greetings i am taylor manali and i am a prosthodontist that works here
with glidewell dental lab those that know me know one of my passions is implant dentistry
in the ever-evolving world of digital technology both placing implants and restoring implants have
become more and more predictable and rewarding today i'm going to talk to you about utilizing
one of these technologies an intraoral scanner to submit implant impressions to the lab
this can be a very simple procedure for both you and your patient when executed correctly
to do this you are going to start with a clinical scan abutment or sometimes called a scan body this
is the type of impression coping whose specific shape is captured by the intraoral scanner which
is then translated to the laboratory software to provide the lab with the position of the implant
this scan body shown here is a part of the han prosthetic family from glidewell
the scan body has been redesigned with a new platform shift emergence profile
that limits tissue impingement for a more predictable seat in addition the scan body
is now fabricated from titanium which makes it easy to confirm seating radiographically
it comes in one length suited for both anterior and posterior sites and the combination of the
coronally placed geometrical pattern along with the roughened surface makes scanning the critical
patterns easy to do for this clinical case i am utilizing an itero element 2 scanner to complete
this acquisition in general my workflow for capturing an implant impression is as follows
i start with the prep scan where the clinical scan abutment is used the remainder of the
scans the arch scans and the byte scan will be performed with the healing abutment or
the provisional restoration in place this is especially important when taking the bite scan
the scanning abutment can prevent the patient from completely biting down which can result in
a delay of your case or even occlusal adjustments the day of delivery this patient had an implant
placed previously at site 11 and has come to our office ready for a restoration in a single unit
case an intraoral scan acquisition is my first choice of impression technique with any impression
i first evaluate the adjacent and opposing teeth to see if the contact points or occlusion needs
adjustments here i have decided to do a minor enamel plasti to the contacts to create broad
parallel contact points the contacts should be parallel to the long axis of the implant
for a common path of draw making seeding the restoration much easier to help visualize
this i like to evaluate the path of draw with either a lab screw or the scan abutment itself
after inserting the scan body radiographic confirmation can help to ensure that it is
fully seated this is an example of how soft tissue can impinge the seating of the scan body
on the left you can see that the scan body is not completely seated while on the right
you can see that it is now fully seated engaging the connection of the han implant
if the scan body is not properly seated the final crown will not seat either
prior to starting each scan be sure to fully dry off the hard and soft tissue surfaces of interest
in the prep scan i make sure to capture the surrounding soft tissue adjacent teeth both
the contacts and occluding surfaces and of course the scan body geometry
the new han scan body's geometrical pattern is located on that coronal third ensuring that
this critical registration is not lost under the soft tissue as shown here in this example
taking the time to scan the adjacent contacts in soft tissue in the high resolution prep scan makes
it easier to accurately merge the prep and arch scans if or when i remove the scan body in between
after the prep scan is complete i like to remove the scan body and
reinsert either the healing abutment or the provisional if i have fabricated one
remember the soft tissue collapses fairly quickly so make sure whenever you unscrew one component
you replace it right away with another in this case we scan site 11 with the scan body in place
then remove the scan body and replace our healing abutment at this point i am ready
to do my full arch scan or arch scan even though i changed out the abutment the software will marry
the two scans as i have captured the surrounding soft tissue and those adjacent occluding surfaces
once both arches are scanned the bite registration is now captured just as in the conventional method
i always confirm the patient's position of bite before i capture it removing the scan
body prior to the bite allows the patient to predictively and comfortably occlude
in their maximum intercuspation position if taking a full arch scan capture both sides of
the mouth try to avoid skipping this step as it may cause some occlusal discrepancies like shown
here this can make it really challenging for the lab to accurately create your restoration
in the digital world it is so easy to accurately capture and communicate the patient's bite to
the lab on cases like these you can take the bite and within seconds confirm the digitally acquired
bite with the patient still in the chair take a few moments to evaluate your scan make sure you
look at it in the model mode or stone mode as the lab receives the files in the stone or model mode
try to avoid evaluating your final scan in color mode if your scanner has that
once switching to model mode you want to make sure that there are no grainy areas or
unwanted blebs this could mean that there was moisture contamination
simply clean and dry the area before re-scanning for a more accurate representation
leaving the scan with this grainy look means that there will be guesswork involved from the lab side
this also means that more often than not you will have to make adjustments on delivery day
to your final restoration on the itero is it easy to switch between the collar and model mode after
each step to ensure the acquisition is clean and true although it can be a nice feature for some
things be sure to avoid using an autofill feature on implant sites themselves the adjacent teeth
or even the teeth directly opposing the implant site in this example it was used on both the
adjacent tooth and the scan body itself although it completes the scan it is an inaccurate scan
and will result in adjustments on delivery day or even worse a complete remake of the restoration
remember be sure to evaluate your scans in the model or stone mode prior to sending
them to the lab keep the scanning field clean and dry to capture an accurate acquisition
avoid the auto fill feature and be sure the bite registration matches the patient's intraoral bite
all in all scanning clinical implant scan abutments can be easy to perform and a
pleasant experience for your patients as far as impressions go thank you for watching keep smiling