Written by: Maggie Augustyn, DDS
In my 23 years of practice and my own evolution as a clinician, I have seen implant dentistry come a long way. When I first learned about implants in 2000, it was arguably the greatest innovation in dentistry thus far. And it still represents the most profound impact we can make as healers. However, 25 years later, we understand much more about implant placement and integration.
Digital dentistry, specifically the integration of a CBCT scan with an intraoral scan to produce a surgical guide, has enabled clinicians to plan the precise positioning of the implant required to support an ideal prosthetic outcome. We are no longer restoring implants based solely on bone quality and availability.
A tremendous amount of care can be taken to plan implant placement, with unique control from the clinician acting in the best interest of the patient. It only makes sense that the restoration be planned with equal input from said clinician. In the past, we could only see the final restoration when it arrived in our office, ready for delivery.
If an implant restoration needs to be remade, the patient is dismissed with a healing abutment or temporary, just as they presented. This is frustrating to everyone involved, resulting in a loss of an appointment, a loss of further production (ergo, profitability), and a decrease in patient confidence.
But what if we were to apply the same degree of digital planning and verification used in guided implant placement to the restorative phase of treatment? What if we were to push the boundaries of what is available to us as clinicians before the restoration is produced and ask for more? What if there were an opportunity for us to evaluate a proposed restoration in 360° rather than screenshots emailed by the lab?
That very technology is available—and it has spoiled me. Dandy Dental Lab has a revolutionary mission in its implant restoration workflow to collaborate with clinicians on the final restoration. It leads to less stress, reduced chair time, increased patient satisfaction, and elevated celebration for the clinician and their team.
Case Description
In the following case study, we move from an edentulous space to a final implant restoration, with all points digitally designed under the restorative clinician’s input and control. And because this is real life, we will encounter hiccups along the way—but they will be addressed in real time, without unnecessary stress, frustration, or additional appointments. This approach to implant restoration delivers a higher level of satisfaction for patients, clinicians, and the team.
Patient Presentation
The patient is a male in good general health who initially presented for treatment to our practice in August 2023. He was interested in fully restoring his oral health, including restoration of the edentulous space in his lower left jaw. Since his initial visit, the patient needed some other restorative services, which were completed prior to receiving implant treatment.
The patient was ready for implant placement in October 2025. The edentulous space was created due to a tooth that had fractured. As the patient remembers, he had an amalgam filling on tooth No. 19 from his childhood. The tooth had fractured at the gumline in 2014, and it was deemed nonrestorable. Immediately after the extraction, a bone graft was placed.
Almost 8 years had passed since the tooth extraction, during which the patient had been waiting to find the right doctor to take over his care, which was part of the reason the site hadn’t been restored. After building a relationship through multiple restorative visits and providing care for his family, the patient felt confident receiving implant treatment from my practice.
CBCT Analysis and Treatment Planning
To begin treatment planning, CBCT scans were taken along with an intraoral scan using the TRIOS 5 (3Shape) equipped with Dandy’s Chairside scanning software. The case was planned for implant placement based on restorative needs. The surgical guide was designed to ensure precise placement of the implant within the available bone, at a safe distance from vital patient anatomy, and in a position that allows the screw-access channel to exit through the central fossa of the implant crown (Figure 1).
Figure 1. Intraoral and CBCT scans were taken, and a restorative-driven digital treatment plan was created for guided surgical implant placement in the area of tooth No. 19.
Implant Placement
At the next appointment, a 4.2-mm x 10-mm Simply Iconic implant (Implant Direct) was placed. The final implant position met clinically acceptable metrics (Figure 2). The placed implant was finalized with a flat cover screw, and the site was then sutured. The patient was evaluated for healing over the subsequent months, which occurred within normal limits (Figure 3).
Figure 2. (a and b) CBCT scans illustrate the final placement of the implant compared to the initial plan.
Figure 3. Condition of the implant site at recall appointment 1-week post surgery.
Implant Uncovering and Intraoral Scans
The easiest way to plan and deliver the restoration is through the Dandy workflow. At no additional charge, the clinician can order the appropriate scan body in advance of the intraoral scanning appointment through the dental lab’s portal. The appropriate scan body for the case is either delivered to your practice or you are reminded that you already have the correct one.
The patient presented several months after implant placement for the uncovering. Because the implant was finalized with a cover screw, a small incision was made to gain access to the implant. The cover screw was removed, and the bone quality was evaluated. Because some bone had overgrown the implant platform, bone profiling was performed. Implant stability was assessed physically using reverse torque to 40 Ncm, with no movement observed. With enough space around the implant and the platform fully exposed, a scan was taken to communicate to the lab exactly where the tissue lies.
One option I had was to place a healing abutment, wait for healing to take place, and have the patient present for the scan 2 to 3 weeks later. I chose to forgo this because I believed the healing would occur in a fairly predictable manner, based on the distance between the soft tissue and the bone. Thus, the scan body was connected to the implant, a radiograph was taken to confirm complete seating, and the implant site was scanned. A healing abutment was inserted, and the surrounding tissue was sutured around it. The case was then submitted to the lab (Figures 4 to 7).
Figure 4. Patient presentation 3 months post-implant placement, ready for restoration.
Figures 5. The implant was exposed and evaluated prior to restoration, and an initial scan of the implant site was taken to capture the soft-tissue level. Then, the scan body was seated, and a radiograph was taken to confirm full seating.
Figure 6. The scan body, implant site, and lower arch were scanned to communicate the position of the implant and the anatomy of the implant site and surrounding teeth to the lab.
Figure 7. A healing abutment was attached to the implant, and the site was sutured.
Implant Restoration Design and Fabrication
The lab created the CAD design based on information submitted through the scanner’s Chairside ordering + Rx software, which thoroughly captures all details needed to design the case based on the patient’s anatomy, soft tissue, emergence profile, surrounding teeth, and other aspects captured in the scan, along with the doctor’s specifications for the restoration.
Within the Dandy digital workflow, you can choose from the following options when prescribing the restoration:
- Interactive, 360° Digital Design Preview
- Live review of the restoration design with the lab technician
- Video recording of the technician presenting the restoration design
In the implant case presented here, I chose to review a 3D Digital Design Preview, and also have the technician review the case for me via recorded video within the portal.
After viewing the video, I began examining both the restoration and the abutment in a 360° view via the Digital Design Preview. I could either review them together or take off the crown and just look at the abutment. I could also remove both the abutment and the crown to assess the soft tissue. Last, I could remove the model and examine the restoration alone. There is tremendous control in what you can view (Figures 8 and 9).
Figure 8. Screenshot of the Digital Design Preview video recording received from the lab technician who designed the implant restoration.
Figure 9. Full case design with upper and lower arches present using the Digital Design Preview tool (Dandy), which allows for close evaluation of the restoration design in 360°. This tool offers rotation and magnification from any view, evaluation of one arch at a time, stone model view, occlusal heat map, and a range of other interactive features.
When I’ve worked with other labs for restorations, their setups only allow me to preview static screenshots, and there is no time to review the design with the technician—if they offer such services at all. When it is done with other labs, it is via email communication at best, with many days sometimes passing between the request and information delivery.
With this software, after reviewing the proposed design, changes can be communicated to the technician via a call with screen share in the Chairside scanning portal. There is also an instant live chat option available. When communicating via the portal, there is an opportunity to easily draw on or near the restoration to indicate alterations or provide more detailed information.
Once the technician has made the design adjustments, the doctor is notified via email or phone that an updated Digital Design Preview is available. When you’re reviewing the recommended adjustments, you can pull up the restoration design before and after changes have been made for comparison.
I have found that collaborating with the technician is quite beneficial, because you have an opportunity to ask for their expertise and recommendations, right there in real time. Once you arrive at the restoration you’re 100% satisfied with, you click the approved button, and the restoration is sent to fabrication (Figures 10 and 11).
Figures 10. (an and b) Before and after of a Digital Design Preview, following a request to bulk out the abutment. The Digital Design Preview feature allows the clinician to live chat or participate in a live video collaboration with the lab technician to fine-tune the proposed restoration until completely satisfied with the design.
Figure 11. Final restoration design following collaboration with lab technician and minor alterations to the abutment.
Delivery of the Final Implant Restoration
About 1 to 2 weeks after the initial scan, depending on any requests made to the proposed design, you will receive the restoration in your office. A full-arch printed model with flexible gum tissue material is included at no additional charge.
The final restoration, consisting of a custom abutment with a pre-cemented crown that includes a screw access hole, was seated and immediately established a precise fit. A screw was threaded into place, and prior to final torquing, a radiograph was taken to confirm full seating. No interproximal, occlusal, or other adjustments were needed (Figures 12 to 15).
Figure 12. The screw-retained restoration, consisting of an implant crown cemented over a custom abutment in-lab, was provided to our practice on a full-arch model with soft tissue material, and the patient was recalled for final delivery.
Figure 13. After removing the healing abutment and evaluating the soft tissue and implant platform, the restoration was tried in, confirming accurate occlusion, interproximal contacts and emergence profile.
Figure 14. Restoration delivered with access opening sealed with plumber’s tape and composite.
Figures 15. (a to c) Scans from the planned restoration overlaid with a scan of the delivered restoration, showing precise alignment between each phase of treatment.
The patient immediately wanted to see the restoration, and after viewing it, was thrilled. He even took a photo with his own phone to celebrate.
It is important to note that, unlike other labs I have worked with, Dandy charges a single cost for the restoration, which includes the milled titanium custom abutment and zirconia crown (or material of your choice). In addition, when you partner with Dandy, you also get a free scanner and a free scan body for every case. And importantly, you can provide real-time feedback on the restoration design.
One last thing to note. As mentioned above, the decision was made to proceed directly to scan-and-restore fabrication rather than wait for the tissue to shape around the healing abutment we placed after uncovering the implant. That is not a decision that is made in every case. On the day of restoration delivery, there was a small space between the crown and soft tissue on the mesial-buccal of the crown. A week later, the tissue had filled in. The presence of bone in the final radiograph within 2 mm of the soft tissue makes it likely that the soft tissue will fill in to the cervical aspect of the restoration.
A Note About the Laboratory
Dandy was the first nationwide laboratory to offer free scanners to its clients. Several years ago, I was interested in moving away from analog impressions toward digital. I was also a small-business owner, attempting to grow my practice and my craft. We had been working with a consultant to become more profitable, which was another line in the budget. Our margins were tight. Dandy made it possible for me to enter the digital dentistry category at no cost. There was no risk. Even if I did not like it or decided to go back to analog dentistry, I could simply ship the scanner back. There would be no loan to worry about, no attempt at a resale.
Had it not been for Dandy, I never would have become passionate about digital dentistry. I would not have taken the time to learn and execute restorative-driven implant planning. I might not even have gotten a CBCT scanner, and later a mill. My relationship with Dandy was revolutionary for my evolution as a clinician. It allowed for risk-free entry into the digital space and paved a path for me that has been filled not just with promise—it has delivered on the satisfaction I longed for as a clinician.
CONCLUSION
What you have seen in this case has been the treatment of an edentulous space that illustrates the evolution of implant placement and restoration. And not just any implant placement and restoration, but one that was planned and executed with function and the restorative outcome front of mind, meticulously designed to eliminate potential complications and reduce chair time. You’ve seen the one-of-a-kind collaboration between clinician and laboratory, made possible by innovations in scanning technology, and the opportunity to co-create and design restorations in partnership with the lab, reach their full potential.
ABOUT THE AUTHOR
Dr. Augustyn is a Dawson-trained practicing general dentist, the owner of Happy Tooth, an award-winning author, and an inspirational speaker. She earned her DDS from the University of Illinois at Chicago (UIC). She is a Fellow of the Academy of General Dentistry, the Internaional Congress of Oral Implantologists, the American Academy of Implant Prosthodontists, and the International Academy of Dental and Facial Esthetics. She is also been newly elected as a Fellow in the American College of Dentists. Dr. Maggie is a national spokesperson for the Academy of General Dentistry. She has been named one of Dentistry Today’s Leaders in CE for 3 years in a row. Augustyn reads, researches, writes, and speaks on the things that make us human, that make us hurt and that make us come alive. She has published over 100 articles and takes the greatest pride in her role as a columnist for Dentistry Today, publishing monthly in “Mindful Moments” online. She has been featured on various podcasts and is a sought-after speaker, bringing attention to the importance of authenticity and self-discovery. She can be reached via email at [email protected].
Disclosure: Dr. Augustyn is a key opinion leader for Dandy.
