Table of Contents

Cover Story
  • The 5th Annual Tech Issue Paul Feuerstein, DMD, Gerard Kugel, DMD, MS, PhD, Dayna Johnson, Andrew C. Koenigsberg, DDS, Anthony R. Cardoza, DDS, David P. Sarment, DDS, MS, Ali Allen Nasseh, DDS, MMSC, PC, Parag Kachalla, DDS
    pp. 85-107
Practice Building
Continuing Education
Implants
Restorative

Inside Dentistry

July 2014, Volume 10, Issue 7
Published by AEGIS Communications

Today’s Digital Workflow

John F. Weston, DDS, FAACD

Everywhere we look, the power of computer-based technology is becoming integrated into our daily lives, and dentistry is no exception.

Anyone who has picked up a dental publication in the past 5 years does not need me to explain the effect digital processes are having on dentistry. The laboratory side of dentistry has been using digital fabrication workflows for many years with the goal of improving not only productivity, but also quality and predictability.

Some clinicians ask, “What I’m doing is working just fine, why change?” That’s a valid question. Interestingly, the basis for most of the research to determine the accuracy and effectiveness of digital impressions is based on a comparison to traditional impressions. Clinicians will accept technology as long as it’s as good or better than what they are currently using.

While some studies show an increase in accuracy of marginal fit, occlusal fit, and very accurate printed models, doctors have not readily adopted the technology due to cost and the learning curve required to become efficient. As a result, the clinical side of dentistry has been slow to catch up: only about 10% to 15% of doctors currently use digital impression systems.

However, as with all technology, we are finally seeing more affordable and efficient systems coming to the marketplace. Multiple companies are introducing accurate, easy to use scanners that have smaller wands and smaller footprints. Some are even laptop-based platforms. No longer are digital impression systems used just for single restorations or chairside milling. We are seeing expanded uses of digital scanning to fabricate models for larger cosmetic cases, orthodontic aligners, multiunit bridges, implants, abutments, implant crowns, and removable prosthetics. The benefits are becoming obvious, and doctors who are not willing to jump in to the digital world may very soon find themselves behind the curve.

While there is no requirement to purchase an “in-office” mill, most systems integrate well with high-tech tabletop mills that allow production of single crowns using a wide range of modern materials. Some mill systems also include a workflow for single tooth surgical implant guides. Now that digital x-rays are firmly established as the standard of care in the clinical setting, doctors new to digital technology should consider starting their digital journey by fully integrating digital radiographs. The natural progression would be to add digital impressions. Even more exciting is the integration of digital radiography with digital scanning. These new workflows merge the digital impression STL file with 3D dicom files for precision “full-arch” design of prosthesis and implant surgical guides.

There is no doubt that as this technology grows and improves, new workflows will be developed and analog impressions will become a thing of the past. Most of the current digital impression systems cause minimal disruption by allowing the user a choice to send the file to their current laboratory or invest in a chairside milling option.

Digital impressioning saves time by reducing steps, maintains equal or better accuracy, and is continually evolving new workflows to improve productivity. This technology is here to stay for sure. Right now the biggest drivers of successful and complete adoption by the marketplace revolve around building a small, accurate system that’s affordable and easy to use.

About the Author

John F. Weston, DDS, FAACD, is an accredited fellow of the American Academy of Cosmetic Dentistry (AACD), an honor shared by fewer than 50 clinicians worldwide. Dr. Weston is past chair of the AACD Professional Education Committee and has served two terms as an elected member to the Board of Directors. He is currently an active Accreditation and Fellowship Examiner and served a 3-year term on the American Board of Cosmetic Dentistry. He has has been practicing in La Jolla, California, for more than 20 years with an emphasis in reconstructive and digital esthetic dentistry. He is owner and director of “Scripps Center for Dental Care,” a multi-specialty dental center located at Scripps Memorial Hospital.