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Insights Into Digital Design and Fabrication

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woman using computerDigital design and fabrication are ubiquitous in modern dental practice. Even offices that use analog workflows are likely to embrace digital radiography, and the conventional impressions they send to the laboratory, and resulting prostheses, are the result of digital scanning and computer aided design/computer aided manufacturing (CAD/CAM) by lab technicians. Of course, with constant advances in software and hardware, more practices are bringing intraoral scanning and digital design and fabrication in-house — sometimes using an all-digital workflow, and in other cases by blending conventional and CAD/CAM technologies.

For insights into the state of digital dentistry, we turned to prosthodontist Seung Kee Choi, DMD, MS, FACP, of the Department of Advanced Oral Sciences and Therapeutics at the University of Maryland School of Dentistry, for his thoughts on the advantages of today’s CAD/CAM technology.

As a rule, this process starts with intraoral scanning. While acknowledging clinical indications for conventional impressions, Choi says intraoral scans often improve case acceptance and outcomes. “Using digital data, clinicians can quickly gain diagnostic values, such as occlusion and positions and proportions of teeth. Moreover, digital designs can be created in less time than diagnostic wax-ups and can serve as an effective visual tool to communicate issues and treatment options with patients,” he reports. “Restorative dentists can evaluate tooth preparations immediately after an intraoral acquisition of the preps, which can be magnified, checked, and adjusted for occlusal clearance, taper and smoothness.”

Digital data also enhance communications with referring dentists, specialists and lab technicians, Choi notes, adding, “Improvements in care, as well as integration of digital datasets and diagnosis, are just a few of the advantages CAD/CAM technologies bring to the clinic.” And like other proven modalities, digital dentistry is not simply a matter of convenience and efficiency — the ultimate goal is better outcomes.

Although some offices and labs are committed to going “fully digital,” it is sometimes beneficial — and even necessary — to incorporate conventional techniques in digital workflows, Choi explains. How the workflow is designed for a given case depends on multiple factors, including the types of restorations or dental implants planned, availability of compatible digital support, and clinician preference.

Workflow demands, the office’s design and fabrication capabilities, and the team’s skill set all affect treatment planning, so it really becomes a case-by-case decision. For most routine restorations (such as single-unit crowns), designing prostheses using CAD software should be relatively straightforward for the dentist or a trained team member. But whether the practice has its own milling unit and/or three-dimensional printer dictates if it will produce the prostheses in-house or outsource fabrication to a laboratory. Offices that wish to maximize production and realize the marketing advantages of “same-day dentistry” may wish to consider training a designated staffer as the design and manufacturing expert, Choi advises, as this allows the dentist to concentrate on patient care. Other clinicians may prefer to delegate these functions to the lab, so the entire team remains focused on chairside treatment.

Initially, it’s important to realize that practices can get started in digital dentistry without investing in all of the components of an in-office CAD/CAM system. As noted, they can start with an intraoral scanner and transition — as desired — into the design and fabrication of prostheses, occlusal devices, surgical guides, implant components and more.

While numerous studies support the benefits of digital technologies, at its essence, CAD/CAM dentistry remains deeply rooted in the sound concepts and principles that govern all phases of evidence-based care. As with all clinical approaches, successful outcomes depend on the clinician’s grasp of the advantages and limitations of this ever-changing field — and how these relate to the case and patient’s best interests.

From Decisions in Dentistry. December 2022;8(12)46.

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