Soft Tissue Transfer Utilizing Digital Impressions of Anterior Implants

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1 Soft Tissue Transfer Utilizing Digital Impressions of Anterior Implants Pacific Coast Society for Prosthodontics Anchorage, Alaska June 28, 2013 Kenneth F. Hinds DDS

2 Traditional(Analog) ImpressionTechnique

Traditional(Analog) ImpressionTechnique How

International Journal of Periodontics and

3 Traditional(Analog) ImpressionTechnique How do we transfer digitally? Custom Impression Coping For An Exact Transfer in The Esthetic Implant Restoration. International Journal of Periodontics and Restorative Dentistry, NOV-DEC 1997; Vol 17, No#6: Pages Hinds, K

4 Traditional(Analog) ImpressionTechnique

5 Traditional(Analog) ImpressionTechnique Why is an Accurate Transfer Necessary? Abutment / Prosthetic Margins at Gingival Level

6 Residual Excess Cement & Peri-Implantitis AAP April 2013 White Paper Consensus Conference Peri-implant Disease Risk Factors: 1. Previous Periodontal Disease 2. Poor Oral Hygiene 3. Residual Excess Cement 4. Diabetis 5. Smoking 6. Other Factors Wadhwani C, Pineyro, A, Akimoto K, An Introduction to the Implant Crown with an Esthetic Adhesive Margin (ICEAM). J Esthet Restor Dent 2012;24: Wadhwani C, Rapoport D, La Rosa S, Hess T, Kretschmar S, Radiographic detection and characteristc patterns of residual excess cement associated with cement-retained implant restorations: A clinical report JPD Mar 2012;107:3,

Residual Excess Cement & Peri-Implantitis Abutment / Prosthetic Margins at Gingival Level Accurate Soft Tissue Transfer Abutment Collar Same Shade as

7 Residual Excess Cement & Peri-Implantitis Abutment / Prosthetic Margins at Gingival Level Accurate Soft Tissue Transfer Abutment Collar Same Shade as Prosthesis Wadhwani C, Pineyro, A, Akimoto K, An Introduction to the Implant Crown with an Esthetic Adhesive Margin (ICEAM). J Esthet Restor Dent 2012;24:

8 1. Pressed Glass 2. Add Abutment Porcelain / Prosthetic Margins at gingival level Accurate soft Tissue Transfer Abutment Collar Same Shade as Prosthesis

9 1. Pressed Glass 2. Add Abutment Porcelain / Prosthetic Margins at gingival level Accurate soft Tissue Transfer Abutment Collar Same Shade as Prosthesis A procedure for a modified cylindric titanium abutment. J Prosthet Dent May;77(5): Marchack CB, Yamashita T

10 Custom Impression Coping - Part Two: The Digital Transfer IMMEDIATE IMMEDIATE DIGITAL DEFINITIVE IMPLANTS PROVISIONALS IMPRESSIONS PROSTHESES Accurate Surgical Guide One - Piece Screw Retained Custom Scan Body CAD CAM Zirconia Abut Virtual Design All Ceramic Working Cast Prosthesis

11 Intraoral Digital Impression Systems Itero Trios Cerec E4D Lava Chairside IOS Fast Scan Align Tech 3 Shape Sirona D4D Tech 3M Glidewell

12 Intraoral Digital Impression Systems Itero Trios Cerec E4D Lava Chairside IOS Fast Scan Align Tech 3 Shape Sirona D4D Tech 3M Glidewell Manual Capture CAD/CAM Modeling No Powder Active Streaming capture SLA Modeling

13 Intraoral Digital Impression Systems Itero Trios Cerec E4D Lava Chairside IOS Fast Scan Align Tech 3 Shape Sirona D4D Tech 3M Glidewell Manual Capture CAD/CAM Modeling No Powder Capture and Milling Active Streaming capture SLA Modeling

14 Intraoral Digital Impression Systems - New Generation Itero Trios Cerec E4D Lava Chairside IOS Fast Scan Align Tech 3 Shape Sirona D4D Tech 3M Glidewell Apollo DI E4D Nevo True Definition Sirona D4D Tech 3M Trios Pod June 2013 June 2013 Oct 2012

15 Intraoral Digital Impression Systems - New Generation Itero Cerec E4D Lava Chairside IOS Fast Scan Align Tech Sirona D4D Tech 3M Glidewell Trios Apollo DI E4D Nevo True Definition 3 Shape Sirona D4D Tech 3M Trios Pod June 2013 June 2013 Oct 2012

16 Active Streaming Capture - Trios Itero Cerec E4D Lava Chairside IOS Fast Scan Align Tech Sirona D4D Tech 3M Glidewell Trios Apollo DI E4D Nevo True Definition 3 Shape Sirona D4D Tech 3M

17 Implant Intraoral Scan Bodies Two - Piece(Straumann) Mono (Straumann) 3i Encode (Biomet 3i) IOS Fast Scan Astra Tech - NONE Nobel - NONE

18 Mono Scan Body Implants #12 & #13 Mono Scan Body

19 Itero - Digital Impression STL Files STL Files Digital Capture

20 Mono Scan Body Virtual Working Cast STL File Design Program Titanium Abutments Lava Plus

systems Int J Comput Dent, 2013;16(1):11-21

micron Full Arch Scan precision + / - 30.

21 Influence of scanning strategies on the accuracy of digital intraoral scanning systems Int J Comput Dent, 2013;16(1):11-21 Ender A, Mehl A. Intraoral Digital Impression Systems - Working Cast Full Arch Scan trueness + / - 35 micron Full Arch Scan precision + / micron CAD / CAM Milled (Itero) (Urethane) Steriolithography(SLA) 3D Printing, Rapid Prototyping

22 Analog vs Digital Work Flow DIGITAL ANALOG Provisional Impression Working Cast Lab Scanner Abutments

23 Custom Scan Body Immediate Implants & Immediate Provisionals Male Age 26 #7, #10 Congenitally Missing

24 Custom Scan Body Immediate Implants & Immediate Provisionals Male Age 26 #7, #10 Congenitally Missing

25 Custom Scan Body Treatment Plan Immediate implants Immediate Provisionals Attend Surgery Digital impressions Zirconia abutment All Ceramic Prosthesis #7, #10 Congenitally Missing

26 Presurgical Planning Estimate Gingival Margin Set Replica 3mm Depth Triad Index Surgical Guide Provisionals Flat to Facial 3 Minute Transfer Clear Acrylic Resin

27 IMMEDIATE PROVISIONALS Day of Surgery Options Immediate Implant Immediate Provisional Restorative Attend Coordinate Appt Healing Abutment

28 IMMEDIATE PROVISIONALS Day of Surgery Options Immediate Implant Immediate Provisional Immediate Provisional Direct Modify Index Implant Restorative Attend Coordinate Appt Healing Abutment Indirect Modify Deliver Provisional

29 IMMEDIATE PROVISIONALS Day of Surgery Options Immediate Implant Immediate Provisional Delayed Provisional Immediate Provisional Direct Modify Index Implant Custom Healing Abut Early One Week Restorative Attend Coordinate Appt Indirect Modify Essex Retainer 1. Implant Stability 2. Unfavorable Occlusion Delayed 6-24 Weeks Healing Deliver 3. Provisional not Fitting Abutment Provisional 4. Implant Position

30 Immediate Implants

31 Immediate Provisional Options to Fit Provisionals Add Composite Directly Transfer to Study Cast & Modify

32 Before 3 Weeks Immediate 4 Months The Team Approach to Replacing The Congenitally Missing Lateral Incisor Restorative and Periodontal Considerations, Clincal Advances in Periodontics, Vol 3, No 2, May 2013: , Clem D, Hinds K.

33 4 Months Healing

34 Standard Round Scan Bodies(Two Piece) STL Files

35 CAD/CAM Modeling(Urethane)

36 Custom Scan Bodies(Two Piece) STL Files

37 CAD/CAM Modeling(Urethane)

38 CAD/CAM Modeling(Urethane)

39 Custom Scan Bodies Work Flow Custom Scan Body Itero Milling Machine CAD/CAM Modeling Digital Impresssion STL File Virtual

40 Virtual Working Cast - Custom Scan Bodies

41 Place Implants into digital casts

42 Design Abutments

43 Design Abutments

44 Manufacture Abutments Design Software STL File 3 Shape, Dental Wings, Milling Center

45 Itero CAD/CAM millled Working Casts

46 Itero CAD/CAM millled Working Casts

47 Itero CAD/CAM millled Working Casts Zirconia Abutments Lava & Layered Porcelain Prostheses

51 Before Immediate 4 Months 3 Weeks Definitive Prostheses

52 Custom Scan Body Non-Ideal Implant Placement Female Age 67 Loss of vertical dimension of occlusion Lacks posterior support, multiple missing teeth Anterior crowding Before Panoramic Radiograph

53 Custom Scan Body Non-Ideal Implant Placement Female Age 67 Loss of vertical dimension of occlusion Lacks posterior support, multiple missing teeth Anterior crowding Before Panoramic Radiograph

54 Custom Scan Body Treatment Plan - Complete Rehabilitation Female Age 67 Open Vertical Dimension of Occlusion Place 5 implants, #7 crown lengthening Orthodontic Treatment to Correct Anterior crowding Implants 4,5,18,19,31

55 2 years

56 2 years

57 Mineralized Freeze Dried Bone Allograft Memlock (Long Term Collagen Membrane)

58 Standard Round Scan Bodies(Two Piece)

59 Standard Round Scan Bodies(Two Piece)

60 Custom Scan Body Custom Scan Body STL File Virtual Master Cast

61 Design Virtual Abutment

62 Design Virtual Abutment

63 Itero CAD/CAM millled Working Casts

64 Itero CAD/CAM millled Working Casts

65 Itero CAD/CAM millled Working Casts Titanium Abutments Lava Plus

66 Itero CAD/CAM millled Working Casts Titanium Abutments Lava Plus

67 Custom Impression Coping - Part Two: The Digital Transfer Custom Impression Coping For An Exact Transfer in The Esthetic Implant Restoration. International Journal of Periodontics and Restorative Dentistry, NOV-DEC 1997; Vol 17, No#6: Pages Hinds, K

68 Custom Impression Coping - Part Two: The Digital Transfer Future? Custom Impression Coping For An Exact Transfer in The Esthetic Implant Restoration. International Journal of Periodontics and Restorative Dentistry, NOV-DEC 1997; Vol 17, No#6: Pages Hinds, K

69 Custom Impression Coping - Part Two: The Digital Transfer Future?

70 Custom Impression Coping - Part Two: The Digital Transfer Future?

71 Custom Impression Coping - Part Two: The Digital Transfer Future?

Implant Restorations: A Step-By-Step Guide

Implant Restorations: A Step-By-Step Guide Drago, Carl DDS, MS ISBN-13: 9780813828831 Table of Contents Contributors. Foreword. Acknowledgments. Chapter 1. Introduction To Implant Dentistry. 1. Introduction.