The Pros and Cons of Computer-aided Dental Implant Surgical Planning

Although computer-aided dental implant surgery and the aid of surgical guides were originally developed to reduce the risks of standard implant procedures, dental professionals must still weigh the cons and pros of such procedures. Much research has been conducted to offer a clinical perspective on the accuracy of computer-aided oral implant surgery and computer-designed (SLA) surgical guides. Some findings have concluded computer-aided implant surgery, using three-dimensional (3D) virtual planning software and computer-aided surgical guides, is a reliable procedure to optimally position dental implants; however, some disadvantages have been reported as well.

Combined technologies of computed tomography (CT) scans integrated with three-dimensional (3D) virtual planning software, and computer-aided design/computer-assisted manufacture (CAD/CAM) allows the “clinicians to virtually plan the location, angle, depth, and diameter of the virtual implants on the basis of the diagnostic casts and by using wax-ups as an exact replica of the final restoration” (Beretta, Poli, and Maiorana). Its worth mentioning more cutting edge dental laboratories are using 3D printers, such as Stratasys 3D printers, to print diagnostic casts or models at a faster rate with acute accuracy then previously manufactured.

Intraoral digital scanners, such as iTero, create high-resolution 3D images of the surrounding oral cavity; allowing the dentist to check on the health of the tooth, their roots and bone surrounding them. Computer-aided implant surgical planning utilizes 3D imaging software from a CT system, such as Carestream, to customize surgical templates to help the dentist correctly drill and position the dental implant. With 3D imaging software, there are many possibilities to enhance the treatment planning process and improve patient care. Features range from implant placement planning to viewing in 3D high-resolution the sagittal, coronal, axial, obliques and panoramic angles for a more accurate diagnosis of dental treatment. 

In 2014, the Science Journal of Periodontal & Implant Science published a clinical study aimed at evaluating the accuracy of flapless, computer-aided implant placement by comparing the angular deviations of the planned and placed implant positions. They concluded that “computer-aided flapless implant surgery seemed to provide several advantages to the clinicians as compared to the standard procedure; however, linear and angular deviations are to be expected” (Beretta, Poli, and Maiorana). They found no complications and all implants achieved successful osseointegration. Their research also affirmed the development of “more accurate 3D planning programs for the CT scan analysis and virtual planning contributed to the progress of this type of surgery and implant rehabilitation with a one- or two-stage approach” (Beretta, Poli, and Maiorana).

Here are several Pros of computer-aided oral implant surgery that Beretta’s study reported:

·         Flapless surgery with a consequent decrease in surgical time and patient morbidity.

·         Preservation of soft tissue structure and hard tissue volume in the surgical site.

·         Integration of the restorative determinants into the surgical planning, resulting in a more aesthetic, functional, and predictable prosthetic outcome.

·         Simplification of the technique-sensitive and operator-dependent surgical procedure (Beretta, Poli, and Maiorana).

Beretta’s study reported some cons to computer-aided oral implant surgery as well:

·         The surgeon's inability to visualize anatomic structures.

·         The increased risk of axis and depth deviations during implant placement.

·         A decreased ability to contour the jawbone topography when needed for prosthetic purposes (Beretta, Poli, and Maiorana).

Although this digital technique was originally developed to reduce the risks involved during standard implant procedures, providing greater control of the system, the problem of deviation between the planned and the placed implant positions still occurs. In a 2012 clinical study, researchers evaluated the accuracy of computer-designed (SLA) surgical guides for 116 implants inserted in both partially and completely edentulous patients. By comparing the three-dimensional positions of the planned and actual placement of the implants, they were able to report some deviations. However, “[the implants] do not appear to have resulted in important clinical complications. This suggests the necessity of always keeping a safety zone of at least 2 mm to avoid critical anatomical structures” (Cassetta et al).

In Baretta’s study, they make suggestions on how to achieve an optimal accurate and stable position of the surgical guide for best outcomes in dental implant placement. In order to improve the stability of surgical guides, it is suggested the use of anchor pins inserted into the jawbone is necessary to prevent micromovements and “better results were obtained with the use of [such] stabilizing devices” (Beretta, Poli, and Maiorana). According to Cassetta et al., the use of three osteosynthesis screws in a tripod formation was the best option for the necessary stability of the surgical guide.

Although there are some cons to computer-aided implant surgery and the use of surgical guides, if the procedures are implemented and executed correctly there can be major pros that out weigh the cons. The advent of technological advances in dental care provides clinicians with viable options to providing better patient care. Dental professionals should not only keep up-to-date with new techniques and procedures in order to make the best decisions for their patients, but also weigh the cons and pros for assured quality.

About Iverson Dental Laboratories

Iverson Dental Laboratories is a leading edge dental lab that utilizes advances in dental technology and procedures to fabricate high quality dental lab products and to provide excellent dental lab services. As a full service dental laboratory, they specialize in all-ceramic restorations, dental implants, cosmetic dentistry and digital dentistry. They have developed their own surgical guide, AccuGuideÒ, to maximize the use of available bone and provide greater accuracy for implant placement. They built an onsite operatory and training facility to train new and experienced dentists on new implant procedures and digital intraoral scanner systems to help enhance their practice. They proudly manufacture 100% of their dental lab products in-house at their Southern California lab, allowing them to have one of the fastest turnaround rates in the industry.

To inquire more about computer-aided implant surgery and surgical guide products, please visit http://www.iversondental-labs.com.

Sources:

1. Mario Beretta, Pier Paolo Poli, and Carlo Maiorana. "Accuracy of Computer-aided Template-guided Oral Implant Placement: A Prospective Clinical Study." J Periodontal Implant Sci Journal of Periodontal & Implant Science: 184. Web. 15 July 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148631/>.

2. M. Cassetta, LV. Stefanelli, M. Giansanti, and S. Calasso. "Accuracy of Implant Placement with a Stereolithographic Surgical Template." Int J Oral Maxillofac Implants 27.3 (2012): 655-63. Pubmed.gov. Int J Oral Maxillofac Implants. Web. 15 July 2015. <http://www.ncbi.nlm.nih.gov/pubmed/22616060>.

Find the Best Dental Lab to Provide High Quality and Safe Dental Lab Products

Although there are thousands of foreign and U.S. dental laboratories not all of them provide their dentists with high quality dental lab products and services. The infamous dental case, reported by the NADL, concerning an Ohio Woman in 2008 that after a chemical analysis of her 3-unit dental bridge found “unsafe levels of lead in the porcelain on the restoration” made from China is all to well known in the dental community, but still concerns many dental professionals today. The materials being used and quality of dental restorations from foreign and U.S. dental laboratories is still a major concern for the dental lab industry, dental professionals, and their patients. 

Provided in this article is a brief overview of the concerns that the dental community and the United States Government have with low quality, and potentially unsafe imported and domestic dental lab products. Discussed next are considerations when choosing a dental laboratory, so new and experienced dentists can ensure their dental practice is an ongoing success and ultimately provide the best dental health care services to their patients.

Imported dental restorations (and those fabricated domestically) are medical devices that must meet U.S. Food and Drug Administration requirements. Foreign laboratories, like U.S. Laboratories, are required to register their establishment, list medical devices, report medical device defects, and manufacturing in accordance with the quality system regulations. Although foreign and domestic dental labs are required to comply with these regulations, the FDA cannot regulate the contents of all imported and domestic dental lab products for assured safety. The FDA told NADL back in 2007, that it was concerned with safety management of the “increase in dental restorations coming in from foreign dental laboratories” and, more recently, the FDA revealed an all-time high of 38% of dental restorations being imported from foreign labs.

U.S. States including Texas, Missouri, South Carolina, North Carolina, Kentucky, Illinois, Ohio, Pennsylvania, Virginia, Florida, Minnesota and Oklahoma are the only states that require some existing administrative or governmental laws regulating dental laboratories and/or technicians. Only 10 states require some regulations: material and point of origin disclosure, lab registration, at least one CDT for each lab or continuing education certification. Having only 10 out of 50 states that require regulations of dental labs and products, such as certification and material origin disclosure, is alarming when the public’s health is at risk. It should be a right for a patient to know what is being sold to them and where it is coming from, especially when it comes to medical devices that must be biocompatible with the oral cavity.

Infection control and material safety in dental lab products are the main concerns when dental labs can go unregulated without the requirement of a license and/or certified dental technicians. In one such case in Springfield, Ohio, a man arrested over unrelated incidents at his home, police found an unsanitary dental lab in his basement. The “basement lab” was broadcasted by a local news station in Ohio, Local 12 News, and the man responsible for the alarmingly unsanitary dental lab told the news station that he learn dental work while he was in prison, taking a one year certificate course. In order to be a certified dental lab technician, a lab technician must have 5 years of experience along with certified courses; however, there are no laws in Ohio that required a dental lab and/or dental technician to be certified. Therefore the reported “basement lab” in Ohio, even though unacceptable, was not illegal because of the lack of laws and regulations. In over 40 states in the U.S., anyone can operate a “dental laboratory” without a required license.

The National Association of Dental Laboratories (NADL) and American Dental Association (ADA) have supported material disclosure to dentists and their patients. They also support stricter FDA regulations for dental labs and dental products for all 50 states, not just for only 10 states.

In 2007, the Food and Drug Administration and Federal Government officials collaborated with the National Association of Dental Laboratories (NADL) to address concerns about the regulation of imported dental lab products and the lack of FDA regulation for U.S. dental labs. FDA’s representatives told “NADL that there was concern about the government’s ability to adequately track the material safety of import dental restorations being used by U.S. consumers.” So the NADL concluded they would develop a framework of “best practices and guidelines for the dental laboratory industry” to help the FDA improve import safety for dental restorations to ultimately protect the dental health of U.S. dental patients. Since then very little has been done on the legislative side of all 50 states to improve regulation of dental products and labs, hence currently only 10 states are minimally regulated.

In a 2008 ADA member survey, 45% of their dental patients requested material content information for a dental restoration or inquired about the materials that may comprise a restoration. Surprisingly, a 2009 ADA member survey showed that 65% of dentists believed that dental labs and technicians in their state are licensed. 

"Such common-sense regulations are critical because in many cases, the dental technician--not the prescribing dentist--makes the selection of dental materials that will be used for a particular patient's restoration," said Bennett Napier, CAE co-executive director of the National Association of Dental Laboratories. "Without having some requirement for the person or manufacturer creating the device to have the appropriate knowledge and training, the issue of material selection and/or safety is left to chance."

The bottom line is dentist’s need to be able to reassure their patients of the type of documentation they can provide about the origins of their dental restorations and what type of quality they are paying for. Furthermore, dental practices and dental patients need to be aware and educated about the differences and opportunities available when choosing dental restorations from a foreign or domestic dental lab.

Low quality, or ill-fitted dental lab products can make your patient unsatisfied and bring the quality of services you provide to a damaging level, giving your patient a reason to find another dentist. When this happens the dentist is usually to blame by the patient so it’s imperative to know what level of quality you are getting to prevent any dissatisfaction. Dentists need to make decisions not based solely on price but also on quality, customer service, accessibility, remakes, and effective communication.

When choosing the best dental lab for quality dental lab products, consider these tips to make the success of your dental practice and the public’s health a top priority:

·         Do they use certified materials and implant components?

·         What are the material origins used to make the restoration?

·         What are the origins of the restorations?

·         Do they outsource any of their dental work to foreign labs?

·         If they outsource to foreign labs, make sure you are provided with the FDA registration number and compliant with ANSI and ISO standards.

·         Are they a certified dental lab (CDL)?

·         Do they employ at least one certified dental technician (CDT)?

·         Physically visit and inspect the dental lab on a regular basis.

·         Build a relationship with your dental lab to ensure effective communication.

About the company

Iverson Dental Laboratories is a cutting edge dental lab that utilizes advances in dental technology and procedures to fabricate high quality dental lab products and excellent dental lab services. As a certified dental laboratory, they specialize in all-ceramic restorations, dental implants, cosmetic and digital dentistry. They strongly believe in using certified materials and authentic manufacturing components to fabricate all their restorations. They proudly make 100% of their dental products in-house at their Southern California lab, allowing them to have one of the fastest turnaround rates in the industry. They also pride themselves on having the lowest remake and adjustment rate in the industry at 2.6%.

To inquire more about quality dental lab products and services, please visit http://www.iversondental-labs.com.

What to look for in a dental lab to ensure quality are also discussed to help new and experienced dentists ensure their dental practice is on going success and ultimately provide the best quality services to their patients. 

Iverson Dental Labs Uses CAD/CAM Technology for Innovative Dental Lab Products & Services

Iverson Dental Labs has recently reported how they are able to provide innovative dental lab products and services with the growing popularity of CAD/CAM (computer-aided design/computer-aided manufacturing) technology in the dental industry. The expansion of CAD/CAM digital technologies in the past 10 years has greatly improved the techniques used to fabricate dental lab products, especially surgical guided implants and dental impressions.

Continued improvements to CAD/CAM technologies has challenged and enhanced the techniques used to fabricate dental lab products, particularly implant-supported prosthesis and the use of surgical guides. With 3-Dimensional intra-oral scanning capabilities, the dentist and dental lab are able to easily view the upper and lower jawbone to plan for optimal implant placement. Implant-supported dental restorations are gaining huge popularity among dental patients who have one or more missing teeth because of the longevity and biocompatible nature associated with dental implant treatment.

In a 2014 research study conducted by Dr. Kapos, DDS and Dr. Evans, BDSc Hons (QLD) at the Harvard School of Dental Medicine, researchers wanted to measure the failure and survival rates of CAD/CAM implant-supported restorations and abutments compared to conventionally fabricate dental implant prostheses. Although they found the survival rate from conventionally fabricated implants was comparable to CAD/CAM implant-supported prosthesis, they found color matching and durability was significantly better for all-ceramic dental crowns. The researchers found dental Implants aided by CAD/CAM technology to be highly reliable. They estimated the mean failure and survival rate of implants supporting CAD/CAM crowns was 98.85%. The failure and survival rate of implants supporting CAD/CAM abutments was an astonishing 99.85% with no reported technical complications. 

Utilizing CAD/CAM technology to digitally plan and create surgical guides has made the procedure of implanting restorations more accurate and dependable then previous methods. Iverson Dental Labs utilizes CAD/CAM technology to virtually plan and design their surgical guides so the dentist can use them as a aid in surgery to correctly drill and position the implants. Iverson Dental Labs developed an innovative surgical guide, AccuGuideâ, to better address the need of highly accurate implant positioning to maximize the use of available bone. Iverson’s dental implant department assists their dentists with implant treatment and planning to provide the best experience for their dentists and ultimately to their patients.

By not owning a digital intra-oral system does not exclude dentists from taking advantage of the cutting edge CAD/CAM technology because Iverson Dental Labs has made a Model Free dental crown/bridge option available for dentists. Iverson’s dentists deliver a physical impression to Iverson’s Lab and the lab scans the impression digitally, then designing the model on the computer for acute precision and cost efficiency. By utilizing CAD/CAM digital design software, Iverson’s certified dental technicians are able to save time by skipping tedious steps such as fabricating prosthetics and stone models by hand. With Stratasys 3-Dimensional printers, Iverson Dental Labs are able to save time and labor costs by printing dental lab products such as surgical guides, models, removable partial frameworks, diagnostic wax-ups and more.

One of Iverson’s long-time clients, Ronald G. White DDS, sheds some light about the company stating, “Iverson Dental Laboratories has been meeting my laboratory needs for more than 14 years. Their quality and service has always been excellent. I would recommend them to anyone looking for a cutting edge full service dental laboratory.”

About the company

Iverson Dental labs is a full service dental lab based in Southern California that specializes in implants, cosmetic and digital dentistry. They make all of their high quality dental lab products in the USA, giving them one of the fastest in-lab turnaround times in the dental industry. They also provide dental lab services such as patient acquisition to assist dentists in increasing revenue, and educational seminars for digital intra-oral scanning systems, advanced dental implant techniques and procedures.

Visit their website http://www.iversondental-labs.com/ for more info.

Iverson Dental Labs Reveals Statasys’ 3-D Printers Greatly Improves Dental Manufacturing Processes

Iverson Dental Laboratories, a provider of dental laboratory services to North America, has announced its latest collaboration with Statasys Ltd. and their cutting-edge 3-Dimensional Printers to create the most accurate dental models and dental lab products the industry has seen yet. Statasys is a world leader in creating 3-D printing systems and materials for various industries including the dental industry. All Stratasys’ systems use PolyJet™ materials to create accurate, clean, smooth and highly detailed 3-D models.

Recently, Iverson Dental Lab’s President Cody Iverson and a representative from Statasys Ltd., Jeff Youngman C.D.T., held a webinar on how 3-D printers are improving the workflow within the dental lab and manufacturing process of high quality dental lab products. They discussed the many advantages of 3D printing and how 3D printing is redefining the dental laboratory industry to ensure not only highly accurate dental models and other dental parts, but also mass-produce them at a faster rate than they ever have before. Cody Iverson reveals in the webinar how his dental lab team has applied 3-D printing to their daily production to increase productivity and acute accuracy for dental products. Iverson utilizes Stratasys highly durable PolyJet™ materials to print various types of dental lab products including dental models, surgical guides, removable partial frames, diagnostic wax-ups, all-on-4 tryins and more.

“We believe in utilizing the latest technologies to ensure that our level of dental lab services and products improves with technology, making us a leader amongst digital dental labs. With Stratasys’ 3D printing technology in-house, we are able to mass-produce highly accurate and excellent quality dental models and other dental lab products at an affordable cost," stated Cody Iverson. Jeff Youngerman added, “What impressed me the most with Cody Iverson and the Iverson team is the way they run their business and how they are not afraid to invest in the technology. It’s proven time and time again to allow them to grow their business. Even as a new user of 3-D printing, he is able to implement it into his daily production and not only run with conventional methods and switch them over to digital but also develop new dental products.”

Stratasys’ 3-D printing solutions are an exciting advance for dental technology. Dentists and dental laboratories will electronically submit their dental cases from intraoral impression systems, such as Cerec Connect, to Iverson Dental Laboratories, and the dental models are designed and printed. Printing models, which can be sent as either a digital impression or a physical impression that’s converted to digital, eliminates variables from human error such as inconsistent material in stone models. Designing and printing dental lab products is faster, less labor intensive, and much easier to teach new dental technicians. This new process also reduces shipping costs and improves turnaround times, which adds more value to the services and products dental labs provide to dentists and their patients.

“With challenges facing the dental laboratory industry like high overhead costs due to intensive manual fabrication and decreasing profit margins due to overseas competition, can be overcome when a digital workflow is implemented,” continued Jeff Youngerman. “We can’t be continuing to manufacturing products so labor and skill intensive. There is a need for highly skilled dental technicians that is not meeting the demand today, so it’s the software’s and digital processes that is creating a level of consistency and accuracy that every technician will be able to achieve.”

About Iverson Dental Laboratories

Iverson Dental Laboratories is a full service dental lab and leader in dental implants, cosmetic dentistry and digital dentistry. Dentists can utilize Iverson’s onsite operatory and training facility on intraoral impression digital technologies to enhance their practice. Being a leader in Digital Dentistry, Iverson strives to make the transition from a conventional workflow to an advanced, digital workflow as seamless as possible. Iverson Dental Laboratories was founded in 1991 and is based in Riverside, Calif., USA.

About Statasys Ltd.

Stratasys Ltd., the innovation leader in 3-Dimensional printing, provides 3-D printing systems that enable manufacturers and industrial designers to reduce costs of product development. Manufacturers use Stratasys 3-D printers to create models and prototypes for new product design and testing, and to build finished goods in low volume. Stratasys’ ultra-thin-layer, high-resolution 3-D printing systems and materials utilize PolyJet™ and PolyJet Matrix™ polymer jetting technologies to print ultra-thin layers. Stratasys offers FDM and PolyJet 3D printers, FDM for durable thermoplastic parts that withstand tough testing, and PolyJet for precise models that look and feel like the final product.