Adam Nulty didn’t plan on becoming a dentist, but the opportunity to combine art and technology swayed him. He’s now president and one of the founders of the UK-based International Digital Dental Academy (IDDA) and a cosmetic dentist practicing in Bury and London. A self-professed computer geek, Adam got hooked early on guided surgery to bring more precision and predictability to implant procedures and now holds several worldwide patents and designs to aid guided surgery and implant placement. Adam shares how exocad’s guided surgery software exoplan helps him deliver the best care while requiring patients to spend less time in the chair.
Q: When did you first start using exoplan and why?
A: I've been using exoplan now for a few years because the software offers more opportunities for customization. I was using another software but often faced limitations in copying, designing and integrating with different scanners. As I expanded, I needed more. It was a natural progression to bring exocad into what I was doing as a clinician.
Q: What’s your favorite exoplan tool?
A: The reason why I use exoplan now is the anatomical prosthetic planning is much more advanced than any of the alternatives. exoplan has the power of exocad’s CAD design. You can do virtual teeth extractions, take all the same steps that you go through to bring in a virtual design before you produce your final prosthesis, and you have validated workflows.
Q: Explain what you mean by validated workflows.
A: I mean in terms of being able to provide a surgical guide with the correct and validated measurements and sizes. exocad’s wide range of libraries means that it's not just planning the implant position. I don't think a lot of people have understood yet the power of exoplan. It's not just implant planning—prosthetic planning is automatically included. That's not just planning the prosthetic virtual envelope but also preplanning the temporary prosthesis—preplanning every little bit of the workflow, in terms of abutment choice, height and position. You have all those virtual libraries at your fingertips.
Adam shares exoplan tips online as part of his work with IDDA
Q: How does exoplan change your surgical workflow?
A: On the day of the surgery, I know what implant I'm going to use, I've planned where the abutment is, or the direction of an abutment, or the size of the abutment. I have the exact virtual counterparts of the abutments to be able to produce a very specific plan that I can take to the patient. I know exactly what I can use, which has many benefits for a clinician in terms of time savings, cost savings and not having to stock a lot of different parts. I can try out different things. Do I need to take the implant a little bit deeper? Do I need to create a smoother emergence profile? Do I need to use a larger or wider abutment? Do I need to use an angulated abutment or a multiunit abutment? I can try those things out very quickly and get predictable results. That was something I was missing from previous guided surgery software that I used.
Q: How does exoplan affect your communication with labs?
A: I produce almost everything in-house, but I've migrated more recently to outsourcing the design of custom abutments to outside labs. I can work with a partner lab using dentalshare. If I work with a lab that has exoplan and DentalCAD, the lab can produce the surgical guide if I want to just handle the planning side of things. So even though I do most everything in-house, I can still pass along all those planning components, and the lab can preplan a custom abutment.
Q: Any final insights to share with colleagues?
A: I'd say probably one of the nicest things about exoplan is the ability to take in scans, not only from multiple providers, but to have integrations with multiple scanners for direct send-in, and the ability to take in color scans as well. You can bring the scans in and see where the gingival levels are around the teeth. That can really help you visualize as you’re planning to look at the bigger picture, in terms of soft tissue, for your emergence profile planning. But it also means that your choices are open for scanner choice as well. It doesn’t matter what kind of scanner you use, you can bring in those scans in a variety of formats. Plus, with exoplan, you can think outside the box a bit more.
Q: Do you have an example?
A: I had a patient with two failing teeth. I wanted to preplan the extraction of those teeth, the placement of two implants, the production of a temporary prosthesis on two abutments, and be able to do all that before I even touched the patient. I had a scan of the patient with a full dentition upper and lower and took that into exoplan. Using expert mode, I could go in and virtually extract teeth in a very quick and effective way, resulting in a very elegant-looking proposal. I could then use the proposal to plan the emergence profile, abutments, and virtual prosthesis. I could then have that either manufactured, 3D printed in-house, or sent to a lab to have them do the design. That way, on the day of surgery, I took the patient’s teeth out, placed the implants to the required depth, position, orientation and set the coronal rotation in the correct position. Finally, I was ready for the custom abutments and the custom crowns that had been predesigned and preprinted already.
Q: Best song to start your day?
A: My favorite band is probably Muse. I love rock and roll like AC/DC and Iron Maiden. But probably what I listen to most at the moment is Odesza.
Q: Favorite tooth?
A: The canine, and I'll tell you why. I actually find female smiles with an accentuated canine not only appealing as a beautiful smile but attractive as well. My designs always end up with pointier canines and premolars. I just think they look natural and nice. I hate when I see canines that are flat. They have no life.
Q: Favorite weekend getaway?
A: Santorini. I don't think you can beat it.
Q: If you could give advice to your younger self, what would it be?
A: Start earlier with everything. Life is short. If you work hard enough at something, you'll succeed.
Adam Nulty is the Principal Dentist and owner of Dentist On The Rock in Bury, close to Manchester, UK. He is a Cosmetic & Digital Dentist at Digital Smile Studio on Harley Street, London, and one of the Executive Board members of the IDDA. Follow his work on Facebook or Instagram.
by Caitlan Reeg
Writer at exocad
Caitlan Reeg spends her days telling the world about the innovations her colleagues create. She’s passionate about healthcare, technology, and the ways the two interact to improve our lives. A former journalist, Caitlan has worked on staff at Dow Jones Newswires in Frankfurt and at the national public radio program Marketplace in Los Angeles.
