NBGC2010: Nobel Biocare Global Symposium 2010 Day Two

25 06 2010

While the first day of the Nobel Biocare Global Symposium 2010 kept the focus on clinical topics related to implant procedures, day two got underway with the focus turned to the technology powering treatment planning for implant cases. The international panel of speakers stressed the importance of planning cases with three-dimensional imaging, and the morning sessions concluded with Dr. Eirik Salvesen from Stavanger, Norway previewing Nobel Biocare’s NobelClinician™ and NobelConnect™ software systems which are slated to roll out this fall.

But prior to Dr. Salvesen’s preview of the host company’s enhanced software systems, a slate of speakers were given the stage to discuss technologies shaping the future of dental implants beginning with a keynote address from Swiss posthodontics professor Dr. Joerg Strub who reviewed the various digital systems being used to improve implant treatments in both the United States and Europe. Beginning with the intraoral impression systems, Dr. Strub’s presentation encompassed digital articulation systems, digital shade selection systems, digital assessment and tooth configuration programs (including an iPhone app from Vita), and finally software to virtual manipulate all that data and plan the actual cases. Throughout his review, he stressed the importance of keeping up with technology and the benefits of 3D imaging systems.

“We all agree on the fact that the 2D planning image is out,” he said.

While reviewing the more than 10 virtual treatment planning software titles currently available, Dr. Strub said they all have powerful capabilities and it is up to the individual clinician to decide which one is best for his or her practice. However, as good as guided surgery planning may be, he added that solid training and a deep understand of the principles of the procedures is still necessary because they are not so accurate as to allow for “blind implant placement.” As he continued to discuss CAD/CAM technologies, Dr. Strub said he is encouraged by the fabrications of the digital light processing technology being marketed by envisionTEC. However, while all of those technologies are impressive, he said what he is most excited about is the future of all-in-one systems such as one by 3dMD that handle all aspects of digital dentistry.

Next up, Dr. Stefan Holst used his time to discuss how CAD/CAM systems are improving the predictability and success of implant cases. However, while he spoke in favor of the technology, Dr. Holst began by stressing that he remains skeptical of the accuracy of some of the technologies and prefers to work in closed architecture systems because they keep the entire design and production process within one company’s software and production technologies. Still, the available technologies are capable of producing very accurate abutments and the ability to mill implant overdenture bars from a block of monolithic material is invaluable. The more accurate production technologies available certainly make it easier to produce restorations that will last, but he added that the patient still plays a role in case success.

“Hygiene is one of the key aspects when it comes to the longevity of our full mouth restorations,” he said.

From here the lectures shifted focus to discuss developments in the materials arena, with Drs. Mauro Fradeani and Eric Van Dooren speaking about the benefits of working with Ivoclar Vivadent’s e.Max lithium disilicate. Dr. Fradeani explained that e.Max’s strength and versatility allow it to be used for full contour restorations that are thinner than those produced with other materials, thus allowing for minimally invasive prep designs. Dr. Van Dooren presented a case completed just last week where he had the CAD/CAM produced e.Max crowns produced by NobelProcera and sent to his lab technician in the blue phase so they could be customized with cutbacks and layering effects.

“If by CAD/CAM design we can have these crowns, the future is very bright,” he said.

Continuing on the materials discussion, Dr. Dianne Rakow presented data from her National Institutes of Health-funded studies on the strength qualities of materials. While stressing that fabrication techniques have great impact on the final strength of dental materials, Dr. Rakow reviewed the various testing procedures used to determine material strength. She explained that no single number can tell the full story of how strong a material actually is, while describing the ongoing efforts to create ways to test materials that will accurately imitate conditions crowns are put under when they are actually placed in a patient’s mouth.

The presentations then returned to the subject of guided surgery with Dr. Luc Gillot sharing data from a study he and some colleagues conducted as an attempt to gauge the accuracy of guided implant surgery. While it is easy to see how 3D imaging and treatment planning software make it easier to plan procedures that will place implants in sites with sufficient bone, it is hard to determine how the surgical guides impact the accuracy of the procedures themselves. To test this, he and his colleagues did a study where they tested guided and freehand implant placements on cadavers, and by measuring the results of the actual placements against scans showing the desired placements, they found the guided procedures to be two to three times more precise than the freehand procedures.

“If you are going to insist on one thing, you have to be very accurate when you place the guide,” he said.

Finally, to close out the session, Dr. Salvesen presented the new features of Nobel Biocare’s upcoming software release. Introducing NobelClinician as the updated version of NobelGuide, he explained that the new software keeps the focus on the esthetics and function of the final restoration and offers improved case planning and communication for both patient and clinician. The new software adds more workable views of scan data, improved diagnostic capabilities, easier review of the surgical templates and cross sectional views that make choosing implant placements an easier process.

“All in all, the user experience for the software is much better,” he said.

The NobelConnect system that will be launched as a part of NobelClinician is an online communication portal designed to increase communication and collaboration between clinicians, specialists and lab technicians, Dr. Salvesen said. The system provides a secure way for patient files to be uploaded to a site where selected colleagues are able to access and work with the file. It is designed to improve teamwork and make working remotely a far easier situation.

While these lectures provided some of the more interesting opinions and findings on the day, other sessions covered implant solutions for edentulous patients, clinical decision making and minimally invasive implant procedures. Additionally, attendees had opportunities to see hands on previews of the new Nobel Biocare software as well as the company’s implant systems, Vita’s shade matching technologies and material options from Ivoclar Vivadent and Noritake. On Saturday, the final day of the event will feature a lab technician forum and presentations on short and thin implant designs.

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