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Inside Dentistry
January 2016
Volume 12, Issue 1

That said, Pizzi is a great proponent of technology when used correctly by well-educated providers. “Computers only do what we tell them to do—so we have to have the basic knowledge of contour and form, function, and biomechanical capability of the patient before we can just grab a tooth from the library and mill it out in a material.”

“I think technology is fabulous and that every lab today must incorporate some type of technology—whether in basic form or advanced sintering and printing. The challenge is the education that comes with that process. In reality, you need more skills to transfer the information into the computer system than the other way around. However, I find that many of the technicians who are using this technology do not have the understanding to didactically work through a case,” says Pizzi.

Technology Changes to Come

Sometimes challenges with technology stem not from the user, but from the hardware or software itself. A significant barrier for dentists and laboratories wanting to embrace the digital workflow concept has been that the myriad technologies on the market can’t always “talk” to one another optimally. Even with “open” systems, unless labs and dentists have the same software program, data sharing can be imperfect.

Johnson says, “There is currently not the seamless free exchange of information and digital data due to the significant amount of proprietary software that hinders those communication lines. So, if the dentist owns Brand A digital impression scanner, he or she can’t just simply send that capture data in a usable format to any laboratory he or she chooses.”

However, a change is in the works. As reported in a recent issue of Inside Dental Technology, Mike Selberis, chief information officer at Glidewell Laboratories, and Andy Stark, general manager, Jenmar International, envisioned a software platform that would enable dentists to send digital impressions to whatever laboratory they choose using a standard language that wouldn’t require the use of complementary software. Universal dental exchange (UDX), the standard language created by their Open Exchange Dental Interoperability Group, was designed to convey data, “in a way that if one system exported a digital file, another could import it and would know what to do with all the meta data contained in the file,” Selberis explained. UDX was submitted to the ADA Standards Committee on Dental Products, which had been searching for a universal file format. The committee, which functions as the US representative for the International Organization for Standardization (ISO), then created a version largely based on UDX for consideration and possible adoption as an ISO-certified standard. The universal language is still under global review, Johnson notes. “It must go through a total of five international audit, review, and feedback meetings to get approved and put into a final format that everyone agrees on, at which point it becomes the ISO standard. Equipment manufacturers then may or may not choose to comply with the ISO standard in developing their technology.”

Another major development for the industry is that robotic processes once considered to be especially futuristic are now available in dentistry. According to a case presented on its website (www.universal-robots.com), Glidewell Laboratories is using robotics to increase production and save time. The company set the goal of a 10-minute milling cycle, which made operator-manned stations unfeasible. In the new process, the crowns are manually inserted in batches of 15 every 2 hours. The UR5 robot is programmed to take a milling blank from the dispensers, place it in the milling lathe, remove the milled crown, and place it on a conveyor after the 10-minute milling cycle is complete. According to the report, the robots cut production-cycle time from 27 to 18 hours, enabling employees to turn their attention to more complex tasks, which ultimately helps to improve the quality of the product.

Evolving Roles and Relationships

As the industry evolves, both Johnson and Hornbrook expect the friendly but rigid demarcation of roles between the dentist and laboratory to change. Hornbrook recognizes that bridging the divide requires better communication, as well as recognition on the part of doctors that they need to be open to a different relationship with their laboratory. “Traditionally dentists did not rely on their labs for information or advice, expecting them to follow their prescriptions,” he explains.

Restorations based on collaboration with laboratory technicians, including ceramists, enhance the longevity, esthetics, and function of restorative cases, LeSage says. Collaboration should involve all players—dentist, patient, and ceramist. He further suggests that doctors and technicians make a point of meeting regularly—every 3 to 6 months—“to discuss, explore, and integrate the various material options.”

This can lead to the development of a true partnership, which is happening already in many cases where dentists recognize technicians’ specific expertise and often superior ability to leverage technology. “In these cases, the laboratory is no longer acting as a mere vendor of products and services, but rather as a consultant, one that may offer dentists technical knowledge and insight and take on a significantly expanded role in the treatment and care of the patient,” says Johnson.

“I think the best technicians now and in the future are those who can didactically work through a diagnostic process with their dental partner, not just mill out a molar from a machine,” adds Pizzi. He sees a proliferation of highly trained and talented young technicians on the horizon.

Johnson sees two extremes evolving in clinician–laboratory relationships—for large and complex cases, close communications will exist between team members, whereas routine cases (eg, single crowns and three unit bridges) will be handled impersonally by larger labs that have transformed themselves into digital production centers.

As for the future of milled restorations, LeSage is emphatic: “CAD/CAM is here to stay.” He expects more restorative work to be done chairside and that many impression materials will “become extinct.” Johnson adds that she has concerns about new zirconia formulations that make it possible for dentists to mill the material chairside and deliver a full-contour zirconia crown in an hour, and the impact this may have on the laboratory industry in the future. This concern may seem premature in light of Hornbrook’s findings about the low adoption of digital impressions. He does not expect most dentists to clamor to purchase mills any time soon, given their steep prices.

Pizzi is encouraged by the simultaneous rise of technicians and dentists striving for growth and excellence, but he recognizes a laboratory industry phenomenon that mirrors the current American socioeconomic environment: “The upper and lower classes are growing and the middle is disappearing. They have to decide whether to work harder to become more educated and more viable in this environment—or give into temptation to sell things cheaper and faster.”

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