Computer-assisted implantology sounds attractive – but how does it actually find its way into the practice? This is precisely the question addressed by the third episode of the trilogy on computer-assisted implantology in the podcast Queens & Sons of Dentistry. An implantologist who runs three dynamic navigation systems in parallel describes step by step how a successful start is achieved – from the first case through the basic equipment to the typical beginners' mistakes.
The ideal first case: deliberately simple
For the start, the practitioner recommends a first molar in the upper or lower jaw: plenty of bone, plenty of tissue, no great risk – a situation that would also be manageable freehand. At first this sounds paradoxical, since it is precisely with a single-tooth implant that the effort seems hardly worthwhile. Yet that is exactly where the logic lies: at the beginning, the new navigation system itself is the actual stress factor of the procedure. Using it in an operation that presents no surgical challenge allows the workflow to be learned calmly. Complicated situations, or even full-arch cases, are explicitly off limits for the start.
Basic equipment: what is genuinely required
Among the indispensable basics the implantologist counts a CBCT scanner as well as a camera for patient photographs – although he qualifies this by saying that an iPhone is sufficient today, provided no lectures are planned. The artificial intelligence behind Smilecloud now corrects smartphone photographs to such an extent that they fit the smile design – six or seven years ago that would still have been unthinkable.
With the intraoral scanner he draws a distinction: it is not strictly necessary. Work is also possible with an alginate impression that the laboratory digitises – that is how his own practice started out. Because of the back and forth between practice and laboratory, however, this is not ideal: in theory it is possible to work in a very digital way while owning almost no tools at all – possible in theory, but not in practice. His clear recommendation is therefore to invest in an intraoral scanner: it is the entrance door to the digital world. The market now offers very good devices that are not cheap but good value – the most expensive model is no longer a necessity. As an example he names the X3 from Straumann, which at the same time opens access to the AXS cloud, from which further doors open up: planning software, Smilecloud, Smile Box and the Falcon system.
The right order of investment
The podcast guest says he committed the classic beginner's mistake himself: buying everything at once. His recommendation today: first the intraoral scanner, then the planning software, and only after that the navigation system. Practices that do not yet own a scanner should not begin with the purchase of a Falcon or a Navident.
With the planning software, too, he advises a step-by-step approach. coDiagnostiX, for instance, can be tested for a month instead of having to be bought outright as in the past – which creates familiarity with the system before money is committed. He regards planning competence of one's own as central: anyone who later outsources cases to external service providers has to be able to judge how the implant was planned – and that requires an idea of how the software works and how difficult planning can sometimes be. For those who find planning stressful at first, he recommends sitting down with a trusted dental technician and planning cases together, slowly – dental technicians are often considerably more digitally versed than dentists.
Static guided or dynamically navigated?
For newcomers to implantology the practitioner recommends static guided surgery with a fully guided surgical guide. Those who are already more experienced, who want to guide the bone themselves and to see what they are doing without a guide, should opt for a dynamic navigation system – it is simply a great deal of fun.
Learning curve and typical mistakes
The implantologist creates no illusions: something will go wrong at the beginning. With navigation in particular there is a genuine learning curve, because despite the glasses used with the Falcon system the gaze has to shift repeatedly between the screens and the mouth. In addition, every procedure comes with a checklist that has to be correct. All the more important, therefore, to start simply and not to try to exhaust every possibility at once – otherwise nothing at all gets finished in the end.
In the episode's quick-fire round the guest sums up his position: his absolute game-changer tool was coDiagnostiX, he prefers guided implant placement to the freehand method – and those considering the step should start soon, because otherwise it will at some point be too late. The route there leads via a simple first case, a well-considered order of acquisitions and the willingness to accept a learning curve.