1. Efficient integrated treatment workflow for single and partially edentulous patients

2. Efficient integrated treatment workflow
Increase treatment acceptance
Collaborate effectively
Increase treatment efficiency
Treat more patients better

3. Options of treatment workflow
With NobelProcera surface scan, without radiographic guide
Consultation
Single tooth / partially edentulous
Clinical diagnostics & Implant treatment acceptance: Impression (CB)CT scan NobelClinician 3D Diagnosis
NobelProcera Scan of dental cast / diagnostic setup
NobelClinician (prosthetic-driven) planning
Treatment communication to treatment partners and patient
Surgery: freehand, pilot drill template or fully guided surgical template
Clinical Diagnostics - Impression
(CB)CT scan
NobelClinician 3D diagnosis & (prosthetic-driven) planning
Treatment communication to treatment partners and patient
Surgery: freehand, pilot drill template or fully guided surgical template
Large partially edentulous / edentulous
Radiographic guide
(CB)CT Double scan
Surgery: freehand or fully guided surgical template
Single tooth / partially edentulous / edentulous
NobelClinician 3D diagnosis and planning
Surgery:: freehand, only treatment plan report as reference
(CB)CT scanner in-house
(CB)CT scanner NOT in-house
With radiographic guide
Without prosthetic reference during planning, free-hand surgery

4. Efficient integrated treatment workflow
Increasing treatment efficiency
NobelConnect seamlessly links the tools the clinician needs:
NobelClinician supports efficient treatment planning by linking with the NobelProcera 2G System
NobelClinician Viewer or Communicator facilitates collaboration with all treatment partners and the iPad® App allows for presenting patient-specific treatment options
OsseoCare Pro records and documents final implant values or any surgical information needed
Switch to Guided Surgery at any point during the planning process with no need for an additional patient visit.
iPad® is a trademark of Apple Inc.

5. Efficient integrated treatment workflow
After completion of the initial planning the treatment options can already be discussed
The Communicator App supports the conversation between patient and clinician
After treatment acceptance the clinician can start planning the individual treatment
During the first visit, the (CB)CT scan and the dental impression are done
The DICOM files can immediately be uploaded to NobelClinician
Supporting files like clinical pictures can be added
The diagnosis and planning can start immediately

6. Efficient integrated treatment workflow
After the first visit and the treatment acceptance by the patient, the impression is sent to the dental laboratory
A gypsum model is poured and a tooth setup done
The model and the tooth setup are scanned with the NobelProcera 2G System
The data is transfer to the NobelClinician software via NobelConnect
SmartFusion™ aligns the two data files to one files showing the (CB)CT scan and the model scan information

7. Efficient integrated treatment workflow
Efficient and predictable treatment outcomes
The NobelProcera 2G System provides accurate data of the gypsum model
No additional (CB)CT scan with radiographic guide is needed minimizing the radiation dose for the patient
SmartFusion™ combines the information of the (CB)CT scan and the model scan (hard and soft tissue)

8. Efficient integrated treatment workflow
Work and communicate efficiently
Effective and easy communication options using NobelClinician Communicator or Viewer
Involve treatment partners in the planning process
Optimize treatment outcomes leading to increased patient satisfaction

9. Efficient integrated treatment workflow
Communicate convincingly
Increase treatment acceptance by communicating in an understandable way with the patient
NobelClinician Communicator iPad® App allows to present patient-specific treatment options in a clear and visual way

10. The efficient treatment workflow
1. Clinical diagnostics
& treatment planning
3. Treatment planning
5. Production of
surgical templates
2. Digitizing prosthetic
information
4. Communicate
treatment plan
6. Implant surgery

11. Treatment workflow for single unit and partially edentulous patients
The treatment workflow for the partially edentulous patient allows the clinician the flexibility of taking a (CB)CT scan of the patient at any time during the initial examination of the patient. Following preliminary diagnostics and treatment planning, implant treatment can be proposed to the patient if applicable, and after the patient’s treatment acceptance the decision can be made to add clinical situation information via a surface scan of the dental cast and if applicable the diagnostic setup. With this information added in NobelClinician, the clinician can plan the implants according the patient’s anatomy and prosthetic requirements. Then he can decide on the type of surgery, either go straight to surgery or order a surgical template for either pilot drilling only or for fully guided drilling and if applicable guided implant placement.

12. Treatment workflow for single unit and partially edentulous patients (with NobelProcera® surface scan)
Case presentation
1 Clinical diagnostics and
treatment acceptance
2 Digitizing prosthetic
information
3 Treatment planning with
communication of plan
4 Implant placement
freehand or guided
5 Prosthetic design and
restoration placement

13. 1. Clinical diagnostics and impression taking
The indications for a medical procedure must be established by the responsible clinician. This decision relies on essential findings from the entire interdisciplinary treatment team. Careful initial clinical diagnostics, including systemic and dental considerations, are the basis for proper indication setting.
Systemic evaluation
Age
Immune status including diabetes
Smoking
Clinical evaluation
Caries activity
Presence of periodontal disease
Radiographic diagnostics
Control of disease prior to treatment
Patient cooperation including oral hygiene
Dental evaluation
Functional status (maximum intercuspidation, centric relation, occlusal interferences, anterior guidance)
Indications for parafunctions
Inter-arch relationships (prosthetic considerations)
Esthetics
Tissue health, attached keratinized tissue
Clinical evaluation for edentulous space (visual / palpation)
Diagnostic models, diagnostic wax-up

14. 1. Clinical diagnostics and impression taking Additional considerations
Assess tissue stability – important for pilot drilling and fully guided surgery
All sites must be fully healed following extractions or dental grafting procedures to ensure stable surgical template support reference (extraction sites and immediate implant placement for a single tooth is supported).
Assess mouth opening – important for pilot drilling and fully guided surgery
A minimum mouth opening of 40 mm at implant sites is required to accommodate guided surgery tooling.
Assess patient smile line
Evaluate the transition zone and verify with the intended treatment (fixed or fixed-removable final prosthetic solution).

15. 1. Clinical diagnostics and impression taking Additional considerations
Evaluate soft tissue
Assess the quality and quantity of soft tissue
Note: Consider (mini-) flap elevation as an alternative to punching in situations with reduced or minimal attached keratinized tissue.
(CB) CT scan
Take a (CB) CT scan of the patient (axial slices, DICOM format, single frame uncompressed data)
Separate the jaws by slightly using a wax plate or small wooden spatula taking care not to distort the facial anatomy
Preliminary diagnostics and treatment planning can be done in NobelClinician, determine treatment options

16. 1. Clinical diagnostics and impression taking Additional considerations
Case selection criteria
Strategically distributed teeth
6 teeth left per arch
Immediate extraction is not supported, except single tooth
Identical CBCT and impression
Indications and contraindications for guided implant surgery remain same
Extraction and immediate implant placement of a single tooth

17. 1. Clinical diagnostics and impression taking Additional considerations
Boarder line cases
Front teeth missing: both canines and all incisors are missing.
Molars missing on both sides: All molars (on both sides) and the second premolar (on both sides) is missing.
Half arch: All molars, all premolars and the canine are missing on one side of the teeth arch.

18. 1. Clinical diagnostics and impression taking Additional considerations
Take impressions
Take fully extended, definitive impressions of both jaws for dental cast and diagnostic set-up
The impression quality must meet requirements of a definitive impression for the intended treatment
Record an accurate bite registration using registration plates or clinical bite index
Impressions are then sent to the NobelProcera lab*
Diagnose the patient’s anatomy in NobelClinician
Analyze the patient’s anatomy
Make a preliminary implant plan
Propose implant treatment to the patient
* The NobelProcera 2G system using NobelProcera Software version 4.10 or higher must be used.

19. 2. NobelProcera scan of dental cast, with diagnostic setup, if applicable
Request NobelProcera lab technician to scan plaster cast, optionally diagnostic setup
NobelProcera lab (not in-house):
Place order request in NobelClinician Software:
Enter address from your NobelProcera lab
Request the digitized scan of the dental cast and optionally diagnostic setup
Send impression to lab technician
NobelProcera lab (in-house):
No order request needs to be submitted.
* The NobelProcera 2G system using NobelProcera Software version 4.10 or higher must be used.

20. 2. NobelProcera scan of dental cast, with diagnostic setup, if applicable
Lab technician pours dental cast using Type 4 CAD stone (if CAD stone is not available, the Type 4 stone used can be sprayed using CAD spray).
The dental cast must represent the same clinical situation as captured in the (CB)CT scan.
Note: Trim model minimally to ensure all information will be captured in dental cast scan

21. 2. NobelProcera scan of dental cast, with diagnostic setup, if applicable
Lab technician creates removable prosthetic setup/wax-up using
CAD wax
Acrylic
CAD acrylic
Any other material using CAD spray when scanning

22. 2. NobelProcera scan of dental cast, with diagnostic setup, if applicable
Prosthetic set-up scan
Add prosthetic set-up to dental cast and secure dental cast into the NobelProcera 2G scanner. Scan the prosthetic set-up according to the scan protocol
Dental cast scan
Remove prosthetic set-up carefully, without moving the dental cast. Scan the dental cast according to the scan protocol
Note: Ensure that the model scan captures the entire model
Note: Do not move the dental cast in the scanner holder. The same position must be maintained during the prosthetic set-up scan and the dental cast scan

23. 2. NobelProcera scan of dental cast, with diagnostic setup, if applicable
Provide clinician with scan of dental cast, optionally diagnostic setup
NobelProcera lab (not in-house):
Lab technician uploads scan to NobelConnect by selecting “Upload” in NobelProcera software
NobelProcera lab (in-house):
Lab technician exports the scanned file by selecting “Save to Disk” in NobelProcera software
* The NobelProcera 2G system using NobelProcera Software version 4.10 or higher must be used.

24. 3. NobelClinician (prosthetic-driven) treatment planning
SmartFusion™
Download or import the scan of the dental cast, with diagnostic setup data, if applicable, into NobelClinician
Align to the patient’s (CB)CT data using SmartFusion™. Check carefully that the alignment is correct.*
Finalize (prosthetic-driven) treatment plan
Finalize the treatment plan
Select surgery type for each planned implant
Create surgical template, if applicable
Approve treatment plan
NobelProcera 2G System
(CB)CT scan
SmartFusion™ in NobelClinician Software
* In case of doubt, contact Nobel Biocare local technical support.

25. 4. Communicate treatment plan to treatment partners and patient
Collaborate with treatment partners Securely share NobelClinician treatment plan with other NobelClinician users over NobelConnect
Communicate treatment plan to treatment partners
treatment plan report as PDF
Share NobelClinician Communicator iPad® presentation
Send NobelClinician viewer
Communicate treatment plan to patient
Present treatment plan through NobelClinician Communicator iPad® presentation. Option to share iPad® presentation
Document treatment plan and be prepared for surgery
Include treatment plan report (PDF) in patient management system
Print treatment plan report, regardless of chosen surgery method, as a reference during surgery
Export treatment plan as OsseoCare Pro surgery, be prepared for surgery

26. 5. Surgery Treatment plan report
Regardless of chosen surgery method, have report available as a reference
The details of the implant dimensions per implant site are included
The guided drill depths per implant site are included, if applicable
OsseoCare Pro
Log in with your NobelClinician credentials. The surgery is automatically set up
After completing the surgery, the surgical details are securely saved on NobelConnect
The surgical report can be retrieved in NobelClinician
Surgical template assisted surgery
CADCAM created surgical templates
Option for pilot drilling only, or fully guided implant placement

27. Additional considerations (CB)CT scan of patient
CT Scanning
Axial slices in DICOM format DICOM: Digital Imaging and Communication in Medicine, DICOM is an open and widely used standard for communicating medical images
CT and CBCT scanners can export to DICOM files
! Use single frame, uncompressed DICOM files
Modern CT scanning equipment
Cone-beam (CB)CT scanner dedicated dental CT scanner using a cone shaped x-ray beam
Multi-slice CT scanner medical CT scanner typically used in radiology departments of hospitals

28. Additional considerations (CB)CT scan of patient
(CB)CT scanner compatibility requirements
Field of view: it must contain the entire jaw bone Typical minimal field of view: diameter of 8 cm, height of 7 cm
Resolution and related voxel size: maximum 0.5 mm in all directions, typically 0.3 mm
Diagnostic image quality: high enough for the clinician to appropriately read the (CB)CT image data
Export the axial CT slices: single-frame uncompressed data
Note:
Some (CB)CT scanners offer smaller volume scans only, not scanning the entire jaw bone. These scanners should not be used
It is the responsibility of the clinician or the radiologist to generate (CB)CT images of optimal quality according to the standard routine and at as low radiation doses as possible. Use the “ALARA principle” (As Low As Reasonable Achievable)

29. Additional considerations (CB)CT scan of patient
Take the patient’s (CB)CT scan
Ensure the patient’s occlusal plane is positioned horizontal
Slightly separate the occlusion if possible, using a wax plate or small wooden spatula
Ensure quality of the scan with adequate resolution optimized settings and reduced noise
Ensure that the entire dental arch is scanned including all teeth (prosthetic crowns)
Note:
Take into consideration patient factors such as patient movement and metallic restorations
The (CB)CT data and NobelProcera scan data must include the same information

30. Additional considerations (CB)CT scan of patient
Check for patient movement during (CB)CT scan
Indicators for movement of the patient during scan include:
Multi-slice CT: discontinuity of the anatomy, clearly visible in 3D
CBCT: double anatomical borders, clearly visible on X-ray data, resulting in noisy 3D model
If patient movement is identified, it is strongly advised to repeat the scan
! Movement artifacts introduce inaccuracies, potentially leading into incorrect diagnosis. They may also prevent the SmartFusion™ from working.
Patient moved when taking a scan with a multi-slice CT scanner
Patient moved when taking a scan with a CBCT scanner

31. Additional considerations (CB)CT scan of patient
Streak artifacts
Streak artifacts from radio-opaque tooth restoration material corrupt diagnostic information
The SmartFusion™ is robust and has been developed to handle (CB)CT data with artifacts. However, when severe artifacts arise, this might cause issues
Note: When severe artifacts are identified, contact (CB)CT manufacturer to ensure the (CB)CT settings are optimized or to calibrate the (CB)CT scanner.
Export (CB) CT data
Export scan data as uncompressed single-frame DICOM files