Contemporary digital workflow for efficient cost-effective implant-borne full-arch hybrid prosthetics

This introduction by Daniel B. Spagnoli spotlights the importance of a digital flow and innovative technologies to the implant practice.

Innovative digital technologies are no longer a “need to have” but rather a “must have” in our daily implant procedures. In my experience, these advancements have had a substantial, positive impact on the safety and efficacy of my patients. Over the years, I’ve noticed that the use of the latest digital trends in my own practice has helped influence my patients’ trust and confidence that they’ll receive treatment and results that go above and beyond initial expectations. In my facility, specifically, we’ve taken full advantage of many digital-engineering solutions in the world of dental implants.

The evolution of dental implant-related technologies has considerably improved the safety, efficacy, efficiency, and scope of treatment available to patients. Patients with terminal dentition that require full-arch fixed hybrid prosthetics in particular have reaped the benefits from enhanced care as a result of digital diagnostic records, virtual planning, guided surgery, indexed prosthetics, and indexed 3D-printed prosthetics. Traditional visual facial analysis is augmented by digital photography and 3D photography to provide greater accuracy in the virtual-planning phase. Cone beam CT scans obtained in centric relation “CR” are the cornerstone of virtual planning. Intraoral dental scans or digital denture dual scans can be merged with cone beam CT data and 3D photography. Digital records are then transferred to virtual planning software such as exocad to develop the engineering and architecture of a functional and esthetic dental arch. Proper vertical dimension, occlusal plane orientation, and implant-to-prosthetic relationships are evaluated and modified using a virtual articulator. It’s important to keep in mind that implant spacing, emergence position, and appropriate restorative space are integral to the final design. Bone-borne implant guides are registered and rigidly fixated to basal bone transfer concepts from the digital design to the surgical field. Base portions of the guide create a platform for appropriate bone reduction, vertical dimension, occlusal plane orientation, and prosthetic attachment. Implant guides registered to the base guide assure appropriate implant position and alignment to the prosthesis within the trabecular bone space. Ensuring proper placement of implants within trabecular bone stimulates anisotropic bone remodeling during integration and avoids stress-related bone loss.

The use of 3D printing has been a game changer in dental implantology. 3D-printed composite resin prosthetics are designed to permit indexed placement by attaching to the base guide during bonding to cylinder abutments. This provides for transferring the plan for arch form, vertical dimension, occlusal plane, and occlusal relationships using an efficient and accurate process. Advances in 3D printing permit the use of sophisticated composite resins with fiber-reinforced bases and micro-hybrid or zirconium-filled dental bridges. The greatest benefits of 3D-printed composite resin prostheses offer a lower cost, good wear resistance, strength, esthetics, and the potential to be modified or repaired later on down the road.

Moving forward, I anticipate that many of the technologies will continue to evolve and give oral surgeons more accuracy in their daily routines. By adding these cutting-edge solutions to my daily workflow, I’ve noticed how much more time and cost efficiently I’m able to operate, and I’m excited to see what’s to come in the future.

In summary, the digital flow outlined here eliminates dental models and leads to time and cost-efficient fixed implant-borne prosthetics.

Dr. Justin Moody also advocates a digital flow in his article, “Systems-driven dental implant practice.” Read it here:

Daniel B. Spagnoli, DDS, MS, PhD, completed his Oral and Maxillofacial Surgery (OMFS) residency at Louisiana State University (LSU) School of Dentistry and Charity Hospital. Dr. Spagnoli became certified by the American Board of Oral and Maxillofacial Surgeons and is a past Board examiner. Following his residency, he entered private practice in Charlotte, North Carolina, at University Oral and Maxillofacial Surgery, which eventually became the Carolinas Centers for Oral, Facial, Cosmetic & Dental Implant Surgery. While practicing in Charlotte, Dr. Spagnoli maintained academic affiliations with Louisiana State University and the University of North Carolina (UNC). The Charlotte practice became a training site for Oral and Maxillofacial Surgery residents initially from the UNC, and then and currently from LSU. Dr. Spagnoli has served as Director of Oral and Maxillofacial Residency Training at Carolinas Medical Center. He became the James Peltier Chairman of Oral & Maxillofacial Surgery and the Director of Dental School Hospital affairs at the LSU Health Science Center School of Dentistry. Dr. Spagnoli now brings his years of private practice and academic experience to a new practice — Brunswick Oral & Maxillofacial Surgery in Brunswick County, North Carolina.

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