Balraj Sekhon discusses the benefits of guided surgery to deliver predictable treatment outcomes
Although implant dentistry has evolved into one of the most predictable treatment alternatives for patients with missing teeth, we are still striving to improve our surgical and restorative techniques. The foundation for all procedures should be a proper diagnosis to determine the appropriate treatment options.
To help take the guesswork out of the diagnostic phase, the use of 3D imaging (CBCT) with interactive treatment planning software, such as coDiagnostiXTM, aids the planning of implant placement, the design of surgical drill guides and the ultimate restoration. I have found that by incorporating a digital implant planning system and working closely with a dental laboratory that offers CAD/CAM production, I benefit from well-designed surgical drill guides and high quality, implant-borne restorations. This, in turn, reduces complications and enhances the communication within the interdisciplinary team.
The use of CBCT and coDiagnostiXTM has greatly impacted my ability to diagnose in all dimensions, allowing a full appreciation of individual, patient-specific anatomy and a clear understanding of the existing quantity and quality of bone, trajectory of the alveolus, and location of vital structures. It also serves as a powerful communication tool for patients, colleagues, and with my laboratory of choice.
Digital workflow for implants
The ideal for me is to achieve prosthetically driven implant reconstruction. To achieve this, I need a complete understanding of the relationship between the tooth and the underlying bone. In addition, proper diagnosis may require working closely with a laboratory to create ‘virtual’ diagnostic wax-ups of the surgical guide and the proposed final restoration, allowing adjustments to be made to achieve the best possible outcome. Therefore, it’s not the scan but the plan™ that becomes my driving force.
When a tooth is fractured or requires extraction, a dental implant is the ideal treatment option that will restore the root of the tooth and provide support for a new clinical crown.
The coDiagnostiXTM system offers many options for diagnosis, consultation and seamless workflow integration. Virtual implants of known length and diameter can be simulated within the receptor site, establishing the proper trajectory of the implant within the cross-sectional image and in relation to the desired restorative option (i.e. screw- or cement-retained). Using advanced software features and the process of segmentation, the existing tooth root can be virtually extracted and the proposed implant with an abutment projection can then be positioned to emerge through the desired restorative result.
As a general dentist I have found using advanced implant planning software, such as coDiagnostiXTM, to be very beneficial and have been using it fully for about a year now. We don’t have a CT scanner in- house and it would be difficult for me to justify the costs because we are a mixed practice, so we refer our patients to a local scan centre and they send us an open file scan that we can place into the software. Once in the coDiagnostiXTM system, we can take the various measurements and access the best placement for the implant.
Improved clinician/ laboratory communication
I currently work with Ken Poland Milling in London and I regularly share my STL files with them. The communication features in the system synchronise planning and design work between practice and laboratory, allowing us to collaborate in real time, which makes the treatment planning process considerably easier and ensures that all parties’ expectations are met.
Another advantage of the coDiagnostiXTM system is improved patient communication. Rob Poland comments, ‘We have been supporting clients with coDiagnostiXTM for a number of years from stent production to full planning, design and final restoration. The results have been excellent, eliminating compromised situations and aiding communication between clinician and dental technician.’
I now have the ability to show the patient a digital representation of the proposed implant placement and the design of the final restoration. Patients respond well to being involved in the planning and design process, it gives them the opportunity to discuss the case in-depth and raise any areas of concern, and it undoubtedly helps manage the patient’s expectations of the final results.
coDiagnostiXTM is an investment in terms of direct cost and time to gain the depth of knowledge to fully utilise all the elements and tools in the system. However, I firmly believe it improves the patient journey, enhances communication and clarity with the dental laboratory, delivers a more efficient and robust surgery process, reduces stress, and ultimatelydelivers better dentistry.
Case example 1 using Straumann coDiagnostiXTM
Case example 2 using Straumann coDiagnostiXTM
6. Initial presentation
7. Initial presentation 2
8. Gap x-ray
10. Final placement x-ray
11. Final restoration
12. Final restoration 2
Balraj Sekhon, BDS (Manc), MJDF RCS (Lond), PGCert (UCLan), MSc Dental Implantology (Distinction)
Balraj graduated from the University of Manchester in 2003. He is one of the principal dentists at Circle Dental.
Since qualification he has acquired the Diploma of Membership of the Joint Dental Faculties from the Royal College of Surgeons and a Master’s Degree in Dental Implantology with Distinction from the University of Central Lancashire. Balraj is also a published author in the Journal of Operative Dentistry.
Balraj has studied dental implantology to a high standard and currently works with a Yorkshire-based surgical team with specialist surgeon Dr Robert Dyas. He has a keen interest in teaching and this has been recognised by his appointment as Educational Supervisor by the Northwest NHS Deanery.
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