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Bread and Butter AZENTO

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Just completed my first Azento case today.  This is probably the easiest guided surgery workflow I'​ve ever used.  

I uploaded the cerec scan through the sirona connect portal and the dicom through the www.orderdigitalsolutions.com website.

Within a few days I had the planned surgery available for viewing.  The best part of this was that the portal is accessible from my iPhone.   I was able to approve the case design from my phone while being away from the office/computer/etc.

This case from anesthesia to final radiograph was under 25 min.  

The design of the guide was so convenient with a lingual access window.  This was great for working in the area of #30.  

This keyless system is a breeze. But better than that, having a streamlined surgical kit makes setting up the operatory and passing the correct drills so easy for my assistant.  Just compare the size of the Azento kit versus the standard guided Astra EV kit.

Finally, I was really impressed with how easy it was to line up the implant timing to replicate the digital plan.  The custom healer matched the profile of the tissue perfectly. 

The digital workflow just keeps getting better and better!


Very slick Dr Snider!


Nice case Snider!


I must have missed this in some of the previous posts, but what is the cost and turnaround time ?


Good stuff Snider!


Love it Snider!  Awesome case!


I just bought a 3 pack at Dan’s lecture tonight so I’m gonna try it soon


Sweet.
Michael, did you run into any downsides at all? Anything at all where you thought, "hmmm, they could improve that a little bit?"


This system is really nice. 

If I had one complaint it is that the guided carrier for the implant is a little finicky to place.  It only engages in one specific orientation, obviously for the guide to work.  The issue is that the implant is not static in its packaging, so it rotates around in its housing while you are trying to engage the carrier.   I was told this was being improved, with the standard "next quarter" answer.

Even with fighting the carrier a little, to have this procedure be around 20 min is a huge benefit in my practice.

 

 

 


Thanks for the insight baby bird, looking forward to doing my first azento case scheduled for later this month.


Nice work snider.
It works great. I have been placing Astra exclusively for awhile so you will get used to the annoying carrier issue.


Nice Post


On 10/13/2018 at 9:03 pm, Arun Garg said...

Nice Post

I had a great implant instructor.big grin


So I am dying to try this prefab system. I have much stock still left for Straumann and Neoss and wanted to use that up first. Also the cost per ‘kit’ is still very high. I added it up separately for what it costs me start to finish to do this independently with a guide and all, and it is way less. Any thoughts on this? I always always do guided surgery. I felt like the throw away drills were a high cost part of kit?


On 10/15/2018 at 4:14 am, Beth Skovron said... So I am dying to try this prefab system. I have much stock still left for Straumann and Neoss and wanted to use that up first. Also the cost per ‘kit’ is still very high. I added it up separately for what it costs me start to finish to do this independently with a guide and all, and it is way less. Any thoughts on this? I always always do guided surgery. I felt like the throw away drills were a high cost part of kit?

Beth,

I think it would be helpful to see the cost as you add it up start to finish with your current workflow.  Are you using Sicat or a cg2 for your guide?  

Cost of implant?

Cost of surgical guide (plus time for design, milling, cleanup if using cg2)?

Value of having someone plan the implant for you (maybe nothing or maybe a lot depending on comfort level)?

Value of fresh drills for each case and no staff time getting inventory together?

Cost to make a custom healing abutment (TiBase, block, cement, 45 min of chair time to design, mill, bond to TiBase)?

Speed of surgery and delivery of custom healing abutment - reduced chair time(variable, maybe faster or same depending on workflow)?

Value of final abutment, temp crown and core file (maybe nothing if you don't use it, but it could eliminate Tibase, block, imaging appointment if you do use it)?

Azento may not be right for every practice or every case you do, it's just another tool and workflow to have when you need it.  Having said that, I find myself making excuses to use it everywhere since my staff loves it and I've gotten a little lazy letting someone else do all the work :)

 


Dan, 

I just submitted my first case today.  It took my computer a real long time to export my CBCT, zip the file, and then upload to the site.  Is there anything I can do to make that process faster? 

Super excited to get it back. Have they been good about 5 days after approval getting the box to the office? 

 

Kirsten


Congrats Kirsten!

To speed up the CBCT upload, don't zip the whole Dicom File, just the CT1 file and upload that.  PM me if you need help with that... I think I show it in my Azento video.

They are good at getting it back quickly, they'll send you a shipping notification with a tracking number so you'll know exactly when it's arriving.

 


The shipping is occasionally quicker than the emails; I had a couple cases show up the same day the tracking number was emailed! It’s an extremely efficient workflow; everyone should try it at least 2 or 3 times


On 10/15/2018 at 4:46 am, Daniel Butterman said...
On 10/15/2018 at 4:14 am, Beth Skovron said... So I am dying to try this prefab system. I have much stock still left for Straumann and Neoss and wanted to use that up first. Also the cost per ‘kit’ is still very high. I added it up separately for what it costs me start to finish to do this independently with a guide and all, and it is way less. Any thoughts on this? I always always do guided surgery. I felt like the throw away drills were a high cost part of kit?

Beth,

I think it would be helpful to see the cost as you add it up start to finish with your current workflow.  Are you using Sicat or a cg2 for your guide?  

Cost of implant?

Cost of surgical guide (plus time for design, milling, cleanup if using cg2)?

Value of having someone plan the implant for you (maybe nothing or maybe a lot depending on comfort level)?

Value of fresh drills for each case and no staff time getting inventory together?

Cost to make a custom healing abutment (TiBase, block, cement, 45 min of chair time to design, mill, bond to TiBase)?

Speed of surgery and delivery of custom healing abutment - reduced chair time(variable, maybe faster or same depending on workflow)?

Value of final abutment, temp crown and core file (maybe nothing if you don't use it, but it could eliminate Tibase, block, imaging appointment if you do use it)?

Azento may not be right for every practice or every case you do, it's just another tool and workflow to have when you need it.  Having said that, I find myself making excuses to use it everywhere since my staff loves it and I've gotten a little lazy letting someone else do all the work :)

 

Agreed Dan!   The convenience of this workflow is incredible.   I was hesitant at first looking at the cost; we were already used to printing guides in office and fabricating custom healing caps chairside.    The time savings alone starts to make up for the difference in cost.


Ok I lost my whole post let me try again.
Costs I calculated:
(1) planning and guide fabrication service I use (not sicat) $140 with shipping
(2) implant $450
(3) regular healing abutment $70 custom closer to $145
(4) wear and tear on Straumann drills came up with about $65 based on how many uses I get from them.
(5) and yes .. I lose advantage of being able to have file for final abutment.

This all being said it comes to about $800 or so ... I feel like I’m missing something. I did the math at Siroworld. Let’s just bump it up to $1100 for arguments sake.


One thing I would like to understand more and would make the whole system more attractive is if I could eliminate the final impression appointment. If I use Azento and place the custom healing abutment, is there a way to go to final abutment and crown without a second digital impression appointment?


On 10/16/2018 at 4:08 pm, Beth Skovron said... One thing I would like to understand more and would make the whole system more attractive is if I could eliminate the final impression appointment. If I use Azento and place the custom healing abutment, is there a way to go to final abutment and crown without a second digital impression appointment?

This is just one of the benefits of the Azento workflow.  You can confirm the timing of the implant placement with the final abutment and temp crown at the surgery appointment.  As long as the tissue heals adequately, the core file of the abutment is sent to you prior to surgery.  The core file can be imported to the chairside software and the final restoration can be milled prior to the second appointment. 

In the anterior I think I might go with the custom healer initially, or immediately provisionalize.  After the tissue is where I want, move to the final abutment/crown.  However, in the posterior I don't see an issue with having the final abutment premade, unless there are large bony or soft tissue defects. 

 

 


I agree with Snider. 

Look at it another way, there are patients that call every dental office in an area looking for the cheapest crown price because they believe all crowns, dentists and workflows are equal. I’m proud when my front office says we are for sure not the cheapest, because we offer a premium workflow, result, and experience with CEREC. Azento is sort of the same way, this a premium service using a premium product and workflow.  You can print a guide for $7 and put on a stock healing abutment and I’m sure you’ll get a great result, but the time, effort and experience will be different. 

If you are having success and are happy with the workflow you are doing, no need to change, but as CEREC users, many of us crave better workflows and experiences for us and our patients, this usually does come at a cost. I do understand that every purchase we make is a business decision, you need to judge for yourself if the time savings, experience and results are worth it.