Implementation of digital workflow for every-day cases
Ken M. Akimoto, DDS, MSD Issaquah, WA USA
Applications of digital workflow in our office
3D printed surgical guide for all implants
Introducing intra-oral scanner will allow creation of stl files for importing into implant planning software.
Planned case can be shared with restorative office as well as patients, allowing us to communicate possible problems.
Take definitive impression for straightforward posterior cases
By providing lab and restorative dentist with digital impression, we anticipate up to 50% saving on chair time for restorative dentist.
Selection of hardware and software
It is very important to consider how captured images (Files) are going to be transferred and used. Our selection was heavily influenced by necessity to communicate with different dental labs ensuring compatibility with their dental software.
Most of our cases are single implant cases. Small field of view and high definition images capture were important. While sit-down type was preferable, we chose standing type due to space restriction and cost.
Implant planning software
Many of software come in two flavors. One that allows planning only, and the other that allows to export stl file for printing. Some software requires to use their facility to produce guide.
Selection criteria for us included ease of integration with our intraoral scanner, no per-guide cost, ability to output stl file, as well as being more focused on teeth supported guide for smaller cases.
While hardware cost is manageable, considering maintenance and running cost as well as need for human resources, we concluded it is not feasible to own 3D printer at this point.
We have four standard surgical kits and one guided kit. We decided to add 2.8mm milling cutter as well as 2.2mm and 2.8mm drill handles to all standard kits. This allows us to use up to 2.8mm drill on both 5mm and 2.8mm sleeve. Upgrade cost is minimal.
Feasibility analysis (5 year depreciation for CBCT)
Initial cost MaintenanceTCO
TRIOS 3 $45,800 $3,690/year$53,180
Implant Studio$6,008 $803/year$7,614
Per unit cost of printing
Model with Analog$100
Total cost of $158 per surgical guide (300 guides/yr)
Since May 2015, digitally printed guides have been used for every implant placement in our office. Over 80 cases have been completed by restorative dentists using digital workflow and 3D printed models. www.NWPERIO.com