Posted July 8, 2020
Here is another case, which turned out great (INMHO) that was a little tougher than the last at Implant Pathway. As I’ve posted before Implant Pathway is a teaching center in Tempe, AZ that works with New Horizons a non profit that delivers dentistry at low or no cost to the needy. I teach the “Restorative Solutions” course teaching docs not only the Digital Workflow” but also how to restore implants with good old fashioned impressions. When scanning for a digital hybrid, the easiest way is to use a converted denture, which is retrofitted at the time of surgery, to get the bite. This deserving patient was in a locator overdenture and wanted something a little more permanent. First step was to trade out his locators for multi units. If you are not familiar with multi units, we use them to correct implant and angulation and is a “screw with a screw hole” that allows us to torque down a hybrid. As you may have seen in other posts, we use white composite “fiducials” to match up the bite on the palate and the retro molar pad. So we had to alter the overdenture a bit to get these areas exposed.
http://www.Digitalenamel.tv
I know its a bit “belt and suspenders” but we are comparing the accuracy of the gold standard, which is Photogrammetry or basically a bar code reader of implant position vs just scanning with CEREC Primescan. In this case we used the Imetric ICAM4D scanner to record the implant positions and a CEREC scan using these short scan bodies to get the soft tissue and relate the bite.
By scanning the overdenture with the exposed attached tissue we can use the overdenture for the dual buccal bites, match them to the soft tissue markers and then relate the implant positions we get through Imetric. The result is a super accurate, passively fitting prosthesis with a rigid bite the patient has been functioning on for years.
If you keep the tissue really dry these markers easily guide the CEREC software with a little help, to match the scans up.
We can then export the scans with the proper VDO and occlusion out from CEREC and then into the Imetric software. Big thank you to Dr Michael Skramstad helping me with ExoCAD inBox for Sirona Connect to convert these to PLY so I don’t lose the color.
By using a free app on the Iphone 10 and above, Bellus 3D we take two 1 minute scans. One smiling big and another retracted. We can bring this data into ExoCAD to help with the lip line, the midline and tooth size and shape. As you may or may not know, we do overdentures sometimes on patients with high lip lines as you can see the border between the hybrid and the gums. Using Bellus 3D face scans can save you a ton of heartache before you get the final done and also help in treatment planning these cases, so your patients know if they can get fixed or removable.
Tons of good data here to help your lab make a perfect prosthesis. If you are feeling risky, you could even do upper and lower hybrids straight to Zirconia.
I think I am approaching 70 digital arches scanned and I am finally getting to a point where I am not grinding the heck out of the bite! Look at the ExoCAD images of the planned occlusion and where we ended up with this PMMA prototype! Just will need some minor adjustments of the anterior teeth and then straight to Zirconia!
We inserted the final with almost no adjustment and a great passive fit! Full upper and lower Zirconia from Prosmiles dental lab at Implant Pathway in Tempe!
Gad we could go with a more natural shade, you can see the occlusion, “right out of the box”.
The true test to any hybrid is if its seated and has a passive fit. The restorations went right in with minimal pressure to screw down.
A man of few words but he seemed happy with the final!! More deliveries to come!!
If you want to try this out live, we will be lining up multiple arches to scan using any IOS scanner and the Imetric system! Doc will learn the analog as well as the digital workflow from everything from singles, over dentures and hybrids! Come to Implant Pathway Nov 5-7!1. Register at https://www.implantpathway.com/restorative-solutions/
Also I have put my 3D Printing Party online! 12 CE credits and hours of hands on from surgical guides, to aligners, to digital dentures and hybrids and more!
https://3d-printing-party.teachable.com/p/dental-3d-printing-party-online
