Implant restoration with CEREC Primescan and Galileos CBCT By Clark Brown, DDS, PA

Typically, the drawbacks of fabricating these two restorations with a single full arch image are difficulty in obtaining a full arch image and having an incorrect bite.

With practice, the CEREC AC Omnicam can easily produce full arch images.  It does take several passes (occlusal, buccal and lingual) to obtain the image.  Also, once a quadrant is imaged and the second quadrant is imaged, the dentist should not go back to the first quadrant for re-imaging.  An accurate bite can be obtained on one quadrant, but in a case like this, if the bite is taken on the right side, the left side will be open.  If taken on the left side, the right side will be open.  If the dentist takes the bite in the anterior, both posterior sections will be open.  As a result, the most accurate way to handle this case would traditionally be to open two separate incidences of CEREC software and do each side individually.

With the new CEREC Primescan and 5.0 software, these drawbacks are completely eliminated.  The new scanner has an incredible depth of field, which allows for capture of the buccal surfaces and gingiva with one pass.  A second pass at a 45-degree angle ensures adequate capture of the tooth surfaces.  The depth of field also allows for easy and accurate capture of subgingival preparations.  CEREC Primescan and the latest software allows for captured images to be “over written”.  If the dentist takes a pre-operative impression, once the tooth is prepared, the dentist can scan over the pre-operative areas to capture and replace the pre-operative image with the prepared tooth image.  If there is an area of blood in the original captured image, drying and re-imaging results in accurate images.   There is now a dual buccal bite, similar to the ortho software.  Being able to take a bite on both sides allows for proper and accurate articulation of the full arch scans.

This patient presented with missing teeth numbers 4 and 13.  The patient desired to have dental implants for replacement of these missing teeth.  A Galileos CBCT was taken and it was determined that there was adequate bone for dental implants without prior bone grafting.  A pre-treatment CEREC scan was taken and crowns virtually designed.  These designs were imported into Dentsply Sirona’s Galaxis software.  Implants were virtually placed with the final restoration in mind.  A surgical guide was exported from Galaxis and imported into CEREC SW for two CEREC 2 surgical guides.

The patient was taken to the treatment room, prepared and anesthetized for the implant placement procedure.  A Megagen AnyRidge 3.5 x 10 implant was placed in sites #4 and #13.

fter an adequate healing period, the healing abutments were removed and the ISQ for each implant was measured.  Both implants had an ISQ value of 80.  Dentsply Sirona Scan Posts were placed and full-arch images using the new CEREC scanner and 5.0 software were obtained.  The teeth were designed as screw retained restorations and fabricated from e.Max abutment blocks. 

The teeth were tried in and required no adjustment.  The implants were torqued to place according to manufacturer’s instructions and Teflon tape and composite was used to seal the access hole.

The entire procedure was made easy by the technology developed and provided by Dentsply Sirona.  Pre-operative planning, virtual implant placement, guided surgery and final screw retained crowns became an effortless and predictable process.