PDF Download - Glidewell Dental Labs

But the real key is not just the CBCT.
It’s putting it in the software and being
able to manipulate it. I call it virtual
planning. I want to be able to show
my patient that I’m going to put in
this size implant, and this is why, and
this is how it’s going to be contoured
and shaped, all the way to the final
restoration. Because I think the key to
success is treatment planning from the
restoration backward.
BB: What is your favorite planning software?
There are several on the market.
DL: I use SimPlant ® (Materialise Dental
Inc.; Glen Burnie, Md.), mostly
because you can use every implant
system. But with whatever implant
you’re using, there is going to be a
system that will work with you. So,
again, I think you’ve got to look at the
total picture.
BB: We’ve had the same experience. We
do a lot of SimPlant cases here because it
has an open architecture. Let’s talk about
guided surgery and level of guidance.
DL: Obviously, you can have the lab
make a guide for you from a wax-up.
That will kind of give you the position,
but it doesn’t really give you the angle,
doesn’t give you the depth. It just gives
you a guide to stay within that area.
Or you can go all the way to where
you can actually control depth, angle,
and position; you can even place the
implant through the guide (Figs. 1, 2).
Everything is planned out. I like that
the best because it gives me the perfect
emergence profile. The software helps
me establish what my abutment is
going to be like, so the laboratory can
work with me to create a provisional
that stays in that same position —
everything is worked through.
I’ll also say that using even the
patient’s denture as a guide is huge
because that makes sure that you keep
those implants in the neutral zone,
and you’re going to get a great result
as well (Fig. 3). There are a lot of guide
techniques, but I like using the one
that controls all of it, if I can.
BB: At the California Dental Association
(CDA) meeting in Anaheim last
May, you spoke on the topic of overdentures.
Can you talk a little bit about how
you approach your edentulous patients?
DL: A lot of denture patients are dental
cripples. They really can’t function
and they can’t eat. So, one of the
things I do is I ask them, “Do you want
to eat what you want, or eat only what
you can?” Then I talk about what the
different solutions are. I ask questions
like, “At the end of this, would you just
like it that your denture stays in a little
better, or are you looking for something
that you never have to take out?”
Their answers will tell you the direction
they want to go. Then I look at
implant-retained, soft tissue-supported
as a solution. You can do that with
mini implants, or you can do that with
two or four conventional implants,
with different attachments such as O-
rings and Locator ® attachments (Zest
Anchors; Escondido, Calif.) (Figs. 4, 5).
Or, you could go to implant-retained,
implant-supported. The ANKYLOS ®
SynCone ® (DENTSPLY Friadent) is what
I use for that particular one. It is implant-retained
and implant-supported,
but still removable. And, finally, we
have the option to go screw it in and
either use processed denture teeth,
which are very esthetic today, or make
it out of porcelain.
So, you have that whole range of solutions.
And I really like what Glidewell
has done in establishing one fee. If you
ask a dentist how much an implant
costs, they know the surgical fee off the
top of their head. But if you ask them
how much a crown is, they go: “Uh, it
depends.” On what? Well, it depends
on abutments, etc. So it’s having a
solution — a two-implant solution, a
four-implant solution. If you include
everything in that, it’s just a whole lot
better when you present it to patients.
BB: And you understand all your costs
as a dentist. Talking about the edentulous
patient, how do you make that
decision between a screw-retained denture
and a crown & bridge procedure?
Figure 4: Locator attachments and overdenture
Figure 5: Restored overdenture case
DL: I look at the situation and treat
it four ways: First, I look at it and
treat it in my mind. Second, I wax it
up so I can see if what I’m thinking
can work. Then I sit down with the
lab and we discuss how this is going
to work out. Then we ask the patient
because they’re most important. That’s
who we’re doing it for. Do they want it
fixed? Hopefully, if they want it fixed,
they have enough bone to do it. That’s
usually what we have to deal with. If
they do have enough bone, then I tell
them, “Look, if you have a lower denture,
you’re eating at about 10 percent
efficiency.” If I put in two or four implants
— implant-retained, soft-tissue
supported — you’ll be at about 40 to
60 percent. But if you really want to
– Implant Q&A: An Interview with Dr. David Little – 41