DOUBLE FACTOR TECHNIQUE
Double Factor Technique® by Dra Carmen Pomares.
Dr. Carmen Pomares is a Periodontist, Stomatologist and Implantologist. She graduated Medicine and Surgery in Alicante. She achieved her specialty in Oviedo where she studied Stomatology with an interest in Periodontics. She continued and furthered her studies in Implantology at the Complutense University of Madrid. She is following the most advanced techniques taught in countries such as the US, Italy, Portugal, Hungary, Brazil, Argentina and Israel, among others.
She founded Clínica Perio&Implant in Alicante, Spain, in 1997 with exclusive dedication to Periodontics, Implantology and Oral Surgery, and continued to do so until present day. She provides training and education courses and attends conferences and is involved in publications nationally and internationally, always betting on excellence in Dentistry.
Since 2005, she has implemented Guided Surgery in her clinical practice, which allowed virtual implant surgery adapted to the anatomy of each patient using innovative software, which enables placement of the implant through a prosthetically guided stent. Teeth and implants in one session for patient comfort. From the very start, Dr. Pomares was part of the international group for testing and development of the current technique.
In 2018, the Navigated Surgery technique was launched and Dr. Pomares once again was part of the first European group to acquire the technology and training. This is a virtual design of the implants to be placed during the operation while looking through a monitor at real time at 360º during the implementation of the implants in the jaw bone. This technique has worked very well for patients with unitary or partial edentulism but not for total tooth loss. Therefore, the author decided to develop her own technique that would provide a solution to real clinical needs.
With the aim of using the best of each of these techniques in a single procedure, the idea of merging both techniques arose. Dr. Pomares created the Double Factor Technique for Implantology, which uses virtual surgery, software and Guided Surgery stents with a necessary adaptation to make it compatible with the Navigated tools with double verification and security mechanism and hence the name.
This took an arduous effort and many engineering and clinical hours to achieve great result.
This combined procedure allowed the author to operate a complete maxila without opening the tissues in less than an hour through a stent, while making it possible to navigate at 360º in the patient´s jaw bone, enabling placement of the dentition in a single session in a fast, comfortable, safe and painless way.
This technique, registered and patented in 2019, was presented in 2020 on a digital dentistry platform and the first scientific article was published in The Journal of the Prosthetic Dentistry. Since then, Dr. Pomares has presented herself in specialized forums, recently participating with a clinical case in the Congress of the Spanish Society of Oral Surgery in 2021. In September 2022, she performed Live Surgery for the SECIB Congress with the Double Factor Technique; with a second article pending publication with successful clinical results.
At the end of September 2022, where the largest and most recognised International Osseointegration Congress EAO was held in Geneve, Dr Carmen Pomares received the award for the best European surgical clinical video of implantology in this contest, establishing this protocol and its international diffusion called “ Double Factor Technique by Dr. Carmen Pomares”.
Fusion Guided Surgery and Navigated Surgery
This technique will allow us to use the benefit of Guided Surgery as a first factor in verification and precision for the placement of dental implants, adding the benefit of a second factor in accuracy of Navigated Surgery.
The Objective is to avoid handicaps such as the imprecision of the raised hand of the Navigated tour, the excess time taken for total edentulism, the lack of certainty of the prosthetic emergency or in the Guided procedure, lack of, or poor vision of the jaw bone and dental spaces in real time.
With the aid of the Double Factor Technique, it is possible to reduce the clinical time to approximately one hour between design, calibration and execution which in turn increases predictability, as well as providing better postoperative, functionality and aesthetic improvement.
The deep knowledge about these techniques and their limitations led Dr. Pomares to the idea of merging them into the Double Factor Technique, to take advantage of both Guided and Navigated systems, for patients who have lost all their teeth.
Since 2005, Computer Guided Surgery developed the concept of minimally invasive surgery to place implants by protocol with 3D clinical and radiological diagnosis, to prepare a future implant-supported prosthesis for a patient.
In this manner, based on 3D scan of the patient´s jaw and a digital model of their future teeth, by converging the data in the designed software, the virtual surgery can be performed producing a stent that allows operating on the jaw bone without opening the tissue, with maximum accuracy and comfort.
This is a much less traumatic process than “Traditional Surgery”, which involved opening of the jaw tissues by the surgeon, without precisely knowing where the implants are inserted, in relation to the bone condition and its prosthetic functionality. The Tradicional Surgery takes double or triple the duration of the Guided, causing both discomfort and increased risks.
With the Navigated Surgery since 2018 inspired by Neurosurgery, it is now possible to carry out the operation with the aid of the monitor, precisely inserting the implants in their desired location. With the aid of radiological scanner and a direct virtual designed software, it is possible to browse and calibrate the instrument using QR codes, operated by GPS, allowing movement inside the jaw bone in real time at 360º.
Finally, to execute the Double Factor Technique we require a system of two Stents: A Radiological Stent that incorporates the future teeth and converges the radiologically scanned images in the Guided design software, where virtual surgery is performed. The STL delivery for manufacturing the
Surgical Stent will have steps for guided implantation, incorporating the virtual design of implants together with the prosthetic emergen of the future personalized teeth for the patient.
CBCT (Cone Beam Computerized Tomography)
1. Case studies: 3D clinical and radiological studies of the patient´s jaw to consider their suitability as a candidate for this technique and assess whether they require any prior dental treatment.
2. Record taking: Photographic record plus scanned or physical impression of the alveolar ridges plus bite and intermaxillary relationship to the physical or digital models of waxing.
3. CP Stent R (Radiological Stent): Digital wax-up of the future dentition of the patient for convertion into the radiological stent for scanning.
4. Double Scan: of the patient’s edentulous maxilla with the CP Stent R and scanning of it with CBCT to introduce the DICOM files to converte into the Guided designed software.
5. Virtual Planning: In the designed software the ideal locations of dental implants assessed with respect to anatomy and prosthetic emergence profile. An STL file is created for the reference milling center to produce the CP Stent Q (Surgical Stent).
6. CP Stent Q: the Surgical stent is prepared for the patient.
7. Implant Surgery: With the Surgical Stent imagery entered into the navigated surgery software, the software is calibrated to proceed with implant surgery in the patient’s mouth.
8. Immediate Prosthesis: Installation of the prosthetic implants previously designed for immediate loading.
In one session and without any discomfort, the dental implants is fixed without opening the tissue, providing possible simultaneous insertion of the provisionally fixed functional dental prosthesis with the greatest predictability and efficiency.
3 days trainning course for the above mentioned technique is now available ∫in Alicante, Spain, 3 Techniques, 3 Surgeries
The course provides training and immersion in Guided and Navigated Surgery and its fusion in the Double Factor Technique, knowledge and update.
Review of the concepts, advantages and indications of current techniques, with review of clinical cases for computer-guided implant surgeries in different modalities.
Analysis of the step by step mentioned protocol and the techniques.
Integration of the Digital Flow: Diagnosis, Planning, Surgery and Prosthetics.
Live Guided, Navigated and Double Factor Technique Surgeries.
Possibility of training individual experts as well as with their auxiliary team. Requests accepted.
Please choose the date that interests you most and confirm your attendance with us at: firstname.lastname@example.org
What’s your level?
Please stage your level of experience, for example if you are at the start of your career.
– The three-day modality course is available from Thursday to Saturday. We recommend this course for beginners.
– The two-day modality course, is available and recommended for experienced surgeons. This course is available Friday and Saturday only.
Don’t hesitate to contact us to personalize your stay
Courses starting in 2023.
– March 2nd, 3rd and 4th
– July 6th, 7th and 8th
– November 9th, 10th and 11th
10:00 Concept and development of Guided Surgery with work protocol.
11:45 Coffee Break
12:00 Concept and development of Navigated Surgery with work protocol.
13:00 Software Planning
15:00 Software preparation, Scanning and Calibration
16:00 Live surgeries
18:00 Clinical cases and questions
19:00 End of the day´s program
10:00 Comparison and Review of the current techniques of Guided Surgery and Navigated Surgery. Discussion towards advantages and handicaps of the two technique. Applications and Clinical Cases.
11:45 Coffee Break
12:00 Double Factor Technique. Discussion of the Concept, Protocol, Phases and Description.
13:00 Clinical cases
15:00 Digital Flow. Design, Stents and Prosthetics
16:00 Flujo Digital. Diseño, Férulas y Prótesis
17:00 Planificación en Software. Práctica
17:00 Software Planning and hands on practice
18:30 Discussion and questions
19:00 End of the day´s program
10:00 Case Presentation
10:30 Patient preparation and equipment preparation and calibration.
11:30 Live Surgery
12:30 Inmediate Loading
13:30 Discussion and questions
14:00 End of training.