Mark Ferguson

	The explosion of digital technology has drastically changed the dental landscape.

With a larger percentage of clinicians starting to go digital, the workflow for all types of patient care is changing. No workflow has changed more than implant-based restorations.

Related technique: How to do same-day implant restoration

	Here, I will discuss five ways in which digital workflow has changed the way in which implants are restored.

	Continue to the next page to see how technology has impacted the implant workflow.

	The first big way technology has changed the implant workflow has been the availability of custom abutments. While custom abutments are not new to implant cases, the availability has increased. A few years ago, labs would have a difficult time finding custom prosthetics (outside of expensive UCLA cast abutments) they could control.

 in a large percentage of labs, labs are now able to plan the entire restoration (screw- or cement-retained) digitally and provide exceptional restorations for patients. The accuracy of digital information has allowed highly trained teams to deliver accurate restorations quicker and more predictably than ever before. This includes the growing prevalence of modeless restorations. Intraoral scanning of scan bodies can save time and money while providing exceptional accuracy when a case can be done modeless.

	While this has been available for years, the proliferation of different software has made surgical planning commonplace. As more software providers have entered the marketplace, this software become more and more desirable, both on the lab side as well as clinical. The accuracy of guided surgery has convinced many clinicians to move most if not all their implant surgeries to guided. Combine that with the cost of 

 coming down and the accuracy getting better, and there is a perfect storm to make guided surgery available to more people. The big winner here is the patient.  

	With guided surgery software on the rise, some of these software solutions are able to provide implant positioning data to prosthetic design software. With this connection, the ability to design patient specific temporaries or healing abutments becomes the next step for a better outcome. This is a great example of how a complete digital workflow, not only makes appointments more efficient, but enables vastly improved case outcome.

	Traditionally, implant surgery has had several degrees of separation for the dental labs. From the lab perspective, a case came in and the technicians had to work with what they had. The largest purchasers of 

 are dental labs. They are doing this as a value-add to their clientele, and also to start planning the restorations prior to surgery. This has helped the technicians to better understand why an implant would be placed in a particular location or angulation. 

	Dental labs have traditionally operated outside of FDA involvement. Several factors have converged to shine a light on the laboratory industry. Labs have been milling restorations for well over a decade. Recently the cost of these milling machines has come down to a point that makes them available to a majority of labs.

	Additionally, the cost and accuracy of 3D printers has also made them an attractive asset to many labs. The desire to use these machines has pushed some labs into the realm of 

. Custom abutments (and surgical guides) are medical devices, and require the manufacturer to register with the FDA. With the lack of experience of FDA registration within the lab field, many people didn’t know the regulatory standards for fabricating these prostheses. 

Articles

From the FDA to digital technology, implant technology is evolving all the time.

5 ways technology has changed the implant workflow

	As the market adoption rate of intraoral scanners grows, clinicians and laboratories are finding added value to the use of digital technology. While some benefits of intraoral scanning, such as accuracy and speed, are more evident, other benefits are not as apparent.

	Here are a few reasons your laboratory loves intraoral scans.

	As clinicians begin to consider digital technology for their practices, labs are reinforcing just how valuable a resource they can be for their doctors. Leading labs have been using digital technology for over a decade and have a greater understanding of the differences between the different scanners on the market, helping clinicians to seamlessly implement new technology. 

	Each intraoral scanner has a slightly different workflow. These differences can drastically change when a doctor chooses to use the technology or goes back to an analog workflow for a given case. Labs will have their favorite scanners that work well with the lab CAD/CAM system. Often having an open system doesn’t mean that the files can be used by anyone at any time, but rather someone must pay extra fees to be able to use or even have access to the files. I recommend clinicians speak to their labs to make sure the introduction of an expensive piece of equipment will provide the benefits advertised.

Related reading: 5 questions you need to ask before buying an intraoral scanner

	Intraoral scanners provide unparalleled accuracy when compared to traditional impressions. Dimensional accuracy of intraoral scan data has progressed to the point of counting microns. Accuracy measurements from high-end intraoral scanners are about 6.9 μm, whereas traditional impressions range just under 40 μm on an acrylic tooth model. This accuracy helps the restorative team in several ways. The clinician will see reduced chairtime as the restorations will fit better. The restorative team will appreciate that intraoral scans have shown to bring down the industry wide remake percentage from an approximately 4 percent remake down to under 1 percent. This decrease in remakes helps all aspects of the dental field. Obviously, the clinician is being paid for the time they have patients in the chair and the lab is not making free crowns, so everyone benefits. Further, labs are also happy with some of the newer scanners that have shade taking capabilities, resulting in fewer restorations coming back for shade adjustments. 

	The ability for the lab to access intraoral scan data within minutes of the scan being sent allows for the lab to start the case before a traditional impression would even arrive at the lab. When questions on the quality of the scans arise, the office can call the lab to check the scans. This can potentially eliminate the need for extra appointments due to unsatisfactory impressions. The bigger benefit of the speed of file transfer is that turnaround time can be decreased for restorative cases, or for labs with a set turnaround time, this will give them more time to work with the case.

Trending article: Streamlining the workflow with CAD/CAM dentistry

	With digital case communication, the process of planning for more complex cases becomes more predictable. Take, for example, a case with an implant. The surgery could be planned virtually with ideal implant placement leading to better restorative options, and the possibilities of custom provisional options delivered at time of surgery. Labs are assisting doctors with the planning for implants. As a lab technician, the more planning that goes into a case prior to the restorative phase the better. For crown and bridge cases, this planning may include a diagnostic wax-up. Modern dental labs have more manufacturing options, so these diagnostic wax-ups can be done by digitally creating files that can be accessed and used when the case comes back for restorations.

	The biggest advantage of digital impressions is the increased communication between the lab and clinician. This expanded communication encompasses everything I have previously covered. For more complex implant cases, the entire team (surgeon, restorative doctor and technician) can start to examine and decide what options are going to be the best for the patient. Location is no longer an obstacle. Sharing of files, even on a smartphone, is easy and accessible from almost anywhere. Far too often the lab technicians feel left out of the discussion when looking at restorative options.






Intraoral scanners are only growing in value-particularly for labs.As the market adoption rate of intraoral scanners grows, clinicians and laboratories are finding added value to the use of digital technology. While some benefits of intraoral scanning, such as accuracy and speed, are more evident, other benefits are not as apparent.Here are a few reasons your laboratory loves intraoral scans.

Top 5 reasons your lab loves intraoral scanners

	As dentistry has moved to a digital platform, more clinicians and labs have started taking advantage of enhanced communication tools in order to provide greater patient care.

	The accuracy currently achievable with digital dentistry is unparalleled. This accuracy, along with teamwork within the surgical and restorative team, is creating workflows where the final outcome can be visualized before a case is started.

	Implant dentistry is no different. Using 

 software (Implant Studio and Dental Designer), the entire restorative team (lab, restoring doctor and surgeon) can plan the surgery and restorative options based on the planned implant placement. Benchtop testing is showing fully guided implant surgery places the implant within .1 mm in all directions of planned placement. This certainly allows for the ability to place better temporary restorations or healing abutments than what has been used in the past.

Trending article: 7 ways 3D printing is changing everything 

	1. In Figure 1, we have an intraoral photograph of the patient with existing metal reinforced temporary bridge, which is planned for replacement with three implants and individual crowns. In Figure 2, we see another intraoral photograph after removing a PFM bridge, to reduce scatter in the DICOM image of the bone.

	Fig. 1                                                                                  Fig. 2

	2. This patient was then scanned with a 

. The resulting color scan is shown in Figure 3. This scan was then pulled into 3Shape Implant Studio and aligned with the DICOM data, and placement of three BioHorizons Implants was planned. Tooth position #12 was planned with a 3.0 mm x 15.0 mm implant. In Figure 4 you can see the root formations for teeth 11 and 13 created a limited space situation.

	Fig. 3                                                                           Fig. 4

	3. Implant placement was planned during a conference call between the surgeon, the restoring doctor and the lab. In this instance, the restoring doctor wanted to place screw-retained crowns for each of the implant sites. Thus, angulation of implant for tooth #8 was critical as well as the safe placement of tooth #12. Once the placement was agreed upon by all involved with the case, a surgical guide was created. Figure 5 shows the printed guide. Figure 6 shows the guide during try-in.

	Fig. 5                                                                                     Fig. 6

	4. After surgery, several X-rays were taken to verify implant placement. Figure 7 shows accuracy to the guided placement for the implant in tooth #12 position (which mirrors the planning stage of Figure 4). Figure 8 shows the implant in tooth #8 position with healing abutment. Figure 9 shows the placement of the implant for tooth #5.

	                     Fig. 7                                                        Fig. 8

More from the author: Why it's time to embrace the digital workflow

Through the use of guided surgery software, this case was preplanned based on a particular restorative selection. In this case, the choice was screw-retained crowns and single unit restorations for the anterior eight units. By using technology, the entire restorative team was able to discuss the case and see potential difficulties each member would face. The implant for tooth #12 was difficult based on limited space between the adjacent roots. Tooth #8 was carefully planned in order to allow for a screw-retained crown with the access hole coming through the lingual.

	By using a guide and preplanning the case, the implant surgeon felt confident he would be able to place the implants optimally, and the restoring doctor and lab knew the implant restorations would be able to blend nicely with the final   crowns on natural teeth.

How digital tools and communication come together to deliver safer, more dependable implant results.

How guided implant surgery can deliver better patient care

	Digital technology is creating workflows never seen before in the dental industry. The pathways of sharing information and collaborating on cases are becoming more abundant and easier to use. As members of the restorative team strive for more accuracy in all aspects of the process, from implant placement, impression taking and prosthesis creation, one tool that is sure to get used more often is 3D printing. There are very few things that have advanced as quickly as 3D printing over the past few years. This advancement has come from the convergence of hardware and material development happening simultaneously. Along with this external development, the people using the 3D printers have also learned to optimize both the files they are printing and the machines they are using.  

	The amazing thing is that this could just be the tip of the iceberg as it relates to 

. As material manufacturers continue to strive for government approval for intraoral use, the printer and software companies, and the forward-thinking people operating the machines, continue to gain knowledge of the possibilities offered by additive manufacturing. This technology will grow exponentially.

Related Article: 10 things you need to know about 3D printing

	A large barrier to 3D printing has typically been the cost of entry. Most labs are not willing or able to spend over a hundred thousand dollars to print models or restorations for lost wax technique processes. This gives the impression to the labs that they are paying high prices for what is typically low cost parts. In the 

, this is very counterintuitive: Why do we need to spend significant amounts of money to do something we pay very little to do now?

	But the missing aspect of this line of thinking is the potential for labor saving by digitally designing a larger number of restorations. As technicians, we have been able to see lack of crisp detail in these prints, and frankly haven’t been able to trust the accuracy. This in part comes from a lack of understanding of the difference between accuracy and resolution. The accuracy of these printed parts is now beyond what we could have imagined a few years ago. However, we still see the resolution can certainly be improved.

	The difference between the two factors can easily be explained using a scale as a reference point. The resolution in this case would be the number of decimal places the scale can measure to. The accuracy, on the other hand, is how the weight of what is being measured is portrayed in the reading of the scale. For example, a 10-and-one-third-pound weight put on the scale giving a reading of 10.33 pounds doesn’t have the resolution of 10.33333333333 pounds, but in the end is accurate. This is more accurate than a scale that reads 10.66666666666 pounds. This contrast is evident in models. With expansion and contraction of impression material and stone used to pour the models, a technician can see great detail, but the model is still not exact and has a degree of inaccuracy. On the other hand, the printed models from intraoral scanners are more accurate dimensionally, but don’t show the same amount of details.

Related Article: How 3D printing streamlines your workflo

	As the printer companies continue to improve, we will see layer thickness get smaller and smaller, and thus higher and higher resolution prints. This doesn’t necessarily mean that the cost of the machines is going to increase. There are several new companies in the 3D printing space. This includes companies that didn’t exist in dental previously and who are now making big names for themselves. They offer high quality printers for under $5,000. These companies were offering high-end consumer printers, thought to be expensive by the hobbyist, that through testing were found to be up to the quality standards we expect in dental at a fraction of the cost we currently expect. Looking at cost, where we once thought of these machines being in $100,000-150,000 range, we now have a price range of $5,000-150,000.   

	Of course, as we would expect, the more expensive machines offer significant advantages over the less expensive ones. One of these are the ability to print in different materials. This could be an added color selection, or hardness/elasticity variability. While this has limitations, we can see how our 3D printers will morph into uses similar to what has happened with our home 2D printers. We now rarely print anything outside the home, where once photo huts littered every parking lot around us.

Related Article: What the future holds for 3D printing

	This same thing will happen with 3D printing. In our lifetime, we could see an end of toy stores. Instead, we will purchase files off the internet to customize with colors and print at home. The advancement in machines and materials running parallel could enable this sooner than we think. The higher end of industries leads this development, because they are willing to spend the most money. F1 racing has been using 3D printing for a couple years. Boeing has more than 20,000 non-metallic additive manufactured parts on airplanes they delivered to customers.

	Dental doesn’t have the capital of these other industries, and also has the hurdle of government regulations. But once the materials we would like to use, or ones that haven’t been released yet, have registered with the proper government agencies around the world, the doors will open even wider with options for these machines. For some it may mean the printing of custom temporaries, dentures, bite splints or surgical guides. For others, maybe printing porcelain will become the norm. Regardless of how we use the technology, the advantages of additive manufacturing will continue to be exploited for the benefit of our patients.

Mark Ferguson analyzes the state of 3D printing, looking both at what it can do now and what the future might hold for it.

The state of 3D printing

	I think it is safe to say we have reached the tipping point of acceptance of digital dentistry across the dental industry. Just look at where we’ve been in this progression in the past 30 years. Patients received the first CAD/CAM restorations in 1985. 

3D design software has been around since 2003. The technology has changed dramatically over that time and continues to evolve at an exponential rate when you consider that the level of precision we chase today involves mere microns. This is a level never considered, and perhaps even judged impossible to achieve, in an analog world. Dr. Bernard Jankelson said ,“If it can be measured, it is a fact. If it cannot, it is an opinion.” I might add to this: Just because something is a fact doesn’t mean it matters.

We can now scan, design and manufacture such a wide variety of indications and materials that the workflow has strayed far from what was originally envisioned as a straight line. For example, the workflow for a fixed hybrid denture is very different from that of a simple coping, and the difference in accuracy of the scan data required for these two procedures is also very different. In my experience, every scanner being used today, whether an intraoral or lab scanner, is accurate enough for crown and bridge. 

	However, and this is a key point you should always have in mind, only a few are accurate enough for multiple-implant screw-retained cases. The pain of accuracy in a scanner is often only judged as the difference in the initial purchase cost of the equipment. I suggest to you it goes much further if you are doing more complex cases. Consider the cost (dollars and time) of inaccuracy in poor fits, remakes and failures for all concerned: lab owner, technician, dentist and patient.  

	Scanning is just one step of the CAD/CAM process. I often speak of clinical significance. Does the fact that one scanner is three microns more accurate make it better? Not necessarily! It depends on the use of the scanner, accuracy of the design software used to create the restoration and what you are going to use the system for. This question drives to the heart of the digital workflow. The next question is: Are your doctors using intraoral scanners? With the acceptance of intraoral scanning, scanners used by the dentist client have just as much of an impact. 

	The most involved step for most labs is the design process. Depending on where the scan data comes from, the design process can change dramatically. Are models produced? Were models scanned? One nice thing about digital is that materials generally don’t matter. They are just data entered that might change some background functions. These should be imperceptible to the technician during the design phase. In effect, if the designer knows what a tooth should look like, he or she can design for all types of cases.

	With the acceptance of intraoral impressions on the clinical side, labs today often scramble to find partners to help with aspects of their cases. This help can come in the form of model printing, education on the file quality or even data exchange. Most labs can’t be everything to everyone as this can be extremely expensive. That doesn’t mean they have to turn down cases. It may just mean they have to outsource a portion of the work.

	The most often-overlooked portion of a CAD/CAM restoration is the CAM (or nesting) software. This vital piece of software controls the movements of the milling machine. I have visited many labs where they promote their “five-axis machine,” but it is actually being used as a three-axis or occasionally a 3+1 or two-axis machine. Why? Because the CAM software itself does not allow the five-axis movement of the machine. As this software is vital to the end result, creating the “finish” and accuracy on a restoration, we certainly want the package we purchase to utilize the machines’ capabilities to the fullest extent. Unfortunately, this software is often looked at as a throw-in in the total purchase and is more likely than not closed to the lab. Most of us are not machinists; we’re dental technicians. The fact that most CAM software is generally not fully open may be a good thing! 

	As the complexity of the cases goes up, we see the traditional circle that starts and ends with a doctor and patient in the chair changing from that original digital workflow straight line to something that looks more like a spider web. However, the nice thing about a digital case is moving data around is now as simple as sending an email. This is where we revert back to the traditional basis of most dental transactions: relationships. Labs of all sizes seek to find partnerships. These partnerships come in the form of material companies, milling centers, educators and others. The areas of specialty are more and more focused. There are now companies that offer design services so if a small lab has a technician go on vacation, that department can be covered. Labs are using these services rather than hiring technicians. Are you? Who would have thought dental labs would outsource the contours of their restorations five or 10 years ago? The contour of our crowns was our signature as a technician. 

	The proliferation of CAD/CAM has drastically changed the dental landscape. It has raised the quality of weaker technicians. Best of all, I have seen technicians embrace the technology and make the system into something as individual as they are. The possibilities are limitless. The technology is there to make almost anything happen.

Mark Ferguson graduated from the American Institute of Medical/Dental Technologies in 2001. He has worked with the Aurum Group in Las Vegas for the past 12 years with six years at Aurum Ceramic at LVI and six years with 

. He recently accepted a position as GM of 

Mark Ferguson explains why dental technicians should embrace a digital workflow to the fullest extent they're able.

Why it's time to embrace the digital workflow

	As technicians, we all want to be comfortable with the workflow to process cases through the lab. Most technicians are most comfortable with what they have been doing for years. They may bring 

 into the process here and there, but they haven’t fully given in to the digital revolution. Yet, with a greater understanding of today’s machines and software, the dental lab can improve on this, providing more precise restorations while still improving turnaround time.

 continues to make dramatic inroads within the dental operatory. With several 

intraoral scanners already gaining new dentists

recently announced at Chicago Midwinter and IDS in Cologne, labs 

need to be ready to accept these types of cases.

 Currently, there is no one digital dental lab workflow. Labs have to make choices on what they can handle between locked and open clinical scanners. The trouble with that is there is no one correct solution. Labs are often kept out of the loop as their doctors decide to make the leap to digital. This ends up leaving the lab scrambling for answers while the clock is ticking on a case. The key is to take a proactive approach to the digital question.

Let’s start by being honest with ourselves: The typical laboratory alone cannot be all things to all people with digital dentistry. It’s prohibitively expensive to have the lab equipped to handle any and all types of digital cases coming in every day. Labs should make that decision themselves upfront, 

 such as volumes expected by technology, the return on investment on those volumes and which ones they want be prepared for, and then find partners to handle the cases they can’t or don’t want to handle internally. These partners can also open up new business for a lab by connecting to a network previously not available.

Related reading: 5 things every lab needs to know about outsourcing

So what are the key factors in choosing these “digital partners?” 

The best partner to pair with is capable of handling any quality of scan data.

Not all STL files are created equal; each scanner’s files are unique. Core3dcentres has software to make otherwise unusable files clean and usable. The reason some manufacturers choose to use proprietary file types is the meta data that can be associated with a file. This could be margin lines, implant positioning or restoration type to name a few. The question becomes, do I need this extra information and what do I want to do with this file? 

Read this: How to handle digital files from your dentist

The ability to create a monolithic restoration without a model is not only here but in daily use.

Yet when a model is desired for these or other types of restoration, digital dentistry makes these models incredibly accurate. The manufacturing of these models has additional labor and hardware/software considerations that you may wish your partner to handle. Can your partner help you create these models for your clinicians? Scan data STL files have no thickness. Additional design software is required to add thickness and preparation sectioning.

An implant case has additional considerations.

Will the model have a replica of the designed abutment or will it be created with a socket for a lab analog? An 

 with an approved scan body from an implant library with the dimensions of a lab analog has the most accurate and streamlined workflow. Can your partner supply it? 

Let’s expand on that question: Do we need a model to fabricate the restoration? With the accuracy of digital technology, my answer to that is usually no. Of course, the type of restoration is a big part of that answer. For monolithic restorations, even those with a cutback, 

 has been done for years. With experience and training, digital restorations can be designed for more accurate and better fitting.

Must read: How to improve your implant work using a digital workflow

When I talk to technicians now, we discuss microns of differences between scanners or machines. Prior to digital, there was no accurate way to measure differences from one case to another (but we would not have been discussing microns for sure). The inherent differences, particularly expansion and contraction from impression materials, stones and investments, left the fit of a case up to the feel of the technician. Digital technology puts a quantitative value to this feel. It also gives the technicians views of cases that were never possible before. To be able to measure the distance to the opposing within the central groove area of posterior teeth is a great example of this. 

Digital workflow has evolved over the past few years. As more elements of the dental field become digital we can expect a higher quality of restoration in a shorter amount of time. Our goal is always to 

provide the highest quality restoration for the patient

. As we keep more accurate records of how we restore cases, we can learn to provide the highest level of care.

 As technicians, we all want to be comfortable with the workflow to process cases through the lab. Most technicians are most comfortable with what they have been doing for years. They may bring CAD/CAM into the process here and there, but they haven’t fully given in to the digital revolution. Yet, with a greater understanding of today’s machines and software, the dental lab can improve on this, providing more precise restorations while still improving turnaround time.

How to understand and handle today's digital workflow

	The CAD/CAM world can be confusing if you don't understand the terminology. Read the top five terms you need to know below:


	STL is a file format of the surface geometry of a three-dimensional object. STL files are geometry only-there is no representation of color, texture or other attributes. In order for digital scanners and CAD software to have these attributes, the software manufacturers use proprietary file extensions, like .dcm, .cdt, .3dc or .cmf. Open systems will automatically convert their proprietary file format to STL.


	Milling starts with a block/disc of a material and takes away the excess of material to leave the geometry of the part. The advantage of this is stability of the material. The disadvantage of this process is that it is limited to the size of the tool used to mill/grind away excess material (drill compensation) and minimum thickness before potential chipping.

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	Additive manufacturing is currently being used in several forms. SLM (Selective Laser Melting, Laser Sintering) and SLA (Stereolithography, printing) are the two most prominent methods used. These methods start from nothing and build up the manufactured product. The advantage of this is increased possibility of detail. The disadvantage is thickness is limited to grit/grain size of material used and the need for further post-processing for the product.


	With IOS (IntraOral Scanning) technology becoming more prevalent in dentistry today, understanding differences between scanners (price and accuracy) can make or break a laboratory. Lab scanning has reached widespread acceptability. Any scanner will have its own workflow. Understanding of the differences between these will dramatically affect the ease of use of the STL files. With varying levels of accuracy between the scanners, an understanding of these differences and how they affect the accuracy of different types of cases is the clinical significance. For crown and bridge cases, the accuracy of all scanners (lab and intraoral) is more than acceptable. The level of clinical significance in accuracy rises when looking at multiple-unit, screw-retained bridges (implant bars).


	With the dental field becoming more digital, 

 compliance will be scrutinized more and more. Basically, HIPAA compliance laws state that patient privacy cannot be compromised. The emailing of files (including photos, STL files, case notes, etc.) with any patient identifying information through conventional means is illegal. 

 is one example of a HIPAA-compliant email service.
	 

The List: Top 3 products that can help your dental clients take better impressions

 The CAD/CAM world can be confusing if you don't understand the terminology. Read the top five terms you need to know below:

The List: Top 5 CAD/CAM terms you need to know

	The word’s out! Digital dentistry is no longer a dream. It isn’t about the future. It is here and now. It is here to stay. Unfortunately, as with any fast-evolving methodology, doctors have an abundance of choices to handle their digital requirements.

As is usually the case, it is now up to the lab to have a solution that allows them to handle all these different digital file formats. What complicates the situation is that most technicians are under the misguided notion that any open laboratory CAD system can read all open STL files. Unfortunately, that is certainly not the case. At Core3dcentres, as we have gained experience with the STL files created by different systems, we have found that they are anything but the same. This begs the question: What is a lab to do?

As with all aspects of the relationship between clinician and laboratory, the key to success is extensive communication. For a lab to be ready to accept digital cases, it certainly helps to know what system the files are going to be originating from-and well before the cases start coming in! The optimal situation is to be able to guide the doctor to a system in which the laboratory has confidence. Unfortunately, this is not always possible. Labs are often left to gather information about the system and files when the clock is already ticking on a case. This process includes what we might consider basic information on case options. Does the case need a model? How will the restoration be manufactured? What material is requested or required on the case?

For typical crown and bridge, the answers to these questions can be simplified. Monolithic restorations can be fabricated without a model-end of story. The question I am asked most often is “can a lab guarantee fit of a restoration without a model?” The easy answer is yes. However, this can require a bit of a leap of faith. Labs have fabricated restorations without models, but had trouble fitting them to the model they then receive for the case. What happened?

Through a series of tests, we have determined the cause of this is more likely inaccuracies in the model, not in the restorations. Depending on fabrication of these models, different types of inaccuracies can occur. The thing to remember here is that the digital data collected from the intraoral scanner is the most accurate data to work from. With proper parameters in the design software, a lab should have the utmost confidence that modeless restorations can be counted on to fit. This goes back to communication between the lab and doctor as to how the restorations are working in the mouth.

That being said, when these cases start to involve implants, the workflow gets a little harder to decipher. The start of the data collection process here should be “where the doctor purchased the scan body.” Once that information is verified, the next step is to follow up with the scan body manufacturer.

Scan bodies are connected to implant libraries-and are not able to be used without their particular library if you want to achieve an accurate result. Depending on the implant library, it may, or may not, be possible to fabricate a model. There are also different types of models that can be created. Some libraries have the ability to print a model with a socket for a lab analog to embed in, while others only have the ability to print the model with a replica of the designed implant abutment. The best place to determine this, and the rest of the workflow, would be the manufacturer of the implant library.

The “unspoken factor” in digital workflow is always the scanner the doctor uses. With the variety of scanners on the market, doctors have many choices and many different reasons for making their decisions. Some doctors wish to also take on in-house manufacturing; this does not mean they won’t still send some work to their labs. The ability to work with these cases often requires additional software for the lab. Some of the scan-only intraoral scanners also require that the data runs through additional software before it becomes usable in particular laboratory CAD design software. The key point? Differences in scanners represent, for the most part, differences in workflow. 

Core3dcentres has the in-depth experience and ability to work with scan data from all the major intraoral scanners, and the additional software to make that data usable for laboratories. We also have an implant library that has the versatility to make models with embedded implant replicas, allowing labs to retain their current workflow. Perhaps most important of all, we also provide training through our Core3daCADemy™ and the on-demand technical assistance that helps labs help themselves.

Photos: Top photo-a-r-t-i-s-t / Getty Images (top). Workflow image courtesy of Core3dcentres.

 The word’s out! Digital dentistry is no longer a dream. It isn’t about the future. It is here and now. It is here to stay. Unfortunately, as with any fast-evolving methodology, doctors have an abundance of choices to handle their digital requirements.