cone Beam Computed Tomography
CBCT scans facilitate the creation of exceptionally detailed 3D representations of the patient’s oral anatomy (as shown in Figure 13.1). Today, CBCT is regarded as the gold standard for implant placement because it has achieved a significant reduction in radiation exposure, bringing its radiation dosages in line with those of conventional panoramic X‐rays. In addition, CBCT scans are characterised by short scan durations and the accuracy of CBCT data has been rigorously established in the scientific literature.
13.2.3 Digital Implant Treatment Planning
The patient’s scanned image (STL file) and CBCT scans (DICOM) are amalgamated and aligned using diagnostic 3D modelling software.
The data synthesised by the diagnostic 3D modelling software allow for the following:
- Precise evaluation of bone volume and density: Both bone volume and bone density can be accurately assessed.
- Visualisation of anatomical structures
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