September 2010, Volume 31, Issue 7
Published by AEGIS Communications
GALILEOS® Improves Diagnosis and Planning
“From my perspective, the more implants I place, the more confidence I have,” says Armen Mirzayan, DDS, of Los Angeles, CA. “By virtue of placing a greater number of implants, I offer more to my patients who can explore an option they might not have had before.”
Mirzayan has placed implants since he opened his practice 10 years ago. “After a few non-ideally placed implants, I started to shy away from placing my own with a freehand traditional technique,” he explains. “The advantage that I have with the cone-beam scan and, more importantly, the ability to scan an edentulous area with my CEREC® CAD/CAM machine is that I can design where I want the final prosthesis to go and retrofit the implant and the abutment to this prosthesis. Then the surgery matches exactly where I placed it during the planning. This allows me the confidence to get on board with placing more implants and I place them myself, because I know they are going to go exactly where I planned. The process is much improved over the way I placed implants the previous 8 years.”
Mirzayan explains that he no longer offers removable appliances to his patients unless they are anchored with implants. “If you can get two implants in and attach the removable denture to those implants, it’s a far better lifestyle in terms of form and function for the patient. I’ve exhausted a lot of energy trying to satisfy patients with removable dentures—many patients struggle with them.
“My own father, who was edentulous for 40 years, really struggled with dentures. About 10 years ago, we placed five implants in his lower jaw and were able to attach a hybrid prosthesis. That was a life-changing experience for him—he’s been ecstatic ever since. From that personal experience, I have come to the conclusion in my practice that removable dentures are below the standard of care I would like to deliver to my patients.
“Sirona makes a comprehensive system that assists you with placing implants exactly where you want,” Mirzayan says. “Now there are two components to this. You can use the 3D information to plan your implants and place them conventionally without surgical guides. The more advanced technique is to use fully guided implant placement with incredible precision—you can use a surgical guide that was designed using the virtual prosthesis during the planning phase to precisely guide the drills and to place the implant.”
John Smithson, Marketing Director, adds, “Our GALILEOS® cone-beam product allows for better diagnostic capabilities and virtual implant planning all the way through the clinical workflow of making surgical guides to assist with the implant placement process. No other company is doing all this—only pieces of it. And now you can use the CEREC CAD/CAM file, which is patient-specific, as a prosthetic planning tool as part of that virtual implant plan, so that you know exactly what the tooth should look like in its final form. Combining the accuracy of an intra-oral CEREC scan with the information from a cone-beam x-ray allows you to see highly accurate tooth, gingiva, and the anatomical structures underneath. You can see the differences between the cortical and the cancellous bone, where the nerve canal is, or where the sinuses are located. With that information, you can do a better job of planning for all these factors. You can plan the specific abutment that you are going to use and know exactly what that final crown is going to look like once everything is healed in.”
Sirona maintains an open standard with regard to incorporating implant libraries into the system. “For instance, we have 30 different lines and over 4000 implants in our implant library,” Smithson says. “The major lines have fully guided surgical kits that can be used to do the osteotomies all the way through to guided implant placement. This is something we’re showcasing with all the patient case presentations we are doing.”
In terms of education for advancing clinicians’ use of implants in a practice, Sirona offers the 3D Summit on Digital Dentistry nationwide. “This is a day-and-a-half event where a number of clinicians present their patient cases, and we do a live patient case at the end that demonstrates the full GALILEOS® CEREC Integration. That’s the starting point but certainly not the end.”
The company provides three levels of extensive training. “When we install the system, we teach them how to use it not only from a radiology perspective, but how to use the software to do virtual planning, and then all the way through to the surgical guides. A 3D specialist comes in with our territory managers who do two levels of in-office training. Then, the third level—which is probably unique to Sirona—is 2 days of clinician-to-clinician training at one of our three facilities. They spend a day each on radiology and on the implant training side, focused on the software and surgical guides, doing virtual planning on several patient cases. They can also bring in patient scans from their practice. At the end of the first day, we set aside some time for the board-certified Oral Maxillofacial Radiologist to review these scans with them. On the second day, an implant specialist goes through the cases with the clinicians who come in for advanced GALILEOS® training.” The class and accommodations are included for two people from each office that purchases a GALILEOS®.
“Even more training is being initiated by independent experienced GALILEOS® clinicians,” Smithson adds. “A number of dentists are starting courses that specialize in the GALILEOS® CEREC Integration and how it applies to implants. They’re putting more of a focus on new materials such as lithium disilicate for CAD/CAM, making it a better application for implants. For example, courses are being offered at the Scottsdale Center for Dentistry, from clinicians affiliated with the Spear Education Group. They provide the clinical education with a focus upon implantology. We are just fortunate that they have chosen our tools to assist with the clinical processes.”
Sirona is working with a number of implant companies to cross-pollinate clinical implant knowledge and help their joint customers understand what they need to consider when they are doing virtual implant placement. “This allows the clinicians to make more educated decisions when selecting the implant systems they work with,” Smithson says.
“I think the possibilities are huge,” Mirzayan concludes. “I think the predictability and the ease of use is really going to propel a lot of general practitioners to confidently offer and place implants, which is going to have a tremendous impact on their patients’ well-being.”
Sirona Dental Systems, Inc.
4835 Sirona Drive, Suite 100, Charlotte, NC 28273