Why I Love Digital Implant Restorative Workflow

There are three main reasons why I absolutely love the digital workflow.  First and foremost is the patient experience, secondly is the clinical outcomes, and finally is the economic benefits.  Many quickly dismiss CEREC as they believe it is only for chairside uses.  I firmly believe that CEREC Connect is one of the most underutilized features of the CEREC platform.

In this case example I want to share a recent case that really exemplifies the great benefit of CEREC digital workflow.

Shirley came to our office with an existing partial that she didn’t really love replacing a couple of missing lower anterior teeth.  Over the years her adjacent lower incisors had also become mobile.  She was now at a point where she needed to have these lower laterals removed and a new partial made.  But she didn’t want a partial.  She wanted a fixed solution.  So we went with implant therapy.

As an office that participates with dental insurance as a ‘contracted provider’, I don’t always have the luxury of working with some of my most talented laboratories.  And most of the time my patients aren’t willing to pay a surcharge for this higher level of aesthetics.  But I still strive to provide excellence!

I look to the digital restorative workflow to allow me to deliver very nice work at a PPO fees and still maintain a healthy profit margin.  And it’s not just about the savings in impression material.  It’s more about laboratory communication to help achieve clinical results while minimizing chair time.  After all, chair time is the most valuable overhead item we have in our office.

The first part of the digital workflow is the digital impression.  First digital implant scan bodies are attached to the implant and verified for complete seating via a digital X-ray.

Below are the CEREC intraoral digital impressions that are submitted to the laboratory via the Connect portal.

Any photographs and detailed instructions are included with the digital impressions to assist in ideal fabrication of the case.

So here’s the problem I face (and likely each of you face the same issue).  What I am looking for may be very different from what the dental lab has in mind.  So how do we close this gap in communication.  What I have found is that labs that I can communicate with digitally can also communicate with me digitally.  So I ask the lab to share with me a screenshot of the digital design.  This allows me the ability to communicate any changes that may be necessary.

So here is the iterations we went through for this implant bridge design.

The labs first attempt.

I find the above design to be quite bulky and not very natural.  In a matter of minutes via a few words on email I ask to make the emergence more narrow and ‘root shaped’.  A few hours later here is design #2.

This looks much better.  But I still don’t like the ridge lap and prefer an ‘ovate’ pontic style.  Additionally, if you notice the adjacent teeth have ‘root’ showing and I’d like these restorations to have the same.  So we finally arrive at design #3.

This design is much better and more natural.  It also appeals to my patient.   Now the lab is ready to go ahead and finalize the solid zirconia screw retained implant bridge.

So now I have avoided the original case coming to me and having to send it back for adjustment – this costs everyone money and frustration.  The patient loses time and confidence, the lab loses time and has to remake the restoration, and the dentist loses chair time.

A few minutes of communication can avoid all of this.  On this case I literally spent 5 minutes in between patients communicating digitally and ensuring I got a result that meets my expectations.  It creates a win-win-win.

Whether you are digital or not – I encourage you to open the lines of communication with your lab for the betterment of your patient!