Don’t Skip Steps – True Prosthetic Based Implant Planning

The world has changed.  We are digital and that is now extending into dentistry in a big way.  Just as digital has changed the way we live our lives, it is dramatically changing the way we change our patients lives.

Each year I choose to work closely with a few young dentists as a mentor.  Generally speaking, they are young dentists who have taken some of my hands-on workshops and have shown an excpetional desire to learn and grow.  I would love to do this more, but the ‘hustle and bustle’ of practice, training, speaking, husbandry, and being a father, make it difficult.  I like to mentor the same way I train/educate – by provoking thought.

Here’s a case where I am mentoring a young dentist.  He submitted this case and my first question was “Why did you plan the implants so lingual?”  His response was because I intend to bring the teeth back into arch form.  This is a logical answer.

I asked him to send me the original CEREC .rst file so I could work with it.  My belief is that we should take the few extra minutes – or sometimes learn the complete capabilities of the software – to really make this work ideally.

I redesigned the case as a 4 unit bridge virtual waxup bringing in the central incisors to ideal aesthetics.

What it showed me was that to get this ideal result I needed to do some minor orthodontics on the lower teeth.

The great news is that this minor orthodontics can be easily done with a removable appliance such as the Inman Aligner.  It could also be done as a single arch straight wire ortho case using Six Month Smiles or PowerProx six month braces.  It could even be done as an Invisalign Express case.

To me the real beauty of doing this exercise doesn’t necessarily lie in the implant planning, but more in the patient communication.  Just look at the photo above and you should quickly be able to help the patient understand the importance of doing this and how it will improve the results.

We then export the case from CEREC to Sirona Implant software as a .ssi file.

Then we are able to plan the implants based on the final ideal prosthetic position.  Take a look at the implant plan with the original teeth and compare it to the virtual idealized waxup.

Here is a side-by-side perspective.