Establish VDO in Less Than Half the Time in Full Arch Implant Cases Using a Novel Scan Body with Bite Screws

You will be amazed at how it can enhance your practice to quickly set the vertical dimension of occlusion in the same clinical visit and to obtain an accurate full arch implant scan. Welcome everyone to the Phil Klein Dental Podcast Show. You just heard a clip of what's coming up today, as we'll be discussing an innovative and time-saving technique, and I might add it's quite simple, to establish the patient's VDO when doing an all-on-four or all-on-six implant case. Our guest is Dr. Philippe Nuytens, a prosthodontist in Flanders, Belgium. He is currently finishing his PhD at the University of Ghent on virtual prosthetic workflow in the edentulous jaw with multiple implants. He is the inventor of the ScanBody Pillar concept for digital maxillomandibular recording and transfer of intraoral and extraoral data for full-arch implant rehab. He holds several patents. He's a member of the Digital Dentistry Society, and he has published several articles in international journals that are shaping modern dentistry. Dr. Nuytens, thank you for joining our show. Thank you so much for having me, Phil. Yeah, my pleasure. We're very happy to have you on and thank you for your incredible webinar that you gave. And for those of you who missed it, it's really worth seeing. And it talks about a very interesting technique in the transfer of the occlusal record for cases that are complex where there's no teeth, for instance, all on four or all on six. And it's really a fantastic webinar. And you can find it on VivaLearning.com. Just look up Dr. Nuytens. It's spelled N-U-Y-T-E-N -S. And just put that in the search bar on VivaLearning.com and you'll find that webinar. It was really, really well done. So when you're planning and performing a full arch implant rehabilitation, Dr. Nuytens, one of the challenges that we all face is not so much measuring the VDO before we start, but accurately. transferring this occlusal record into the final prosthetic results. And our goal, of course, is to make sure the patient is not only functional, but also comfortable with their occlusion once that prosthesis is delivered. And as a dentist, you're one that has quite a few under your belt on the all-on four and the all-on six. And I think subconsciously as an entrepreneur and an inventor type person, you continue to think about this. And one day you were at a restaurant or somewhere and a table, you were sitting at a table and that table had a rock in it. It was just kind of rocking back and forth, which is obviously very annoying to all of us. We all hate that. To solve this issue, we typically put some paper or cardboard under the end of one of the legs on the table to stabilize it against the floor. And this sparked off a brilliant idea in your mind. that led you to your invention of the scan body pillar concept. And a lot of times that's the way inventions start. It's a very simple concept that you just notice something in real life and apply it to what you do for a living. So if you would, tell us about this whole idea and how this came about. And not only has your invention simplified the transfer of the occlusal record into the digital workflow, but also it saves the dentist and patient an enormous amount of time. So please tell us all about this. Thank you, Phil, for this very interesting question. The idea actually came to me while actually I was sitting at one of my favorite restaurants. You know how sometimes you sit down and the table wobbles a bit. Naturally, you check the legs and maybe adjust a small screw to level it out. That's when it hit me. Why not apply the same concept to implant scan bodies? So I came up with a simple technique using adjustable screws to align the scan bodies with the opposing arch, like you saw in the webinar, kind of like leveling a table. It was straightforward solution that really helped me fine tune this process. And to be honest, Once I had this idea in mind, and you all know it, it took me a few years to find the right company that could help me manufacture and market this ScanBody system. Funny enough, I actually came across Dynamic Abutment Solutions while I was searching for help with a particularly tricky implant case. It was one of those moments where things just aligned perfectly they loved my ideas and really believed in what i was trying to achieve i named the new system like you told me uh here in this nice introduction the complete arch pillar system or a caps for short what makes it unique is that it combines both lateral and occlusal pillars in the same system what sets the pillar concept apart is its ability to enhance a workflow significantly for prosthodontists, surgeons, general dentists. In various articles I've published in leading US journals like the Journal of Prosthodontics and the Journal of Prosthetic Dentistry, I emphasize how integrating pillars with scan bodies can streamline our processes and ultimately save time in practice. Before you get into the details of your invention, Dr. Nuytens, tell us the typical way we transfer the information into the digital workflow in an edentulous situation because we're using wax and we're using bite registration material. And that's how typically we do that. So if you would talk about that first and tell us what we're trying to achieve with the traditional method, the analog method. and then get it into the digital workflow, everybody will see how really innovative your idea is. And now it's commercialized and it's actually available. Okay, that's correct, Phil. So let's explain how we do it in an analog, conventional way. Normally, to set the vertical dimension of occlusion for patients with an edentulous arch and multiple implants, you use... rims or you use wax or you use moldable materials or you even use a wax rim screwed onto your implants and then you set your video your centric relation your maximal occlusion and you need an extra clinical visit so actually I came across that idea I thought about it like the adjustable table legs and what I did I called someone and I asked him can you adjust the height of a scan body and can you adjust the intracordinal so the screw hole of your scan body with a thread in which you can add a screw an additional screw which is my first invention the occlusal pillar and then you can turn it in and out so you can set intra-orderly your vertical dimension so you don't need wax anymore you don't need a bite rim so you can you can do it Right in your first visit of your digital impression in the full arch. And of course, today, implant scan bodies are widely recognized in dentistry. And the scan devices had gained the accuracy. Because actually, back in 2012, I started working on some of my first drawings for a new implant scan body. Designed specifically for full arch implant cases. Basically for fixed implants. restorations the challenge back then and we are talking about 12 years ago was that full arch cases weren't being done with intraoral scanners yet In both Europe and U.S., only a handful of experimental projects were even trying to take full-arch digital impressions. So at that moment, at that table, in that restaurant, it was 2012. So I had the idea, but the technology was not ready. You need the scan bodies to have that platform screwed into it. That was the challenge. So the difference in the configuration of the scan body versus a typical scan body. when you're doing a digital scan of an all-on-four, all-on-six case, these scan bodies have a hole in it on the occlusal surface of it, right, that is threaded. Yes. And a screw goes in there, which is an adjustable screw with a little platform. And it's almost exactly like the chair, a chair that has one of those things, you know, screwed into the bottom of the leg. That's it. First of all, you have to learn how to work on multi-unit platform because I wrote a lot of articles since 2012 and all prosthodontists say that a multi-unit platform is the key to work on full arch because you settle your gingival level right. And at that moment, I had the idea about adjusting the height. So you need... a zero point. So actually, when you start on your all-on four, all-on six, you have to mount your multi-unit abutments. And that's why I contacted a company in which they produce, they fabricate very nice multi-unit abutments for over 500 implant brands. And they are now working with me. And it's actually one of the keys. And the second key... besides the working on the multi-unit platform is that you have to adapt the height of a scambody because most scambodies are 10 millimeter that's too high because i measured 1500 screw holes on definitive restorations inside the from coronal to the the screw and i had a variation between um six and and 14 so the the 10 is in between so i had to change my scambody to seven and then into that scambody of seven on the multi-unit platform you can add a bite screw i call it bite screw now i call it occlusal pillar and that's the whole idea so when you start with your patients the only consideration you have to make is actually that you have to place your implants perpendicular to your antagonists. That's one of the keys you have to say to your surgeon, because that's very important. In my Viva Learning webinar, I showcase clinical situation demonstrating this technique in action. So you can watch it very well there. So for a second, Dr. Nuytens, let's pivot over to the patient. When you're establishing their video and you want their feedback, typically with the wax and the bite registration material, the patient is somewhat stressed and that affects obviously the results of what a relaxed, comfortable occlusion really is. But with your technique, and you covered this a little bit in the webinar, the patient is much more relaxed during this process, which is very important and certainly should not be discounted by any means when it comes to establishing the VDO. So tell us about that and why that's important and the difference between the results you're getting from when you used to use wax and bite registration material versus the CAP system. So that's a very good question, Phil. Actually, a bite registration is one of the most difficult things you have to perform during your full arch. And actually, I gave courses to students and every time I see students doing the bite registration, I feel the stress in the room. And at one moment... I was thinking, why not saying to my patient during my novel technique of the occlusal pillars with the prototypes, come, come, don't sit on the clinical chair. Don't sit there. No, no, no. Come to me. Look, the birds outside. Look there. And now you bite. And I take my scanner and I take my bite. And I have the best bites ever because my patient is relaxed. What is bite registration? Do you have to record the bite in a stressful situation? Or do you want to record the bite just with someone comfortable who wants to have these prostheses for their whole life? And actually, you have to record something comfortable. So I say to my patient with my bite screws, and I don't need anything. I just have my toolbox with me. I created myself the toolbox so I can say to the patient, relax, come to me, look to the birds outside. Look, look, look. Correct me if I'm wrong because I'm an endodontist, so I'm far from a prosthodontist. But with your technique, you can micro-adjust these platforms multiple times and have the patient, you could spend more time on establishing the VDO before going further into the digital workflow by having this opportunity to keep micro-optimizing these platforms. It's clear and logical. So when you start with the tools, you will see what you have to do. Actually, first you take your impression antagonist and then you take your implant scan. But when you focus on this technique of the occlusal adjustment of the vertical dimension of occlusion, then at the beginning, when you see your patient at the intake and you did not... the extractions you did not install the implants you can measure the video and you can say to the patient are you comfortable or not comfortable and you can as your clinical measurement will tell you that the video you have to augment the video for instance for one or two millimeter okay you write down and then the patient comes back i don't take any Further notes, I just need this and I take my natural references, which are the ala of the nose and the vermilion of the lower lip. You can watch this very well in the webinar. And then I just take natural references and I set the video for when the surgery is done. Patient comes, I set the video extra oral. I adjust, adjust, adjust, occlusal pilar, walk, look to the birds, come to me. and check and that's just something you actually we go back in dentistry with this technique it's actually a technique it goes way back because now we have developed our digital dentistry our digital implant dentistry our guides but we did not create simplicity We just made superimposing again and again and again with Exocut dental wings and everything. And look to my bridge, look to my guides, look to my pin constructions with my guides and everything on. But they forgot the general dentist. They want to make full arch bridges. Yeah, well, it's the same concept with anything. When you're moving to a new way of doing things, in this case, digital. When you're not thinking out of the box, you're taking the same methodology and you just make it into a digital workflow. Whereas what you did was you started that way and then said, since we have all these digital tools at our fingertips, why is the methodology not changing? So by doing your system, you're changing the whole concept of doing byte registration and transferring the occlusal record into the digital workflow in a much simpler way. How much time are you actually... the dentist doing this method. Talk about that. Actually, when you want to know this, you can read my first study of, I think it was in 2021, for the Journal of Clinical Medicine. It was a gain of 60% because we treated like, I think, 15%. on the analog protocol and we treated uh 15 patients with the digital protocol we recorded the analog the analog registration and we recorded my byte screw protocol and we came with a fantastic conclusion it was 60 percent time gain and not not this but also because we performed in the single visit So you don't need another visit. I can fabricate the first restoration in 40 minutes, 40 minutes. And then we have one restoration, full arch, temporary, and then we go further. So you did touch on this earlier, Dr. Nuytens, but just to reiterate, the complete arch pillar system that you developed is compatible with almost every implant system that's out there. Absolutely, Phil. work with over 500 implant brands. That includes major names like Stroma, Noble Biocare, Zimmer Biomet, Dansply Sirona and Ostem and many more. So if you're able to place dynamic abutment solutions multi-unit on your implant, you're all set to get started with the CAPS system. We also made an effort to manufacture the CAPS system specifically for the noble biocare dance play and stroman multi-unit platforms so their platforms as we recognized that these are the major the leading brands commonly used by dentists in their every everyday practice this focus uh allows us uh to more effectively address the needs of uh dental professionals in both europe and the us but The company has designed its multi-unit system also to be compatible with more than 500 implant connections. This means that there is a wide variety of options available for dentists to choose from. So having such a broad selection makes the system flexible and very adaptable, allowing clinicians to find the right fit for their specific needs and actually the real benefits. When you start using it, as I said in my webinar, Phil, it's just a tool. You understand what I was saying? It's just a tool. So feel free to play and experiment with it. You will be amazed at how it can enhance your daily practice to quickly set the vertical dimension of occlusion in the same clinical visit and to obtain an accurate full arch implant scan. And if you face any challenges, Don't hesitate, of course, to reach out. You can find my contact information in the Viva Learning webinar. Yeah, we'll put it in the description of this podcast. Thank you. Yeah, for sure. So my last question is, what about the training? There's a learning curve to everything, and dental practitioners are really very set in their ways, those that are doing surgical implants, those that are doing more complex cases like you are. What's the learning curve for the CAP system? Once you complete your first full arch case with this system, you will be amazed at how quickly the workflow just clicks into place. If you've got a solid background in prosthodontics and you're good with internal scanning, you'll find yourself handling full arch cases using this new system. It's actually quite simple to learn since the process is very clear and logical. The most important aspect, as I told in this podcast, is that this system, this new system, is comfortable working with multi-unit abutments. That's the best way to master this system. Once the multi-unit abutments are in place, you are ready to scan. Okay. So most prosthodontists or general dentists are aware of how much more efficient a multi-unit platform is. Plus it's definitely more comfortable than handling the bone level implant connections. So I always try to share as many guidelines and cases as possible to explain these techniques I use in daily practice. So actually it's easy. And I'm not the kind of dentist who only highlights the perfect cases. I believe in sharing the whole journey, including the challenges and learning experiences along my way. So it's quite easy. Yes, it's an easy system. By the way, Dr. Nuytens is in Belgium. He's in the evening over there. And I'm in the morning here in Austin, Texas. So hats off to technology, which we can never take for granted that we can have this conversation. uh, thousands of miles away. But I do want to reiterate, um, the webinar that he did, which was really fabulous. It's titled complete arch implant restoration with intro oral scanner. And check that out again on viva learning.com. He goes through case by case. He explains the principles behind everything he's doing. And I think anybody who's doing multi-implant cases would certainly benefit from. from seeing this webinar. And again, for more information on the actual CAPS system, you can check out Dynamic Abutment Solutions. Just look them up online, Dynamic Abutment Solutions. Dr. Nuytens, thank you so much for joining our show tonight. We look forward to having you on more podcasts. Thank you so much. It's really my pleasure. It was fun. Thank you.