Dr. Irfan Atcha's case was published in the Inclusive magazine about the All-on-4 Dental Implant concept. It's a great read for someone to gain insight into the All-on-4 Technology.

1. Inclusive®
Restorative Driven Implant Solutions
A publication of Glidewell Laboratories
Vol. 1, Iss. 1

3. Utilizing Digital Treatment Planning and Guided
Surgery to Restore Fully Edenulous Arches with the
All-on-4 Technique
In this case report, Dr. Irfan Atcha details the process and ben-
efits of utilizing digital treatment planning and guided surgery to
restore fully edentulous arches using the All-on-4 Technique. Dr.
Atcha explains that this technology can be used to rehabilitate a
fully edentulous patient in just one appointment.
Screw-Retained Denture
with CAD/CAM Framework
Dr. Kenneth Hebel and Victor Rodriguez, CDT, present this photo
essay on delivery of a screw-retained denture featuring a preci-
sion-milled CAD/CAM framework. In this piece, the clinician offers
step-by-step instructions on delivering such a case, complete with
details on how to proceed at each appointment.
The Restorative-Driven Surgical Practice
What is the “restorative-driven surgical practice”? Dr. George V.
Duello describes it as a dentist, specialist or laboratory that uses
a menu of services to provide patients and referrals with their
implant services. Find out more about Dr. Duello’s philosophy on
implant dentistry in this excerpt from a video lecture you’ll find at
www.inclusivemagazine.com.
Cone Beam Computed Tomography:
Applications in Diagnostic Oral and Maxillofacial
Radiology and Pathology
Dr. Parish Sedghizadeh discusses the benefits and increased utili-
zation of Cone Beam CT scanning. Three-dimensional imaging is
rapidly becoming the standard of care in dentistry, he explains,
and its applications are increasing. Dr. Sedghizadeh also offers a
refresher on pathology, as well as a discussion on medical-legal
liability and CBCT.
Determining Implant Fees
Dr. Samuel Strong provides a strategy to help clinicians decide
what to charge for their implant cases. Taking into account lab
costs, implant component costs and overhead costs, Dr. Strong de-
termines: Are you charging too little for your implant cases? Read
his fee analysis to find out.
Contents
6
13
30
31
33
22 R&D Corner: Mechanical Testing
of Inclusive®
Custom Abutments by
Grant Bullis
24 Product Spotlight: BruxZir®
Solid
Zirconia and Inclusive®
Titanium
Abutments by Dr. Richard Seberg
26 My First Implant by Dr. Michael
DiTolla
27 Guided Surgery with Grafting
and Ridge Expansion by Dr. Richard
Seberg
32 Removable and Digital Treatment
Planning Instructions for Use
Features
– Contents – 1

4. Implant dentistry is one of the fastest-growing fields in our profession. With to-
day’s technologies and materials, implant placement is now truly a restoratively-
driven procedure. To provide you with the latest information in this field, Glidewell
Laboratories is pleased to present this inaugural issue of Inclusive, a new print
and online magazine focused on implant dentistry. Inclusive will be a multimedia
publication, offering printed articles in this magazine and complementary videos
and expanded content online at www.inclusivemagazine.com.
As your laboratory partner, our goal is to provide you with the most up-to-date,
practical information available from some of the most knowledgeable, experi-
enced educators, clinicians and technicians in the field. From tips on obtaining
more accurate implant impressions to the prosthetic benefits of digital treatment
planning and guided surgery, we will cover an array of subjects related to implant
reconstruction in our new quarterly publication. Included will be reviews of the
latest technologies and materials, along with information on how to utilize these
tools to provide a higher quality of care to your patients, improve your productiv-
ity and increase your profitability.
In our premiere issue, you’ll find an informative photo essay by Dr. Irfan Atcha on
“Utilizing Digital Treatment Planning and Guided Surgery to Restore Fully Eden-
tulous Arches with the All-on-4 Technique.” You’ll also learn about “Cone-Beam
Computed Tomography: Applications is Diagnostic Oral and Maxillofacial Radiol-
ogy and Pathology” in a piece by Dr. Parish Sedghizadeh, an expert in the field
who serves as an assistant professor at the USC School of Dentistry. Also, find out
how to determine fees for your overdenture cases in a practice management article
by Dr. Samuel Strong.
At Glidewell, we are committed to continuing education. That’s why we offer you
the opportunity to earn CE credits by taking the online test that accompanies des-
ignated articles. We’ll also provide you with information on how to access other
continuing educational opportunities that may be of interest to you.
We are eager to hear your feedback. Let us know what topics, products and proce-
dures you would like to see discussed in future issues. We welcome your questions
and comments, as well. Contact us at inclusivemagazine@glidewelldental.com
Letter From the Editor
Yours in quality dentistry,
Dr. Bradley C. Bockhorst
Editor in Chief, Clinical Editor
inclusivemagazine@glidewelldental.com
– www.inclusivemagazine.com –2

5. Contributors
■ GRANT BULLIS
Grant Bullis, Glidewell Laboratories’
Research & Development Depart-
ment Manager, began his career in
the dental industry at Steri-Oss in
1997. After Nobel Biocare acquired
Steri-Oss, Grant worked in the R&D
department, where he was responsi-
ble for the development of implants,
prosthetics, surgical tools and pack-
aging. Today, Grant manages CAD/
CAM, implant product development and manufacturing
at Glidewell. Since joining the lab in March 2007, he has
obtained FDA 510K clearances for Inclusive Titanium
and Zirconia Custom Abutments on six major implant
platforms and now directs manufacturing for more than
150 implant laboratory and prosthetic components.
Grant has a degree in mechanical CAD/CAM from Ir-
vine Valley College in Orange County, Calif., and an
MBA from Keller Graduate School of Management. To
contact Grant, call 800-521-0576 or e-mail inclusivemag-
azine@glidewelldental.com.
■ Irfan Atcha, DDS, DICOI, DADIA
Dr. Irfan Atcha graduated from the
University of Illinois College of Den-
tistry in 1996. Today, he operates a
private practice in Dyer, Ind., that
focuses on general, cosmetic, seda-
tion and implant dentistry. Dr. Atcha
owns the Center of Implants, Seda-
tion and Cosmetic Dentistry and
the No Dentures Chicago Dental
Implant Center. He is a Diplomate
of the International Congress of Oral Implantologists
and American Dental Implant Association and board of
directors member of the American Dental Implant Asso-
ciation. An expert on implantology, occlusion and TMJ,
Dr. Atcha specializes in one-day implants and lectures
across the U.S. Contact Dr. Atcha at www.NoDentures-
Chicago.com, dratcha@sbcgobal.net or 888-416-4109.
■ Bradley C. Bockhorst, DMD
Dr. Bradley Bockhorst is known for
his unique perspective, which incor-
porates both clinical and industrial
backgrounds. After receiving his
dental degree from Washington Uni-
versity School of Dental Medicine,
Dr. Bockhorst served as a Navy Den-
tal Officer. Dr. Bockhorst has held
positions as Director of Marketing
and Education for several leading
implant companies. He is currently Director of Clini-
cal Technologies at Glidewell Laboratories, where he
oversees Inclusive®
Digital Implant Treatment Planning
Services and acts as editor in chief and clinical editor
of Inclusive magazine. A member of the CDA, ADA, the
Academy of Osseointegration, International Congress
of Oral Implantologists and the American Academy of
Implant Dentistry, Dr. Bockhorst continues to lecture
internationally while maintaining a private practice in
Mission Viejo, Calif. Contact him at 800-521-0576 or
inclusivemagazine@glidewelldental.com.
■ Michael C. DiTolla, DDS, FAGD
Dr. Michael DiTolla is Director of
Clinical Education & Research at
Glidewell Laboratories in Newport
Beach, Calif. Here, he performs clin-
ical testing on new products in con-
junction with the company’s R&D
Department. Glidewell dental tech-
nicians have the privilege of rotat-
ing through Dr. DiTolla’s operatory
and experience his commitment to
excellence through his prepping and placement of their
restorations. He is a CR evaluator and lectures nation-
wide on both restorative and cosmetic dentistry. Dr. Di-
Tolla has several clinical programs available on DVD
through Glidewell Laboratories. For more information
on his articles or to receive a free copy of Dr. DiTol-
la’s clinical presentations, call 888-303-4221 or e-mail
mditolla@glidewelldental.com.
– Contributors – 3

6. Publisher
Jim Glidewell, CDT
Editor in Chief
Bradley C. Bockhorst, DMD
Managing Editors
Jim Shuck, Mike Cash, CDT
Creative Director
Rachel Pacillas
Clinical Editor
Bradley C. Bockhorst, DMD
Contributing editor
Greg Minzenmayer
Copy EditorS
Melissa Manna, Kim Watkins
Magazine Coordinators
Lindsey Lauria, Vivian Tsang
Graphic Designers/Web Designers
Jamie Austin, Deb Evans, Joel Guerra, Lindsey Lauria,
Phil Nguyen, Gary O’Connell, Rachel Pacillas,
Staff Photographers/Clinical Images
Sharon Dowd, Kevin Keithley,
Jennifer Brunst, RDAEF, James Kwasniewski
Illustrators
Phil Nguyen
Ad Representative
Vivian Tsang (vivian.tsang@glidewelldental.com)
If you have questions, comments or suggestions, e-mail us at
inclusivemagazine@glidewelldental.com. Your comments may be
featured in an upcoming issue or on our Web site.
© 2010 Glidewell Laboratories
Neither Inclusive magazine nor any employees involved in its publica-
tion (“publisher”), makes any warranty, express or implied, or assumes
any liability or responsibility for the accuracy, completeness, or useful-
ness of any information, apparatus, product, or process disclosed, or
represents that its use would not infringe proprietary rights. Reference
herein to any specific commercial products, process, or services by
trade name, trademark, manufacturer or otherwise does not necessar-
ily constitute or imply its endorsement, recommendation, or favoring
by the publisher. The views and opinions of authors expressed
herein do not necessarily state or reflect those of the publisher and
shall not be used for advertising or product endorsement purposes.
CAUTION: When viewing the techniques, procedures, theories and ma-
terials that are presented, you must make your own decisions about
specific treatment for patients and exercise personal professional judg-
ment regarding the need for further clinical testing or education and
your own clinical expertise before trying to implement new procedures.
Inclusive is a registered trademark of Glidewell Laboratories.
■ Kenneth s. Hebel, DDS, MS
Dr. Kenneth Hebel received his den-
tal degree from the University of
Western Ontario in 1979 and a mas-
ter of science degree in anatomy at
the University of Rochester in 1985.
Dr. Hebel has the appointment of
Adjunct Professor at the School of
Dentistry, University of Western On-
tario. He also maintains a private
practice in London, Ontario. He is
a certified prosthodontist, a Diplomate of the Interna-
tional Congress of Oral Implantology and a fellow of
the American Academy of Implant Dentistry. Dr. Hebel
is a published author and lectures on implant dentistry.
E-mail him at drhebel@handsontraining.com.
■ George V. Duello, DDS, MS
Dr. George Duello graduated from
UMKC School of Dentistry in 1979
and received a master’s degree in
oral biology at UMKC School of
Dentistry in 1981. He has been in
private practice in St. Louis, Mo.,
since 1983. Dr. Duello was named
a Diplomate of the American Board
of Periodontology in 1987 and is a
member of the American Dental So-
ciety, Academy of Osseointegration and the American
Academy of Periodontology, among others. Dr. Duello
serves on the Professional Advisory Committee for No-
bel Biocare. Contact him at 314-965-3271 or dr.duello@
stlouisdentalimplants.com
■ Greg Minzenmayer
Glidewell Laboratories Director of
Business Development Greg Min-
zenmayer joined the lab in 2006.
With a career in the dental indus-
try that spans nearly 15 years, Greg
has a proven track record in sales,
product management, marketing
and business development. Greg
attended Chapman University in
Orange, Calif. In 1994, he began at
Den-Mat and in 1996 moved to Steri-Oss. In 1998, Steri-
Oss was acquired by Nobel Biocare, and Greg was later
promoted to product manager in charge of the Steri-
Oss family of products. In 2002, he was promoted to
Director of Marketing for the Americas. Contact him at
inclusivemagazine@glidewelldental.com.
– www.inclusivemagazine.com –4

7. ■ Parish P. Sedghizadeh, DDS, MS
Dr. Parish P. Sedghizadeh is Direc-
tor of the University of Southern
California Center for Biofilms and
assistant professor of Clinical Den-
tistry. He received his undergradu-
ate degree in biology from UCLA,
and went on to receive his dental
degree from USC. After his doctor-
ate, he pursued specialty training in
Oral and Maxillofacial Pathology at
Ohio State University, where he also attained a Master
of Science degree in oral biology and Fellowship sta-
tus in the American Academy of Oral and Maxillofa-
cial Pathology. He was also awarded Fellowship in the
American Cancer Society for conducting research at the
Arthur G. James Cancer Hospital and Richard J. Solove
Research Institute, investigating the early molecular
events involved in the progression of head and neck
cancer. Dr. Sedghizadeh is a Diplomate of the American
Board of Oral and Maxillofacial Pathology, and he con-
ducts research, publishes, consults and teaches in this
capacity. Contact Dr. Sedghizadeh at 213-740-2704 or
sedghiza@usc.edu.
■ Samuel M. Strong, DDS, DICOI
Dr. Sam Strong received his den-
tal degree from Baylor College of
Dentistry. He has been involved
in implant prosthetics and teach-
ing since 1985. He is a member of
the American Academy of Fixed
Prosthodontics and International
Congress of Oral Implantologists
with Fellowship and Diplomate sta-
tus. He is also a Diplomate of the
American Board of Dental Sleep Medicine. Dr. Strong’s
patient education DVD, “Dental Implant and Alterna-
tive Options Featuring Informed Consent,” has been ac-
claimed as one of the most effective case presentation
tools available. Presently, Dr. Strong maintains a private
practice in Little Rock, Ark., and is an adjunct professor
at the University of Oklahoma College of Dentistry. He
is co-designer and co-developer of the Massad Edentu-
lous Impression Tray and the Strong-Massad DenPlant
Impression Tray. Contact him at 501-224-2333 or info@
strongdds.com.
■ Victor Rodriguez, CDT
VictorRodriguez,ManagerofRemov-
able Implants at Glidewell Labora-
tories, studied Dental Technology at
Orange Coast College and Southern
California College of Medical and
Dental Careers. In 1994, he achieved
certification in the Swissedent Tech-
nique and passed the national CDT
exam in the area of Full Dentures.
Victor spent most of his 25 years in
the industry as part of a restorative team focused on re-
construction, as the in-house technician for a group of
prosthodontists in Newport Beach, Calif. In 1995, Victor
received his Credential of Mastership in the Technology
section of the American Academy of Implant Prostho-
dontics. Victor served as component president for the
California Dental Laboratory Association (South Coun-
ties) from 1996-1998. Today, Victor is a member of the
Osseointegration Study Club of Southern California, as
well as the American Prosthodontic Society, lectures ex-
tensively on removable and fixed-removable prosthetics
from the laboratory perspective. Contact him at 800-
521-0576 or inclusivemagazine@glidewelldental.com.
■ Richard L. Seberg, DDS
Dr. Richard L. Seberg is a graduate
of the Nebraska School of Dentistry.
He entered the U.S. Navy Rotating
Internship in 1964 and served on
the USS Sperry from 1965-1967. Dr.
Seberg is a member of several pro-
fessional organizations, including
the American Dental Association,
the Orange County Dental Society,
the California Dental Association
and the American Academy of Osseointegration. He is a
Diplomate of the American Board of Implant Dentistry
and a Fellow in the American Academy of Implant Den-
tistry and the Academy of General Dentistry.
– Contributors – 5

8. Utilizing Digital Treatment Planning and Guided Surgery to
Restore Fully Edentulous Arches with the All-on-4 Technique
We now have access to technologies that
greatly enhance our abilities to restore our
patients with high precision in a shortened treatment time
utilizing a minimally invasive surgical procedure. This
case report will demonstrate several of these technolo-
gies. Utilizing Glidewell Laboratories’ Digital Treatment
Planning Services allowed me to easily integrate these
technologies into my practice.
There are several treatment planning software programs
on the market. These programs allow you to virtually plan
your cases utilizing CT scans. Scanning the patient with
an appliance that has the teeth to be replaced in the ideal
positions allows you to digitally plan the case from both
the surgical and prosthetic perspectives, making it a truly
restoratively-driven process. Because Nobel Biocare im-
plants were to be placed, the NobelGuide™
System (Nobel
Biocare; Yorba Linda, CA) was utilized for this case. The
case was planned following the All-on-4 technique.1-5
This
design involves tilting the distal implant on each side of
the arch distally in order to improve the anterior-posterior
spread and provide posterior support for the prosthesis.
Using stereolithography, a Surgical Template was pro-
duced to transfer the digital plan to the clinical setting.
An immediate screw-retained provisional restoration was
delivered at the time of surgery through a flapless proce-
dure.
This technology can be used to completely rehabilitate
a fully edentulous patient by placing the implants and
delivering maxillary and mandibular provisional restora-
tions in one appointment. These cases require meticulous
attention to detail and must be staged correctly. I had re-
stored more than 20 individual arches using the All-on-4
protocol prior to restoring both arches in one appoint-
ment. Working with Glidewell Laboratories and utilizing
the Digital Treatment Planning software allowed me to
make the major planning decisions pre-surgically.
by Irfan Atcha, DDS, DICOL, DADIA
– www.inclusivemagazine.com –6

9. Pre-surgical work-up and
digital treatment planning
The patient was a young male that had been
edentulous for some time. His chief desire was
to have a fixed restoration. Due to the amount
of ridge resorption, screw-retained dentures
were the restoration of choice.
Standard procedure was used to determine
the ideal positions of the teeth. Impressions
and bite blocks were used to fabricate and ar-
ticulate the study models. A wax try-in was
done to finalize the set-up.
Radiographic Guides were fabricated and the
patient was sent for a CT scan.The DICOM files
of the three scans (patient with Radiographic
Guides, then maxillary and mandiubular Ra-
diographic Guides alone) were uploaded and
sent along with my Digital Rx to Glidewell’s
Digital Treatment Planning Department.
Following a Web-based teleconference, the
plan was finalized. Due to the size of the im-
plants that could be placed and the patient
profile, six implants were planned in the max-
illa: four in the anterior and two angled dis-
tally paralleling the anterior walls of the max-
illary sinuses (Fig. 1-3).
The mandibular plan included four implants:
two in the lateral incisor regions and two an-
gled distally to improve the anterior-posterior
spread (Fig. 4,5).
Figure 3: The implant parallels the anterior wall of the sinus.
Figure 5: This is a view of the mandibular digital plan.Figure 4: The implant is angled distally to improve the A-P
spread.
Figure 2: A digital plan of the implants and Anchor Pins is cre-
ated.
Figure 1: A panoramic view of the planned implants is shown
in the scan.
– Utilizing Digital Treatment Planning and Guided Surgery to Restore Fully Edentulous Arches with the All-on-4 Technique – 7

10. Pre-surgical laboratory
procedures
Once the plans were approved, the Surgical
Templates were ordered from Nobel Biocare.
Master casts were fabricated from the Surgi-
cal Templates (Fig. 6) and articulated utilizing
duplicate dentures.
Provisional restorations were fabricated based
on the approved set-up (Fig. 7).
Jigs were fabricated to correctly reposition
each of the 30-degree Angled Multi-Unit Abut-
ments in the mouth. A Surgical Index was fab-
ricated to ensure accurate seating of the Surgi-
cal Templates (Fig. 8).
Surgical procedure
After obtaining adeqaute anesthesia, the Sur-
gical Templates were seated in the patient’s
mouth with the Surgical Index (Fig. 9). The
1.5 mm Twist Drill was used through the sleeves
for the Anchor Pins in both arches.
The Surgical Index and mandibular Surgical
Template were then carefully removed (Fig. 10).
Figure 6: Master casts are fabricated from the Surgical Tem-
plates.
Figure 7: Reinforced provisional restorations are fabricated.
Figure 8: A Surgical Index is fabricated.
Figure 10: The anchor pins are placed and the index removed.Figure 9: The Surgical Templates and Index are seated intraoral-
ly.
– www.inclusivemagazine.com –8

11. Figure 13: Healing Abutments maintain the soft tissue
opening.
Figure 12: The remainder of the implant sites is pre-
pared.
Figure 11: The first site is prepared and the implant placed. A
Template Abutment further secures the Surgical Template.
Figure 15: The osteotomies are prepared and the implants
placed.
Figure 14: The mandibular Surgical Template is reseated and
the Anchor Pins pressed into place.
The first maxillary implant was placed and a
Template Abutment used to lock it to the Sur-
gical Template (Fig. 11).
The second implant was placed in the #10 area
with a Template Abutment. Between the three
Anchor Pins and the two Template Abutments,
the Surgical Template is held securely in place
and the remaining oseotomies prepared (Fig.
12) and the implants threaded into place using
the Guided Implant Mounts.
Healing Abutments were threaded into the im-
plants to maintain the soft tissue opening dur-
ing the mandibular surgery (Fig. 13).
The mandibular Surgical Template was seated
and the Anchor Pins pressed into place (Fig.
14).
Standard NobelGuide procedure was followed
to create the osteotomies and place the im-
plants (Fig. 15).
– Utilizing Digital Treatment Planning and Guided Surgery to Restore Fully Edentulous Arches with the All-on-4 Technique – 9

12. Prosthetic delivery
The jigs were used to deliver the 30-degree
Angled Multi-Unit Abutments (Fig. 16,17).
The anterior implants were restored at the im-
plant level (no abutments).
The remaining Healing Abutments were re-
moved. The prostheses were delivered and the
prosthetic screws tightened (Fig. 18).
A post-operative radiograph was taken to ver-
ify complete seating (Fig. 19).
Adjustments were made and a bilateral bal-
anced occlusion was verified. The screw ac-
cess openings were then sealed (Fig. 20) and
post-operative instructions given.
Impressions for the final prosthesis will be
made in approximately six months (Fig. 21).
Figure 16: Jigs are used to correctly align the angled Multi-Unit
Abutments.
Figure 17: This is what the Multi-Unit Abutments look like in
place.
Figure 18: Prostheses are seated and the prosthetic screws
tightened.
Figure 20a: The screw access openings are sealed.Figure 19: A post-op radiograph verifies complete seating.
– www.inclusivemagazine.com –10

13. Conclusion
The All-on-4 technique in combination with digital treatment planning and guided surgery
has allowed us to take a patient with a severely atrophic ridge from a poorly fitting denture
to a fixed prosthesis in a precise manner with a shortened treatment time.
To earn Continuing Education credits on this topic, visit www.inclusivemagazine.com.
References
1. Malo P, MechEng MN, Rangert B. All-on-Four Immediate-Function Concept with Branemark System Implants for Completely
Edentulous Mandibles: A Retrospective Clinical Study. Clinical Implant Dentistry and Related Research, Vol. 5, Supplement 1;
2003.
2. Malo P, MechEng MN, Rangert B. All-on-Four Immediate-Function Concept with Branemark System Implants for Completely
Edentulous Maxillae: A 1-Year Retrospective Clinical Study. Clinical Implant Dentistry and Related Research, Vol. 7, Supplement
1; 2005.
3. Bellini CM, Romeo D, Galbusera F, Taschieri S, Raimondi MT, Zampelis A, Francetti L. Comparison of Tilted Versus Nontilted
Implant-Supported Prosthetic Designs for the Restoration of the Edentulous Mandible: A Biomechanical Study. The Interna-
tional Journal of Oral & Maxillofacial Implants, Vol. 24, Number 3; 2009.
4. Cruz M, Wassall T, Toledo EM, Paulo de Silva Ba L. Finite Element Stress Analysis of Dental Prostheses Supported by Straight
and Angled Implants. The International Journal of Oral & Maxillofacial Implants, Vol. 24, Number 3; 2009.
5. Bedrossian E, Sullivan RM, Malo P. Fixed Prosthetic Implant Restoration of the Edentulous Maxilla: A systematic Pretreatment
Evaluation Method. Journal of Oral and Maxillofacial Surgeons; 2008.
Figure 20b: Mandibular Access openings are sealed. Figure 21: The provisional restorations in place.
– Utilizing Digital Treatment Planning and Guided Surgery to Restore Fully Edentulous Arches with the All-on-4 Technique – 11

15. Screw-RetainedDenturewith
CAD/CAMFramework
The screw-retained denture, also known as the hybrid denture, has been the standard fixed-removable res-
toration for edentulous mandibles for more than 40 years. I used this prosthesis extensively 25 years ago.
However, after experiencing problems obtaining a passive fit accompanied by routine screw loosening and
fracture, I stopped providing it to my patients as a routine solution. It simply became too high-maintenance
and repair-intensive, creating frustration for both the patient and myself and hurting profitability. The intro-
duction of new technologies such as CAD/CAM fabrication of frameworks and bars has allowed me to re-
introduce the screw-retained denture back into my practice with confidence as a solution for the edentulous
patient.
by Ken Hebel, DDS, MS
Labwork by Victor Rodriguez, CDT
The patient, a 56-year-old female, presented with recurrent decay
around the crown margins of her mandibular teeth and a chronic in-
ability to successfully wear a partial lower denture, which compro-
mised her ability to function. She sought a long-term solution for her
mandibular dentition. The recommended treatment plan was to remove
her mandibular teeth and access the mandibular symphysis for place-
ment of implants to support a fixed, detachable prosthesis. All other
options were discussed with the patient as part of the informed consent
process.
The severe atrophy of the posterior areas precluded the placement of
posterior implants. The teeth were extracted. Implants were placed be-
tween the mental foramina and spaced according to the available bone.
Two of the implants were placed closer together due to bone anatomy.
An immediate denture was delivered. The intaglio surface of the den-
ture was relieved and soft tissue relined in the area over the implants.
ImplantPlacement
PreoperativeAppointment
Screw-Retained Denture with CAD/CAM Framework 13

16. FirstProstheticAppointment
Figure 3: The decision was made to place and restore the case at the abutment level for ease of access and
to avoid disturbing the soft tissues during the restoration process. Multi-Unit Abutments were
seated on the implants. The Abutment Screw was tightened to a torque of 35 Ncm with a manual
wrench.
Figure 4: The abutment collar heights were selected so the shoulder is supragingival. Once the abutments are
placed they will not be removed. All procedures are performed at the abutment level.
Figure 5: Multi-Unit Abutment Transfer Copings are threaded on top of the abutments in preparation for
preliminary impression. The cast made from this impression will be used to fabricate a verification
jig. This will allow a final impression to be made with verification occurring within the impression.
This step will be clarified as we move forward with the technique.
Figure 6: Impression material is injected around the copings, taking care to capture the copings accurately.
Figure 7: A stock tray is filled and seated.
Figure 8: Once set, the impression is removed from the patient’s mouth. The impression is inspected for voids
and proper border extensions. An impression of the opposing dentition should be made. If the
patient is happy with the mould of the existing denture, an impression of the patient’s mandibular
denture is taken to help the lab select the proper denture tooth mould.
Figure 3
Figure 6
Figure 4
Figure 7
Figure 5
Figure 8
– www.inclusivemagazine.com –14

17. Figure 9: The Transfer Copings are removed and replaced with Healing Caps. These caps will protect the tops
of the abutments between appointments. The patient’s existing denture is relieved so that it does
not ride on the Healing Caps. The denture is relined with tissue conditioner.
Laboratory
Figure 10: A soft tissue model is poured from the preliminary impression utilizing Abutment Analogs.
Figure 11: A bite block is fabricated. This consists of a base plate and a wax rim. Two Temporary Cylinders
are incorporated to provide stability while obtaining occlusal records.
Figure 12: Because all overdenture bars and screw-retained denture frameworks are fabricated utilizing CAD/
CAM technology, it is critical to obtain accurate impressions. The procedure Glidewell Laborato-
ries recommends involves “picking-up” an Implant Verification Jig (IVJ) in the final impression.
The lab fabricates the IVJ by tying Titanium Cylinders together with Triad material. A thin slice is
made between each cylinder. Each section is numbered on the model.
Figure 13: A custom tray is fabricated with openings to allow access to the tops of the Guide Pins.
SecondProstheticAppointment
Figure 14: The Healing Caps are removed, exposing the tops of the Multi-Unit Abutments.
Figure 9 Figure 10 Figure 11
Figure 12 Figure 13 Figure 14
Screw-Retained Denture with CAD/CAM Framework 15

18. Figure 15: The IVJ sections are seated in the mouth in the same positions as they were on the model. The
Guide Pins are hand-tightened. Ensure there is a thin space, about the thickness of a credit card,
between each section of the IVJ. If necessary, the sections can be trimmed with a disk.
Figure 16: The sections of the IVJ are luted together with a self-cured or light-cured resin material. The space
should be completely filled in order to ensure a solid connection.
Figure 17: The custom tray should tried in, making sure there is clearance around the IVJ. Border molding
can be done to ensure accurate border extensions.
Impression material should be injected around and under the IVJ. The custom tray is filled and
seated. Instruct the patient to lift their tongue and go through all border molding procedures as
you would for a denture impression. Uncover the heads of the Guide Pins.
Once the material has set, loosen the Guide Pins and pull the impression. The IVJ will be picked
up in the impression. Inspect the impression for accuracy.
Figure 18: The bite block is seated and the two prosthetic screws tightened, providing excellent stability.
The wax rim should be adjusted to the correct vertical dimension of occlusion and the midline
marked.
Figure 19: Bite registration material is injected onto the top of the bite block and the patient closed into
centric relation.
Figure 20: The bite block is removed and the Healing Caps replaced.
Figure 15
Figure 18
Figure 16
Figure 19
Figure 17
Figure 20
– www.inclusivemagazine.com –16

19. Laboratory
Figure 21: The master cast is fabricated from the final impression.
Figure 22: The models are articulated using the bite block and bite registration.
Figure 23: Denture teeth are set on the bite block with a bilateral balanced occlusal scheme.
ThirdProstheticAppointment
Figure 24: The trial set-up is seated and the two prosthetic screws hand-tightened.
Figure 25: VDO, CR, midline and esthetics are evaluated, and any necessary changes are made or noted on
the Rx. Final tooth position is always established before the fabrication of the substructure. The
substructure needs to be designed under the teeth for esthetics and support.
Figure 26: In this case a discrepancy was found in CR, so a new bite registration was made.
Figure 21 Figure 22 Figure 23
Figure 24 Figure 25 Figure 26
Screw-Retained Denture with CAD/CAM Framework 17

20. Laboratory
Figure 27: A functional remount was done using the new bite registration.
Figure 28: The teeth were adjusted to the new CR.
Figure 29: The lingualized bilateral balanced occlusion was checked and adjusted as needed.
Figure 30: A silicone putty index was made of the final set-up.
Figure 31: The soft tissue model and the set-up were optically scanned and the framework was virtually
designed.
Figure 32a: Once the CAD is completed, the framework is milled from a solid block of titanium.
Figure 32b: The framework is seated back on the model. Here you can see the precision fit of the framework
utilizing CAD/CAM technology.
Figure 33: The putty index is used to transfer the tooth set-up to the framework.
Figure 34a: The denture tooth set-up, on the framework in wax.
Figure 34b: An occlusal view shows the locations of the prosthetic screws.
Figure 27 Figure 28 Figure 29
Figure 30 Figure 31 Figure 32a
– www.inclusivemagazine.com –18

21. FourthProstheticAppointment
Figure 35: The Healing Caps are removed. The trial set-up is seated on the abutments.
Figure 36: The fit of the framework is evaluated. This can be done by tightening one screw and making sure
no lifting occurs on the opposite side. Remove the screw and repeat the process for each abut-
ment. Periapical radiographs should be taken if the interface is subgingival or cannot be easily
seen clinically.
Figure 37: In this case, the patient was very concerned about support for the lower lip. The anterior section
of the prosthesis was built up to “plump out” the lip. Here you can see the patient profile during
the try-in appointment.
Laboratory
Figure 38: The model with the prosthesis is placed in a hydrocolloid flask.
Figure 39: A hydrocolloid mold is fabricated.
Figure 40: The teeth are removed and the wax boiled off the model. Pink opaque is applied to the framework
to mask the gray color.
Figure 32b Figure 33 Figure 34a
Figure 34b Figure 35 Figure 36
Screw-Retained Denture with CAD/CAM Framework 19

22. Figure 41: The denture teeth are seated back into the hydrocolloid mold. Note diatoric holes have been
added to the base of the teeth for added retention.
Figure 42: The prosthesis is processed.
Figure 43a: The prosthesis is finished and polished.
Figure 43b: The occlusion is verified.
Figure 44: The screw access openings are checked to ensure there are no interferences for the prosthetic
screws.
Figure 45: In this case, the underside of the prosthesis is an ovate, high-water design to facilitate ease of
hygiene.
FifthProstheticAppointment:FinalDelivery
Figure 46: Delivery of the definitive prosthesis. The Healing Caps are removed, the abutment screws of the
Multi-Unit Abutments are retightened to 35 Ncm, the prosthesis is seated on the abutments and
the prosthetic screws tightened to 15 Ncm.
Figure 47: The occlusion is checked and adjusted as needed.
Figure 48: The heads of the prosthetic screws are covered with a cotton pellet and access opening sealed
with composite or acrylic.
Figure 37
Figure 40
Figure 38
Figure 41
Figure 39
Figure 42
– www.inclusivemagazine.com –20

23. Figure 43a
Figure 45
Figure 48
Figure 43b
Figure 46
Figure 49
Figure 44
Figure 47
Figure 50
Figure 49: Panoramic radiograph is taken to verify complete seating of the prosthesis.
Figure 50: The patient is given oral hygiene instructions and put on a recall schedule.
Conclusion
The use of CAD/CAM technology has allowed me to re-introduce the hybrid, or screw-retained, denture into
my practice. This case report illustrates how, working with an experienced lab, a severely resorbed edentu-
lous mandible can be restored in a very systematic, predictable manner with a fixed prosthesis.
Screw-Retained Denture with CAD/CAM Framework 21

24. Glidewell Laboratories offers three options for custom implant abutments under the Inclusive®
brand:
Titanium, Zirconia with Titanium Insert and All-Zirconia. We use your implant level impression and pro-
vide a tailor-made CAD/CAM solution that is fabricated to fit your patients’ individual needs. The margin and gingival
contours are designed to ensure ideal soft and hard tissue esthetics. The abutment height and the emergence profile are
precisely milled to facilitate gingival health and prosthetic support, resulting in a superior restoration.
■ The Inclusive Titanium Abutment provides strength and biocompatibility. It is primarily indicated to support posterior
restorations.
■ The Inclusive All-Zirconia Abutment provides superior esthetics without sacrificing durability and is ideal for anterior
restorations.
■ The Inclusive Zirconia with Titanium Insert Abutment is another esthetic option that maximizes
strength and is suited for anterior restorations.
♦ The All-Zirconia Abutment is available for the following implant systems:
• NobelReplace
• Biomet 3i Certain
• Zimmer Screw-Vent
♦ The Titanium and the Zirconia with Titanium Insert Abutments are available for:
• Noess
• NobelReplace
• NobelActive
• Branemark System RP
• Biomet 3i Certain
• Zimmer Screw-Vent
• Straumann Bone Level
RD Corner
MechanicalTestingof
Inclusive®
CustomAbutments
by Grant Bullis, RD Manager, Glidewell Laboratories
– www.inclusivemagazine.com –22

25. Zirconia with Titanium Insert Abutments include a metal insert and provide
a titanium-to-titanium abutment-implant interface. The insert is permanently
cemented to the zirconia section in the lab.
Inclusive Abutments are designed utilizing CAD/CAM technology and milled
from precision-machined blanks. Extensive testing is performed, and high-
strength materials are utilized to provide a consistent, high-quality product.
Superior materials
The high strength of Inclusive Titanium Abutments begins with material se-
lection. The titanium abutments are precisely machined from ASTM grade 23
alloy titanium. Grade 23 titanium has a minimum yield strength of 760 MPa
before plastic deformation occurs compared to the 480 MPa minimum yield
strength of grade 4 commercially pure titanium used for many abutments. For
ceramic materials such as zirconia, flexural strength is used to measure the
strength of the material in bending. Inclusive All Zirconia Abutments are ma-
chined from high strength zirconia with a flexural strength of 1500 MPa.
Glidewell Laboratories uses titanium abutment blanks that are manufactured
on Swiss-style CNC automatic lathes utilized throughout the implant industry.
The zirconia abutment blanks are manufactured on five-axis CNC mills. The
entire manufacturing process is tightly controlled, from material issue to final
inspection, to ensure quality and consistency.
Rigorous testing
Abutment-to-implant compatibility requires manufactur-
ing the prosthetic components to very close tolerances.
Further, the mechanical function and performance of the
abutment/implant assembly should be determined by
fatigue testing that approximates actual-use conditions.
Fatigue-strength testing based on the ISO 14801 protocol
was conducted on the implant/abutment assemblies to
determine fatigue strength. Fatigue-strength testing was
performed at an independent laboratory on both Titanium
and All Zirconia Inclusive Custom Abutments for every
implant system offered.
The fatigue strength is the maximum force that the as-
sembly can withstand after cyclical loading at a frequency
of 14Hz. Testing is typically done on the smallest, and
therefore the weakest, diameter implant. In this test, 3.5
mm (Narrow Platform) Inclusive Zirconia Abutments had a fatigue strength of 289 – 333 N after 5 million cycles. To put
it in perspective, the bite forces in the anterior region where zirconia would be primarily indicated have been reported
in the range of 109 to 299N.1,2
The clear choice
Inclusive Custom Abutments provide an array of benefits that ultimately lead to superior final restorations. A variety of
options including All Zirconia, Titanium and Zirconia with Titanium Insert allow you to work with a material that best
meets the needs of you and your patients. Mechanical testing results show that you can count on a dependable abut-
ment that maintains long-term prosthetic function.
1. Helkimo E, Carlsson GE, Helkimo M. Bite forces used during chewing of food. J Dent Res 1959;29:133–136.
2. Waltimo A, Könönen A. A novel bite force recorder and maximal isometric bite force values for healthy young adults. Scand J Dent Res 1993;1001:171–175.
Inclusive is a registered trademark of Glidewell Laboratories.
Mechanical Testing of Inclusive Custom Abutments 23

26. Screw-Retained
BruxZir®
Crown
The Screw-Retained BruxZir Crown pro-
vides a one-piece alternative to cement-
ed implant restorations. This restoration
combines the abutment and crown into
one solid restoration. The benefits in-
clude: no crown margin, and therefore
no concerns about excess cement; easy
retrievability; and because it is all zirco-
nia, there is no possibility of porcelain
fracturing off. Inclusive Custom Abut-
ments, as well as the Screw-Retained
BruxZir Crown, are compatible with the
following implant systems:
• Neoss • NobelReplace • NobelActive
• Biomet 3i Certain • Branemark System RP
• Straumann Bone Level • Zimmer Screw-Vent
by Richard L. Seberg, DDS, and Bradley C. Bockhorst, DMD
BruxZir®
Solid Zirconia
Crown and Inclusive®
Custom Titanium Abutment
Why should you be interested in the
monolithic concept of a solid zirconia
crown? As you know, when you fuse
porcelain to a metal or zirconia sub-
structure, there is always the possibil-
ity that the two layers could separate.
The best-case scenario is a small chip
of the porcelain that you might be able
to polish off. The worst-case scenario is
that the porcelain completely fractures,
exposing the substructure and requiring replacement.
A key benefit of monolithic restorations is that nothing can chip off, as
we don’t have two materials fused together. The restoration is made of
one homogeneous material. BruxZir is a full-contour zirconia restora-
tion with no porcelain veneer.
More brawn than beauty, the BruxZir Solid Zirconia crown has rap-
idly gained popularity for posterior restorations thanks to the preci-
sion milling of CAD/CAM technology. With the increasing price of gold
for porcelain-fused-to-metal restorations, the proven strength of zirco-
nia gives you a viable option for your posterior implant crowns and
bridges.
Inclusive®
Custom Titanium Abutments provide ideal support for the
restoration and the soft tissue. This CAD/CAM-designed abutment ex-
hibits a natural-looking emergence and provides strength and durabil-
ity. The laboratory virtually designs your abutment and mills a tailor-
made solution of the highest quality. Also available in the Inclusive line
of products is the Inclusive All-Zirconia Abutment and the Inclusive
Zirconia Abutment with Titanium Insert.
BruxZir and Inclusive are registered trademarks of Glidewell Laboratories.
Inclusive®
Titanium Abutment BruxZir®
Solid Zirconia Crown Screw-Retained BruxZir®
Crown Sealed screw access opening
Product Spotlight
– www.inclusivemagazine.com –24

28. My First Implant
As featured in the last issue of
Chairside®
magazine, “My First
Implant” showcases the selection, work-up
including digital treatment planning, and
placement of a single-tooth implant utiliz-
ing guided surgery. The restoration consisted
of an Inclusive®
Custom Titanium Abutment
(Glidewell Laboratories; Newport Beach, CA) and
a PFM crown.
Below is an excerpt from the article detail-
ing the experience of seating my first implant
case. You’ll find the complete article, a photo
essay, video of the procedure and more at
www.inclusivemagazine.com.
I’ve always known that patients would rather
stay in my office than be referred to another
office, but I was afraid to surgically place an
implant. Up to this point I had been restoring
implants for some time and had taken numer-
ous implant courses. However, when our im-
plant department convinced me that Digital
Treatment Planning technology would elimi-
nate the guesswork, I decided I was ready to
give it a try.
I can honestly say it was the most fun I have
had in a long time, and it was easier than al-
most any crown prep I’ve recently done. I wish
there was this much technology available to
walk me through molar endo, wisdom tooth
extractions or multiple-unit bridge preps.
With the patient anes-
thetized, we begin the
procedure by inserting
the Surgical Guide and
using the start drill. The
tip of the start drill creates a countersink in the bone, while the
upper part of the start drill acts as a tissue punch. Since no
grafting was necessary, no flap was utilized as part of the pro-
cedure. Note how the large diameter of this drill fills the sleeve
in the Surgical Guide.
A close-up view of the Surgical Guide on the model. It should
seat into place, much like an occlusal splint. The guide will have
some inspection windows from which cusp tips will stick out so
that you can verify that the guide is completely seated. The metal
sleeve in the Surgical Guide controls the angle and the depth of
the implant drills.
by Michael DiTolla, DDS, FAGD
– www.inclusivemagazine.com –26

29. Guided Surgery
with Grafting and Ridge Expansion
Guided Surgery and Grafting
FIGURE 1: After fabrication of a Radiographic Guide, the patient
has a CT scan taken and the case is virtually planned. Note: The
patient’s buccal defect can be seen in the cross-sectional slice. A
Surgical Template is fabricated based on the digital plan.
FIGURE 3: Next, the Surgical Template is seated.
FIGURE 2: At the time of surgery, a full thickness flap is re-
flected.
FIGURE 4: The drills are guided through the Surgical Template
to create the osteotomy.
ne of the most exciting recent advancements in implant dentistry is digital treatment planning and guided sur-
gery. In some cases ancillary procedures may be required. This photo essay showcases grafting and the use of
osteotomes in conjunction with guided surgery.
Here, you will see the step-by-step process, from planning the case to the final restoration.
O
by Richard L. Seberg, DDS
Guided Surgery with Grafting and Ridge Expansion 27

30. FIGURE 5: The implant is threaded into place. FIGURE 6: The buccal graft is placed and the flap closed.
FIGURE 7: Once the implant has had time to osseointegrate, an
implant level impression is made.
FIGURE 8: The model is scanned and an Inclusive®
Titanium
Custom Abutment is virtually designed.
FIGURE 9: An Inclusive®
Titanium Custom Abutment is deliv-
ered.
FIGURE 10: After adjustments are made, the PFM crown is
cemented into place.
Guided Surgery and Ridge Expansion
FIGURE 11: The patient’s old bridge is removed and the preps
are cleaned up. Note the typical saddle defect in the edentulous
area.
FIGURE 12: The patient had a CT scan, and the implant was
virtually planned. The SurgiGuide®
is fabricated based on the digi-
tal plan.
– www.inclusivemagazine.com –28

31. FIGURE 13: The SurgiGuide is seated and used to direct the
pilot drill.
FIGURE 14: Osteotomes are used to expand the ridge and
create the osteotomy.
FIGURE 15: The implant is threaded into place. FIGURE 16: An implant level impression is made.
FIGURE 17: Note the improved labial contour due to the ridge
expansion.
FIGURE 18: A BioTemps®
bridge is modified to seat over the
Healing Abutment during the osseointegration period.
FIGURE 19: An Inclusive All-Zirconia Custom Abutment is seat-
ed.
FIGURE 20: Individual Prismatik Clinical Zirconia™
crowns are
delivered.
BEFORE
AFTER
Prismatik Clinical Zirconia is a trademark of Glidewell Laboratories. Inclusive and BioTemps are a registered trademark of Glidewell
Laboratories. SurgiGuide is a registered trademark of Materialise.
To see two videos related to this article, go to www.inclusivemagazine.com.
Guided Surgery with Grafting and Ridge Expansion 29

32. A key to the success of any implant case, from the simplest to the most advanced, involves the team
concept in which the surgeon, restorative dentist and laboratory are all in sync. Here, we will outline a
practice concept in which the surgeon, working closely with the laboratory, can support his or her referral base through
a restoratively-driven approach. That support can be offered at various levels, from the traditional approach-to a hybrid
that includes immediate loading-to digital dentistry.
Utilizing technologies such as cone beam scanners with digital treatment planning and guided surgery allows the case
to be focused on the prosthetic side from the start, providing a more predictable end result. The surgeon can differenti-
ate himself or herself and provide superior treatment to the patient by incorporating this concept into daily practice.
The restorative dentist, no matter his or her level of experience, can benefit from working closely with the surgeon who
has incorporated this practice approach to achieve simple, esthetic solutions.
The first thing I think we need to discuss is: “What is the restorative-driven surgical practice?” Is there a definition, or
how is it applied. For me, the definition that I like is: It is a dentist, a specialist, a laboratory that uses a menu of services
to provide patients and referrals with their implant procedures. This menu will vary depending on your philosophy,
your understanding of the literature and your clinical experience.
With any menu, we need to think about our basic philosophy of implant dentistry. My menu has been shaped much by
my colleagues and mentors. The present philosophy I have on implant dentistry is that it is a laboratory procedure with
a surgical and a prosthetic component. It’s my belief that because in implant dentistry, for the most part we’re working
with prefabricated machine parts or CAD/CAM parts, that everything should fit, and we should not dedicate a lot of
chairtime to making things fit, when in fact the laboratory can get things to fit for us.
My experience in traveling across the United States is that depending on what group you’re talking to, they will tell you
that their part of implant dentistry is the most important. So if I’m talking to restorative dentists, they’ll tell you their part
is most important; if I’m talking to surgeons, they’ll tell you why what they have to do in placing implants is so critcal;
and finally, somebody has to make the teeth – dentists don’t make their own teeth, so to speak — so the laboratories
will be owning implant dentistry. We’ll discuss this further in the section on digital dentistry.
To see Dr. Duello’s complete lecture on the Restorative-Driven Practice, go to www.inclusivemagazine.com. You’ll also find a photo essay on this piece online.
The Restorative-Driven Surgical Practice■
by George V. Duello, DDS, MS
– www.inclusivemagazine.com –30

33. Recent advancements in Cone Beam (CBCT) scanners have resulted in much greater utilization of this
technology as a diagnostic and treatment planning tool. Three-dimensional imaging is rapidly becoming a
standard of care in dentistry. The online presentation by Dr. Parish Sedghizadeh includes:
❖ A brief introduction to conventional CT and CBCT scanning technology.
❖ An overview of the use of CBCT scans in various fields of dentistry
including diagnosis and treatment planning for implants.
❖ A brief refresher on common pathology, including osteonecrosis
of the jaw secondary to bisphosphonate use.
❖ A discussion on medical-legal liability and CT scans.
Conventional CT works in slices. Cone Beam CT, as the name implies, is a cone through the tissue. This volume is then
reconstructed into various slices such as axial, coronal and sagittal views. The software can also create a 3D rendering
of the anatomy. While both types of CTs are similar, the applications and uses for Cone Beam CT are better in dental
use, as you’ll see.
The applications of CBCT are increasing right now in dentistry, and pretty soon it’s going to become a standard of care
for radiology and for radiographic diagnosis – not just digital planning for implants, but for many disciplines.
The standard of care is shifting to Cone Beam CT, and it’s happening now. It’s not going to be a very long time before
in dentistry and dental-related procedures and treatment planning, it is the standard of care over any other imaging
studies. The reasons for that: The radiation from CBCT, in one volume, is very low. So if you just do one Cone Beam CT,
that’s your baseline imaging for anything you need for that patient. Right now we don’t do it because it’s not as sensi-
tive and specific for caries detection and periodontal disease detection. But that’s changing because oral radiologists are
on the cutting edge of research and fine-tuning this technology and the software associated with it to allow us to start
looking at things like caries and periodontal disease and pocketing, two dimensionally and three dimensionally with
these different slices. So it will become the standard of care in the very near future for probably any dental imaging
procedure that needs to be done.
To see Dr. Parish Sedghizadeh’s complete presentation, including specific examples of Cone Beam CT applications and detailed images, along with a discussion on
pathology and medical-legal liability, visit www.inclusivemagazine.com.
by Parish P. Sedghizadeh, DDS, MS
Cone Beam Computed Tomography:
Applications in Diagnostic Oral and Maxillofacial Radiology and Pathology
Cone Beam Computed Tomography: Applications in Diagnostic Oral and Maxillofacial Radiology and Pathology 31

34. Implant Removable Instructions for Use
Digital Treatment Planning Instructions for Use
Step-by-step guides for procedures used during the implant reconstruction are available
from Glidewell Laboratories. These informational pieces will guide you through the entire
process, from the initial appointment to delivery of the final prosthesis. In addition, these
guides will help you schedule appointments with your patients thanks to a list of laboratory
turnaround times. Go to www.glidewelldental.com to obtain copies, or call 800-839-9755.
Digital Treatment Planning and guided surgery are rapidly becoming a standard
of care in implantology. This technology allows you to plan implant cases from
both surgical and prosthetic perspectives in a 3-D environment. Glidewell Labo-
ratories can help you easily integrate this technology into your practice without
having to spend extensive time training on, or investing in, expensive software.
■ Locator®
Overdenture
Get information on restoring an edentulous arch with an overdenture and free-standing
attachments.
■ Locator Bar Overdenture
Instructions on restoring an edentulous arch with a CAD/CAM bar overdenture.
■ Screw-REtained Denture (Implant Level)
Find technical information on restoring an edentulous arch with a fixed prosthesis, di-
rectly to the implants. This piece features a CAD/CAM titanium framework with denture
teeth and pink acrylic.
■ Screw-Retained Denture (Abutment Level)
See step-by-step instructions on restoring an edentulous arch with a fixed prosthesis, on
abutments. Device features a CAD/CAM titanium framework with denture teeth and pink
acrylic.
■ Screw-Retained Denture (Glidewell Selects Abutments)
Get information on restoring an edentulous arch with a fixed prosthesis that features a CAD/CAM titanium framework
with denture teeth and pink acrylic. Impressions are taken at the implant level. The laboratory determines the abut-
ments, if necessary, based on the positions of the implant analogs in the model and the trial denture tooth set-up.
■ Premium Bar Hybrid
Restore an edentulous arch with a fixed prosthesis that features a CAD/CAM titanium framework with individual all-
ceramic crowns and pink composite to simulate the soft tissues.
■ NobelGuide™ Fully and partially Edentulous
These guides offer specific instructions on how to plan cases for fully and
partially edentulous patients. Get detailed information on Digital Treatment
Planning and Guided Surgery using the Nobel Biocare system.
■ SimPlant®
fully and Partially Edentulous
These convenient guides offer all you need to know about utilizing SimPlant on your fully and partially edentulous
patients. This system has an open architecture. Most implant systems available today can be planned with the Sim-
Plant software.
For a complete step-by-step guide detailing how to utilize Glidewell Laboratories’ Digital Treatment Planning Services, visit www.inclusivemagazine.com. Here, you can
download the full IFU for future reference on how to take advantage of this cutting-edge technology.
– www.inclusivemagazine.com –32

35. Beyond learning the techniques and procedures for successful completion of im-
plant prosthetics lays the problem of fee determination. This can be a thorny issue with many
clinicians unless a rational method for analysis of the case can be identified. In order to deter-
mine a fair fee for any implant case, we must first know our total costs involved to produce the
prosthesis. I suggest breaking down the total case cost figure into three components:
■ Lab costs ■ Implant component costs ■ Overhead costs
Learn how to calculate your costs and determine the fee you should be charging for these types of cases in a comprehensive article
available exclusively at inclusivemagazine.com.
by Samuel M. Strong, DDS
Fee Determination...
Fee Determination for Implant Cases 33

36. 994