The Preat workflow advantage

Solving the complexities of restoring multiple implant interfaces while maintaining restorative consistency

Introduction

The United States dental implant market size was worth $1.37 billion in 2022 and is projected to grow at a compound annual growth rate (CAGR) of 6.9% during the forecast period. The U.S. has had an increased need for dental restorations that replace missing teeth. Approximately ½ of the adults in the U.S. suffer from periodontal disease. Furthermore, the need for esthetic restoration of individual dental implants and increasing amounts of disposable income for adults over 50 years of age are indicators of an ever-increasing need for dental implants and restorations.

According to Elani, et al., there has been a large increase in the prevalence of dental implants, from 0.7% in 1999 to 2000 to 5.7% in 2015 to 2016.¹ The largest absolute increase in prevalence (12.9%) was among individuals 65 to 74 years old, whereas the largest relative increase was ~1,000% among those 55 to 64 years old. There was an average covariate-adjusted increase in dental implant prevalence of 14% per year (95% CI, 11% to 18%). This study demonstrated that dental implant prevalence among U.S. adults with missing teeth substantially increased since 1999. Yet access to care overall is still low. Prevalence was consistently higher among more advantaged groups.

Over the last decade, technological advancements have played a considerable part in development of multiple industries. Dentistry is no different. From electronic recordkeeping and impressions or scans to treatment planning and producing restorations in-house, digital technology is having a significant impact on the industry.

Technological innovations have allowed dental practices improved access to new technologies that were previously too expensive. Developments in technology are helping to change dentistry by providing more efficient workflows, better treatment outcomes, and increased patient comfort.

The changing implant environment

The realities of practicing implant dentistry today have vastly changed over the decades. In the 1980s, implant treatment was geared towards fully edentulous patients, and implant placement was primarily performed by oral and maxillofacial surgeons, while implant restorations were fabricated under the direction of prosthodontists. This was per the original Brånemark protocol.²

Times have changed:

1. Implants now are placed by restorative dentists, periodontists, and implantologists. Market research estimates that 31% of general practitioners in the U.S. placed implants in 2023. While the number of general practitioners placing implants is not projected to grow much over the next few years, those general dentists are expected to place more implants each.
2. Even with the advancement of implant-placing general dentists, specialists are still projected to place the majority of implants. Complex cases will still require an interdisciplinary team approach to ensure an optimal Communication will continue to be essential in the team approach.
3. As the dental implant landscape has matured over the decades, there is a growing population of patients with implants placed years ago that were never restored. This may be a dilemma as some implants have become obsolete, and restorative components are no longer available. Dentists may have trouble identifying a specific implant. There are several websites, including https://www.preat.com/implant-identification, that will assist dentists in determining specific implants. Preat receives between 40 to 50 implant ID requests per day. The technicians can determine the specific implant and implant/abutment connection for dentists who submit a form on the website with the requisite information and will generally respond within 24 hours (or within 60 minutes for expedited requests). Preat will identify the implant as well as suggest instruments and products to assist with the treatment plan. Preat offers a convenient tool caddy called the Implant Buddy which includes prosthetic drivers for six common screw connections and reduces the complexity of restoring multiple implant systems.
4. In addition, there is a growing population of patients with existing restorations who need continued care. Aside from general hygiene and maintenance, these patients may need new restorations or may have lost additional teeth and need additional implants. Dentists should make an attempt to use the same or similar implant and implant/abutment connections to facilitate treatment. Attempts should be made to minimize implant component types (internal, conical, external hex, etc. connections) to decrease the potential for confusion and errors in selecting components.
5. Further complicating implant restoration is the continuous growth of dental implant systems available in the U.S. While market leaders introduce new designs, new companies are also entering the U.S. with their implant systems. According to the FDA 510(k) database, approximately 130 dental implant systems (from over 90 different companies) have been cleared by the FDA since 2019. This challenging environment makes finding ways to simplify the restoration of multiple implant systems more critical than ever. Open platform digital systems that allow the practice to standardize a process, instrumentation with common connections, and technical resources that possess holistic, rather than proprietary, knowledge of the implant landscape are all prime examples.

Digital dentistry

Digital dentistry means the use of digital instrumentation and processes for diagnostic and treatment processes. Digital formats are used across all areas of practice, from equipment and scheduling to patient treatment and lab collaboration. Switching from analog to digital dentistry makes dental procedures more efficient and can improve treatment outcomes. Many dentists still use traditional processes such as conventional impressions and dental stone casts. Digital dentistry is quickly expanding as more digital tools become available, and dental practices look to meet changing patient demands.

Scan bodies are essential for the digital process. Scan bodies are recognized by intraoral scanners and provide the dental designer/laboratory technicians the exact location of the implant in CAD software used in designing a particular restoration. This includes the implant connection type, implant diameter, location of peri-implant soft tissues and adjacent teeth — information that was once mailed to the laboratory via an impression and written form — now sent electronically in seconds. Once received, the designer then has the ability to select the appropriate abutment in the CAD software.

Key considerations when choosing scan bodies include: material/surface, marking, and restorative flexibility. A titanium scan body with matte finish is ideal to allow seating verification by X-ray without reflection that will interfere with the intraoral scan. Clear marking on the scan body itself is helpful especially when working with multi-unit cases. Restorative flexibility will maximize efficiency both in the office and in the lab by allowing a single scan body design to be used for a full selection of restorative options — rather than requiring different scan bodies to be used and scanned for certain abutment options. The Preat titanium scan bodies, for instance, provide 18 implant-level abutment options per implant interface plus 9 different options for industry-standard multi-unit abutments.

The Preat workflow advantage

The Preat digital workflow was designed with simplicity and efficiency in mind for both the office and the lab. The features and restorative flexibility of the scan bodies make it easy to enter the workflow. In addition, Preat’s digital analogs and CAD library are designed to allow for easy digitization of traditional impressions.

The restorative flexibility combines a variety of abutment designs with compatibility for all major implant systems. This breadth is advantageous in managing the complexity of implant treatment over a patient’s lifetime.

Developments in technology are helping to change dentistry by providing more efficient workflows, better treatment outcomes, and increased patient comfort.

Angulated screw channel

Preat ASC Titanium Bases utilize an angulated screw channel in certain restorative situations. This solution is beneficial in situations where a screw-retained restoration is desired, and implant placement and screw access channels compromise the ideal esthetic or functional outcomes. ASC Titanium Bases allow the screw channel to be angled up to 30° off-axis, thus directing the screw access hole to an optimal position. Available for both implant and multi-unit abutment level restorations, this improves esthetics for single crowns and helps simplify complex cases.

Abutment height versatility

Both the Verification Cylinders and the 9 mm tall ASC Titanium Bases can be reduced to 3 different heights, giving designers multiple restorative options while only needing to stock one component. The abutment is cut down to the correct height prior to luting the abutment to the milled or printed restoration. This is another example of the restorative flexibility that helps deliver the best restoration possible from a single scan body — not to mention an inventory advantage for those with an in-office lab.

Best prosthetic solutions for patients

While every patient is different, patient expectations are to receive esthetic, functional restorations. The Preat workflow is about providing technicians and clinicians with the option to choose restorative components best suited for successful restorations. With the ever-evolving implant practice, the ability to treat patients with various implant types is now the expectation. Having a trusted multi-platform prosthetic partner is important in maintaining consistency and efficiency in today’s practice.