September 2011, Volume 32, 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 Mirzaya, DDS, of Los Angeles, CA. "By virtue of placing more implants, I offer more implants confidently to my patients who can explore an option they might not have had before."
Mirzaya has placed implants since he opened his practice 10 years ago. "After a few nonideally placed implants, I started to shy away from placing my own with a freehand traditional technique," he explains. "The advantage that we 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 design face to this prosthesis. Then the surgery matches exactly where I placed it during the planning. This allows me the confidence to get on full board with the implants and place them myself, because I know it's going to go exactly where I planned. So that's a very different way of placing implants than I had done in the previous 8 years."
Mirzaya explains that, personally, he no longer offers any removable appliances to his patients as treatment unless they are anchored as 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 just 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 universal machine that you can utilize to place an implant where you want. Now there are two components to this. You can use the 3D information to plan your implants and conventionally place them as you have done in the past with just surgical stents. The more advanced technique is to use guided stents with incredible precision, you can use a surgical stent that was developed around the planning phase to precisely 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 x-ray 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. Combine that with the accuracy of an intra-oral scan with the information that's offered by a cone-beam x-ray and the 3D capabilities underneath the surfaces to see the anatomical structures. 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 43 different lines and over 3,300 implants in our implant library," Smithson says. "The major ones are those with fully guided surgical kits that can be used to do the osteotomies all the way through to the implant placement. This is something we're showcasing with all the patient case presentations we are doing."
In terms of the 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 in-office 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 that training. Then, the third level—which is probably unique to Sirona—is two 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, with the software and surgical guide, going through 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 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 cost of the class and accommodations are included as part of the package.
"Even more training is being initiated by clinicians," Smithson adds. "A number of our dentists are starting courses that specialize on 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. One of our trainers in San Francisco already has classes on implant planning; other courses are being offered at the Scottsdale Center for Dentistry, which we are affiliated with, and with the Spear Education Group. So we've given them a pretty good foundation. But in terms of actual implantology, they go out and build courses on their own."
Sirona is working with a number of implant companies to cross-pollinate the knowledge and help their joint customers understand how the implants will interface and what they need to consider when they are doing virtual implant placement. "From there, they'll move into the actual implant placement with the surgical kits from the various companies," Smithson says.
"I think the possibilities are huge," Mirzaya 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."