Digital Intraoral Impression Systems
New technologies increase their foothold in the dental industry
Ever since the era of copper bands and wax compound impressions, the dental profession has gradually evolved to utilize increasingly predictable and accurate means of recording prepared teeth. Dentistry is a profession steeped in the tradition of excellence and the entire dental team has worked tirelessly to ensure that the treatment provided to patients is held to the highest of standards. The impression and model making processes have remained a crucial step in this endeavor. Incrementally, our scientists and manufacturers have developed increasingly accurate materials for the physical reproduction of the tooth. And yet, now the industry is in the midst of the greatest change in this process since its inception—digital impressioning. It is the author’s opinion that none of the changes brought on by previous developments in impressioning will match the industry-wide impact of this radical technology.
Many clinicians have been able to produce uncompromising results with physical impressions and stone-work, and there is no doubt that some of the greatest dentistry performed today is being done using conventional processes. However, the industry is changing. The use of digital impressions and digital prosthesis fabrication systems is finding a strong foothold within the industry. These technologies will almost certainly be met with some resistance from those who have worked hard to get to elite levels using conventional methods. However, the balance beam will tip as more young dental students and recent graduates enter the dental workforce, as this demographic tends to favor digital methods of capture over analog. Already, they are eager to adopt and integrate this technology into their practices and they have taken to it readily. The author has seen how quickly second-year dental students master the use of a digital impression unit, and watched them do so with much less frustration than seasoned clinicians. This is a technology they understand and that seems to align better with their day-to-day lives, which are already dominated by digital devices.
Improving Patient Care
When considering the impending wave of integrated digital workflows, the dental industry must not only ponder the effects digital might have on individual patients, but also what it means for the patient population as a whole. Educators have increasingly less time within their curriculums to train hands-on skills, and there is the critical issue of fewer and fewer technician educational programs. Digital technology will help mitigate these problems and create new opportunities for dentists and technicians to improve their level of patient care. It will also undoubtedly increase the level of communication between clinicians and technicians, as well as dramatically improve the predictability of the final prosthesis. Additionally, this technology has improved—and will continue to improve—the quality of the impressions sent to the laboratory, as it offers a greatly increased magnification level for reviewing the prepared tooth. The quality of digital impressions will become even more refined as the technology develops methods to minimize imaging issues created by fluids and soft tissue.
Digital impressions and fabrication processes can be standardized and monitored in real-time level unmatched by analog processes. As a professor on the clinical side of a digital impressioning training program, the author is eagerly anticipates using this technology as a means of providing highly accurate and easy-to-understand feedback to dental students and residents alike.
As digital workflows inherent to digital impression units become more commonplace, the dental industry will start to expect real-time collaboration between the various members of the dental team. This constant, deep interaction will enhance team communication should any difficulties or unexpected challenges arise. Technicians will have the opportunity to give feedback to their clients before a case is even processed. Digital impressions will also allow for extensive and complete interaction between the restorative and surgical implant treatment planning team. However, the greatest advantage to come of the digital impression systems and fully digitized workflows will be the enhanced communication and collaboration possible between clinicians and technicians.
Make no mistake—digital impressioning has arrived. We are all a part of the digital revolution and are experiencing the beginning of one of the biggest advancements in indirect dentistry since its inception. The initial deployment of this technology occurred more than 25 years ago with the debut of the CEREC® 1 from Sirona, and it was not without its growing pains. CEREC 1 was indeed a technology before its time. Over the past few years, there has been an explosion of research and development in the digital impression arena, with increasingly user-friendly, accurate, and affordable options coming to market. Today, the developments are coming fast and the competition is fierce, and it is worth taking note that there continues to be a variety of approaches and options available to the dental team.
Manufacturers developing digital impression technology have approached this segment of the industry from a number of different angles. This not only applies to their hardware and software, but also the business models supporting the technology.
As time goes on, already-existing digital impression units will evolve and new manufacturers will enter the market with their own technology. The evolution of existing products and the introduction of novel products are already happening at a staggering rate. There is a long awaited shift across the board toward making the systems more affordable, more portable, and more accessible across multiple platforms. Clinically, the trend is moving to a powder-free scanner that is slimmer and more intuitive.
Opportunities for Teamwork
As a clinician, the author is most excited about the collaborative opportunities digital workflows provide for real-time interaction with his technicians and the improved patient outcomes that it will create. As dentistry embraces this new technology, digital impressioning will increase the quality of our restorations overall. Laboratories will face fewer and fewer remakes due to all-too-common problems with physical impressions, and fabrication processes will become faster and more accurate.
The technology will also have a positive impact on planning implant treatment, as the ability to align data from highly accurate intraoral scans with CBCT data allows the dental team to properly diagnose, plan, and execute implant treatment with a level of accuracy simply not possible with traditional means. It is the author’s hope that this will significantly improve access to implant treatment and the predictability of the procedure as a whole.
Additionally, a digital workflow will help the dental team establish a deeper and more predictable understanding of issues related to occlusion. Even properly calibrated, fully-adjustable articulators fail to truly replicate the architecture of the TMJ and the functional movements of the jaw. Digital technology as a whole will allow the dental team to incorporate the actual anatomy of the individual patient’s TMJ into analysis of their occlusal situation and identify any related signs or symptoms. Soon, the profession will be able to incorporate something that is currently reserved for only the most complicated or troublesome cases on a regular basis.
Like so many new technologies, it will take time for clinicians and technicians to adjust their protocols and techniques to the recent developments in the field. Dentistry as an industry can be slow to change. We are often blinded by the inefficiencies and inaccuracies we are familiar with, and scared of those we are not. It will also take time for the dental research community to objectively test and validate the various methodologies, and the bulk of available research on the accuracy of digital impression systems is funded by interested parties. Not that this data is without merit, only that as a part of a scientifically-based profession, third-party data is necessary to verify claims. Fortunately, the laboratory side of the dental profession has been much more aggressive and efficient in adopting the digital scanning and fabrication methodologies. The industry has already seen some large scale laboratories move away from wax and stone all together.
This is the beginning of a new era for laboratories, for dentists, and for patients. Soon, physical model work will be entirely superfluous, and even now it is maintained only to ease minds during the digital adoption process. This rapid adoption on the laboratory side will indeed shape the path for the clinical side. The revolution of digital dentistry is here.
About the author
Todd R. Schoenbaum, DDS, FACD, is an Assistant Clinical Professor of the Division of Restorative Dentistry, and the Director of Continuing Dental Education at the University of California-Los Angeles School of Dentistry, Los Angeles, CA.