Inclusive...ROBERT A. HOROWITZ, DDS Dr. Robert Horowitz graduated from Columbia University School of...

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Inclusive Restorative Driven Implant Solutions A Multimedia Publication of Glidewell Laboratories www.inclusivemagazine.com Vol. 3, Issue 1 Implant Q&A: Darrin Wiederhold, DMD, MS Implant Division, Glidewell Laboratories Page 26 Digital Design of Custom Temporary Components Dzevad Ceranic, CDT Page 17 Building a Healthy Referral Network Dr. Robert Horowitz Page 22 Recession Relief: Are Dental Implants the Answer? Dr. Ara Nazarian Page 34 Technology’s Impact on Restorative Implant Treatment Dr. Timothy Kosinski Page 43 Introducing the Inclusive ® Tooth Replacement Solution Dr. Darrin Wiederhold and Dr. Bradley Bockhorst Page 6 Inclusive Contest: How Many Implants? Page 56

Transcript of Inclusive...ROBERT A. HOROWITZ, DDS Dr. Robert Horowitz graduated from Columbia University School of...

Page 1: Inclusive...ROBERT A. HOROWITZ, DDS Dr. Robert Horowitz graduated from Columbia University School of Dental and Oral Surgery in 1982. After a one year general practice residency, he

Inclusive™

Restorative Driven Implant SolutionsA Multimedia Publication of Glidewell Laboratories • www.inclusivemagazine.com

Vol. 3, Issue 1

Implant Q&A: Darrin Wiederhold, DMD, MSImplant Division, Glidewell Laboratories

Page 26

Digital Design of Custom Temporary ComponentsDzevad Ceranic, CDT Page 17

Building a Healthy Referral Network Dr. Robert HorowitzPage 22

Recession Relief: Are Dental Implants the Answer?Dr. Ara NazarianPage 34

Technology’s Impact on Restorative Implant TreatmentDr. Timothy KosinskiPage 43

Introducing the Inclusive®

Tooth Replacement SolutionDr. Darrin Wiederhold andDr. Bradley Bockhorst Page 6

Inclusive Contest:How Many Implants?Page 56

Page 2: Inclusive...ROBERT A. HOROWITZ, DDS Dr. Robert Horowitz graduated from Columbia University School of Dental and Oral Surgery in 1982. After a one year general practice residency, he

Contents

Benefits of the Inclusive® Tooth Replacement SolutionComplex treatment modalities can make it difficult to treat implant patients efficiently while still maintaining quality of care. With their in-depth look at the Inclusive® Tooth Replacement Solution, Drs. Darrin Wiederhold and Bradley Bockhorst address this challenge by utilizing predesigned custom temporary components to provide patient-specific temporization and contoured healing.

Building a Restorative Driven Referral NetworkA thriving surgical practice is largely dependent on the success of the restorative dentists, laboratory technicians and other co-treating professionals who help carry an implant case to completion. Experi-enced periodontist Dr. Robert Horowitz identifies some of the most common areas of miscommunication in the treatment progression and looks at how implant specialists might help to maximize patient satisfaction and profitability for their referring doctors.

Implant Q&A: An Interview with Dr. Darrin WiederholdFor some clinicians, venturing into the realm of dental implants is a daunting prospect. In his first published interview as a member of the Glidewell Laboratories clinical team, accomplished dentist Dr. Darrin Wiederhold outlines some of the practical steps a clinician can take to gain the knowledge, confidence and experience required to successfully join the ranks of implant professionals.

Incorporating Implants into Your Daily PracticeA dentist feeling the pinch in a difficult economy is apt to seek more efficient ways to provide services, or to take on new services typically referred to another provider. Dr. Ara Nazarian addresses the difficulties of traditional implant treatment and explains how a restorative-driven approach simplifies the process, making it more convenient and affordable for both the dentist and the patient.

Implant Solutions Utilizing the Latest TechnologyDentists today stand to benefit from technological innovations that make procedures more predictable and less invasive. Dr. Timothy Kosinski showcases the use of digital treatment planning to promote safe and simple guided implant delivery, followed by the place-ment of prefabricated custom temporary components that allow for unprecedented versatility at the time of surgery.

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14 Clinical Tip: Implant Orientation for Inclusive Tooth Replacement Solution Components

17 Lab Sense: Virtual Design of Inclusive Custom Temporary Components

40 Clinical Tip: Placing Custom Healing Abutments

52 Restorative Driven Implant Treatment: From Immediate Temporization to Final Restoration

56 Inclusive Contest: How Many Implants?

ALSO IN THIS ISSUE

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Page 3: Inclusive...ROBERT A. HOROWITZ, DDS Dr. Robert Horowitz graduated from Columbia University School of Dental and Oral Surgery in 1982. After a one year general practice residency, he

Contributors

■ BRADLEY C. BOCkHORST, DMD

After receiving his dental degree from Wash­ington University School of Dental Medicine, Dr. Bradley Bockhorst served as a Navy Dental Officer. Dr. Bockhorst is director of clinical technologies at Glidewell Laboratories, where he oversees Inclusive® Digital Implant Treatment Planning services and is editor­in­chief and

clinical editor of Inclusive magazine. A member of the CDA, ADA, AO, ICOI and the AAID, Dr. Bockhorst lectures inter­nationally on an array of dental implant topics. Contact him at 800­521­0576 or [email protected].

■ DZEVAD CERANIC, CDT

Dzevad Ceranic began his career at Glidewell Laboratories while attending Pasadena City College’s dental laboratory technology program. In 1999, Dzevad began working at Glidewell as a waxer and metal finisher, then as a ceramist. After being promoted to general manager of the Full­Cast department,

he assisted in facilitating the lab’s transition to CAD/CAM. In June 2008, Dzevad took on the company’s rapidly growing Implant department, and in 2009 completed an eight­month implants course at UCLA School of Dentistry. Today, Dzevad leads a team of 220 people at the lab and continues to implement cutting­edge technology throughout his department. Contact him at [email protected].

PUbLIshErJim Glidewell, CDT

EdItOr-IN-ChIEf aNd CLINICaL EdItOrBradley C. Bockhorst, DMD

MaNagINg EdItOrsJim Shuck; Mike Cash, CDT

CrEatIVE dIrECtOrRachel Pacillas

CONtrIbUtINg EdItOrsGreg Minzenmayer; Dzevad Ceranic, CDT; David Casper; Tim Torbenson

COPy EdItOrsEldon Thompson, Barbara Young, Megan Affleck, David Frickman, Jennifer Holstein

dIgItaL MarkEtINg MaNagErKevin Keithley

graPhIC dEsIgNErs/WEb dEsIgNErsJamie Austin, Deb Evans, Joel Guerra, Audrey Kame, Lindsey Lauria, Phil Nguyen, Kelley Pelton, Melanie Solis, Ty Tran, Makara You

PhOtOgraPhErs/CLINICaL VIdEOgraPhErsSharon Dowd, Mariela Lopez James Kwasniewski, Marc Repaire, Sterling Wright

ILLUstratOrPhil Nguyen

COOrdINatOrs/ad rEPrEsENtatIVEsTeri Arthur, Vivian Tsang

Neither Inclusive magazine nor any employees involved in its publica-tion (“publisher”) makes any warranty, express or implied, or assumes any liability or responsibility for the accuracy, completeness, or useful-ness of any information, apparatus, product, or process disclosed, or represents that its use would not infringe proprietary rights. Reference herein to any specific commercial products, process, or services by trade name, trademark, manufacturer or otherwise does not neces-sarily constitute or imply its endorsement, recommendation, or favor-ing by the publisher. The views and opinions of authors expressed herein do not necessarily state or reflect those of the publisher and shall not be used for advertising or product endorsement purposes. CAUTION: When viewing the techniques, procedures, theories and materials that are presented, you must make your own decisions about specific treatment for patients and exercise personal profes-sional judgment regarding the need for further clinical testing or edu-cation and your own clinical expertise before trying to implement new procedures.

Inclusive is a registered trademark of Inclusive Dental Solutions.

If you have questions, comments or suggestions, e­mail us at [email protected]. Your comments may be featured in an upcoming issue or on our website. © 2012 Glidewell Laboratories

■ ROBERT A. HOROWITZ, DDS

Dr. Robert Horowitz graduated from Columbia University School of Dental and Oral Surgery in 1982. After a one­year general practice residency, he finished a two­year specialty training program in periodontics at New York University and the Manhattan VA Hospital. In 1996, Dr. Horowitz completed a two­year

fellowship program in Implant Surgery at NYU, focusing on bone grafting procedures. He is a clinical assistant professor in the department of periodontology and implant dentistry at NYU College of Dentistry, where he teaches and conducts research in bone grafting. He is also on faculty and conducts research in the departments of oral surgery, biomaterials and biomimetics, and oral diagnosis. Dr. Horowitz has lectured nationally and internationally and published more than 40 scientific articles and case studies. Contact him at [email protected].

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Restorative Driven Implant ConceptsBuilding a Referral Network Through

by Robert A. Horowitz, DDS

IntroductionOne might argue that the outcome of any implant case begins with a successful surgery. Most patients are less concerned with root-form placement, however, than they are with the esthetics and functionality of the final restoration. The success of any surgical practice is therefore highly dependent on the success of its referral network — the restorative dentists, laboratory technicians and other co-treating professionals who help to carry an implant case to completion.

Fortunately, the factors that drive growth for a specialist practice are the same as those that drive growth for a general practice or laboratory, chiefly patient satisfaction and profitability — factors that derive from proper planning, efficient treatment and minimal complications. Treatment planning each case to include restorative considerations from the outset and ensuring proper collaboration and communication among all members of the team will greatly enhance the likelihood of a successful outcome and the efficiency with which it is achieved.

The Inclusive® Tooth Replacement Solution from Glidewell Laboratories represents an intriguing new tool in the effort to address planning, communication and component issues

that have been known to complicate implant cases between the surgical and restorative phases. Intended to promote an effective, streamlined process resulting in a predictable outcome, this all-in-one, restorative-based solution (Fig. 1) offers a number of advantages for the team of providers working together to ensure each patient receives the best possible care.

Figure 1: Temporary, impression and final phases of the patient-specific Inclusive Tooth Replacement Solution

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Page 5: Inclusive...ROBERT A. HOROWITZ, DDS Dr. Robert Horowitz graduated from Columbia University School of Dental and Oral Surgery in 1982. After a one year general practice residency, he

Restorative Treatment PlanningTo obtain an ideal surgical outcome, a full diagnosis must be completed before the initiation of treatment. The final prosthetic design should also be considered. The more comprehensive the diagnosis, the better the final restoration will be. Clinical photographs and radiographs, periodontal evaluation, esthetic evaluation, diagnostic casts on an adjustable articulator with a wax-up of the teeth (present and missing) in ideal functional and esthetic locations, and a cone beam volumetric tomogram taken with a radio-opaque stent are all helpful tools for accomplishing this.

It is tempting for some surgical specialists to take prosthetic diagnosis and soft tissue sculpting for granted. They might think these are concerns chiefly for the restorative dentist. Why should a specialist take time to do general work? The truth is, these are foundational components that help lay the groundwork for the definitive restoration. Extra time spent in the planning stages can be rewarded tenfold in terms of time saved addressing complications that may otherwise result later in the case. Making the restorative clinician’s job easier is pleasing to both the clinician and the patient, fostering goodwill and leading to a greater number of future referrals.

The Inclusive Tooth Replacement Solution places a great degree of emphasis on the preplanning of each case from a restorative perspective. Implant and case-specific surgical drills are provided according to the surgeon’s prescription, along with a prosthetic guide — fabricated from an initial impression — to help ensure proper implant placement (Fig. 2). Laboratory technicians then utilize digital technology to design and mill a custom temporary abutment and provisional restoration (Fig. 3), making them available at the time of surgery. For clinical flexibility, a custom healing abutment is also provided (Fig. 3). The purpose of these custom temporary components is to begin sculpting the gingiva on the day the implant is inserted. Rather than ignoring the soft tissue contours or leaving them to chance, they are guided during the healing phase to prepare for an ideal emergence profile of the final restoration. And because the components are pre-milled, the chairside time that might otherwise be spent crafting a provisional restoration is eliminated.

Restorative CommunicationUpon completion of the healing phase, the patient returns to the referring restorative clinician, who takes the impression for the lab. The typical challenge with implant cases is that a stock, cylindrical impression coping cannot properly capture the gingival architecture.

Figure 2: The Inclusive Tooth Replacement Solution includes a prosthetic guide to help ensure proper implant placement.

Figure 3: The Inclusive Tooth Replacement Solution also includes a custom tem-porary abutment, a provisional restoration, and a custom healing abutment.

The laboratory technician is forced to approximate the design of the restorative components. In many cases, this results in an abutment or crown that does not quite fit properly, causes tissue blanching or looks less than natural where it emerges from the gingiva. Adjustments or even a remake may be required, costing the clinician and patient valuable chairtime.

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Page 6: Inclusive...ROBERT A. HOROWITZ, DDS Dr. Robert Horowitz graduated from Columbia University School of Dental and Oral Surgery in 1982. After a one year general practice residency, he

Figure 4: A custom impression coping (right) is designed to match the gingival architecture sculpted by the custom temporary abutment (center) and custom healing abutment (left). The custom impression coping would be forwarded to the restorative dentist.

The Inclusive Tooth Replacement Solution addresses this issue from the outset with a custom impression coping (Fig. 4) designed to match the gingival architecture sculpted by the custom temporary abutment. When the patient returns to the referring doctor, the doctor simply removes the temporary, places the custom impression coping, takes the impression and sends it to the lab. The full gingival architecture is precisely captured for lab use, without the need to create a custom impression coping chairside.

Restorative OutcomeWhen utilizing the Inclusive Tooth Replacement Solution, restorative dentists get the benefit of a laboratory that has restored more than 160,000 implant cases. They can therefore expect precise, quality restorations without any unnecessary complications. A custom abutment and monolithic crown are milled to precisely match the digital design files used in the creation of the custom temporary components. Because of this, the abutment and crown should seat easily with a precise fit. Any adjustments should be minimal, allowing the patient to leave the office with a natural-looking definitive restoration requiring no further corrective appointments.

Laboratory SupportTo maximize the number of successful referrals, an implant specialist needs to offer support to less-experienced restorative providers. An important ancillary benefit to Glidewell’s Inclusive Tooth Replacement Solution is that each case incorporates patient-specific custom components, simplifying treatment steps for less-experienced restorative clinicians. Further, the solution includes the customer support of a highly experienced team of technical advisors who can assist the restorative doctor with any questions or concerns that arise. This frees up the specialist staff to focus on specialized procedures, while still providing the referring doctor with answers to any questions or concerns. Users of the Inclusive Tooth Replacement Solution also benefit from a significant cost savings over the price of individual components. As the laboratory manufactures the implants and all other components on site at its state-of-the-art U.S. facility, vendor markups are reduced. A single price covers the entire cost of the solution, eliminating the guesswork often associated with determining treatment fees for the placement and restoration of implants.

SummaryThe success of those who specialize in the placement of dental implants is determined in no small measure by the success of their restorative teams. A specialist who demonstrates an appreciation for the concerns of his co-treating professionals stands a better chance of achieving a positive outcome for the patient in the most efficient, predictable manner possible. With the Inclusive Tooth Replacement Solution, many of the communication gaps that traditionally interrupt the treatment chain are avoided. Soft tissue architecture is carefully managed from the outset and communicated effectively to the restorative team. Parts produced with CAD/CAM technology demonstrate precise fit and proper occlusion. The restorative process is simplified, encouraging referrals from clinicians who might otherwise be reluctant to prescribe implants, considering them too complex or time-consuming. By maximizing the patient satisfaction and profitability of referring doctors, the specialist practice will ultimately benefit. IM

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