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Compendium
May 2016
Volume 37, Issue 5

A: Dr. Gratton

Digital dentistry is here now, and here to stay. Chairside CAD/CAM is just one part of digital dentistry. The term chairside CAD/CAM is extremely limiting in the context of what digital dentistry is; in fact, the term may have inadvertently slowed the widespread adoption of digital dentistry. This is because the implication is that a practitioner must invest in a complex system that involves a scanner, software, and production hardware—to what end? To “save” on a laboratory bill? The chairside CAD/CAM systems available today are accurate, effective, and efficient, using sophisticated software to produce a multitude of clinically acceptable interim and definitive single-unit and multi-unit prostheses, including those for dental implants. However, is this workflow practical for every clinical environment? Does training an office staff member to complete the prosthetic design and production really save on the laboratory bill?

Consider carefully what’s happening in our industry. First, we are training an increasing number of dentists and simultaneously a decreasing number of dental technicians. Second, many dental technicians are at or near retirement age. This is the perfect time to be integrating dental technicians more closely into the digital dentistry workflow, rather than attempting to replace them with a chairside CAD/CAM system. Would it not be more prudent to transmit the initial data to an individual with formal training in dental anatomy, occlusion, and materials science for the design and production of the prosthesis? Further, in this scenario, the practitioner needs to invest only in a device that produces the intra-oral digital impression. From there, he or she can send the data to the dental laboratory.

Many intraoral scanners are on the market today. Prices have come down, accuracy and precision have gone up, and scanning efficiency has improved significantly with the adoption of video capture. A full-arch diagnostic impression can be captured in the same or less time that it takes for an alginate impression to set. Some devices now capture the oral structures in color—a feature that may have limited applicability for prosthesis production, as margin marking is best completed in a black-and-white mode—but has tremendous impact for patient education and treatment plan acceptance. The diagnostic potential of the intraoral scanner has yet to be fully realized. An intraoral scan should be completed at every recall examination. These sequential data sets can then be superimposed to evaluate and monitor restoration and tooth occlusal wear, tooth positional changes, and gingival tissue positions. Visually, patients can now better appreciate our treatment recommendations. Quantitatively, if this information is shared appropriately, it will lead to powerful data sets to drive evidence-based best practices. Manufacturers are just now bringing these types of applications to the intraoral scanner.

Digital dentistry is now. Chairside CAD/CAM is merely one facet of digital dentistry (which may not “fit” every office). The intraoral scanner is the key to the digital dentistry workflow and should be embraced by all practitioners, not only as a tool for making impressions, but as a diagnostic instrument. In the future, it may replace the mirror, explorer, and periodontal probe.

Disclosure

Brian Schroder, DDS, maintains an ownership in Implant Concierge.

About the Authors

Brian Schroder, DDS
Private Practice
San Antonio, Texas

Christopher A. Hooper, DDS
Private Practice
Virginia Beach, Virginia

David G. Gratton, BSc, DDS, MS
Associate Professor and Director
Division of Maxillofacial Prosthodontics
Hospital Dentistry Institute
University of Iowa Hospitals & Clinics
Iowa City, Iowa

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