“That’s just on the imaging side,” Patel says. “On the CAD/CAM side, I have this feeling things are going to merge. I think the moment these manufacturers figure out how to implement scanning patients in 3D without radiation, they will probably develop a machine that looks like a panoramic radiograph machine but will scan the patient just like a cone-beam does. That image will have the clarity so that we can actually scan the surfaces of the teeth.”
This could eliminate the need for intraoral scanners altogether. “Maybe in 10 or 15 years, we will prepare a tooth that would normally need a crown, and instead of scanning the patient in the mouth with a camera, you’ll take them to another room and the machine will revolve around their head without anything inside their mouth—and because there’s no radiation, there’s no risk,” Patel muses.
With the images obtained in that manner, crowns could be designed. “But the same images would also allow for diagnostics and other things that we already do with the cone beam,” Patel explains. “I think all of these technologies are going to merge together somehow.”
He also looks forward to exciting developments in rapid-fabrication technologies. “Right now there’s an issue with the detail that can be printed. As the machines are invented to be able to print in higher resolution, that will open the floodgates. Instead of being able to mill the restorations, we’ll be able to print them. We’re obviously doing that already, but mostly for things that don’t require permanent accuracy—mouthguards or dentures or surgical guides. All those are in plastics. But the future will be in ceramics,” he predicts. “There’s already technology available to do that. It hasn’t been proven enough or made available to a mass market, but I think printing ceramics for final restorations is where it’s going to be.”
Adjusting the Workflow to Fit Patient Needs
Lyons thinks that many people in urban areas may prefer multiple, half-hour appointments. “I know people in Manhattan. They don’t want 2-hour appointments.” If the dentist makes an impression, transmits the files electronically to a design center, gets a file back for a restoration that he can mill on his chairside milling machine, and delivers it to the patient in a short second appointment, Lyons thinks that might suit many city dwellers best.
On the other hand, “If a patient in a rural setting has to drive 4 hours to see the dentist, do they want to drive back a second time?” Fasbinder asks. “There are a lot of dentists with a lot of different backgrounds implementing these systems effectively in their practices. The military is using them now. Corporate offices are using them now. There are a lot of economic models that are seeing real value in doing in-office chairside CAD/CAM dentistry.”
Patel says it was during a yearlong implant residency and prosthodontic fellowship following his graduation from Ohio State University in 2006 that he developed a “huge passion” for 3D CBCT imaging. He researched it extensively and was tapped to work as a consultant, training other dentists and their staff in the use of various CBCT hardware and software platforms. But after a year he started his own full-time practice, which now offers digitally enhanced services ranging from implants to orthodontics to cosmetic dentistry.
While Patel acknowledges that dentists can certainly adopt digital tools piecemeal, he urges that it’s better for them to develop a vision for going fully digital. “Only then do you really get to see the benefits,” he argues. “Anything that we do from an analog perspective will just slow us down. It’s kind of an all-or-nothing mentality. It doesn’t have to happen at a single point in time. But only when everything is digital and integrated correctly do the systems and equipment start to sync. At that point, you can allow these technologies to communicate and facilitate reducing appointments and chairtime, all while increasing accuracy and the final outcome for the patient.”
He also says that dentists who think the technology isn’t fully developed yet are deluding themselves. Newer technologies will replace the current ones, he notes. “But when a newer technology comes out in 5 years, the dentists who waited won’t have the experience to really maximize that technology. At that point, it will require a lot more change than they may be comfortable with.”
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