More and more patients are seeking treatment for edentulism. Tooth loss can impact a person both physically as well as mentally. It is no wonder then that with over 35 million people suffering from edentulism, there have been tremendous advancements made to offer clinically sound solutions to these patients. One of the fastest-growing treatment options is the implant-supported fixed prosthesis.
These cases tend to be challenging to restore, especially if they are not properly planned and executed. One of the challenges is in the ability to impress cases accurately where multi-unit implants have been used.
With multi-unit cases, there is a greater chance of inaccuracies in the impressions. As the number of implants in a case increases, precision is found to decrease. This is due primarily because of the limitations found in both digital impression methods and conventional methods. Without an accurate impression, the ability to achieve a passive fit of the prosthesis is diminished. Therefore case success depends on the ability to accurately transfer the implant position information.
iCam 4D by Imetric Scanner
At Burbank Dental Lab, to improve the workflow and improve fit passivity, the iCam 4D camera by Imetric4D was found to be an important system that significantly enhances success with these types of cases. Essentially the iCam 4D is an in-office scanner that combines photogrammetric and structured light scanning to capture data in 3D. Scan bodies unique to the system are embedded with 3D coding. They are used to track the orientation and position of the implants.
We are fortunate to work with some genuinely innovative clinicians, such as Dr. August de Oliveira who is an early adopter of innovative technology. Dr. de Oliveira sent in the following patient case using a fully digital workflow that included the ICam 4D camera technology.
Patient Diagnosis
This patient presented as fully edentulous and was seeking a fixed implant-supported prosthesis. Implants had been placed and were ready to be restored.
The initial step then was to receive the digital data. First, a soft tissue scan was taken using an intraoral scanner. If needed, a rapid impression could also be used and then scanned at the lab.
The iCam 4D by Imetric scanner then was used to take an extraoral scan. To do this scan, special scan bodies (iCambodies)(fig2) are inserted in the patient's implant sites. The Imetric scanner precisely records the orientation and position of the implants.
The bite was recorded by taking a pre-op scan of the converted denture. The captured digital data was then merged using the Imetric software.
Here the iCam 4D data and gum tissue scans are aligned to become a high precision dental model and then exported to ExoCAD, where it was sent to Burbank Dental Lab to begin fabrication of a provisional hybrid restoration, as shown below.
Creating the Provisional
The data was sent to Burbank Dental Lab to be designed using Exocad design software.
Then DuraTemp PMMA (Polymethylmethacrylate) provisionals were milled. These provisionals were fabricated with titanium cylinders for use over the implants. This step provided the patient with a prototype of the final restorations.
At the try-in appointment, Dr. de Oliveira observed that the provisionals were designed with too much gum tissue showing. This information was communicated to Burbank Dental Lab, and the provisionals were redesigned by moving the occlusal plane, thereby revealing less gum.
The Final Prosthesis
The final prosthesis was fabricated using Burbank Dental Lab’s ZIRMAX M hybrid prosthesis.
This hybrid option was chosen as it provides both high esthetics and strength. It offers one of the highest flexural strengths (1200 MPa), making it the optimal choice to endure heavy occlusal loads.
Also, ZIRMAX M has the following benefits:
- Provides patients with the closest feel to natural dentition
- Provides one of the most durable options not likely to chip
- Over ten years of clinical success
The new restoration was tied in by using the one-screw test. This is a test done to check the fit of multiple implant-retained dental restorations. This is completed by using a single screw in one abutment and then evaluating the opposite side. The fit is analyzed both clinically and by radiograph to ensure there is no rise and that a passive fit has been achieved. Poorly fitting multi-unit restorations can cause the following:
- Poor overall function
- Implants and framework placed under unnecessary stress
- Poor bone resorption
This case revealed a passive fit, required zero adjustments, and the occlusion was impeccable. The patient was thrilled with the results.
Multi-Unit Workflow
Burbank Dental Lab provides a complete workflow for doctors restoring multi-unit implant-supported fixed prosthesis cases. The steps are as follows:
- To help with final tooth placement and finding the midline, the patient's existing dentition must be retained. This can be an existing denture or study model.
- A Burbank Dental Lab implant specialist should be scheduled to come to your office and place the iCambodies (scan bodies). Call for a complete list of current service areas.
- Using the iCam 4D scanner, take a few scans of the patient's mouth extraorally. This will record the position of the implants.
- Scan the soft tissue with an intraoral scanner.
- The digital data from these scans are sent to the lab to be merged to form a precise dental model.
- Create a DuraTemp PMMA provisional.
- Receive patient feedback regarding the provisional.
- Incorporate the patient’s comments into the final implant-supported fixed prosthesis.
The iCam 4D by Imetric is an excellent solution for digital multi-unit implant cases. This technology reduces the amount of chair time that would otherwise be used and ultimately improves accuracy.
This new workflow from Burbank Dental Lab provides an exceptional restorative option for people suffering from edentulism.
Burbank Dental Lab would like to thank Dr. August de Oliveira for working with us on this case and providing the article's photos and input.
Call or chat with us to find out more about digital workflow solutions at Burbank Dental Lab.
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