Currently, digital impression-taking devices are far from mainstream, but many predict that the day will arrive when their use becomes common and impression materials and pouring models may be things of the past.

“In a word, I love the idea,” said Dr. McLaren, a member of the CR Foundation (formerly CRA) Board of Directors where tests were recently conducted on the iTero unit by Cadent. “Think about this…Wow, what an incredible technology! At the ultimate level, it’s helping you with smile design by scanning the arch. Taking it a step further, systems are being tested that make prototypes for you—rapid prototyping temporaries will tell you how much to reduce, and if you have enough space for the color change. These will all be integrated systems. Let’s say it will take the shade of the prepared tooth and it’s a C4. It’s going to ask you if you want to go to an A1 or an A0 as an example, so you only have 1.1 mm of space, and what material are you going to use, and so on. So just about everything will be digitized.”

Dr. McLaren added that systems are being developed that will allow you to see through soft tissue via a type of sonar. There are also plans for high-resolution CT scans in the future. “They’re going to get these CT scans down to one micron, I’m told, with such low radiation that nothing is ever going to have to go in the mouth again,” he said. “So what will happen is you’ll prep the teeth, put the patient’s head in a machine, and it’s just going to scan the prepped teeth from the outside of the mouth. Unbelievable!”

Dr. DiTolla warns that the current digital impression-taking technology may be perceived by some practitioners as too complex, which could turn them off from incorporating the device into their practices.

“I’ve had the opportunity to use both systems, the iTero from Cadent and 3M ESPE’s Brontes—I actually own the Cadent system,” Dr. DiTolla said. “Plus the other scanning system is for the Sirona CEREC 3 unit.”

Dr. DiTolla said dentists who take sloppy standard, traditional impressions and send them to the laboratory will take even worse impressions with the digital technology if they do not improve their technique. “With digital impressions, you have to take better care of the tissue than you do with a traditional impression,” he said. “You know, with a traditional impression you can get away with a tiny little bit of bleeding. There’s some stuff that you can get away with that you absolutely cannot get away with using these digital impressions.”

A superior result can be assumed, Dr. DiTolla said, because you won’t have impression materials shrinking and deforming when taken out of the mouth. But costs and technique sensitivity may be an issue that keeps some GPs from adopting the technology.

“For quality-conscious dentists who are probably going to the early adopters of this technology, it’s not going to be a big deal because they’re probably taking really good care of the tissue right now with their traditional impressions,” he said. “But when it goes out to the majority of dentists, who send in a traditional impression right now that doesn’t quite capture all the margins—they may find it difficult. Much more difficult, because you do really have to take care of the tissue.

“I think we’re just at the very beginning of where this technology is going to go. I think the technology is going to get better. If there ever comes a day where there is a digital impression system that can see through tissue and not have a problem if there’s a little gum tissue sitting by the margin, that would be a huge step forward. I’m sure that technology is somewhere down the road. I don’t know if it’s five, 10, or 15 years. But I think the days of putting vinylpolysiloxane material in people’s mouths at one point will be over.”

Both Drs. McLaren and DiTolla expect great advances in technology to bring about great changes in the roles labs and lab technicians play. Both predict that today’s freestanding, unaffiliated dental labs—at least in their current state—most likely will not exist in a few decades, yet technicians who can deliver high-quality esthetics should always be in demand.

“This is what I think the model will be in the short- to medium-term,” Dr. McLaren said. “With the really pro-active dentists, what I see as the benefit of the CEREC or the new D4D system is they’d like to eliminate the technician with the complete chairside unit. We are certainly not there yet. I envision a scenario where a combination of chairside and laboratory technologies are used together.”

But looking down the road, Dr. DiTolla sees these processes going a step further.

“You have to think at some point in the future that the entire lab industry as we now know it will be obsolete,” he said. “With one-appointment dentistry, are there really going to be dental laboratories 60 years from now? You have to wonder.

“I can see dental laboratories still being involved, in certain ways. If you had a group of dentists, you could set up a milling center. Imagine a building with 15 to 20 dentists in it, and these dentists probably don’t want to spend $120,000 each for their own CAD/CAM unit. You could set them up with impression scanners. They would take a digital impression in their office and then transmit it via the Internet, to you, the lab in the same building, but maybe on a different floor. You would mill the restoration for them and you would stain it just like you were a laboratory. Then one of your employees runs it up two floors to their office. Now, not only would they have the same-day crown, but it would have been stained by a professional technician. So you have the best of both worlds. You have something that’s available in one day but that also has the artistry of a dental technician so that it matches the digital photograph. That might be the future of laboratories in these centers; remaining involved with the fabrication of the restoration but still having one-appointment dentistry for the dentist. That’s certainly where I think this is headed.”