How current trends are affecting everything from treatment planning to in-house capabilities.
When working with emerging technologies and new companies, my thoughts are always on the future of dentistry. While it’s fun to ponder what could be or what’s coming, I felt that getting the opportunity to discuss what’s current with one of the most knowledgeable experts in the industry would bring great value to our readers.
That’s why I sat down with my good friend, Dr. Marty Jablow, “America’s Dental Technology Coach” and a panel member for the Cellerant Best of Class Technology Awards, to talk about dental technology as it is today.
LS: What are the latest trends in dental technology?
MJ: The latest trends involve digital integration so that we can merge various pieces of digital technology to achieve a more efficient workflow and better restorative product.
We’re now using CBCT and intraoral scanners to integrate data sets to achieve things that just a decade ago were considered difficult or impossible. Another trend is using artificial intelligence (AI), as it improves diagnosis, treatment planning and the use of scanners.
LS: What are your feelings about the use of artificial intelligence (AI) in dentistry?
MJ: Artificial intelligence is in its infancy, but it will totally change the way many things are done in dentistry. I’ve had the opportunity to see and use some of these technologies.
The use of AI in intraoral scanning can eliminate elements such as blood, gingiva and retractors from the scan. This makes scanning easier, more accurate and efficient. It tells you where things are missing and how to better catch the missing data in the areas you need to rescan.
The use of AI in diagnosis may be the most game-changing. You can see caries and determine whether it may be best to watch or restore. You can see lesions on radiographs and get differential diagnosis. And that’s just the start!
LS: What about digital workflow?
MJ: Dental technology is continuing to evolve. The big thing now is digital workflow. In reality, we’ve had a clinical digital workflow for decades.
The digital workflow started with the first CAD/CAM systems, such as the early CEREC systems. What we’re seeing is the evolution with the lower cost of the components such as CBCT, intraoral scanners, mills and 3D printers. Lowering the barrier to entry along with the lower cost of the high-horsepower computers makes using a digital workflow within reach of most dental offices.
LS: How are people using intraoral scanners?
MJ: Intraoral scanning is taking off in dentistry now that the prices are starting to drop. There are currently scanners on the market for less than $20,000. These are high-quality scanners that can produce scans in standard file formats that can be easily shared in any software for diagnosis, treatment planning and restoration design.
Through the use of intraoral scanners, difficult procedures, such as retrofitting a crown to an existing RPD, become easy. Determining occlusal clearance involves using a computer to visualize where to further prep a tooth, rescanning only that area of the tooth and sending it to the laboratory for fabrication of the crown.
The best part is the number of impression retakes is nearly zero and the number of remakes is greatly reduced. I find viewing your preparations on a large computer monitor and marking your margins for the laboratory makes the final restorations much better, as you become better at preparing teeth.
Intraoral scanning also reduces the time it takes to get your prosthetics back from the lab. There’s no longer any transit time to the laboratory, saving days in the process. In many cases, simple crown and bridge or implant cases are started the same day and are returned to my office in less than a week. The fit is usually better and the time it takes to insert the prosthetics is greatly reduced.
The only bottleneck is scheduling the insert appointment. If a temporary crown or small bridge is inadvertently dislodged, the insertion is normally done as a side-booked event with the final prosthesis, as it’s already in the office. The patient is happy and it frees up a scheduled appointment time.
Intraoral scanning is also being used for both full and removable dentures, fabrication of orthodontic appliances, fabrication of aligners in the office and sleep apnea appliances.
LS: How does cone beam integration fit into the digital workflow?
MJ: CBCT has changed diagnostics for surgery, implants and endodontics. Enhanced diagnostics lead to better outcomes. It’s no surprise this makes the patient and dentist happier.
I’ve seen the benefits with better implant placement making the surgery more predictable and with better emergence profiles. Endodontic CBCT diagnostics makes it easier to see missed canals and fractures, along with the emerging use of guided endodontics. Just as guided surgery is improving implant placement, look for similar benefits in endodontics.
LS: Tell me about CAD/CAM and 3D printing
MJ: The ability to produce all types of treatment guides and aligners in-house is transforming dentistry. We all know you can mill a restoration or implant surgical guide. The transformation is happening because of 3D printing.
Many printers are less than $5,000 and can provide a multitude of benefits to a dentist. You can print models to make in-house aligners, implant guides and night guards, or try-in dentures before adjusting and scanning so that the final denture is an exact match. And, you can do all of this for a fraction of the cost of lab-made prosthetics. However, there’s a learning curve and your assistant will need to be doing more lab work, so include that in your cost evaluation.
The biggest part of 3D printing is the continued development of resins. There may be limitations on the long-term life of 3D-printed dentures and night guards, but it may be mitigated by the ease and reduced costs to just make another one. There are esthetic limitations too, but all of this will resolve over time as the printable resins improve, just as composites have evolved.