A Call for a New Era of Dental Alliance
Collaborating using digital dentistry can open new doors for your laboratory
Steven J. Sadowsky, DDS
The advent of digital dentistry with CAD/CAM, implant dentistry, and advanced esthetics has underscored the importance of collaboration between dental practitioner and dental technician.1,2,3,4 In order to capitalize on the digital advances available to the practitioner, a symbiotic relationship must be forged to harness the efficiency and accuracy of these new disruptive technologies. It can only benefit the success of your laboratory to take advantage of these opportunities. The following three examples illustrate how aspects of digital dentistry require a deeper level of collaboration than older methods.
Removable partial dentures (RPDs) have been traditionally fabricated using the lost-wax casting technique. This casting process is arduous, time-consuming, and, when remakes are required, costly. The development of intraoral scanning and 3-dimensional printing technology has made rapid prototyping of the RPD more practical. When considering the irreversible nature of RPD metal frameworks, intraoral scanning and 3D-printing techniques offer both a resin prototype and a definitive metal framework. A try-in can be accomplished and evaluated to assure a successful outcome with the final prosthesis, the accuracy of which has been demonstrated.5
A second example addresses immediate-placement implants. When a patient has a terminal dentition and will require extraction, alveoloplasty, and implant placement in preparation for an immediate-load prosthesis, a digital workflow can be an efficient and predictable means for sequencing the treatment. Using three different CAD/CAM surgical guides, the first one will be referenced to the remaining teeth and allow fiduciary cross-pins to be drilled in the bone to serve as a spatial reference for the subsequent two surgical templates. In this fashion, bone reduction can follow extraction and immediate implant placement can follow the alveoloplasty. The guides are produced by a CBCT Software Planning Program. Alzoubi et al6 looked at the overall accuracy between preoperative planning and postoperative placement and the mean bone reduction deviation was 1.98 mm. The overall deviation for implant angle was 4.14 degrees. This method has been shown to improve guide stability for patients with terminal dentition undergoing complete implant-supported treatment by exploiting the teeth to be extracted.
Lastly, the integration of 3D facial scanning in a digital workflow has revolutionized fabrication of immediate complete dentures.7 Despite the widespread use of this modality, immediate complete dentures are associated with unpredictable esthetic outcomes because of the inability to have an anterior teeth clinical evaluation (try-in). Oftentimes, the denture teeth are modified or replaced in a second prosthesis at a later stage of treatment, increasing time and costs. CAD/CAM techniques have been refined and digitally designed and fabricated prostheses have been reported to be comparable to traditional techniques.8 Advancements in stereophotogrammetric 3D facial scanning technology have led to simpler office devices to capture patient's head in 3D in less than a second. These systems have been employed already in maxillofacial prosthodontics, orthodontics, and orthognathic surgery.9 The 3D design software can be used to create dental mock-up. Here the anterior try-in for the prospective immediate denture patient could be accomplished with a virtual set-up. This could have application with partially edentulous patients that have the need for an aesthetic makeover of their anterior dentition. Here they would have the ability to view multiple smile designs before fabrication of the provisional prosthesis.
Given a significant portion of dental laboratories assist the treating dentist with restorative design today, a team approach will be essential for success.3 A partnership can share in the feedback to flatten learning curves. How can these new technologies be integrated in the restorative practice optimally? This will require a more open forum for the clinician and technician to learn, exchange, and test advances—which can, in turn, create further collaborative and business opportunities.
APS: an opportunity to collaborate
Dental societies have stressed the importance of collaboration in forming stronger and more knowledgeable professional relationships between clinicians and laboratories. The American Prosthodontic Society (APS) been a trailblazer in this domain, acknowledging the importance of inclusion of the technician in all levels of governance of the Society. This year, the APS President, Todd Fridrich, CDT, is the first dental technician to hold this office. The APS will convene in the third week of February 2019 with the charge to collaborate and foster professional relationships.
About the Author
Steven J. Sadowsky, DDS
Professor of Preventive and Restorative Dentistry at the University of the Pacific in San Francisco, CA.
References
1. McLaren EA, Culp L, White S. The evolution of digital dentistry and the digital dental team. Dent Today. 2008;27(9):112, 14, 16-7.
2. Weston JF, Haupt E. Creating aesthetic success through proper clinician and laboratory technical communication. Dent Clin North Am. 2011;55(2):371-82, x.
3. Afsharzand Z, Rashedi B, Petropoulos VC. Dentist communication with the dental laboratory for prosthodontic treatment using implants. J Prosthodont. 2006;15(3):202-7.
4. Harel N, Meirowitz A, Block J, et al. Collaboration Patterns and Processes Between Dentists and Dental Laboratories When Planning and Fabricating Implant-Supported Restorations. Implant Dent. 2017;26(3):475-79.
5. Hu F, Pei Z, Wen Y. Using Intraoral Scanning Technology for Three-Dimensional Printing of Kennedy Class I Removable Partial Denture Metal Framework: A Clinical Report. J Prosthodont. 2017; Nov 16.
6. Alzoubi F, Massoomi N, Nattestad A. Bone Reduction to Facilitate Immediate Implant Placement and Loading Using CAD/CAM Surgical Guides for Patients With Terminal Dentition. J Oral Implantol. 2016;42(5):406-10.
7. Hassan B, Greven M, Wismeijer D. Integrating 3D facial scanning in a digital workflow to CAD/CAM design and fabricate complete dentures for immediate total mouth rehabilitation.J Adv Prosthodont. 2017;9(5):381-86.
8. Kattadiyil MT, Jekki R, Goodacre CJ, Baba NZ. Comparison of treatment outcomes in digital and conventional complete removable dental prosthesis fabrications in a predoctoral setting. J Prosthet Dent. 2015;114(6):818-25.
9. Da Silveira AC, Daw JL, Jr., Kusnoto B, Evans C, Cohen M. Craniofacial applications of three-dimensional laser surface scanning. J Craniofac Surg. 2003;14(4):449-56.
