The expanding role of CAD/CAM in today’s restorative dentistry
While it took slightly longer than anticipated to integrate digital dentistry into the daily practice, the new millennium seemed to have been the catalyst for change as several different CAD/CAM systems have now been introduced as solutions for restorative dentistry. Today’s CAD/CAM systems, both chair-side and laboratory-based, are being used to design and manufacture metal, alumina and zirconia frameworks, as well as all-ceramic and composite full-contour crowns, inlays and veneers that may be stronger, fit better and appear more esthetic than restorations fabricated using traditional methods.
As restorative dentistry evolves into the digital world of image
capture, computer design and creation of dental restorations through
robotics, our perceptions and definitions of the dental laboratory must
evolve also. First, in order to fully understand this concept, we must
clearly define what a laboratory is.
At first thought, we might say that a lab is the place that a dentist
sends his or her patients’ impressions to be processed into
restorations, which are then sent back to the dentist for adjustment
and delivery. This definition does seem to fit well with the
traditional concept of a dentist-laboratory workflow.
However, just as the Internet has forever changed the landscape of
communication through related computer technology, the ability to use
CAD/CAM restoration files electronically has provided the catalyst for
a significant change in the way we view and structure the
dentist-laboratory relationship.
Let us imagine first that our laboratory is not a place, does not have
walls and exists only in the talents of the partners in the restorative
process — the dentist and technician. The equipment we use to create
the restoration may be located next to the chair or in a dental
laboratory.
Our ‘laboratory’ is actually nothing more than a workflow, which is
flexible to the degree that our abilities, our access and our equipment
allow. The primary decision becomes where the hand-off from one partner
to another should occur.
Moreover, a dentist who has the ability to optically scan intraorally
for impressions and who often chooses CAD/CAM restorations as the best
treatment option for his or her patients has enhanced freedom as to
where I believe the hand-off to the technician partner should occur.
The lab is no longer a place; it is, to a large degree, virtual and a fluid entity.
In some instances, it makes sense for the dentist to work independently
and to prepare, design and finish the restoration chairside in a single
visit with the obvious advantages a clinical CAD/CAM system has to
offer.
Other times, it is advantageous to engage the services of the
restorative partner, a dental technician, because he or she possesses
the skill and, perhaps more importantly, the time to create
restorations that either demand more complex characterization or can be
more efficiently created in an indirect manner.
The digital process
The introduction of E4D Dentist System (D4D Technologies) in 2008,
along with its accompanying DentaLogic software and Autogenesis
libraries, became the first computerization model to accurately present
a real 3-D virtual model and automatically take into consideration the
occlusal effect of the opposing and adjacent dentition.
It also has the ability to design 16 individual, full-contour, anatomically correct teeth at the same time.
It essentially takes a complex occulsal scheme and its parameters and
condenses the information, displays it in an intuitive format that
allows dental professionals with basic knowledge of dental anatomy and
occlusion to make modifications to the design, and then sends it
through to the automated milling unit.
For the dental profession, the introduction of the E4D Dentist System
effectively automated some of the more mechanical and labor-intensive
procedures (waxing, investing, burnout, casting and pressing) involved
in the conventional fabrication of a dental restoration, allowing the
dentist and technician the ability to create functional dental
restorations with a consistent, precise method.
Many dental professionals regard CAD/CAM technology as just a machine
that fabricates full-contour ceramic restorations or framework. But
digital dentistry and the digital dental team represent a completely
new way to diagnose, treatment plan and create functional esthetic
restorations for our patients in a more productive and efficient
manner. CAD/CAM dentistry will only further enhance the
dentist/assistant/technician relationship as we move together into this
new era of patient care.
by Lee Culp & Dr Lida Swann, USA /www.dental-tribune.com
