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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
New workflows are improving dentistry for everyone.
There are people who, believe it or not, haven’t set foot in a dentist’s office in 10 years. One can only imagine the new world they will encounter if and when they return.
The workflows available to dentists today are a radical change from what was being practiced just a few years ago. Those new workflows may fascinate, because what dentists can do now can almost seem like something out of a science fiction movie. Here are just a few of the new workflows that are improving dentistry for everyone.
1. All-digital restorations move beyond crowns
In the good old days, dentists would have to make a physical impression of the patient’s mouth using a medium like polyvinyl siloxane. For many patients, having a mouth full of impression material was an unpleasant experience. While the procedure was over for the patient, the inefficiency of the process was just beginning for the doctor and lab.
Next, the impression would be boxed up and shipped to the lab where it would be developed by hand, pouring up models and meticulously tweaking a physical representation of the restoration. When the case was completed, it would again be boxed up and shipped back to the doctor’s office. The whole process would take, at best, several days, but more likely several weeks. And in the event something didn’t fit in the patient’s mouth properly, it would take even longer to get the problem corrected.
Now, however, the digital age makes this process smoother, faster and efficient. All-digital workflows take a lot of the hands-on labor out of the process. In an all-digital scenario, the doctor simply scans the patient’s mouth with an intraoral scanner, sends it to the lab using a secure web portal and the lab can immediately start the case. Even better, the technician can look at the scan while the patient is still in the chair and tell the doctor if anything needs to be corrected. Once the scan is accepted by the lab, the case is designed on the computer, sent for production on the milling machine and can be shipped back to the doctor within a day or two.
The end result is a faster, more efficient process for the doctor and lab, and a more pleasant experience for the patient.
2. Better treatment through digital imaging move beyond crowns
Doctors can tell a lot about their patients’ teeth through radiography. They are not only used to detect locations of decay, but can also be used when planning other types of restorations. The process was first introduced more than a century ago and has evolved ever since.
The conventional method of radiography involved phosphor plates placed in the patient’s mouth and then an exposure to radiation. This method got the job done, but it was far from perfect, both from the standpoint of image quality and risk of radiation exposure to patients and staff. The physical media involved was also awkward to handle and cumbersome to store.
Adding digital radiography to your workflow, however, ameliorates that. Digital radiography uses far less radiation and the results are instantly available on an operatory computer screen. Additionally, since the results are shown on a computer, they can be shared quickly and easily within the practice or with specialists, outside the office.
In addition to 2D radiography, 3D radiography (in the form of cone beam computed tomography) allows even more comprehensive and complete scans of the patient. These scans allow doctors to see the interior of the patient’s head – in addition to tooth structure – allowing better treatment planning and to help avoid unwanted surprises. They’re also useful when planning implant cases, allowing doctors to find the precise location to place implants.
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3. 3D printing goes beyond models
CAD/CAM opens the door for the digital workflow with milling machines providing the final manufacturing component. However 3D printing technology promises to make those workflows even faster, cleaner and more efficient.
3D printing uses the same file type that milling machines use (STL files) and they create the object from materials stored in the 3D printer. Some models of printer can even print multiple colors and types of materials, providing more valuable and useful products.
Currently, 3D printing is widely used to create models and tools for the restorative Another popular workflow for 3D printing is surgical guides. Based on the patient’s scan data, surgical guides can be fabricated and printed. The dentist uses the guide to find the precise location, angle and depth to drill for ideal implant placement.
However, as materials and technology evolve – and get much needed government approvals – the final restorations maybe possible. For instance, once a case has been designed on the computer, it can be manufactured on a 3D printer. Once printed, the restoration can be sent back to the doctor. Some even aspire for the 3D printer to be located in the doctor’s office and the restoration being instantly available to the clinician. It’s hard to say when those materials will be available – some expect within a few months, others within a couple of years.
4. The proliferation of same-day dentistry
It’s bad enough going to the doctor and finding out that a crown or bridge is needed. Not only must the patient endure the prep work involved with such a restoration, but they must also free up their schedule for at least two visits – one to prepare the tooth (or teeth) for the crown or bridge, and the second for the restoration to be placed -- hoping that it will be properly made and well fitting.
With same-day dentistry, however, the entire process can be completed in a single visit, usually taking anywhere from one to two hours.
In this workflow, the doctor scans the patient’s mouth but rather than sending that scan to a laboratory, it is sent to a computer located on-site. There, the doctor or a member of staff – who has been properly trained – designs the case. From there, it is sent to an in-house milling machine and given some final esthetic touches – like staining and glazing.
The materials that are possible with this type of workflow are the same types of materials that labs use. In fact, it is now possible to sinter zirconia in the office, a material that used to only be the purview of labs.
5. Digital dentures
Dentures take a long time to create. Patients must come in for multiple visits to get the proper fit. On top of that, making those adjustments involves the handiwork of a laboratory.
Digital dentures streamlines the entire process. When done most efficiently, patients only require two visits – one to scan their mouth and then one to check the fit of the final device.
In between, the workflow is similar to and all-digital workflow: The doctor scans the patient’s mouth, that scan is sent to a laboratory, the laboratory creates the case, collaborating with the doctor to get the fit just right. When the case is finally ready to be produced, it is sent to a milling machine where the new teeth are created and added to a base plate. In the future, the workflow promises to become even more efficient. 3D printing can be added to the workflow, using different densities of 3D printing materials. This will allow for the creation of gum-like tissue, as well as teeth.
The ability to provide this service results, not only in a happier patient but is also an opportunity to provide a premium service for the practitioner.
These workflows weren’t possible a few short years ago and they may seem like the stuff of science fiction. Doctors and labs do a better, faster and more efficient job and, ultimately, patients benefit from it all.