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Inside Dental Technology
April 2014
Volume 5, Issue 4

Embracing the Digital Movement

How to save time with digital impressioning

By Jay Black, CDT

Just 5 years ago, the author began his journey into CAD/CAM dentistry with Sirona’s inLab® system ( www.inLab.com). In retrospect, having total control over the machining process allowed the author’s laboratory to reduce remakes, improve speed and efficiency, and use a wider variety of materials, all of which were necessary components of building a more successful business. Moreover, the advent of digital impressioning with Sirona Connect has taken dental laboratory technology to the next level.

Digital impressioning lends itself to faster turnaround times, extreme accuracy, and increased patient comfort. In many instances there is no longer a need to take PVS impressions, manage pickup and delivery, deal with disinfection, or pour models. Modeless cases in particular are becoming routine with single and multiple restorations and even bridgework. Furthermore, until recently, cases involving implants and abutments required traditional impressions. Now, with the introduction of the Sirona ScanPost for intraoral scanning, digital impressions can be used in cases involving implants where custom abutments and crown and bridgework are required.

Case Study

In this particular case, the patient presented with an implant placed on tooth No. 19. After contouring the tissue using a contoured healing temporary, the implant was ready to be restored (Figure 1).

The dentist removed the healer and chose the appropriate ScanPost from Sirona. The ScanPost was placed and radiographed to ensure proper seating and then the imaging ScanBody was placed on top of the ScanPost (Figure 2).

The lower jaw with ScanPost, upper jaw, buccal bite, and gingival mask scan were imaged using Sirona’s CEREC AC with Omnicam (Figure 3). The digital images were then sent through the Sirona Connect portal. The author’s laboratory received them within seconds and was able to analyze the case while the patient was still in the clinician’s chair.

Once the digital impression was received and the patient’s expectations were established, the digital impression was accepted and downloaded into Sirona’s inLab software. The “Multilayer” function was chosen in the “Administration” phase, and the crown and abutment were designed in a top-down approach. The crown was designed to have a full-contour design and then be split into an upper veneering structure out of IPS e.max® CAD (Ivoclar Vivadent, www.ivoclarvivadent.com). The lower framework structure was created from Sirona’s inCoris ZI meso block.

During design, the baseline of the abutment was edited to match the previously contoured tissue (Figure 4). The proposal of the restoration was created using Sirona’s biogeneric software.

After design, the Split tool was chosen in the software in order to split the restoration into an upper veneering and lower framework structure (Figure 5). The case was created without a model, but rather with the help of specialized parameters in the inLab software that helped to achieve the desired result (Figure 6).

After being split, the abutment is adjusted to the desired result using the “Scale” tool. The abutment and crown are then checked for proper contour, thickness, and occlusion. The virtual articulator was activated to check for any interference (Figure 7).

The abutment was milled using an inCoris ZI meso block and was sintered in the inFire HTC speed furnace (Figure 8). The veneering structure was milled using an IPS e.max CAD C14 block (Ivoclar Vivadent).

The IPS e.max veneering structure was then crystalized, stained, and glazed to the requested final shade (Figure 9) and the zirconia mesostructure was cemented to the TiBase using Multilink implant cement (Ivoclar Vivadent). The custom abutment and final screwed IPS e.max crown were then sent to the clinician. The custom abutment was placed and torqued, and then the final crown was seated (Figure 10).

Using Sirona’s inLab system in conjunction with Sirona Connect for digital impressioning resulted in improved speed and efficiency in delivering this case to the dentist. Turnaround time was faster, accuracy was exceptional, and the patient received a comfortable and well-fitting restoration.

Acknowledgements

Dentistry and intraoral photos provided by Dr. Paul Helsby, Winter Park Smiles,Winter Park, FL.

Jay Black,CDT is the owner of Winter Springs Dental Lab in Winter Springs, FL.

Disclaimer: The preceding material was provided by the manufacturer. The statements and opinions contained therein are solely those of the manufacturer and not of the editors, publisher, or the Editorial Board of Inside Dental Technology.

For more information, contact:
Sirona
P 855-INLAB4U
W www.inLab.com

After placement of implant and tissue contouring, the patient presented for a cement-retained IPS e.max CAD crown and custom zirconia abutment on implant No. 19 with the use of the Sirona ScanPost and ScanBody.

Figure 1

Sirona ScanPost was selected and screwed down. ScanPost was radiographed to verify proper seating and then scan body was placed.

Figure 2

Once the laboratory received the digital impressions and the patient’s expectations were discussed, the digital impression was accepted and downloaded into the inLab software.

Figure 3

The baseline of the abutment was edited to the previously contoured tissue.

Figure 4

After design, the “Split tool” was chosen from the tool wheel to split the restoration into an upper veneering and lower framework structure.

Figure 5

The case was done modeless with the help of specialized parameters in the software that helped achieve the desired result.

Figure 6

The abutment and crown are checked for proper contour, thickness, and occlusion. The virtual articulator was activated to check for interferences.

Figure 7

The abutment was milled using the inCoris ZI meso block and was sintered in the inFire HTC speed furnace.

Figure 8

The IPS e.max veneering structure was then crystalized, stained, and glazed to the final shade requested.

Figure 9

The final crown was seated.

Figure 10

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