Sario Prosthodontics

2026 Case
1. Auflage 2026
ISBN: 978-3-384-79603-5
Verlag: Azhar Sario Hungary
Format: EPUB
Kopierschutz: 0 - No protection

E-Book, Englisch, 200 Seiten

Reihe: Dentistry

Welcome to the dental clinic of the future, where the analog past is obsolete and the digital revolution has become the standard of care.

This book is a time machine that transports you directly to the clinical reality of 2026. You will witness the total death of the paper chart. You will meet the 'Virtual Patient,' a living digital clone that replaces messy plaster casts. You will discover smart dentures that do more than chew; they monitor glucose and pH levels. You will learn about Artificial Intelligence that acts as your co-pilot. It detects pathology your eyes might miss. It traces nerves with perfect accuracy. The book introduces you to 4D printing. These are materials that change shape when they touch warm saliva. You will explore the world of robotic surgery. The robot guides your hand and prevents errors. You will see how stackable guides make complex surgeries fast and predictable. You will study bioactive cements that actively heal the tooth. This is not just a textbook; it is a complete operating manual for the modern prosthodontist.

This book provides value where others fail because it refuses to look backward. Traditional textbooks still waste pages on the 'lost-wax' technique and the smell of burning acrylic, methods that belong in a museum. This book creates a competitive advantage by treating the future as the present. It replaces the 'artistic guessing game' of old dentistry with the 'algorithmic certainty' of modern engineering. While other guides teach you how to react to failure, this book teaches you how to predict and prevent it using Digital Twins and finite element analysis. It transforms the clinician from a mere tooth carpenter into a bio-data analyst, offering a workflow that is faster, safer, and less stressful. It is the only resource that prepares you for a world where biology and bytes are inseparable.

Dive deep into the 'Photon Era' of prosthodontics. You will learn how to use photogrammetry to achieve a passive fit for implants without ever touching a verification jig. You will understand the physics of 'stackable guides' that allow for immediate loading of teeth in under three hours. The book breaks down the complex chemistry of 'shape-memory polymers' that shrink-wrap around teeth to seal out bacteria. It explains how 'electrolytic cleaning' can save failing implants from infection. You will also find a compassionate guide to Gerodontology, using teledentistry to bring care to the most vulnerable. From the 'smart drill' that senses bone density to the 'holographic' mixed reality headsets used in surgery, every page is packed with actionable, cutting-edge knowledge.

This is a comprehensive roadmap for the dental professional who refuses to be left behind. It covers every discipline-fixed, removable, and implantology-through the lens of 2026 technology. It is written in simple, clear English, stripping away the jargon to reveal the practical science underneath. Whether you are a student, a technician, or a seasoned specialist, this book will upgrade your mindset and your practice.

Disclaimer: This book is independently produced by Azhar ul Haque Sario. The author has no affiliation with any specific dental board or organization, and this work is produced under nominative fair use.

Autoren/Hrsg.

Sario, Azhar Ul Haque

Leseproben

Fixed Prosthodontics II: Digital Impressions and Soft Tissue Management

Module: 8.0 – Optical Impressions & Soft Tissue Management

Sub-modules: 8.1 Advanced Intraoral Scanning Strategies; 8.2 Digital Tissue Management

Introduction: The Photon Era of Prosthodontics

Welcome, colleagues, to the Spring 2026 semester.

If you were sitting in this lecture hall five years ago, in 2021, or even as recently as 2023, the conversation we are about to have would have been radically different. Back then, "going digital" was a choice—a luxury feature for the high-end aesthetic practice. Today, in 2026, it is the standard of care. The analog world of polyvinyl siloxane (PVS) and polyether—messy, gag-inducing, and prone to distortion—is rapidly becoming a footnote in dental history, reserved only for specific, niche scenarios.

We have transitioned from capturing negative physical likenesses to capturing positive optical datasets. This shift requires you to stop thinking like a sculptor pushing clay and start thinking like a photographer manipulating light.

In this module, we will deep-dive into the two pillars of digital fixed prosthodontics: Advanced Scanning Strategies (how to capture the data) and Digital Tissue Management (how to prepare the canvas). You asked for a complete account, and we shall leave no stone unturned. We will explore the physics, the biology, and the clinical reality of the modern workflow.

8.1 Advanced Intraoral Scanning Strategies

The Hardware Landscape of 2026

Let’s ground ourselves in the tools you will be holding. By 2026, the market has consolidated around high-speed, AI-driven wand devices. The "big players" like the Medit i900 and the 3Shape Trios 5 (and the emerging Trios 6 prototypes) have redefined what "accuracy" means.

In the early 2020s, a "good" scanner had an accuracy deviation of about 20-30 microns. Today, your standard chairside unit is pushing 10 microns of trueness for a full arch. But hardware is only half the story. The real magic lies in the software algorithms—specifically, AI-driven noise filtration.

The "Invisible Hand" of AI Old scanners were dumb. They captured everything they saw: teeth, saliva bubbles, your gloved finger, and the patient’s flopping tongue. Post-processing was a nightmare of manual cropping.

Modern scanners utilize "active interference filtering." The Medit i900, for instance, uses a 10-bit imaging engine that doesn't just "see" the image; it understands it. It differentiates the specular reflection of enamel from the diffuse scatter of soft tissue. If a tongue rolls over the preparation, the AI recognizes the texture of the papillae and instantly discards that data, effectively "erasing" the tongue in real-time. This allows you to scan with a level of fluidity that was impossible a few years ago.

The Physics of "Stitching" and Full-Arch Accuracy

To master scanning, you must understand stitching.

An intraoral scanner (IOS) does not take one photo; it takes thousands of video frames per second (3,000+ images/sec is common now). The software's job is to recognize a landmark in Frame A and find that same landmark in Frame B, overlapping them to build a 3D mesh. This is "stitching."

The Danger of the Smooth Arc A common rookie mistake is treating the scanner like a toothbrush, moving it in a long, smooth, continuous arc across the arch.

The Problem: If you scan a long span of smooth surfaces (like the buccal of the anterior teeth) without distinct landmarks, the software gets "lost." It slips. This introduces a "banana effect" or cross-arch distortion, where the digital model appears wider or narrower than the actual jaw.

The 2026 Solution: We use specific "Anchor Point" strategies.

Occlusal First: Always scan the occlusal surface first. The complex anatomy of cusps and fossae provides the best "Velcro" for the software to latch onto.

The "S" Curve: Don't just go linear. Wiggle the scanner slightly in an S-shape as you move along the occlusal plane. This forces the camera to see the buccal and lingual line angles simultaneously, locking the width of the tooth into the algorithm instantly.

Edentulous spans: If you are scanning a patient for a bridge or an "All-on-X" implant case, smooth gum tissue is the enemy. It looks the same everywhere. In 2026, we use "texture markers"—liquid resin drops or even sterilized glass beads placed on the gum—to give the scanner artificial landmarks to track.

Deep Subgingival Margins: The "Multi-Direct" Revolution

The bane of optical impressions has always been the deep margin. Light travels in straight lines. If a margin is buried 2mm under the gum, and the gum is collapsing over it, the light cannot hit the margin and bounce back to the sensor.

Old School (2020s): You had to pack aggressive retraction cords to physically push the gum away. New School (2026): We rely on Multi-Direct Capture Technology.

Newer optical engines use multiple micro-cameras inside a single wand tip, angled at slightly different degrees (e.g., 45°, 90°, 135°). This allows the scanner to "peer around corners." Even if you cannot see the margin directly from a 90° occlusal view, the side-angle cameras might catch it.

Clinical Tip: When scanning a deep distal margin on a second molar, do not just hover. Rock the scanner. Pitch the heel of the wand down and the tip up. This steep angulation allows the "Multi-Direct" sensors to fire photons under the undercut of the gingiva.

Dealing with Reflective Surfaces: The "Glossy" Problem

Metal crowns, gold inlays, and even hyper-polished composite cores act like mirrors. They reflect light so intensely that they blind the scanner (causing "burnout" or holes in the mesh).

In the past, we had to use titanium dioxide powder to dust the teeth. Today, features like "Smart Glare Control" automatically adjust the exposure time of the sensor when they detect high-reflectivity pixels. You can scan a gold crown next to a natural tooth without changing settings; the scanner adjusts exposure on a pixel-by-pixel basis.

8.2 Digital Tissue Management and Retraction

The Golden Rule: "If You Can't See It, Neither Can the Scanner"

This is the most critical sentence in this entire course. Write it down.

An intraoral scanner is not an X-ray. It cannot see through blood, saliva, or gingival tissue. It is a camera. If your finish line (the margin of your preparation) is covered by a flap of gum or a pool of blood, the scanner will record the gum or the blood, not the tooth.

Digital impressions require better tissue management than analog impressions. Why? Because PVS material pushes back. Impression material is viscous; it can displace mild bleeding or fluid. Light cannot displace fluid. Light bounces off fluid. If you scan a bloody margin, the light scatters, and you get a "mushy" artifact on your screen.

The Shift from Cord to Energy: Laser Troughing

In the analog days, we used retraction cords (Size 00, 0, 1, 2) packed into the sulcus to physically shove the gum away. This was effective but traumatic. It crushed the delicate junctional epithelium and caused post-operative recession.

In 2026, the standard of care for digital tissue management is Diode Laser Troughing.

Why Lasers?

Hemostasis (The Dry Field): A diode laser (typically 810nm or 980nm wavelength) has a high affinity for hemoglobin/pigment. When you run the laser tip around the sulcus, it vaporizes the inner lining of the epithelium and coagulates the capillaries instantly. This seals the blood vessels. You get a bone-dry sulcus. This is critical for optics.

Precision Troughing: Instead of pushing the gum back (which it will try to rebound from), the laser gently removes a microscopic layer of tissue, creating a physical "trough" or moat around the tooth. This trough allows the scanner light to travel down, hit the finish line, and travel back up without interference.

Clinical Protocol for Laser Troughing:

Power Settings: Use the lowest effective power (usually 0.8 to 1.2 Watts) in "Continuous Wave" or "Pulsed" mode.

The Movement: Use a light, painting stroke. Do not hold the laser in one spot (that causes charring). Move around the tooth like you are tracing the margin with a pencil.

The Result: You should see a clean, white/cauterized line of tissue and a visible gap between the tooth and the gum.

BOPT and the Vertical Preparation Challenge

One of the biggest trends in European and South American prosthodontics that has gone global by 2026 is BOPT (Biologically Oriented Preparation Technique). This involves "vertical preparations" or "feather edges" with no distinct finish line.

The Digital Dilemma of BOPT: Scanners love sharp corners (chamfers, shoulders). They struggle with smooth, sloping curves (feather edges) because there is no geometric "stop" for the software to delimit.

To successfully scan a BOPT...