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This special issue of Inside Dentistry focuses on technology—specifically on the digital tools that slowly but inexorably have been transforming dentistry since the early 1970s, when clinicians first attempted to use lasers for optical impressions. The articles presented here review technology’s current state and contemplate the road ahead.
Today’s digital toolkit includes many components such as computerized records and practice-management systems, 2D and 3D digital imaging options (digital x-rays, CBCT scanners), chairside CAD/CAM systems, digital intraoral scanners, rapid prototyping options, and more.
Although a limited number of general dentists have embraced the complete suite of current tools, those who have report improvements in both the accuracy of their dentistry and the workflow of their practices. For time-pressed patients, treatment can often be accomplished in less time than previously thought possible, and many dentists are noticing quicker turnaround times from their laboratories.
More commonly, however, new technology is gaining acceptance piecemeal, and at varying speeds, depending on different factors. Dr. Gordon J. Christensen, CEO, Clinicians Report, points out that chairside milling is only in about 10% of general dentists’ offices in the United States. “Moreover, many of those devices, although purchased, are not being used,” Christensen asserts. He believes that unless milling becomes less expensive and devices for planning become easier to use, milling will do what it has done for the past 30 years—“slow growth.”
While Christensen believes chairside milling “works very well” and is a valuable option for the dental practice, he says a number of developments will have to occur before its adoption can accelerate and it becomes ubiquitous. “In-office milling has to become less expensive, easier, and faster, and it has to utilize materials that do not require all of the laboratory orientation that’s been needed in the past.”
In contrast, “Scanning is coming on extremely fast, and the devices are much better than they were even a few years ago,” Christensen says. “They’re easy to use now.” Devices currently on the market continue to range significantly in price, from roughly $16,000 to $50,000, and Christensen notes that the costs at the high end will continue to inhibit many dentists from purchasing those systems. However, “On the lower end of that cost, a dentist would very soon be able to compensate for it by the savings that are obvious from not using polyvinylsiloxane or polyether materials.” He adds, “For at least 75% to 90% of the cases, scanning can be done competently by an educated dental assistant or a hygienist, or someone without any specialized dental training and education.”
Intraoral scanners will also allow for greater diagnostic capabilities, he notes. They can allow the practitioner to examine comparative scans over time. Possibilities exist for other future diagnostic tools as well.
As digital scanners are combined with in-office CBCT systems, Dr. Christensen believes this will open the door to doing more in the realm of diagnosis and treatment planning. These tools can reveal abnormalities and allow general dentists to be comfortable placing dental implants. In the near future, general practitioners could place more implants, and may hint at the way digital tools are encouraging increasing numbers of general dentists to move into service areas that were once the exclusive province of specialists.
Combining data files from the intraoral scanners and CBCT can provide the clinician with the opportunity to treatment plan implant placement with confidence. Simple planning software can facilitate placement of implants from any manufacturer in the proper positions. Also, the dentist, as well as the traditional lab, can now affordably make surgical guides, and third-party resources are available that allow files to be sent and surgical guides made. Such treatment planning is done in real time, providing the clinician with better communication tools and more assurance.
Not long ago, many of the technological breakthroughs highlighted in this issue were the stuff of science fiction. Today, although not every dentist has embraced them all, it seems clear that more and more practitioners will adopt them in the coming months and years, and they’ll be able to do so with confidence as the variables and risks continue to shrink. Doctors want predictable outcomes. The more predictable the outcomes, the more new technologies will become the standard of care.