Soft Tissue Transfer Utilizing Digital Impressions of Anterior Implants

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

Traditional(Analog) ImpressionTechnique

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 585-591. Hinds, K

Traditional(Analog) ImpressionTechnique

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

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;24:246 254 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;107:3,151-157

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;24:246 254

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

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. 1997 May;77(5):546-9. Marchack CB, Yamashita T

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

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

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

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

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

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

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

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

Itero - Digital Impression STL Files STL Files Digital Capture

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

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 + / - 30.9 micron CAD / CAM Milled (Itero) (Urethane) Steriolithography(SLA) 3D Printing, Rapid Prototyping

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

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

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

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

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

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

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

Immediate Implants

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

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: 106-114, Clem D, Hinds K.

4 Months Healing

Standard Round Scan Bodies(Two Piece) STL Files

CAD/CAM Modeling(Urethane)

Custom Scan Bodies(Two Piece) STL Files

CAD/CAM Modeling(Urethane)

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

Virtual Working Cast - Custom Scan Bodies

Place Implants into digital casts

Design Abutments

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

Itero CAD/CAM millled Working Casts

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

Before Immediate 4 Months 3 Weeks Definitive Prostheses

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

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

2 years

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

Standard Round Scan Bodies(Two Piece)

Custom Scan Body Custom Scan Body STL File Virtual Master Cast

Design Virtual Abutment

Itero CAD/CAM millled Working Casts

Itero CAD/CAM millled Working Casts Titanium Abutments Lava Plus

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 585-591. Hinds, K

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 585-591. Hinds, K

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