An Interview with Dr. Todd R. Schoenbaum

INSIDE DENTAL TECHNOLOGY (IDT): How do you envision digital technologies revolutionizing dentistry over the next 10 years?

Todd R. Schoenbaum, DDS, FAGD (TS): Digital technologies have already begun to revolutionize the entire dental profession, and laboratories are leading the way. In a relatively short time, technologies such as CAD/CAM have streamlined the process for milling zirconia copings, full-contour monolithic restorations, wax patterns, custom titanium implant abutments, resin models, and more. Stereolithography has been adapted from other industries for the production of orthodontic aligners, surgical guides based on 3-D cone-beam scans, and resin models for indirect restorations. Bench-top digital scanners with powerful software have allowed significant improvements in efficiency and consistency for the design of copings, crowns, bridges, and custom implant components.

Though highly successful and widely implemented in the laboratory, such technological advancements have yet to see large-scale implementation in the dental practice. Currently, the dental office has only four choices of devices that make use of digital intraoral impressions (with two more due in early 2011). Though widespread adoption has been slow, there is no doubt that the great majority of dentists will be using this technology over the next decade. As existing scanning systems continue to advance, the vast improvements in patient comfort, procedural efficiency, outcome consistency, and return on investment will be remarkable.

IDT: How will dental laboratories benefit from these advances?

TS: Digital technologies will help domestic laboratories thrive in an increasingly competitive global market. Laboratories of all sizes will be able to increase their value to referring dentists—not just through the quality and efficiency of their work, but also in their ability to provide much-needed expertise in treatment decisions and to communicate this information through digital media. Technicians and dentists will be able to work through decisions while viewing the exact same diagnostic data, including digital radiographs, 3-D images, videos, and digitally fabricated models. Complex cases can be reviewed, discussed, planned and, in part, executed well before treatment begins.

IDT: How will treatment planning evolve with these new technologies?

TS: In the arena of implant dentistry, the entire team (technician, restorative dentist, surgeon) can review cone-beam scans to evaluate preoperative bone density and volume. The entire process—from implant placement to abutment and restoration design—can be performed digitally before patient treatment is started. Various treatment proposals can be evaluated through the unique lens of each discipline, allowing comprehensive treatment collaboration from start to finish. When appropriate, precision surgical guides can be fabricated through stereolithography to assist the surgeon in placing the implants at the previously determined optimal position. When the case moves on to the restorative dentist and technician, the implant placement, abutment, and framework designs have been planned in advance so the components can be milled with the final restorative goals already factored in. Digital technologies will allow the entire team to evaluate, co-diagnose, and plan every stage of treatment well in advance.

Comprehensive esthetic and functional reconstructions will also see great advances through the use of digital technology. Using virtual models from intraoral scans of prototypes and the preoperative state, the teeth can be digitally prepared to test various types of restorations based on the patient’s anatomy and desired results. If modifications in tooth or gingival positions are required, the team can plan orthodontic movements. Aligners can then be printed (via SLA) to achieve the previously determined movements.

IDT: How will the use of digital technologies impact the relationship between the dentist and technician?

TS: The most exciting and revolutionary benefit of digital technologies will not be quantifiable in dollars made or minutes saved. It will be apparent in the previously unattainable levels of real-time communication and collaboration between dentists and technicians. For too long we have operated nearly independent of one another. We make decisions unilaterally and communicate with a hastily written note on a small scrap of paper—usually only after procedures have been performed and restorations have been fabricated. It is what we do because it is all we have known.

Digital technologies will reshape this fragmented relationship, enabling fully coordinated decision-making before treatment has even begun. It will allow the dentist-technician team to make decisions in tandem, using their shared experience and expertise to achieve new standards of excellence and predictability.

The 21st century is the time of pioneers, of innovators, of experimenters. It is the beginning of a new era of dentist-technician teams collaborating through digital media. It will be the bold few who will push the dental profession into a future of fully coordinated treatment. These early adopters will create a bridge to “cross the chasm” of technological implementation, ultimately resulting in higher levels of patient care.

Todd R. Schoenbaum, DDS, FAGD, is assistant clinical professor in the UCLA Division of Restorative Dentistry, assistant director of UCLA Continuing Education, and a faculty member in the UCLA Center For Esthetic Dentistry. He also maintains a private practice within the UCLA faculty group dental practice.