Dentaltown June 2019 - 63

Digital workflow
The digital process is initialized by
obtaining and using CBCT and digital
impression technologies. By applying this
digital information, the three-dimensional
position of the final restoration can be
planned.4 This is the primary step in the
digital workflow process for simple and
complex cases; it is only after the ideal
contours of the proposed final restorations
have been planned and approved that the
surgical structures can be correctly evaluated
to precisely and decisively plan the best
implant position that will support that
restorative plan. Furthermore, with the
utilization of digital facial images and video
content, the aesthetic outcomes can also be
predicted digitally.
The fusion of CBCT imaging and
digital impressions is essential in the
overall digital implant workflow. (This is
accomplished by using various available
software.) However, just the fusion of
this information is not sufficient; the full
detailed planning of the final restoration, as
well as the corresponding implant position,
must be completed in the same software.
Once again, the precise planning of the
3D position of the final restoration and
the technical aspects of the final restorative
design are important to allow for ideal and
proper implant placement. When the correct
restoratively driven and biologic digital
implant position has been attained, this
can then be transferred from the digital
world to the oral cavity via dynamic or
static computer-guided surgery.5 This is
the vital phase of the digital workflow.

Computer-guided
implant surgery
The transmission of the virtually
planned implant position to the real world
via computer-guided surgery (static or
dynamic) is a critical step in the digital
workflow. Furthermore, it is only when the

final implant position is planned, based on
the ideal design and 3D position of the final
restoration, that the need for adjunctive
procedures such as osseous or soft-tissue
grafting can be properly evaluated.
For static guided surgery, the surgical
guide is 3D-printed and transfers the precise
digital planning from the software to the
oral cavity.6 For dynamic guided surgery, the
software and monitoring system performs
this transfer of the virtually planned implant
position and aids in guiding the clinician
while placing the dental implant by acting
like a surgical GPS system. The overall
step of transferring the virtual plan of
the implant position to the real world is
crucial to the restorative success of implant
therapy because the specific position of the
dental implant dictates emergence profiles
and aesthetics. Utilizing static or dynamic
guides allows for more accurate and precise
placement of implants when compared to
freehand placement.7-9

Intraoral scanning
There are numerous advantages to
intraoral scanning, such as easier transfer of
information, more efficient communication
with the lab, instant feedback, more preferable
patient experience and time efficiency.10
Intraoral scanning is one of the first steps
in the digital workflow, so the accuracy
of every subsequent step depends on the
accuracy of the initial digital acquisition
method. Accuracy and reliability of intraoral
scanners have exponentially improved in
recent years. They have comparable, if
not better, precision than conventional
impression techniques.11-13
Besides the method of impression taking
(digital versus analog), the other main difference between analog and digital impressions
for implants is the actual impression coping.
Unlike conventional implant impressions
that use either a closed-tray or open-tray
impression coping, digital impressions utilize

Digital
technology
allows for
better
communication
between
the clinician,
laboratory,
dental team
and patient.

dentaltown.com \\ JUNE 2019

63
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Dentaltown June 2019

Table of Contents for the Digital Edition of Dentaltown June 2019
