ENCODE TECHNOLGY: MAKING DENTAL IMPLANT THERAPY EASIER AND PREDICTABLE
Dentistry is all about precision. The field of dentistry is one that is based in fractions of a millimeter. For me, a surgical result can be successful or fail if I am 1/10th of a millimeter in the wrong direction. The ultimate success or failure of a dental restoration can be held to that standard or even smaller. One excellent example of this is in the area of implant restorations. Over the years, there have been many changes in dental implants and especially the restoration of dental implants.
A dental implant is simply an anchor that is placed in the bone that binds to the bone through a process called osseointegration. The implant has a transitional intermediary piece called a healing abutment which allows the gum tissue to grow around it in a shape that mimics the way gum resides around natural teeth. Once the gum tissue heals around this healing abutment, it can be removed and replaced. Gum tissue will form a bond to this metal. Every time it is removed, this bond has to reform. Later, the healing abutment is replaced by the final abutment. This piece is the connecting piece from the body of the dental implant to the restoration that will be placed in your mouth. Lastly, a crown or bridge is attached to the final abutment.
When I began private practice over 22 years ago, typically, as the surgeon, I would place the dental implant and the healing abutment. After the gum tissue healed, I would replace the healing abutment with a stock final abutment. A stock abutment is one produced to hit the majority of the shapes and sizes that will accommodate typical restorations. It is not custom made for your site, but one would be selected that would most closely replicate your natural tooth. A temporary cover would be place on this final abutment. Then your general dentist would make a standard impression of what I had placed using the same things he would for a regular tooth. Often, retraction cord would be packed in the gum space surrounding the abutment and a polyvinyl impression would be made using dental impression trays and the gooey colored impression materials that take 5-10 minutes to harden in your mouth. It would then be tugged off your teeth giving the restorative doctor and his laboratory a replica of what was in your mouth. This was then sent to the lab where it would be poured and made into a stone model that replicated your mouth. The technician would then try to find the margin of your implant abutment and carve the stone away from the model to gain access to this margin. He would then take instruments with hot melted wax and build a crown out of this wax. The wax would then be cast into metal and porcelain would be placed to cover the metal and make a structure that replicated your natural tooth as closely as possible. This is called “analog dentistry.” As you can tell, there were many places here where error could occur. The doctor could miss the margin of your implant in the impression. The impression could distort. The model could shrink or expand when converted to stone. The lab tech could misinterpret where the margin is. They could do a poor job on the waxing, casting or stacking of porcelain.
This method was improved on by the implant companies when they started realizing some of the shortcomings. The next improvement came with stock impression copings. Here, I would place the dental implant and the healing abutment. After the gum tissue healed, I would replace the healing abutment with a stock final abutment. A stock abutment is one produced to hit the majority of the shapes and sizes that will accommodate typical restorations. It is not custom made for your site, but one would be selected that would most closely replicate your natural tooth. A temporary cover would be place on this final abutment. The difference was, a piece was now made that I would send to your dentist. Instead of packing cord and trying to get the exact contours of the implant abutment in an impression, this impression coping would be snapped onto the abutment. It would then be impressed with polyvinyl impression which would be made using dental impression trays and the gooey colored impression materials that take 5-10 minutes to harden in your mouth. It would then be tugged off your teeth giving the restorative doctor and his laboratory a replica of what was in your mouth. An accompanying piece would be sent to the lab which was an aluminum replica of the exact shape and size of your abutment. This replica would be snapped into your impression at the lab and poured up in stone. This was a big improvement because it removed some of the spots in the process where human error could occur. It gave an exact replica to the lab so a much better fitting crown could be made. There were still areas where error could occur. One other huge limiting factor was the fact that if the stock abutment needing any altering, in any way, this completely removed the ability to do this and it would revert back to the original way. In 22 years in private practice, I have seen very few times where I would say a stock abutment wasn’t a little too short, too tall, too angled, not angled enough, to narrow or too fat. Every tooth and every person are so greatly different, it is most often adequate at best but rarely ideal.
The third change that came with dental implants to try to improve on this process was what is called “fixture level impressions.” In this method, I would place a healing abutment and send a fixture level impression kit to your restorative doctor. They would unscrew the healing abutment, screw an impression coping to your implant, make the gooey impression and then remove it from your mouth after it hardened. They would then replace your healing abutment. This would be sent to the lab where a replica of the implant body would be screwed to the impression coping. This coping would be placed back into your impression and turned into a stone model. Now the lab would have a replica of your mouth with the exact position and orientation of your implant. The lab tech would then either select a stock abutment and refine it to fit your space or would design and fabricate a custom abutment to the exact contours of your mouth. They would then go through the process of waxing and casting a crown. This would all be sent back to your dentist who would remove your healing abutment again and then screw in your final abutment and cement your crown. This method was by far the best and gave the most customized result possible. There were still areas where issues could occur with the analog impression taking and stone models. But with standardized techniques and quality control, this can be a very accurate method with beautiful, customized results. The one thing that can’t be avoided is the placement and removal of the healing abutment multiple times which can cause the gum tissue to not rebind to the metal surface as well every time it is removed.
Now, some implant companies are changing the game again. The company I use is Zimmer Biomet. They are world leaders in medical and dental prosthetics and in the field of bone growth and bone grafting. Zimmer completely revolutionized the restorative end of dental implants with the introduction of the BellaTek Encode® Impression System. In this system, I place a specialized healing abutment onto your dental implant called a BellaTek Encode Abutment®. The BellaTek Encode® Impression System aims to provide optimized solutions to clinicians by eliminating the need for implant level impressions, which streamlines the treatment process for the surgeon, restorative clinician and laboratory. In addition, patients have a better experience and a beautiful aesthetic outcome as compared to traditional procedures with an impression coping.
A BellTek Encode® abutment has several advantages. The greatest advantage is the elimination of removing and replacing the healing abutment multiple times for impressions, try-ins and final placement of the definitive restorations which can damage the soft tissue barrier associated with the dental implant. An appreciation of the protective effect of the soft tissue barrier is important for providing optimal aesthetic outcomes. Recent studies show that multiple abutment removals (disconnections/ reconnections) are associated with increased crestal bone loss. These findings suggest using the fewest number of abutment removals to achieve better aesthetic and functional results.1,2 Ultimately, the goal is to use “one abutment, one time” and the BellaTek Encode Impression System provides an important step for achieving this objective.
BellaTek Encode® benefits to the patient and restoring doctor include:
- There is no need to use impression copings, resulting in a less invasive impression procedure for more patient comfort.
- The intraoral scan can be taken by the specialist at the surgical release visit, eliminating a restorative appointment and resulting in less visits to the dentist’s office compared to traditional procedures.
- Abutments designed specifically for the patient for better aesthetic outcomes compared to traditional non-digital procedures.
BellaTek Encode® abutments work by having a unique coding system built into the structure of the abutment itself. When recorded by an intraoral scan with a 3D scanning CAD CAM or through standard impression techniques (which are digitally converted by a lab), this information is exported to a specialized computer program that interprets the recordings made of the BellaTek Encode® abutment surface. This information gives the information of the implant size, implant style, implant angle, implant depth and the exact rotation of the implant. A computer interprets all this data and prints a 3D model that is an exact replica of what is in your mouth. The lab technician designs a custom abutment within an Encode design program as well as the crown that will be in your mouth. Both are milled to the exact specifications and sent to the restorative doctor ready to be placed in your mouth. So much human and material errors are eliminated with this method. Time is saved for the patient by potentially eliminating the impression appointment. Time and discomfort are saved for the patient by eliminating an extra visit at the restorative doctor’s office and not having to endure the gooey impressions needed for analog dental impressions. This also eliminates the need to remove the healing abutment multiple times. Once it is placed, it is only removed when the final restoration is being placed. Below shows the workflow of a BellaTek Encode® case borrowed from Zimmer Biomet literature. To see the workflow click this link.
Out of all the advances I’ve seen in implant dentistry, this is by far one of the best and for so many reasons. It saves the patient and restorative doctor time and discomfort. It saves me as the surgeon in follow-up issues like soft tissue attachment loss or bone loss and from issues like the healing abutment falling off or not being replace properly requiring additional procedures. This jump into digital dentistry is the wave of the future. Within the next 10 years, I think almost the entire dental field will move more and more to digital dentistry because the results and accuracy are unmatched. To summarize the advantages:
-Fewer visits to the dentist’s office. Intraoral scanning at our final appointment can be done eliminating the dental impressions.
-Increased patient satisfaction with a quicker process and more comfort
-Better functional outcomes with a customized abutment and no abutment swapping.
Restoring Clinician Benefits:
-Simplified process, single appointment and no more impressions, parts and pieces.
-Increased patient satisfaction with a quicker process and more patient comfort. Both will increase practice growth through better patient care.
-No need to prepare teeth and less chairtime.
-No need to create working models. No special articulator needed and no need to mail anything to the Zimmer Biomet Milling Center.
-Quicker turnaround time for cases.
-Less technician time on models and waiting times.
Please tell your dentist that you would prefer to use BellaTek Encode® technology to get the most advanced restorations possible. We will give you the best and easiest experience possible for a beautiful tooth replacement to help you smile and function perfectly. Call our office today to schedule a free implant consultation and see how we can help you smile.
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