What does a fully digital workflow in implantology actually look like – from the first consultation through to the screw-retained bridge? In the podcast Queens & Sons of Dentistry, an experienced implantologist uses the example of a full-arch restoration to describe how his practice works today, which software and devices interlock in the process, and why treatment time has almost halved as a result. Precisely with extensive cases, in his assessment, the digital approach makes real sense.
Consultation and digital data collection
Stage one is the consultation. Preparing such cases involves an immense amount of work, which is why his cost estimate provides for this preparatory service to be remunerated as well. Stage two brings photographs, intraoral scans and – if not already available – the CBCT scan. From these the digital patient twin emerges, also called the patient avatar in the podcast: a digital copy showing how the patient bites with his or her own teeth. The principle behind it: gather as much information as possible.
The handling of the occlusion follows the same principle. In full-arch cases all the teeth are removed – if the way the patient bites is not recorded beforehand, every reference point is missing later on. A jaw tracker makes it possible to record the dynamic occlusion, that is, the movement of the jaws against one another. The practitioner argues for registering everything that can be registered before extraction – even if the initial situation is faulty or does not look good. For the temporomandibular joint is a complicated area: if the newly established bite situation does not work, the secured baseline data allow realistic subsequent correction and improvement.
Smile design and wax-up: division of labour with the dental technician
Stage three is the smile design, which is still created in the practice with Smilecloud – this is where the direction of the journey is determined. The dental technician then takes over the wax-up. The implantologist deliberately sees himself as a surgeon, even though he likes prosthetics: he communicates with the technician via photographs and Smilecloud, the technician supplies the wax-up, which is subsequently imported into the planning software. In extensive cases in particular there is no alternative to this collaboration – a good dental technician is an absolute requirement.
Implant planning in coDiagnostiX
The second patient avatar is created in coDiagnostiX. Technically this is a superimposition of files: the DICOM data set, STL and photographs are matched – a process which, according to the practitioner, has become extremely simple today. Planning then takes place on the basis of the anatomy: where does the nerve run, where are the maxillary sinus and the nose, how much bone is available? On this basis the decision is made as to whether immediate loading is possible or whether a step-by-step approach is required.
The implantologist sees a major step forward in AI-assisted radiographic analysis: the teeth are now segmented automatically and the course of the nerve becomes visible. Ten years ago every tooth was segmented individually by hand – an enormous amount of time. The results of the artificial intelligence do have to be checked, but they are said to be rather good. The patient, incidentally, notices none of this: he or she receives an appointment for surgery and knows where the journey is heading – the actual preparatory work happens in the background.
Surgery, photogrammetry and the bridge from the printer
In the procedure itself the navigated instruments come into use. Immediately afterwards a digital impression is taken – by photogrammetry and intraoral scan. The photogrammetry device, in his practice a Micron Mapper, works according to his description like a digital plaster index: it splints the implants digitally and delivers a passive impression within a few seconds, with an accuracy of around twelve micrometres. The digital splinting takes about three minutes – for the practitioner, quite simply brilliant.
The laboratory is 500 kilometres away – in a digital workflow that plays no role. It matches impression and wax-up digitally and sends back a digital bridge. In the practice it is printed by the assistant, finished and screw-retained. For the definitive prosthetics the sequence is short as well: because almost everything is correct after the planning, a passive impression with scan bodies, an intraoral scan and photogrammetry are sufficient; the laboratory adopts the existing design, followed by try-in and completion – three appointments in total for a full-arch bridge. Only three years ago, according to the implantologist, that would not have been feasible.
Halved treatment time as the result
The assessment of the digital workflow is striking: a complete reconstruction with extensive bone augmentation that previously required twelve appointments spread over a year is today carried out in six appointments and seven months – digitalisation has halved the treatment time. At the same time the process becomes simpler for everyone involved: for the patient, who spends considerably less time in the practice, for the team, which actively participates, and for the practitioner himself. There is a plan – and that plan is implemented. For the podcast guest this is precisely where the real appeal of the much-quoted workflow lies: it is no longer an empty phrase but lived practice reality.