Cerec Charlotte, Nc
CEREC Optical Scanning
CEREC Optical Scanning is providing better patient care in Oral and Maxillofacial Surgical (OMS) Practices. CEREC minimizes dental and surgical appointments, provides a method and workflow for precision and safer implant placement and restoration, minimizes office visits for the patient, and allows us to coordinate needed restorative work with your referring General Dentist or Dental Lab.
The beginnings of CEREC application to dental implant placement relate to the history of surgical dental implant placement that began with Dr. P.I. Brannemark (the discoverer of titanium bone integration and inventor of modern-day dental implant technology). Dr. Brannemark- a Swedish surgeon- was a close friend to Dr. Philip Worthington at the University of Seattle, in Washington state, where Dr. Kent Moore performed his OMS surgical residency training (Dr. Moore personally knew Dr. Brannemark, and scrubbed with him during several of his “advanced” surgical courses held at the University of Washington during Dr. Moore’s surgical residency in Seattle).
Dr. Brannemark’s “free-hand” dental implant placement techniques and protocol created the initial standard for dental implant placement, and was developed prior to the implementation of computerized CAD software (the term “free-hand” refers to the surgical placement of dental implants using only intraoperative surgical anatomy as a guide; free-hand placement of dental implants was the surgical “standard technique” for many years prior to the evolution of the field as described below). With Dr. Brannemark’s technique and protocol, the implant(s) was/were placed and allowed to heal for several (3-6) months prior to uncovering and needed prosthetic work then fabricated and placed. Problematic with this protocol, however, was that implants placed using this protocol were often positioned incorrectly by the surgeon, making subsequent prosthetic implant-borne restorations difficult (if not impossible) to be placed in a functional (useable) manner.
Early efforts to solve the problem of implant malposition via modification of Dr. Brannemark’s original “free-hand” delivery of dental implants developed over time into the use of surgical guides to allow more accurate placement of dental implants. These guides, however, were fabricated using traditional dental technologies- involving plaster, impressions, and often wax “mock-up” designs. These techniques and resulting surgical guides, however, often depended upon 2-dimensional (or surface anatomy), and hence, did not provide the ability of the surgeon to appreciate three-dimensional relationships that are now available through the CAD process.
Over time, with improvement in computer speed and software development, the integration of computerized CAD (Computerized Assisted Design) has spread to the dental/ oral surgical environment. CEREC was the first CAD system developed for the dental industry. Other systems were produced over time; but in its present form, CEREC has emerged as the most complex, complete, and sophisticated method to allow CAD-assisted placement of dental implants.
CEREC allows the surgeon to provide safe, efficient, and precise implant results, utilizing guided surgery techniques. CEREC also allows the potential for fabrication of temporary or permanent restorations onto dental implants once placed (assuming specific conditions are met).
As CEREC and software continued to evolve, CEREC optical scans- now later combined and integrated with Galileos 3-dimensional cone-beam CT scan data- provides the surgeon with complete 3-dimensional control over guided implant placement- allowing a far-more precise and accurate planning and implant delivery process- and resulting in a far more predictable and stable final surgical result for the patient.
Optical impressions reduce the discomfort associated with traditional impression methods, and allow digitization and virtualization of the impression and surgical planning process. The virtual images created are exceedingly accurate, and can be manipulated in a myriad of ways (far beyond those using traditional techniques) to enhance the implant planning and placement process.
Once the optical scan is acquired, a virtual “restoration” for each missing tooth is created using the CEREC software. This “virtual restoration data” is imported into the 3D cone beam CT scan software, and allows exceedingly accurate and precise 3-dimensional evaluation and planning of the implant-restoration complex. This type of planning is exceedingly advantageous for the patient, in that proper sized restorations can be used as orientation for the central axis of any implant placed; being able to assess bone volume and adjacent tooth root position with the properly positioned restoration outline enables the surgeon to plan implant placement precisely… avoiding improperly-oriented placement of dental implants. Implants of various diameters can then be planned, chosen, and positioned so as to permit perfectly parallel placement when necessary, and to avoid trauma to the adjacent vital teeth, cortical plates, roots, nerves, and sinuses, and to permit formation of proper embrasure space between implant and adjacent natural tooth or teeth.
Once the planning process is completed, the combined CEREC-3D CT Scan data is then utilized for fabrication of custom-milled tooth-born surgical guides. These guides allow precise replication of the planned CAD-assisted implant plan within the patient, and allows for absolute control over all three dimensional planes of space during surgical implant placement. This is the most accurate method currently available for surgical implant placement.
In cases where front (anterior) teeth are being immediately replaced with dental implants, and in working with your treating general dentist, CEREC allows the surgeon to remove a tooth, then precisely place a dental implant (using the surgical guide technique discussed above) into the most optimal and precise anatomic position. Assuming adequate primary stability of the placed implant is achieved following placement, a subsequent CEREC scan of the placed implant is performed (using a “scan body”). Once completed, the surgeon then designs and fabricates an exact “virtual” match for the missing tooth so that an immediate temporary crown can be fabricated (or “milled”) and placed at the time of implant placement, thereby preserving normal soft tissue architecture and anatomy (once a tooth is removed- without immediate implant placement and immediate temporary crown placement- the surrounding bone and soft tissues begin to shrink and deform; this deformation is particularly problematic in anterior “esthetic” regions of the mouth and leads to long-term problems with crown design and soft tissue relationships). As a result, patients then are often able to (assuming all conditions are met) to have their tooth removed, an implant placed, and a temporary crown then placed immediately (but out of functional contact with opposing teeth)- but thereby preserving both bone and soft tissue normal anatomy! So, the patient walks in with a tooth in need of removal, but leaves with a new, fixed replacement tooth, all in the same day!
Other options for restoration of dental implants are also available with CEREC:
1) If the coordinating/ referring dental office is using CEREC in their practice, we are able to perform an optical scan during the uncovering phase of the implant process. This option allows our office to upload the CEREC optical scan on the patient to their general dentist; the dentist then can fabricate the crown in their office (assuming they have milling capability) and have the permanent restoration placed in just one visit.
2) If the coordinating/ referring dental office does NOT use CEREC, once the implant has been uncovered, the uploaded CEREC scan can be forwarded to the dental lab of your referring general dentist’s choice- permitting the dental lab to fabricate the final crowns and have them on hand so that when you return to their office, no impressions are necessary, and the final crowns can be placed at at that time.
3) CEREC also allows your surgeon to produce custom abutments with the appropriate restoration, or to independently design screw-retained restorations all in one easy step.