Digital Dentistry

Digital Dentistry

Current Trends 3T25-26

Digital Dentistry topics

Introduction; Advantages and Disadvantages; Different types of digital advancement

Different fields of application in digital dentistry

Treatment planning and designing to prototyping steps

Implant surgery procedures to fabrication

Customized prostheses

Devices produced by CAD/CAM technologies

Devices produced by computer-aided design/computer-aided manufacturing additive and subtractive technologies

Trend in dentistry workflows

Both clinical procedures and laboratory methodologies are moving towards workflows oriented in an increasingly digital way

Digital tools changed what?

Diagnostic and clinical practices procedures

Examples of digital tools in dentistry

Computed tomography (CT); Cone beam computed tomography (CBCT); Nuclear magnetic resonance (NMR); Ultrasonography; Optical impression; CAD/CAM technologies; 3D printers

3D printer example

Stereolithography

Fields particularly affected by digital technology

Implant surgery; Prosthodontics; Restorative dentistry

Effect of digital planning and previsualization software

Significant improvements in communication with patients

Patient communication improvements

Explanation of treatment planning goals; Patients’ operative and psychological comfort

IOS meaning

Intraoral scanner

Advanced fabrication processes

CAD/CAM technologies and 3D printing

Effect of IOS and advanced fabrication

Allowed implementation of innovative metal-free dental materials

Benefit of innovative metal-free materials

Substitute conventional metal frameworks and improve biomimetic and esthetic outcomes of restorations

Outstanding characteristics of new-generation materials

Outstanding mechanical characteristics

Effect of new-generation materials

Allowed dentists to reduce removal of bone and dental tissues

Result of reduced tissue removal

More conservative operative procedures

Materials with undeniable advantages

Technopolymers; Hybrid composites; Polycrystalline ceramics; High strength ceramics

Advantages of modern dental materials

Excellent mechanical resistance; Esthetic and optical properties; Reliable precision; Accuracy; Reduction in chairside and production times

PEEK full name

Polyether–ether–ketone

Why PEEK gained popularity

Beneficial characteristics

PEEK description

Performing and biocompatible polymer with several applications

PEEK orthopedic surgery applications

Orthopedic devices; Plates; Screws; Bone replacement articulation implants

PEEK cardiac surgery application

Cardiac surgery

PEEK dental applications

Dental implants and abutments; Fixed and removable dentures

PEEK cranio-maxillofacial applications

Osteosynthesis plates; Skull implant for repair of cranial vault defects; Replacement of nasal, maxilla, and mandible

Applications of PEEK in dentistry

Dental implants; Implant abutments; Removable dentures and components; Fixed crowns; Fixed bridges

PEEK implant dentistry note

Demand on development of alternative non-metallic materials for implant dentistry applications

PEEK functional result note

PEEK already possesses several temporary applications with favorable esthetic and functional results

PEEK limitation

To produce definitive PEEK-based components improvements are still required

Examples of PEEK implant components

PEEK healing screw; PEEK temporary abutments; PEEK prosthetic transfer; PEEK abutment cap

Intraoral camera use

Visualization and patient communication

IOS implementation in dentistry

Coincided with development of CAD/CAM technology

Benefits of IOS and CAD/CAM

Easier planning of treatment; Case acceptance; Communication with laboratories; Reduced operative time; Reduced storage requirements; Reduced treatment times

IOS composition

Handheld camera (hardware); Computer; Software

Goal of IOS

Record with precision the three-dimensional geometry of an object

Most widely used digital format in IOS

Open STL (Standard Tessellation Language) or locked STL-like

Accuracy statement for IOS (2017)

No scanning technique, scanner, or technology can unanimously be considered more accurate due to lack of standardized procedures or comparable in vivo studies

Digital workflow sequence

Intraoral scan → Prescription forms sent to VM Lab → Design restoration in CAD software → Model is 3D printed → Restoration milled from CAM hardware → Final hand touchup → Crown packaged and delivered

Digital Smile Design reference

DEN203

Digital Smile Design procedure

Impressions using alginate obtained die cast scanned by R700 3Shape for digital planning

Software used in Digital Smile Design

Keynote-iWork, Apple, Cupertino, California, USA

Purpose of Digital Smile Design software

Lines drawn to analyze orofacial harmonization

CADCAM meaning #1

Computer aided design, computer aided machined

CADCAM meaning #2

Computer aided design, computer aided manufacturing

Traditional workflow step #1

Dentist makes traditional impression

Traditional workflow step #2

Sends impression tray to dental laboratory

Traditional workflow step #3

Laboratory technician pours plaster inside the tray

Traditional workflow step #4

After hardening, technician scans plaster model to obtain 3D virtual digital model of full arch

Traditional workflow prosthesis design

Technician designs prosthesis using CAD/CAM systems and sends file to milling machine

Traditional workflow milling step

Milling machine produces prosthesis

Traditional workflow final step

Prosthesis applied by dentist and refined inside patient’s mouth to verify and adjust occlusion

Former digital workflow step #1

Dentist captures digital impression using intraoral scanning device

Former digital workflow step #2

Dentist sends digital prescription to laboratory

Former digital workflow step #3

Lab downloads digital file and uses customized software to digitally cut die and mark margins

Former digital workflow step #4

SLA model generated using CAD/CAM systems

Former digital workflow finishing techniques

Hand layered porcelain; Pressing with wax patterns; Digitally designed and milled full contour glass ceramic restoration

Requirement in digitally designed and milled restorations

Technician designs milling machine program using CAM systems

Former digital workflow final step

Final restoration sent to doctor for seating

Rapid digital workflow step #1

Dentist captures digital impression using intraoral scanning device

Rapid digital workflow step #2

Dentist designs restoration and software automatically generates milling unit program

Rapid digital workflow step #3

Final restoration milled in a few minutes

Rapid digital workflow step #4

Dentist issues restoration

3M Mobile True Definition Scanner

Tablet-based intraoral scanner fitting in the hand allowing clinicians to move freely between operatories without power cords or carts

Digital impression

Three-dimensional scanned impression of prepared teeth

CEREC meaning

Chairside Economical Restoration of Esthetic Ceramics

CEREC significance

First commercially available CAD/CAM system developed for rapid chairside design and fabrication of ceramic restoration

CEREC advantage

Teeth restored in a single sitting instead of multiple sittings

How CEREC works

Uses scanning device to collect information about preparation shape and relationship with surrounding structures

Optical techniques used by CEREC

Moire fringe displacement and active triangulation

Purpose of CEREC optical techniques

Measure height and depth of preparation

Optical impression definition

Made by placing a small video camera or scanner over prepared tooth

Restoration design process

Designed on computer screen by drawing gingival margins and proximal contacts

How CAD portion works

System projects image of preparation and surrounding structures on monitor

Operator responsibility in CAD

Inputs and confirms boundaries of restoration such as gingival margin position

CAM portion function

Micromilling device mills restoration out of ceramic or composite block

Time required for milling

Restoration milled in a matter of minutes

Milling device feature

Computer-driven software controls two small diamond-coated milling devices

Material used in milling

High quality ceramics

Ceramic block movement during milling

Ceramic block rotates as diamond cutting instruments move to generate restoration

Post-milling step

Restoration removed from milling device and ready for trimming and try-in

Final preparation after milling

Trimming

Next step after trimming

Ready for try-in

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