One of the newest trends we currently see in the market is conversations about grammetry and its uses. Grammetry is a process whereby the location of each implant is identified as they relate to one another. The reason this is so critically important, especially in All-on-X cases, is the need for passivity. Meaning the implant-supported prosthetic must fit passively over each implant interphase and should not affect the others adversely. This is a practice we perform with a verification jig to ensure passivity and correct lab analog placement. Oftentimes, if this is not adhered to well, it could mean the difference between a successful outcome and a failure. Research has shown that scanning cross-arch loses accuracy in the progression from one side of the arch to the next. Therefore, using only an intraoral scan to restore these types of prosthetics is not prudent; it could produce an ill-fitting implant supported prosthetic that is not passive and may jeopardize the success of the case.
There are several manufacturers who have looked at this process and offer solutions. Some manufacturers have external cameras to capture the locations of each implant in concert, called photogrammetry. Recently we have also seen the integration of photogrammetry in intraoral scanners, and even direct integration into the CAD software for an automatic alignment, while another approach is a hybrid offering of analog clinical verification with a digital laboratory integration.
All these solutions provide for great outcomes that are repeatable and consistent, but they should be aligned with the comfort level of the clinician. Some clinicians feel more confident being "wet-fingered" dentists-they prefer the tactile feel of screwing down an implant and may not be comfortable with the virtual alignment process of photogrammetry. Laboratories should become familiar with other solutions beyond photogrammetry to gain the same passivity in the most predictable and consistent way so that we can all achieve the best outcome for the patient.
It is important for every laboratory owner and manager to become abreast of the needs of the market and their clientele, the solutions that are offered for those needs, and how to incorporate those into their dental laboratories so that they can deliver the highest level of excellence to their dentist clients and their patients.
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