The Secret to Streamlined Implant Cases: The Digital Workflow

Implant placement has become the treatment of choice for completely and partially edentulous patients. With more and more implants being placed, keeping up with demand can be difficult. However, with the ability to make your laboratory workflow more digital, time can be saved to create a more cost-effective, high-quality outcome. 1

Implant-based treatment provides infinite possibilities to practitioners, but it often represents a more time- and cost-intensive solution compared to traditional therapy alternatives with conventional tooth-supported fixed dental prostheses. Reducing the overall clinical treatment and technical production time to achieve a reasonable cost-benefit ratio—in combination with a high-quality outcome—can bring benefits to all concerned. Time is saved by eliminating many of the steps, including pick-ups and chemical-based processes. The delivery of restorations is also quicker and there is less chance of having to provide remakes and returns with a digital workflow.1

Many labs have already started transitioning to a digital workflow, as increased demand, technology advances and the growing shortage of technicians creates an enhanced need for improved productivity. Single digital work steps have begun to infiltrate classical impression-taking procedures, dental master cast fabrication, lost-wax casting techniques and individual finalization of the restoration with hand-layered veneering ceramics. For many years, dentists have taken an impression, sent their prescription off to the laboratory and waited for up to two weeks for a finished restoration to be returned. The restoration could then need further adjustments, despite the best efforts of the dentist and technician. The development of a completely digital workflow has the potential to change the entire process. At first glance, the new systems may seem complicated, but ultimately digital solutions can drastically streamline procedures for both the dentist and lab. Nevertheless, although changes are growing in the field of implant prosthetic treatment, the result of this evolution is a mixed conventional-digital workflow.

The evidence for the clinical and technical outcomes or the economic benefit of a complete digital implant workflow is scarce in dental literature. However, a recent study analyzed time efficiency of a treatment with implant crowns made of monolithic lithium disilicate plus titanium base vs. porcelain fuse to zirconium dioxide in a digital workflow. The results showed that the test workflow was more time efficient than the controls for implant-supported crowns. Time resources are of immense interest in daily practice, where patients expect high quality combined with a convenience-orientated treatment. This includes shortened clinical sequences, as well as a reduced number of appointments.1

The researchers from the study also concluded that laboratory fabrication steps could be effectively shortened with the digital process, resulting in a more than 30 percent reduction in overall treatment costs. A possible explanation could be based on the bypassing of several manual fabrication steps in the complete digital workflow, as well as reduced human intervention. If human work time—in particular—can be cut, this lowers the laboratory costs and allows the dentist to offer the entire treatment for a reduced price. Of course, dental laboratories might have extra investment costs for the digital infrastructure. But once set up, the benefits can easily outweigh any initially perceived disadvantages. Incorporating a digital model-free workflow into the business can really distinguish labs from the competition, putting them on the leading edge of dentistry. Furthermore, with a digital workflow, the need for chairside modifications, such as secondary grinding and polishing, is often not necessary when information is relayed digitally from the dentist to the laboratory. This not only reduces clinical work time, but may also decrease the risk for cracks and chipping of veneer ceramics. Enhanced communication between the lab and practice can allow dentist and technician to communicate more directly and promptly about cases.1

Take the modern intraoral scanner as an example. Digital impressions can be sent to the lab within minutes of being taken, which accelerates the entire process. Plus if the dentist is not happy with the intraoral scan, it is easy to retake with no discomfort to the patient. Communication is enhanced and labs are able to receive detailed images, which can then cut down turnaround times and reduce the many fabrication steps allowing digital impressions to be faster and more efficient. For optimal communication between laboratory and dentist, Carestream Dental has developed CS Solutions. The cutting-edge technologies in the system allow dentists to send an open .STL file to the lab while the patient is still in the chair and labs can continue using the CAD software of their choice to view and manipulate images.

Digital workflows are the future of dentistry and many laboratories are already integrating systems into their businesses. The efficiency and quality made possible with digital workflow can provide a competitive advantage to any lab, large or small.

1 Joda, T., & Bragger, U. (2016). Time-efficiency analysis of the treatment with monolithic implant crowns in a digital workflow: a randomized controlled trial. Clinical Oral Implants Research, 00, 1-7.

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