November/December 2013, Volume 34, Issue 10
Published by AEGIS Communications
Digital Dentistry: A New Era of Patient Care
Digital technology is revolutionizing the quality of dental care being delivered in modern practices and laboratories. Such technologies can enhance the communication between dentist, specialist, and lab technician, ultimately improving the results of the restorative team.
Throughout the years restorative trends and techniques have come and gone. Some developments have transformed the face of restorative dentistry, while other concepts have phased out and died. The concept of digital dentistry is one that started out small but has progressively increased in momentum. Now, its boundaries appear to have become endless. However, new technologies in dentistry can only be successful if they are combined with a complete understanding of comprehensive dentistry. While new technology and computerization can make procedures more efficient, less labor-intensive, and more consistent, it will not replace education, practical experience, and clinical/technical judgment.
The most exciting factor regarding these new digital technologies is not only in their potential applications that are being hypothesized by dental professionals. The excitement lies in the fact that these “hypothetical” applications have actually been developed in recent years,1 and some are even in the final stages. In a relatively short time period, digital technology will revolutionize the quality of dental care that is being delivered in modern dental practices and laboratories.
Based on technology adopted from aerospace/automotive and even the watch-making industry, computer-aided design/computer-aided manufacturing (CAD/CAM) technology is being well received in restorative dentistry because of its speed, accuracy, and efficiency. CAD/CAM systems are used to design and manufacture implant abutments/bars, metal and zirconia frameworks, as well as all-ceramic full-contour crowns, inlays, and veneers that may be stronger, more esthetic, and better-fitting than restorations fabricated using traditional methods.2 When partnered with data from cone-beam computed tomography (CBCT) scanning technology, CAD/CAM offers revolutionary advances in implant diagnostics and treatment planning, and affords the surgeon, restorative dentist, and technician team an expanding horizon of surgical and prosthetic options. It awakens a new focus in implant esthetics, addressing a major concern in both the surgical and prosthetic phases of treatment.
Opening Up Lines of Communication
The basis for all long-term success in restorative dentistry is a comprehensive diagnosis and treatment plan.3 The ability to preview a case from start to finish and communicate and co-diagnose with other specialists and specialties about dental patients via the virtual world is the true power and capability of digital dentistry. Dental design software is currently available that allows dentists, specialists, technicians, and even patients to communicate and create numerous anterior teeth arrangements based on functional–esthetic parameters, as well as patient desires.4 This encompasses both software and output devices to simulate and fabricate intraoral devices for tooth movement, tooth restoration, and tooth replacement.
With so many new emerging technologies and increased patient demand for highly esthetic and functional restorations, today’s state-of-the-art dentistry demands considerable communication between all members of the restorative team, including the general practitioner, technician, endodontist, periodontist, oral surgeon, and/or orthodontist. Complete planning and verification of each treatment step, with input from each member of the restorative team, will result in a multilateral effort that can ensure success based on shared responsibilities.
Dentists and dental technicians share a unique relationship in that they are totally dependent on each other for success, yet, at the same time, they are trained and practice apart from each other. There is, of course, communication; however, the “prescription pad order” is not a two-way street. The occasional curt telephone conversation lends itself to a lack of understanding of each other, poor relationship building, and weak professional cooperation. Common tools (such as shade guides) have been developed to facilitate this relationship, but differences in observation, interpretation, and application that are inherent in separate individuals who have not been trained within the same parameters can lead to a wide disparity of results. What is needed is something more definitive that will allow the two professions to not only cooperate, but to have similar definitions, knowledge, and diagnostic and treatment concepts.
Over the years, technological advancements have typically consisted of an initial design that is improved upon in several iterations until an ideal format is reached. In the past, traditional communication methods often resulted in insufficient data transfer and increased patient dissatisfaction caused by the need to remake an ill-fitting or undesirable restoration. While CAD/CAM technologies were evolving, dental professionals continued to use conventional yet trustworthy methods of data transfer, incorporating digital dentistry to fill in some of the blanks that were caused by familiar methods. As the field of digital dentistry further expands, CAD/CAM systems will be increasingly applied for treatment-planning procedures, implemented from the very beginning of treatment throughout the entire restorative process. By incorporating advanced CAD/CAM technology-based systems into the diagnostic phase, margins for error will be reduced and dental professionals will have a greater ability to replicate natural esthetics while focusing on proper function and occlusal harmony.
The Digital Patient
The emergence of cone-beam CT-scanning 3-dimensional (3-D) volumetric imaging systems now provides dentists and specialists complete views of all oral and maxillofacial structures, giving the dental profession the most thorough diagnostic information available to-date for a variety of treatment areas. This includes implant placement and restoration, temporomandibular joint (TMJ) diagnosis and treatment, as well as the creation of functionally esthetic all-ceramic restorations, allowing for more accurate diagnosis and treatment planning and, in turn, more predictable treatment outcomes. Combining high-resolution data acquired from intraoral laser scanning with the plethora of global information offered by cone-beam CT scanning enables dental professionals to create a true digital patient. This combination of data sets offers dentistry predictable, accurate diagnosis, treatment planning, and restorative outcomes.
The combination of CT scanning, laboratory-based laser scanning technology, along with intraoral digital impression capture technology, in harmony with the design capabilities of state-of-the-art software, for the first time in dentistry affords an accurate representation of a virtual patient. Dentists can now preview and even test different treatment options to enhance patient care, combining data to develop a proper treatment plan for patient analysis and treatment to create solutions that would include all functional–esthetic aspects of oral rehabilitation.
As dentistry progresses into the digital world, the successful incorporation of computerization and new technology will continue to provide more efficient methods of communication and fabrication while also allowing the skilled dentist and dental technician to retain his or her individual creativity and artistry. A close cooperation and working relationship among the dentist/technician team will enhance the utilization of new technology. “Digital waxing” using a diagnostic wax-up and provisional restorations and their digital replicas to guide the creation of CAD/CAM restorations will become dentistry’s “standard operating procedure,” replacing hand waxing. The use of these new technologies, along with the evolution from “hand” design to “digital” design, as well as the addition of the latest developments in intraoral laser scanning, materials, and computer milling/printing technology, will only enhance the close cooperation and working relationship of the dentist/dental laboratory team.
In with the New
Digital dentistry, CAD/CAM technology, and the digital dental team represent a new way of diagnosing, treatment planning, and creating functional esthetic restorations for patients in a more productive and efficient manner. CAD/CAM dentistry will only further enhance the dentist, specialist, and technician relationship as they move together into this new era of patient care.
1. Ayoub AF, Xiao Y, Khambay B, et al. Towards building a photo-realistic virtual human face for craniomaxillofacial diagnosis and treatment planning. Int J Oral Maxillofac Surg. 2007;36(5):423-428.
2. Vigolo P, Fonzi F. An in vitro evaluation of fit of zirconium-oxide-based ceramic four-unit fixed partial dentures, generated with three different CAD/CAM systems, before and after porcelain firing cycles and after glaze cycles. J Prosthodont. 2008;17(8):621-626.
3. Spear FM, Kokich VG, Mathews DP. Interdisciplinary management of anterior dental esthetics. J Am Dent Assoc. 2006;137(2):160-169.
4. Culp L, Touchstone A. CAD/CAM dentistry: a new forum for dentist-technician teamwork. Inside Dentistry. 2006;2(7):94-96.
About the Author
Lee Culp, CDT
Chief Technology Officer, MicroDental Laboratories, Dublin, California. Mr. Culp guides the development of the DTI digital technologies program and their applied applications to restorative dentistry; Adjunct Professor, Graduate Prosthetics Department, University of North Carolina School of Dentistry, Chapel Hill, North Carolina
Continuing Education Resources
Screw-Retained Implant Dentures with Minimal Patient Visits: dentalaegis.com/go/cced508
Computer-Guided Implant Surgery: Indications and Guidelines for Use: dentalaegis.com/go/cced509
Restorative Responsibilities for Achieving Exceptional Implant Esthetics: dentalaegis.com/go/cced510