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Journal of Prosthetic Dentistry

Complete digital workflow for complete arch implant therapy: Fact or fiction?

  • Edmond Armand Bedrossian
    Correspondence
    Corresponding author: Dr Edmond Armand Bedrossian, Private practice- E. Armand Bedrossian DDS Inc, 450 Sutter St, Suite 2618, San Francisco, CA 94108
    Affiliations
    Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash
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      Abstract

      This presentation focuses on whether a complete digital workflow, without a definitive cast, from data acquisition to manufacturing of the definitive prostheses for complete-arch implant treatment, is a scientifically and clinically validated workflow. A review of current literature for intraoral scanning and photogrammetry will provide insight into both technologies, reviewing their respective advantages, limitations, and recommendations. Although many publications have described intraoral scanning and photogrammetry for complete-arch digital implant recording, it has been recommended and emphasized that more clinical studies are necessary to validate the complete digital workflow clinically and scientifically for complete-arch implant–supported treatment. This presentation provides a contemporary approach to utilize digital technology for data acquisition, design, and manufacturing for a dual-arch implant therapy.

      JPD Digital video

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      Digital technology for providing complete arch implant therapy has evolved over recent years. While fundamental knowledge of treatment planning and diagnosis is imperative for treating patients with complete edentulism, the use of digital technology has provided tools to assist in facially generated treatment planning for communication with the dental laboratory technician and patient through digital smile design, manufacturing of prototypes, and fabrication of the definitive prosthesis.
      • Papaspyridakos P.
      • Chronopoulos V.
      Transition from failing dentition to complete-arch implant rehabilitation with a staged approach: a 3-year clinical report.
      ,
      • Coachman C.
      • Calamita M.A.
      • Coachman F.G.
      • Coachman R.G.
      • Sesma N.
      Facially generated and cephalometric guided 3D digital design for complete mouth implant rehabilitation: a clinical report.
      When implants have osseointegrated and functional and esthetic parameters have been assessed, the conventional analog workflow for the fabrication of the complete arch-fixed implant-supported prosthesis involves splinted open-tray impressions, fabricating gypsum definitive casts, verification of the definitive cast, and computer-aided design and computer-aided manufacturing (CAD-CAM) of the definitive prosthesis by the way of milling of a titanium framework for metal-acrylic resin prosthesis or milling of a zirconia prosthesis.
      • Papaspyridakos P.
      • Lal K.
      • White G.S.
      • Weber H.P.
      • Gallucci G.O.
      Effect of splinted and nonsplinted impression techniques on the accuracy of fit of fixed implant prostheses in edentulous patients: a comparative study.
      What has gained interest and has been reported in the literature is the ability to use digital technology for the data acquisition of the implant positions and the use of either intraoral scanning or photogrammetry for capturing the implant positions before fabrication of the definitive prostheses.
      • Papaspyridakos P.
      • Chen C.J.
      • Gallucci G.O.
      • Doukoudakis A.
      • Weber H.P.
      • Chronopoulos V.
      Accuracy of implant impressions for partially and completely edentulous patients: a systematic review.
      • Revilla-León M.
      • Att W.
      • Özcan M.
      • Rubenstein J.
      Comparison of conventional, photogrammetry, and intraoral scanning accuracy of complete-arch implant impression procedures evaluated with a coordinate measuring machine.
      • Wulfman C.
      • Naveau A.
      • Rignon-Bret C.
      Digital scanning for complete arch implant supported restorations: a systematic review.
      • Sallorenzo A.
      • Gómez-Polo M.
      Comparative study of the accuracy of an implant intraoral scanner and that of a conventional intraoral scanner for complete-arch fixed dental prostheses.
      This digital presentation focused on whether a complete digital workflow, from data acquisition to manufacturing of the definitive prostheses for complete arch implant treatment, can and/or should be done. A review of current literature for intraoral scanning and photogrammetry provides the advantages, limitations, and recommendations of both technologies. Once the implant positions have been acquired, how to optimize communication between the clinician and laboratory with a design software program for a collaborative facially generated treatment planning and comprehensive design and manufacturing of the definitive prostheses is presented.

      Supplementary data

      References

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        Facially generated and cephalometric guided 3D digital design for complete mouth implant rehabilitation: a clinical report.
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        Comparison of conventional, photogrammetry, and intraoral scanning accuracy of complete-arch implant impression procedures evaluated with a coordinate measuring machine.
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        Digital scanning for complete arch implant supported restorations: a systematic review.
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        Comparative study of the accuracy of an implant intraoral scanner and that of a conventional intraoral scanner for complete-arch fixed dental prostheses.
        J Prosthet Dent. 6 April 2021; ([Epub ahead of print])https://doi.org/10.1016/j.prosdent.2021.01.032