CBCT Dental Implant Virtual Planning & Guided Surgery Blog!

The Premier Blog to Share Information on Dental CBCT, Virtual Dental Implant Planning & Guided Surgery!

Thursday, October 13, 2016

Dental-XP Cleveland - Site Development/Socket Preservation Course - Price Lowered

What a fantastic opportunity to train with a master!   Price lowered from $2K - $750

Please join Dental XP, LOCAL opportunity to learn under one of the leaders of our time.  Dr. Maurice Salama of Team Atlanta and Dental XP fame will be presenting on extraction site management, bone grafting, and esthetic outcomes.  By introducing atraumatic extraction techniques and the preservation of bone through straight forward grafting, this hands-on course will benefit your practice whether or not you place implants.

Held October 28-29 at the Renaissance Cleveland, the course offers 12 CEs.  Please visit http://www.dentalxp.com/ContinuingEducationCourse.aspx?a=335 orDentalXP.com for complete details and to register for the course.

Look forward to seeing you at his wonderful event!

Michael and Matt
Michael H. Morgan, DDS, MS
Matthew J. Lemke, DDS, MS

Course Description:
Implant site preservation and development is the concept of maintaining the volume and architecture of both the soft and hard tissues. It is critical to minimize tissue loss during extraction to conserve the natural ridge form and architecture for future implant placement.

Tissues should be preserved and maintained in their original forms as much as possible from the time of tooth extraction to the placement of restoration. This concept is crucial to ensure tissue healing, patient comfort, esthetics and functionality of the final implant restoration.

This course will highlight several techniques that facilitate a more esthetic, functional and predictable result in implant dentistry, starting with extraction. Discussion will focus on some of the most commonly asked questions in implant dentistry, such as should grafting be performed after tooth extraction? Which is the best graft materials to use? What type of interim provisional restorations to use in order to minimize tissue loss? What is the current research and what diagnostic tools lead to the correct decisions regarding immediate implant placement versus delayed implant placement.

This course is designed for any clinician managing extraction sites and who place implants implants and is the first in our series on implant site development and essential bone grafting. The hands-on portion will focus on minimally invasive extraction and grafting techniques as well as immediate implant placement. Participants will practice on models.

• Understand the most recent research and literature on Extraction Sites
• Know minimally invasive tooth removal techniques and instrumentation
• Remove broken and difficult teeth with minimal flap
• Various incision and flap designs for optimal end results
• Be able to describe the role of socket grafting 
• Literature and indications for grafting
• What to look for in choosing a graft material
• Membranes; The pros and cons
• Techniques for optimal healing and ridge form
• Know how to evaluate different graft materials
• Know how best to manage extraction sites with facial bony defects - "socket repair"
• Learn how to manage the post-extraction sites in order to minimize ridge contour loss
• Understand the concept of Restoration-Driven Tissue Regeneration (RDTR)
• Understand the pros and cons of immediate versus delayed implant placement
• Be able to describe minimally invasive bone grafting techniques for the compromised implant site
• Learn when to Flap and when you can perform Incisionless treatment

• Learn how to properly place and guide implants into the extraction site for ideal results

Friday, March 11, 2016

Direct Cut Drills - One Drill = One Osteotomy from One Surgical Guide

Are you familiar with Direct Cut drills? This single-drill option has increased in popularity. BlueSkyBio has designed a drill that creates the osteotomy site for the final twist drill. Direct Cut is intended for BlueSky implants, and when combined with a SureGuide is an efficient placement tool.

Tuesday, February 23, 2016

Where to Begin with Guided Surgery - Our Decision Tree

When you or your staff is questioning what to send  to ROE to begin a guided case, please visit the guided surgery page on our web site and click “Where to begin”. This click-through, interactive page breaks down the types of possible cases and the protocol to guidance in a straightforward manner.

Fully Guided Options

If fully guided from the implant manufacturer is not yet in your armamentarium, here are some great options:

Sleeve-in-sleeve is also available. This is a low-cost option that is simple to integrate. The reusable sleeves inserts are only $15 each, and are available for all implants. 

Also, for many non-fully guided systems, we can simply add a raised resin collar above the implant sleeve for your drill to ‘bottom-out’. 

We can supply our individual spoons, which are guide inserts with handles that fit into the master guide tubes.

And, are you familiar with Direct Cut drills? This single-drill option has increased in popularity. BlueSkyBio has designed a drill that creates the osteotomy site for the final twist drill. Direct Cut is intended for BlueSky implants, and when combined with a SureGuide is an efficient placement tool.

SureGuides Fully Guided Compatibility

ROE is compatible with 19 fully-guided systems:

3i Tapered Navigator
3i Parallel Navigator
Ankylos Expert Ease
Astra (Simplant only)
Astra EV (Simplant only)
Bluesky Direct Cut Protocol
Implant Direct
Materialise Universal (AKA Simplant Universal)
OCO Biomedical
Verban Drill Stops (regular 5.0, CEREC 3 sizes, etc)

Thursday, February 11, 2016

CombiGuide IP - The Digital All-On-4, 5, 6, 7 +

Coming soon to your office - CombiGuide IP 

This product fundamentally changes the full-mouth implant surgery in an immediate protocol. From conventional records, and a CT scan, ROE creates a virtual surgery intended to predictably deliver implants and teeth in one pre-planned day. CombiGuide IP is Beta and will be available soon.

Thursday, October 15, 2015

Expertly Crafted PMMA Implant Provisional

PMMA Prototype for immediate surgery! This beautifully crafted provisional is combined with our new BETA CombiGuide IP, a CT based surgical guide that delivers implants and the prosthesis.

Thursday, July 30, 2015

Straumann Pro Arch - Immediate Load for Edentulous Patients

 All-On-4 Page - Click Pro Arch under Documents

ROE supports Straumann Pro Arch restorative protocols. We can assist with surgical guides when needed, immediate provisional denture, chairside support in Ohio, and final restoration. Let us know how we can help.

about Pro Arch: The new Straumann Pro Arch for screw-retained hybrid restorations combines several treatment steps which reduce complexity without compromising the outcome. From planning and implant placement to the final restoration, the entire treatment is seamless for the patient.




Has successfully completed the Implant Studio™ Ready Program

As a long-term 3Shape partner, ROE is very excited to add Implant Studio to our armamentarium. Implant Studio is a bridge from 3Shape restorative designs to implant guides surgical guudies. We offer training, guide sleeves, and surgical guides. 

about ROEROE is a full service dental laboratory that has been offering CT-based surgical guides since 2004, and building long-term partnerships with dentists for more than 80 years. Our team of highly trained and experienced technicians is dedicated to providing the quality and service necessary to maximize patient satisfaction and minimize chairtime. Our goal is to provide functional and aesthetic restorations indistinguishable from natural dentition. We are proud to be a valuable member of the dental team.   Please explore our new web site and contact us to discuss any of our services. We are here to serve you.

about 3Shape Implant StudioDesign esthetic and correctly placed crowns. Based on the crowns’ position, virtually place the corresponding implant while accounting for the clinical situation including bone density, and nerve positions. Optimal clinical results are achieved by iteratively updating the combination of teeth, implant and drill guide.

Friday, July 10, 2015

CombiGuide - All-On-4 Bone Reduction and Osteotemy Guide

Today, many All-On-4 (or 5 or 6) cases include surgical guidance. ROE’s CombiGuideTM provides guidance for the bone reduction followed by a clip-in drill guide. CombiGuide comes with a full drill report for all major implant systems.

Simply upload your DICOM and we'll call you to meet on line.


RAPID Appliance - All-On-4 Restorative Made Easy

NEW RAPID Appliance – At the conversion appointment, thanks to the implementation of our exclusive, complimentary RAPID appliance, we help you help your referrals simplify the final treatment – and they will love you for it!

·      No final restorative implant-level impression – RAPID reline only
·      Eliminate appointments – no custom tray, bite rim, fit jig or prosthetic setup!
·      Increased accuracy – by eliminating steps that can cause errors
·      Significant increases in profitability will have your referrals excited about referring this treatment 

RAPID Appliance (ROE Advanced Prosthetic Implant Device) is a chairside, day-of-surgery appliance that you can offer as a competitive advantage over the traditional All-On-4 techniques. RAPID transfers the conversion denture information to the articulator for future prosthetic fabrication.  This means fewer restorative appointments, less variables, less chairtime for your referrals, and it is included at no additional charge with your first two cases. The only extra charge is the duplicate temporary cylinders. Moreover, this appliance should allow the restoring dentist to provide rapid steps toward the final restoration, even for our popular zirconia Prettau Bridge!

Wednesday, April 22, 2015

DAMAS - An FDA-Type Compliance Certifi cation

Since 2007, in the interest of our valued customers, their patients, and our organization, ROE has devoted thousands bof man-hours and a large financial commitment to become accredited by DAMAS. We are pleased to report that ROE recently joined the approximately .4% of dental laboratories in the United States to become DAMAS-certified!

You might ask, what is DAMAS and what does it mean for you, our customer? DAMAS stands for Dental Appliance Manufacturers Audit Scheme (DAMAS). It is an internationally recognized standard for quality that validates the materials and processes utilized to produce prosthetic devices. These standards closely mirror a strict protocol that follows the U.S. Food and Drug Administration’s Quality System/Good Manufacturing Practice (QS/GMP) specifications, which are required of all dental laboratories conducting business in the United States. DAMAS provides a clear-cut method for documenting every facet of laboratory operations, including dental prescriptions/work authorizations; patient contact materials; subcontractor/supplier agreements; material and equipment purchases; employee training; maintenance and calibration of equipment; labeling; customer complaints, and cleanliness. Due to the strict standards of DAMAS, only 30 of 6700 dental laboratory in the United States have achieved the DAMAS status and we are proud to be one of them. It is noteworthy that only 20 of these laboratories are, like ROE, independent.

The DAMAS certification ensures that the laboratory environment operates in such a way as to ensure product and patient safety. It provides a formula for improved documentation of many aspects of dental lab activity from dental prescriptions to material traceability. Celebrate this achievement with us. You can be proud to inform your patients that restorations produced by ROE are made under the strictest guidelines and that your laboratory is among an elite group. We hope our efforts provide comfort and peace-of-mind to your patients. With DAMAS we emphasize our commitment to excellence every day.

LabTrac - Keep Your Cases On Track

In our continuous efforts to provide superior restorations in a timely fashion, we invested in a magnificent new software platform; one that is more robust and user-friendly, and that allows our clients enhanced communication. Our new software is called Labtrac. Internally, Labtrac manages case-fl ow based upon the tasks involved, employee skill level, and volume of case load, and even allows our customers to have assigned technicians. With this sophisticated software, we now have the ability to micro-manage every aspect of your case to ensure that you and your patient receive exactly what is expected. With Labtrac’s web-based portal, customers can track the progress of cases, receive emails when cases are received, shipped, or on hold. Doctors can request pick-ups, print Rx’s for case-shipping and records, and upload information such as images, digital impressions, and DICOM

Digital Dentures - A Quantum Leap

Avadent Digital Denture
Leading the Way For more than 5 years, Avadent has offered a digital option for dentures. Its product is very impressive, and can be reviewed on our web site. If a patient has an existing denture, and it is time for an upgrade, you simply duplicate the denture chairside, capture a reline impression
and bite and send to ROE to be digitized. In 3 days you will receive a virtual preview, and in 2-3 weeks an amazing new denture. If you are within driving distance of ROE, you can capture the records using the existing denture and ask your patient, or our currier, to deliver the case to ROE for sameday scanning! We call this our 35-minute denture! Call us for more information.

Pala Digital Denture - A New Heraeus Product

Heraeus also offers a digital denture. Its system is more ideal for patients who do not have an existing denture. With Pala, the doctor selects one of four sized Gothic Arch Tracing devices, captures an impression, adjusts the device to record the vertical dimension, then is functionally manipulated to capture centric. Pala then uses science to map tooth location based upon the arch-form and other anatomical
features. The case can be returned for try-in, if desired, prior to fi nishing.

Did you Know? Submitted by Hobe & Lucas CPA’s Inc

The state of Ohio has been stepping up its efforts to collect more revenue! Taxes based on the “honor system”, like sales tax, are lucrative targets. Did you know that buying dental products such as implants, Invisalign, and other tangible property out-of-state does not protect you from paying Ohio sales tax? If out-of-state vendors are not charging sales tax, the purhasers are responsible for paying use tax to the state of Ohio. Recently, Ohio has audited vendors such as Straumann Implants and Invisalign and determined that they are not charging sales tax properly. During the audit process Ohio auditors have extracted names of vendors’ dentist customers, and consequently audited them as well. This has been quite a gold mine for Ohio when you factor in tax plus sizable interest and penalties. 

One other thing…unclaimed funds audits are picking up in Ohio. Does your dental practice have old accounts receivable credit balances or uncashed refund checks that are over 3 years old? In many cases, these must be remitted to Ohio. 

Honesty is the best policy – if you don’t have a usetax account, you probably should; if you aren’t remitting unclaimed funds, maybe you should be. Contact Hobe & Lucas CPA’s Inc. or your tax advisor, or go to: http://www.
tax.ohio.gov/sales_and_use.aspx and http://www.com.ohio. gov/unfd/HolderFaq.aspx for more information.

TLZ-SR - Compatibility for A Great Solution

TLZ-SR is an incredibly popular restoration for restoring single and multiple unit implant cases. As we mentioned in a previous newsletter, screw-retained has made a big comeback due to the absence of intraoral cementation, the low fee ($299), and the high quality. However, not all TLZSR cases are the same! If we do not have what’s called a Ti base, the stock component attached to the crown, then we must order a stock abutment from the manufacturer and raise the fee an additional $100-$180. When completing the work authorization request that we call to discuss pricing.

Check out our compatibility and implants that require special parts and fees: http://www.roedentallab.com/product_implant_options.html 

Scan Bodies - THE Way of the Future for Implant Impressions

If you own a digital impression system, Cerec and E4D included, scan bodies are a great alternative to conventional implant impressions. Scan bodies are digital impression posts that are thumb tightened
into the implant, scanned, and uploaded. ROE uses this scan to fabricate an analog-model for the restoration-of-choice. Visit the aforementioned implant web page to view availability by implant
brand and connection.

excellent page for checking your implant support options: http://www.roedentallab.com/product_implant_options.html 

Tuesday, January 27, 2015

ROE Adds Camlog, MegaGen and Hiossen Custom Abutments

Today custom abutments are more common than ever before. However, not all implant companies offer this necessary service in-house. ROE has a solution to this shortcoming, scan bodies. Scan bodies are customized digital impression posts that are primarily used in the laboratory. They are screwed into implant analogs and scanned into our software. Our technicians then customize and mill the abutments. This is now available for CamLog, MegaGen, and Hiossen implant lines. If you have a digital impression machine (all brands), titanium scan bodies can be purchased for intra oral use.




Thursday, January 22, 2015

Automatic Nerve Detection - Blue Sky Plan

Published on Jan 19, 2015
Advanced algorithms in Blue Sky Plan can now automatically detect and highlight nerve locations

Click Here to watch the Video

Thursday, December 11, 2014

MegaGen Custom Abutments Available Through ROE Dental Lab

If you are a MegaGen user, you now have custom options for zirconia and titanium abutuments, implant bars and more. Simply send your cases to ROE. If you have digital impression capabilities (we accept all scan systems), order our special scan bodies for intraoral capture.

Wednesday, December 10, 2014

Provisionals Based Upon CT Plan

When planning implant cases, often it is important to the patient to have fixed provisionals. At this time, when you are planning your implant positions, which are based upon a digital or physical work-up, ROE has the ability to fabricated immediate provisionals. This could be a single screw retained unit, a full arch denture conversion,
shells for reline over temporary abutments, custom healing collors with a flipper, you name it.

During the planning phase, just let our technicians know your intentions and we will take the specials steps needed, and order the parts. 

Check out this link for our many options.

Wednesday, September 10, 2014

BlueSkyPlan and Romexis / PlanMeca are now integrated!

BlueSky integration feature within Romexis 3.7.  A user can plan a case, combine the STL and then push it to BlueSky straight from Romexis as separate files but with the coordinates still mapped. What does this mean? If you've already learned the Romexis planning software, you can now turn the plan into a surgical guide! 

This is a big announcement for Planmeca owners!

Contact ROE to order your guides!

Wednesday, January 29, 2014

All-on-4 Update, Prosthetic Options, Tips and Procedures

All-on-4 Update, Prosthetic Options, Tips and Procedures

We are excited to be helping more clients than ever before restore screw-retained hybrid dentures popularized by the marketing of the All-on-4 technique. In fact, in 2013 we fabricated more cases with this design than in the previous three years combined. Due to the frequency and volume of this type of casework in the laboratory we have been able to refine our technique to provide an outstanding product at a reasonable flat-rate fee. Our All-in-One fees allow you to quote you

r patient knowing the price will be the same regardless of implant brand (with a few exceptions) or the number of implants placed. Based upon our experience, and the input from customers, we want to share helpful information as we begin the New Year. All of us at ROE thank you for trusting us with these cases and promise to support you in every way we can to help ensure your success and the satisfaction of your patients.

Consider the Need for Multi-unit Abutments (TMA’s)

Multi-unit, or Transmucosal abutments (TMA’s), are permanent fixtures used for three primary reasons. First, they bring the restorative platform of an implant from the bone level to the tissue level which prevents ‘sluffing’ tissue around the implant during restorative and maintenance procedures. Second, they redirect the trajectory of the prosthetic screws to a more esthetic or functional direction preventing access holes from emerging through undesired locations on teeth, especially the facials. Third, they can correct angles of divergently placed implants allowing a common path of insertion.
In our experience, multi-unit abutments are used in 50% of edentulous, fixed cases and are utilized in two common scenarios.

Senario 1 – The treatment plan calls for an immediate provisional appliance. The surgeon or restoring dentist places the implants, aligns the TMA’s to a common path-of-insertion and screw-emergence position to accept the provisional appliance, and torques them in. The TMA’s are the final abutments and will be used for the provisional and final appliance. In other words, there is no need to buy additional abutments for the final restoration in this scenario. It would be prudent to discuss with the placing doctor who will bear the cost of the parts needed for the immediate provisional conversion. The only parts needed for the final definitive restoration of the case are abutment-level impression copings and analogs.

Senario 2 – Implants have been placed as a Two-Stage surgery. The patient will present after successful osseointegration with healing abutments in place. It is important, at this time, that careful analysis is followed to determine the need for TMA’s and the correct angles and cuff heights.

The need for these components should be determined at the very beginning of the process before any final impressions or prosthetic work is done. We suggest the following procedure as the first step in the restoration process:

1.      Make a duplicate of the patients existing denture. (http://roedentallab.com/downloads/duplicatetechnique.pdf)
2.      Take an accurate alginate impression of the arch making sure that the healing abutments are present and visible on the ridge showing the angles of the implants; or take a reline impression inside the duplicate denture capturing the position of the healing abutments.
3.      Provide the deepest probing depth around each implant, or send an implant-level impression.
4.      Send this information to the lab. We will determine the abutment angles needed from either one of these procedures by relating the implant position and angle to the position of the teeth on the duplicate denture.
5.      The appropriate parts can then be ordered and the final restorative process can begin.
Consider the Cost of Multi-unit Abutments in your fee

The cost of TMA’s can be as much as $345 each, and together with multi-unit impression transfers and healing caps can be $510 per implant. Ordering parts directly or using aftermarket parts can reduce the total. The probability of this cost should be taken into consideration when quoting fees. It is also important to note that ROE does not include multi-unit abutments, impression transfers, cover caps and analogs in our All-in-One fees, since many cases do not require them and often they are provided to us by either the restoring or placing doctor.

TMA Selection & Confirmation Jig

During surgery (as described in Scenario 1 above), once the implants are placed, the doctor must decide which angle and cuff-height is appropriate for each TMA. The angle selected and how they are placed will ensure that the screw trajectory is aiming to the correct location on the prosthesis. One method is for ROE to create a clear duplicate of the immediate denture with troughs cut into areas where the screws should emerge. The abutments are tried-in with the seating handles attached, and maneuvered until the handles protrude passively through the troughs. This will ensure accurate selection and placement.

Avoid a Multi-unit Abutment Puzzle

When multi-unit abutments are required it is always suggested that they are placed clinically and an abutment-level impression is sent to the lab. With the various positions that an angled abutment can be placed, and the very small screw size, our clients have reported difficulty in transferring the abutments from the model to the mouth accurately. Save yourself the challenge and consider the above suggestions and determine the need for these parts at the very beginning of the process.

The TLZ-IB Prettau Bridge Alternative

If you are looking to upgrade a hybrid denture or want to offer an option other than acrylic, look into ROE’s TLZ-IB (Prettau) bridge. This exciting, primarily monolithic zirconia design is much stronger and more esthetic than conventional hybrids. This design comes in a unique two-step process. First, if the patient likes their temporary hybrid, we digitally duplicate it into an acrylic prototype that the patient ‘test-drives’ for a week or two. When the patient gives final approval, it is returned and converted into the final prosthesis which is truly an amazing work of dental technology.

Implant Brand Selection – Critical

When it comes to the restoration of both conventional hybrids and TLZ-IB’s not all implants are created equal. Some implant systems provide better restorative options than others. In fact, some brand selections make it very difficult to complete these case designs. We encourage communicating with us, when possible, about the case design prior to implant selection to ensure your objectives can be met and excess cost is not incurred.

Thank you for taking time to read our update. We welcome your calls on these or any other subject!

Warm regards,
The ROE Team

Tuesday, December 24, 2013

Year - end tax deductions for business equipment purchases

You can deduct up to $500,000 of business equipment that is purchased AND placed in service by the end of 2013.  Additionally, new equipment purchased is eligible for a  50% bonus depreciation deduction.  These increased deductions are set to expire at the end of 2013.  There will likely be an extension, however, the Federal government has not made any decisions regarding depreciation at this time.  Plan now to maximize this opportunity! 

Lisa Matuszny CPA
Hobe& Lucas
 4807 Rockside Road Suite 510
 Independence, Ohio 44131