The importance of collaboration

Dr Robin Horton and Bradley Moore discuss the importance of collaboration and communication in guided implant surgery

Planning the surgical guide on Nobel Clinician

The synergistic relationship between a clinician and dental technician is a key aspect of quality implant planning and surgery. We use the NobelClinician treatment workflow to work together to offer predictable and accurate implant treatment to partially and fully edentulous patients.

Due to innovations in e-communication and technologies in recent years, it is easier and more effective than ever before for us to collaborate and communicate with each other. Digitalisation has helped improve and streamline our workflow, most notably the way that we share and provide crucial information. The ability to access images, scans and patient notes easily, quickly and efficiently allows us to work to higher standards in a way that is beneficial to us professionally and to our patients. It is for these reasons that the NobelClinician software is so invaluable to us. In conjunction with a standardised working procedure, all aspects of the planning process can be systematically evaluated, allowing for increased predictability and better results.

Having developed a logical operating protocol that ensures clinical information and materials are sent from the practice with each set of case notes, we are always both aware of what is going on during each treatment process and what the next step is. Communication by text and email is routine, effective and very helpful – any sense of disorganisation or confusion in what we are striving to achieve is eliminated.

My role as the dentist – Dr Robin Horton

Having completed a couple of thousand implant cases over the last 10 years, I can safely say that my current workflow strategy is much more efficient than the old-fashioned way of working, and a lot of this is to do with the advances in technology and the way that I can communicate with Bradley. Now, we’ve got the workflow down to a tee.

The first port of call for every case is clinical data acquisition. To diagnose the extent of the issue and patient anatomy, a CBCT scan is taken of the available bone, which is then turned into a three-dimensional model of the patient’s jawbone. From there, we can place the implant virtually, as well as find out which size is needed, all without even touching the patient.

At the same time, full-sulcus-depth alginate impressions and a bite registration are taken and sent to Bradley who casts the models straight away. He then produces the wax-up of the replacement tooth or teeth for scanning, which are uploaded to the cloud. From here, I can import them into the NobelClinician software for bi-directional treatment planning.

That information is then sent to Nobel Biocare so it can produce the surgical template ready for implant surgery.

My role as the technician – Bradley Moore

In the laboratory, the workflow starts as soon as I receive the impressions.

We receive email notification in the form of a NobelClinician order request before the case arrives, so we know when cases are due. The implant impressions can then be cast as soon as they are received.

Our standard working procedure is to make two models; a study model of the original situation and a duplicate that is used for the wax-up. If more information is needed at this stage, Robin will email patient images when sending the NobelClinician request. It is this level of file sharing that allows us to work so effectively.

The scanning is performed in two stages. First we scan the model with the wax-up in place, then we scan the model on its own. On completion of the scans, we send a screenshot of the completed model scan to Robin to let him know that it’s done.

For the workflow to be most effective, we have adopted a working protocol that includes provision of a simple immediate / replacement denture and an aid for fabricating an immediate placement, provisional unit at the time of surgery. We use the wax-up tooth position to make a clear silicon matrix for the fabrication of an individual composite tooth to be part of the denture. The ensures the temporary denture replacement is in the planned position. The silicon matrix also provides transfer of the proposed planned tooth position to the patient situation.

The benefits of collaboration

Our collaborative relationship is so important because it provides predictability and accuracy, which in turn ensures the optimum outcome is achieved and the long-term result is better for the patient. The format of the workflow helps with this too, as we can determine what the outcomes are going to be before we even begin; we, ‘start with the end in mind’. When we come to do the impressions for the restorative phase, we’ve already got the model and wax-up from the first appointment.

After casting the master model, we check the implant position, emergence profile and CEJ referencing the original wax-up with a putty matrix. Any remodelling of the soft tissue emergence is carried out on the model and captured with resin by adding to a pick-up impression coping. This acts as a guide for laser sculpting and also the pick-up for a secondary impression stage after healing with a custom healing cap.

Efficient workflow and improved communication also helps to reduce chair time for the patient. In turn, that helps to minimise discomfort and improve the overall experience. In the past, surgery would have taken an hour and a half, whereas now, precision planning and state of the technologies mean an implant procedure typically takes about 20-30 minutes.

Through improved collaboration, communication and workflow, implant planning and surgery can be more predictable, accurate and efficient, thus improving the outcome for patients undergoing treatment.

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Dr Robin Horton is principal dentist at Wayside Dental Practice in Harpenden, Hertfordshire. he qualified in 1990 and has undertaken post graduate education in advanced restorative and aesthetic dentistry and implant dentistry, taking referrals for placing implants. Robin is a mentor for Nobel Biocare and a member of the British Academy of Cosmetic Dentistry.

Bradley Moore is a dental technician and director at his own laboratory, Essence Dental Laboratory in Harrogate. He has trained and worked in Germany and has 25 years’ experience of implant dentistry.

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