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October 2012
Volume 33, Issue 9

Developing a Digital Dental Team

Gregg A. Helvey, DDS; Lee Culp, CDT; and Edward A. McLaren, DDS, MDC

Q: How can clinicians integrate laboratory technicians into a “digital dental team” concept?

Dr. Helvey

A: Digital technology is constantly improving the way clinical dentistry is practiced and enhancing dental technology. From the laboratory side, partnerships between manufacturers are growing, therefore more compatibility is emerging among digital systems, which in turn enables greater expansion of services. Scanning and milling technology is becomeing faster and more accurate, and the devices themselves are even more compact today.

Clinicians have a variety of “digital” tools at their disposal that virtually bring their technician into their office. Although laboratories can be “high tech” by incorporating the newest and most expensive digital CAD/CAM fabrication devices, that doesn’t necessarily make them efficient and more connected to the dental office. There are simpler, less expensive tools that can bring together the dental office and laboratory and enhance the growth of both in a “high tech” way. Sharing information and applications over a network can provide immeasurable benefits that improve case management and treatment design modalities while reducing the amount of time required to.complete these tasks. Much of this is made possible through cloud.computing, which enables anyone who can get online to store, use, and share data through a network that is accessible anywhere using simple tools such as cell phones, laptops, or tablets. Large data files can be shared using Dropbox. Dentists and laboratory technicians can.communicate through video using Skype. Quality photographic images can be shared with simple cell phones, iPads, or other tablets. Apple offers free applications that allow users to communicate through iPhones and iPads, including coDiagnostix™ for treatment planning. In addition, denture teeth can be selected based on the patient’s measurements through an application from Candulor ( ) called ToothScout HD.

It’s not the cost of the technology that brings the workplace to the “high tech” level. It is finding and utilizing the small things like video conferencing and data sharing that bring the dentist and technician together as a more efficient “digital team.” Once past the learning curve, most clinicians wonder what they ever did without this technology.

Mr. Culp

A: As restorative dentistry evolves into the digital world of image capture, computer design, and the creation of dental restorations through robotics, perceptions and definitions of the dental laboratory must evolve as well. To fully understand this concept, there must be a clear definition of what a laboratory is. Some might say that a laboratory is the place where dentists send their patients’ impressions, which the laboratory then processes into restorations, which are then sent back for delivery. This definition does seem to fit well with the traditional concept of a dentist-laboratory workflow. However, just as the Internet has forever changed the landscape of communication through relatedcomputer technology, the ability to use CAD/CAM restoration files electronically has provided the catalyst for a significant change in the perception and structure of the dentist-laboratory relationship.

Imagine the laboratory not as a place with walls but instead a repository for the talents of the partners in the restorative process—the dentist, auxiliaries, and technician. While the equipment used to create the restoration may be located in an in-office laboratory area, or at the dental laboratory, the “lab” is actually nothing more than a workflow, which is flexible to the degree that the team members’ abilities, access, and equipment will allow. In this model, the primary decision bes where the handoff from one partner to another should occur. Moreover, dentists with the ability to optically scan intraorally for impressions and who often choose CAD/CAM restorations as the best treatment option for their patients have enhanced freedom as to where the handoff to the technician partner should occur. In this way, the laboratory is no longer a place; rather, it is to a large degree a virtual and fluid entity.

In some instances, it makes sense for the dentist to work independently and to prepare, design, and finish the restoration chairside in a single visit with the obvious advantages a clinical CAD/CAM system has to offer. These might include lesscomplex restorations or fewer restorations for the same patient that do not require any special characterization other than perhaps stain and glaze or polish. Other times, it is advantageous to engage the services of the dental technician as a restorative partner with the skill, and perhaps more importantly, the time, to create restorations that either demand morecomplex characterization or can be more efficiently created in an indirect manner.

The dental profession currently regards CAD/CAM technology as simply a machine that fabricates full-contour ceramic restorations or frameworks. Digital dentistry practiced by the digital dental team represents a totally new way to diagnose, treatment plan, and create functional esthetic restorations for patients in a more productive and efficient manner. CAD/CAM dentistry will only further enhance the dentist/assistant/technician relationship as they enter this new era of patient care.

Dr. McLaren

A: Digital dentistry and the “digital dental team” represent a means of offering a.completely new way to diagnose, treatment plan, and create functional esthetic restorations in a more productive and efficient manner. Despite this, dentistry has moved more slowly towards digitization than other industries—in which automation and digitization decreased costs—largely because digitization of restorations significantly increased costs without initially offering restorations that were as accurate per unit as those fabricated traditionally. However, this is now rapidly changing, as digital systems have improved to the degree that they can create a restoration as well as a human—in terms of biologic and functional aspects—if all procedures are followed exactly.

Achieving the level of artistry is another matter entirely. Machine-generated restorations appear to be what they are—manufactured—which is acceptable for posterior teeth such as molars, as long as they satisfy biology, function, and fit and look reasonably good in the mouth. But in the front of the mouth, teeth need to look real, and machines aren’t quite there yet.

With that in mind, the challenge is to incorporate digital technology into a new-age dental office that allows the dentist to do what dentists do best, machines to do what machines do best, and to bring into the mix what the ceramist does best—the finish work, putting the final touch on a restoration, which is the glaring deficiency of machines right now.

An opportunity for ceramists who have been displaced by machines or offshoring may be in the creation of short-turnaround, high-quality restorations, as “enamelizers,” adding little bits and pieces to customize a restoration with gradation of color or the form. In this “model” dentists would prepare the teeth and have the labor-intensive model, dentin shape, etc, done by machine before having it delivered to the ceramist to work his or her “magic.” The ceramist then returns it to the dentist, who can deliver it to the patient the same day.

Thus, dental CAD/CAM technology could fulfill its potential to revolutionize dentistry by designing all frameworks and full anatomical crowns, and enabling dentists and ceramists to focus on what they do best. Entrepreneurial laboratory people could collaborate on site with dentists who already have a chairside system to offer what many patients want and would be willing to pay a premium for—the convenience of having world-class dentistry.completed in 1 day.

About the Authors

Gregg A. Helvey, DDS

Adjunct Associate Professor, Virginia Commonwealth University School of Dentistry, Richmond, Virginia; Private Practice, Middleburg, Virginia

Lee Culp, CDT

Chief Technology Officer, Microdental Laboratory, Dublin, California; Adjunct Faculty, Graduate Prosthodontics Department, University of North Carolina School of Dentistry, Chapel Hill, North Carolina

Edward A. McLaren, DDS, MDC

Professor, Founder, and Director, UCLA Post Graduate Esthetics, Director, UCLA Center for Esthetic Dentistry, Founder and Director, UCLA Master Dental Ceramist Program, UCLA School of Dentistry, Los Angeles, California

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