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