Digital and dental: What is possible and what will be possible

The digitalization of the dental world is advancing inexorably. Digital and dental are becoming more tightly linked. As a result, dentists have numerous advantages. In this blog, you will learn how to cleverly combine digital and analog working methods and therefore work more efficiently and reliably.

A guest contribution by Prof. Dr med. dent. Daniel Edelhoff (Germany)

More efficiency with CAD and CAM

The world - including dentistry - is changing rapidly. We live in a high-performance culture in which we expect everything to be faster and more efficient. Digitalization is a major contributory factor and has also taken hold of the dental world. Digital working steps are increasing rapidly and digital islands are infiltrating into the analog world.

Digitalization in the dental sector already offers considerable advantages and this has aroused great interest amongst many dentists and dental technicians. These include the standardization of working steps, an increase in material quality and reproducible restorations. Dental technicians today are able to receive far more information from the patient than ever before, thanks to digital imaging such as the DVT and 3D facial scanner. This increases the predictability of dental work so that the desired end result can be achieved safely and efficiently.

Treatment plan, test drive and monitoring

For me as a dentist, there are three key factors with complex treatments:

• planning throughout the entire treatment,
• test driving the restoration and
• monitoring.

Many procedures do not lead to the desired result because they do not have a suitable – or even have no - treatment plan at all. Thanks to the possibilities of CAD/CAM technology there is now great potential.

Planning involves collecting the data obtained from different components and deciding on the best way to implement them. We already have much more planning safety than we did ten years ago. Now, there are only very few problems in certain areas. These issues should be developed and improved further so that the individual systems all speak the same language.

Monitoring gives us confirmation; specific situations, such as the initial situation, are scanned and then, after a certain amount of time, a second scan is taken and superimposed and this is then compared. This method makes it possible to recognize and identify changes at an early stage. Based on the collected data, we can then decide whether restorative treatment is advisable or even necessary.

Retaining as much tooth structure as possible

An important advantage of CAD/CAM is the fact that minimally invasive procedures can be performed.

An example, anterior teeth: Around 70% of the tooth structure has to be sacrificed to produce a classic full crown, whereas 360° veneers only “cost” around 30% of tooth structure. And now that there’s a trend to produce veneers as monolithic restorations, CAD/CAM is becoming increasingly important.

An example, posterior teeth: Around 70% of the tooth structure has to be sacrificed to produce a full crown, whereas only approx. 32% of tooth structure is removed for a partial crown.  And partial crowns (all-ceramic), or so-called occlusal onlays, can be produced monolithically using the CAD/CAM technique.

The benefits of digital processes for you as a dentist and for the patients are very clear. Future developments should include even more gentle procedures. I have visions of being able to replace lost enamel using a purely additive technique - this means, without having to remove any of the existing tooth structure to do so. Digital possibilities and reliable full ceramic materials mean we are already well on the way.

CAD/CAM materials are reliable

This brings me to the topic of material, which is also an important factor in this context. Thanks to CAD/CAM, we now work with great materials, which were previously not accessible to us. One example is zirconium oxide; another is high-performance polymers. For example, CAD/CAM manufactured, tooth-coloured polycarbonate splints are great for a functional and esthetic "test drive", especially as I can continue work under the splint. This is only possible due to digitalization. A final word on CAD/CAM manufactured materials: They have a high degree of reliability due to the standardized production.

Reliable monitoring: Also possible after rehabilitation

There are many other aspects that I could discuss here. For example; there is a special software that superimposes the recorded patient values from scans. This can be used to check how much tooth structure is lost after a restoration over the period of several years, for example by abrasion. Long-term monitoring through regular scans, which may extend over decades, can help to predict future developments and to plan restorations accurately in a targeted manner. In addition, this method also enables reliable statements to be made on the durability of materials.

Data for good communication

Digitalization is not completely new and some things are already expected as given. Digital photography is already a widespread, well-established achievement. Digital patient photos enable the dentist to have better communication with the dental technician. In future, there will be other options available, which are today already partially present. The aim is always to provide the dental technician with as much useful information as possible, so that he can achieve the best possible result. Communication between dentist and dental technician is essential for treatment success - and therefore also for patient satisfaction.

Entering the third dimension

In concrete terms, I hope that in future the facial scan will be used as the third dimension in treatment procedures. This will allow more precise and patient-specific planning and working methods. In my opinion, movements are the most important aspect in the facial scan. Before starting the treatment, the facial expressions, the occlusion and the phonetics should be visible. 

In the end everything stays analogous

Digital processes are becoming increasingly important. Every dentist would do well to integrate it as far as possible into their every day professional life. He would make his own work easier and also that of his dental technician. Through more efficient treatments and high-quality results, he will also have more satisfied patients.

Of course, CAD/CAM can’t do everything. It’s a question of cleverly combining the strengths of digital processes - reliability, reproducibility and standardization - with the advantages of analog working steps - primarily esthetics and creativity. Even if machines and software are capable of a lot: The skilled craftsman - in other words the person - remains indispensable. “Man made” will always be better than “machine made”. And only a person can define what looks good. Only a person can provide indispensable qualities such as empathy and trust when communicating with the patient. At the end of a high-tech treatment procedure everything goes back to analog working methods again, because the treatment ends at the patient and the restoration is inserted into the mouth by hand.

The future of dental-lab technology has long since begun. The digital revolution (CAD/CAM) has also reached the dental world. Are you interested to know where dental-lab technology is heading? We have summarized the six most important trends for you based on interviews with experienced technicians, lab visits and talks with experts.

The author

• 1979 - 1982 Dental technician apprenticeship
• 1982 Examination
• 1986-1991 Study of Dentistry
• 1994 Doctorate
• 2003 Post-Doctorate Habilitation (Venia Legendi)
• Since 2014, Head of the Polyclinic for Dentistry at the University Hospital of Munich.
  Scientific focus: Adhesive techniques, all-ceramic restorations, total rehabilitation, intraoral scanners, CAD/CAM technology, high-performance polymers, build-up of endodontically treated teeth, implant prosthetics.

E-Mail: daniel.edelhoff@med.uni-muenchen.de