Medicine does not stand still, and dentistry is especially actively developing. Which is logical, information technologies are also involved as powerful and accurate tools. In recent years, even the concept of “computer dentistry” has appeared. Probably, all the latest technologies in dentistry that will appear in the future will be associated with computer technology.
Machines to help people
Digital technologies are, first of all, relevant in orthopedic treatment at all stages. Systems have already been developed and are being implemented that completely independently fill out the necessary documents. Automated work includes modeling the oral cavity of a specific client with recommendations on which treatment paths should be optimal in a given situation.
The latest technologies in dentistry allow graphic data to be analyzed and processed extremely quickly, and the patient to be examined in detail, without omissions. The results obtained during the research can be demonstrated to both the patient and colleagues.
It must be said that the first such devices cost a lot of money, but quickly growing competition changed the situation. There are cameras for taking photos and videos in the oral cavity that can be connected to a PC. Using this type of technology is easy. In advanced clinics, traditional X-rays are practically not used; instead, radiovisiographs are used that do not irradiate the patient.
Three-dimensional medicine: the future is already in our hands
Computer programs that record and analyze the patient’s facial expressions have shown effectiveness. These are also new technologies in dentistry. Prosthetics becomes much easier and requires less time if the doctor first has a full-fledged animated model of the oral cavity on his computer screen, where he can rotate it and study it from any angle. Such programs are called 3D articulators.
To select the best treatment option for a particular case, you can use computer treatment planning. By the way, special anesthesia control programs have been developed - the computer can now even cope with the task of pain relief.
Neuromuscular dentistry: new technologies
Only the most modern institute of new technology dentistry can afford the neuromuscular approach. Its advantage is that the neurophysiology of the patient’s oral cavity is also taken into account. Methods have been developed to study how active the masticatory muscles are and what the ideal occlusion is.
The best effect is ensured by the fact that the doctor can simulate the trajectory along which the lower jaw moves and work on the prosthesis taking this information into account. If we are talking about a patient with TMJ dysfunction, then neuromuscular dentistry is the most reasonable option.
The pioneer in this area is the American company Myotronics. The company's specialists developed the K7 system, which has become widespread throughout the world. It is used in the most progressive Russian clinics.
Orthopedics against dental problems
The latest technologies have found application in dentistry and in the work of orthopedic doctors. Modern materials and a fundamentally new approach to prosthetics have helped reduce the time required to eliminate oral defects while maintaining a high level of reliability.
First of all, new technologies in orthopedic dentistry are, of course, materials. Damaged teeth are built up using composites - this is the most effective way. The material is created artificially and includes:
- glass;
- quartz;
- porcelain flour;
- silicon oxide.
The advantage of the composite is its extensive color range. The patient can choose a material that is as close as possible to the natural shade of the teeth. So, the renewed tooth will look exactly like the “native” one.
It is often used in orthopedic surgery. It allows you to make really beautiful and durable dentures, which is why it is used primarily for the front teeth. They will look like real ones, even their coating is like enamel. Ceramics are completely safe for health. Strengthening is provided by a metal frame.
New products in dentistry: all stages of prosthetics are covered
Modern orthopedic dentistry also means new solutions in the following areas:
- connection of materials;
- veneering of dentures;
- methods of manufacturing materials.
A technique for durable joining of composite and metal was developed. It is based on new methods of metal processing: mechanical, physical-chemical, combined. In recent years, there has been a great demand for adhesive technologies. When handled, a super strong adhesion can be guaranteed.
The latest technologies are used in dentistry and when working on veneers, dentures, and onlays. Among the materials, composite is indeed widely used as the highest quality. Visiting the dentist to install such a prosthesis is no longer scary, and no patient will experience pain.
New items in the arsenal of dental therapists
New technologies are the most relevant in root canal treatment. This branch of dentistry is engaged in, which is called endodontics. The main diseases studied in this field are:
- pulpitis;
- periodontitis.
If the root canals have been well treated, the tooth will last a long time despite the removal of the nerve. But complications may arise when pathological processes spread to the jaw bone. Then they talk about cysts and granulomas. Effective modern technologies will help avoid such a disaster.
One of the most effective technologies is depphoresis. It is used if you have to treat a tooth that has already been treated using an outdated method. This technology is irreplaceable if the patient is diagnosed with a granuloma or cyst.
And, of course, we cannot help but mention the new materials used by dental therapists. Recently, glass ionomer cements have become widespread and have shown themselves to be the most promising. These materials have a minimal level of toxicity, but they are durable and beautiful. In addition, due to the increased concentration of fluorides, such cements effectively fight caries.
Dental crowns: new technologies to protect oral health
Modern dental crowns are made from a special material based on metal and ceramics. It was possible to automate the process of crown design and manufacturing.
CAD/CAM is the name given to these advanced technologies in dentistry. Crowns made in this way fit the patient perfectly, and this is ensured by computer modeling of the oral cavity, thanks to which the doctor can examine the most inaccessible areas from all sides at any time.
CAD/CAM is used to create prostheses and onlays, crowns of the most complex types and shapes. The technology is quite expensive, but it significantly reduces the time spent at the doctor’s office and allows you to get perfect crowns, which cannot be said about older methods.
You can't skimp on your health
It's no secret that dentistry with new technologies in Moscow will not be cheap. You can spend much less money if you turn to old, “grandfather’s” methods, or even go specifically to a small town on the periphery of the Moscow region, expecting to find a low price tag.
Doing this is strictly not recommended. Bad dentures can ruin your entire future life and lead to many problems. Therefore, truly reasonable behavior is to turn to specialists who practice the most modern methods.
It is imperative to make sure that modern and effective materials are used in the work.
If you have the opportunity to visit a clinic that offers computer modeling, it is worth the price tag to afford it.
Patient experience: putting it to good use
When choosing a dental clinic, you should definitely study the reviews: find out from friends and acquaintances where they had their teeth treated, what their general impressions were. When collecting information, you need to analyze not only how positive the reviews are, but also how trustworthy they can be.
The latest technologies in dentistry are the key to a flawless smile, as evidenced by reviews from satisfied patients.
CBCT and scan protocol
Conclusion
Improvements in digital dentistry are directly dependent on the progress of technology in the computer field, even if they are associated with the development of some special transistor or microchip.
The digital revolution, which continues to gain momentum, began back in 1947, when engineers Walter Brattain and William Shockley of Bell Laboratory John Bardeen invented the world's first transistor, for which they subsequently received a Nobel Prize. Transistors of those times, in addition to being quite slow, were also excessively large, for this reason it was difficult to include such a design in some kind of integrated circuit, not to mention a microchip. Unlike their arch-relatives, the size of modern transistors may not exceed the size of several atoms (1 atom thick and 10 wide), while such elements operate very quickly at a frequency of several gigahertz, and can be compactly placed in the structure of some small board or computer circuit. For example, a Core processor (from the i-series), released in 2010, contains about 1.17 billion transistors (!), although in the mid-70s similar processors could contain no more than 2300 such structural elements. But this is not the limit. According to Moore's law, every 1-2 years a new microchip is born, which is twice as powerful as its predecessor. It is therefore not surprising that dentistry is currently experiencing something of a boom, with the industry's scanning, analysis and manufacturing capabilities continuing to evolve rapidly. Digital radiography will no longer surprise anyone, because increasingly, doctors are using completely virtual diagnostic and treatment planning protocols, which help achieve the desired results.
One of the innovations that has literally become a routine procedure is the acquisition and analysis of digital prints. For the first time, a similar procedure was tried back in 1973, when graduate student Francois Duret at Claude Bernard University (Lyon, France) proposed taking impressions using a laser in order to later use them in the course of complex diagnostics, treatment planning, manufacturing and fitting of future restorations.
Almost ten years later, in 1983, Werner Mörmann and Marco Brandestini managed to invent the first intraoral scanner for therapeutic dentistry, which ensured impression accuracy of 50-100 microns. The principle of operation of the scanner was based on the capabilities of triangulation to obtain instant three-dimensional (3D) images of teeth, from which future therapeutic structures could be milled. The latter, in the form of inlay-type inlays, were obtained using CEREC (CERamic REConstruction or Chairside Economical Restoration of Esthetic Ceramics), but the constant progress of technology subsequently determined the possibilities for the manufacture of full-fledged single restorations and even entire orthopedic prostheses. CEREC itself has also improved. Thus, a conventional milling machine was upgraded to the CEREC OmniCam system (Sirona Dental), which ensures the most precise designs. The increased attention to this particular system is due to the role of CEREC as a pioneer of such devices on the market, which occupied a leading position for several decades, while other analogues found their feet and improved to the level of an already popular installation. There are currently several fairly accurate and powerful systems for taking intraoral optical impressions and fabricating CAD/CAM restorations, but they all use the same principle of triangulation to form the image. The most famous of them are TRIOS (3Shape), iTero Element (Align Technology), True Definition Scanner 3M (3M ESPE).
Advantages of modern digital systems
All modern digital systems for taking impressions are characterized by high accuracy of replicas of the structures of the dentofacial apparatus, and, of course, complete non-invasive manipulation. Unlike conventional impressions, the resulting images can be easily adapted to all conditions during planning and treatment, and the technique for obtaining them is so simple that it can be learned in a few steps. Thus, these impressions are not only more effective, but also more convenient for the patients themselves, and also increase the cost-effectiveness of dental procedures in general.
Another great advantage is that thanks to digital impressions, the doctor has the opportunity to receive not a negative image of the prosthetic bed, but a real copy of the teeth in 3D format, which can easily be assessed for the presence of shooting defects and the accuracy of individual boundaries.
Also, such impressions are just a volume of digital information, which literally saves physical space both in the dentist’s office and in the dental technician’s laboratory. Studies conducted to compare conventional and digital impressions have shown better accuracy of the latter, while they differ from conventional ones in that they do not need to be disinfected, and there is no need to take into account the time of obtaining the impression in order to minimize the effects of shrinkage and changes in the primary size impression material.
The main advantage of digital impressions is that they can easily be included in the process of comprehensive planning and treatment with the ability to predict future results of dental rehabilitation. Direct copies of teeth and adjacent anatomical structures are visualized in a direct projection immediately after the scanning procedure, and the high resolution of the resulting images helps to assess the condition of existing restorations, defects, the size and shape of edentulous areas, the type of occlusal contacts, as well as the usefulness of the tubercle-fissure closure.
New digital systems, such as TRIOS, CEREC Omnicam, even provide an imitation of the color of the structures of the oral cavity on the resulting replicas, thus helping to more naturally perceive the relief, shape and color of teeth and gums. In addition, such opportunities help the doctor to take a more differentiated and thorough approach to the issue of choosing a restoration material (metal, ceramic, composite), as well as take into account the presence of bleeding and inflamed areas, areas with accumulation of plaque and stone, and take into account color transitions between teeth, which is extremely important for highly aesthetic restorations. Optical impressions are also an effective tool for discussing the initial clinical situation and possible treatment options with the patient. After obtaining a three-dimensional image, problems with defective restorations, the influence of factors of abrasion, superocclusion or angulation of teeth on the future result of treatment can be clearly explained to the patient, without waiting for the receipt of plaster models (photo 1).
Figure 1. Occlusal view of the maxillary optical impression: the image allows detailed examination of the inherent composite and amalgam restorations, the lingual cusp fracture of the maxillary second premolar on the left, the metal-ceramic crown in the region of the maxillary first molar on the right, and the implant-supported prosthesis in the anterior region .
All this encourages the patient to actively participate in the treatment process and conduct an active dialogue with the doctor, understanding all possible risks and changes in their own dental status. Digital files of optical impressions are saved in surface tessellation files (STL) format, and, if necessary, physical models can be produced from them using substrate or additive technologies.
Preparing for optical impressions
Like conventional impressions, their digital counterparts are also sensitive to the presence of blood or saliva in the tissue area of the prosthetic bed, so the surface of the teeth must be adequately cleaned and dried before scanning. You should also take into account the effect of surface reflection, the risk of which may be triggered by specific lighting conditions of the working field. The use of light sticks helps to achieve an adequate level of illumination in the area of the chewing teeth, but at the same time, access of the photocell to this area still remains difficult, and irritation of the palate can provoke a gag reflex.
However, digital impressions are only part of a comprehensive patient assessment, which should also include a general and medical history, clinical extra- and intraoral examination results, and a clear understanding of the patient's complaints and personal expectations for the future. results of the intervention. It is by analyzing all of the above data that it is possible to draw up a comprehensive treatment plan focused on a specific patient and the characteristics of his clinical situation. The latest technological capabilities help the dentist independently simulate future restorations in the area of defective areas, coordinating the design, contours, position, dimensions, size of proximal contacts and the visualization profile with the patient, taking into account the individual characteristics of the occlusion, and thus ensuring the most adapted and expected temporary designs.
However, the main limitation of current dental digital technologies is that they are difficult to fully incorporate eccentric jaw movements and the implications of key occlusal determinants for future restoration design. Due to the fact that recording the exact relationship of the upper jaw to the plane of the defective area is a very difficult task, it is also difficult to establish the objective inclination of the occlusal plane relative to the group of anterior teeth at the moment of their physiological closure.
Equally difficult tasks are the analysis of the articular path, the range of transversal movements, etc., that is, the use of digital impressions is also a kind of challenge for the construction of prosthetic structures, taking into account all physiological or changed parameters of occlusion. Obtaining accurate impressions from soft tissues is also very problematic, especially in areas of completely edentulous residual ridges. However, the ability to visualize 3D, as well as eliminating the need for plaster casting and wax-up, significantly speeds up and tailors the treatment process, helping to achieve the most patient-centered dental rehabilitation results.
The digital planning protocol is demonstrated in Photo 2-7. The patient sought help with an edentulous upper right central incisor (Figure 2).
Photo 2. The patient sought help for edentulous lateral incisor. During the treatment, it was planned to make a structure supported by the central incisor and canine.
After analyzing the individual wishes of the patient, the results of a comprehensive examination and the prognosis of future treatment, it was decided to use a fixed lithium disilicate prosthesis as a replacement structure. A virtual mock-up of the future restoration helped determine the required length, width and profile of the contact surfaces to achieve the greatest possible mimicry of natural tissues (photo 3).
Photo 3. Digital mock-up of a prosthesis replacing a missing tooth.
After this, the supporting teeth were prepared (photo 4), and then using the scanning method, virtual impressions of the prepared units and antagonist teeth were obtained, which were further analyzed in a digital articulator (photo 5).
Photo 4. Occlusal view of the optical impression of prepared teeth with retraction threads.
Photo 5. Virtual articulation of optical impressions of the upper and lower jaws.
The optical impression data was also successfully used to analyze in detail the width of the final line of the preparation area, the routes of insertion of the structure, the level of deliberate tissue reduction in the area of the axial walls and occlusal surface, as well as to verify the undercuts, which were marked in red (Figure 6).
Photo 6. Analysis of the optical impression for the presence of undercuts. Undercuts are marked in red on the labial side of the central incisor and on the mesial side of the canine.
Another advantage of digital impressions is that preparation errors can be corrected during the same visit, based on the information obtained during the scan, and then the manipulation can be repeated on the corrected area of the prepared teeth. After this, the digital files are sent to a technical laboratory for the production of future restorations using milling machines. An example of the final design is shown in photo 7.
Photo 7. The restoration obtained from the optical impression is tried on the model.
CBCT and scan protocol
The use of digital capabilities at the stages of diagnosis and treatment planning is not some kind of innovation, but rather is considered as an already well-reasoned approach to the rehabilitation of dental patients. For decades, dentists have used specialized software to visualize three-dimensional computed tomography (CT) scans: to analyze the growth of anatomical structures in the maxillofacial region; joint pathologies; bone architecture; sizes of individual sections of teeth and jaws; positions of vital organs such as blood vessels and nerves, as well as the boundaries of the maxillary sinuses and the position of impact teeth; diagnosis of tumors and neoplasms. But CT diagnostics is probably most influential in preparation for dental implantation and planning of maxillofacial reconstructive surgery. Technological progress has gained new momentum with the development of cone beam computed tomography (CBCT), which, compared to conventional CT, is characterized by a lower level of radiation exposure and a lower cost of the device. Indeed, the total radiation from a CBCT scan is on average 20% less than from a helical CT scan, and is approximately equal to that from conventional periapical radiography.
CT and CBCT diagnostic results are saved digitally in the standardized DICOM (digital imaging and communication in medicine) file format. In combination with a radiographic template made from a diagnostic wax-up, CBCT data can be successfully used to plan the position and angulation of implants, taking into account the fixation of the future prosthetic structure, based on the existing conditions and volumes of the bone crest (photo 8 - photo 11). Currently, there are two different protocols for implementing radiographic templates into the DICOM data structure for planning future surgical procedures. The first, called the dual-scan protocol, performs the acquisition procedure separately for the surgical guide and separately for the patient, provided that the surgical guide is installed in the oral cavity. Fiducial markers in the structure of the template itself help in the future to quite accurately combine the two resulting images. At the same time, the level of scanning errors is practically reduced to a minimum, and templates can be produced using various adapted software (photo 12).
Figure 8. Use of cone beam computed tomography and specialized software to plan the implantation procedure. The X-ray template together with the CT model was used to plan the future position of the implant.
Figure 9. Use of cone beam computed tomography and specialized software to plan the implantation procedure. The X-ray template together with the CT model was used to plan the future position of the implant.
Figure 10. Use of cone beam computed tomography and specialized software to plan the implantation procedure. The X-ray template together with the CT model was used to plan the future position of the implant.
Figure 11. Use of cone beam computed tomography and specialized software to plan the implantation procedure. The X-ray template together with the CT model was used to plan the future position of the implant.
Photo 12. Example of a surgical template made using a digital dual-scan design.
The second protocol requires only one scan of the patient along with a surgical guide placed in the oral cavity. The obtained data is imported into the implantation planning program without the need for additional image processing. As in the case of the double scanning protocol, the doctor has the opportunity to reasonably plan the position and angulation of the implants, based on the spatial location of the surgical template obtained as a result of the preliminary diagnosis. Three-dimensional radiographic images obtained using a single-scan protocol can be combined with digital templates for future restorations, which are made based on intraoral optical impressions (or scans of models), using existing natural teeth as markers. In this case, different digital masks can be used graphically for bone, teeth, gums and implants (photo 13 and photo 14), and the use of teeth as fiducial markers significantly increases the accuracy of planning the position of future implants.
Figure 13: Optical impression and digital reproduction were combined with CBCT scan results to position the implants during complex treatment. This patient requires a sinus lift procedure to adequately place the implants (blue outlines of the teeth obtained from the wax reproduction/optical impression, red indicates the outlines of the soft tissues).
Figure 14: Optical impression and digital reproduction were combined with CBCT scan results to position the implants during complex treatment. This patient requires a sinus lift procedure for adequate installation of implants (blue indicates the contours of the teeth obtained from the wax reproduction/optical impression, red indicates the contours of the soft tissues).
Similar marker points in the structure of the surgical template, unfortunately, cannot provide a similarly high level of precision. Regardless of the scanning protocol used, the 3D digital imaging, optical scanning and software capabilities provided provide unique tools for future iatrogenic intervention planning in the hands of a skilled dentist. Thus, taking into account the position and contour of the soft tissues, the size and quality of the residual bone crest, as well as the location of the vessels and nerves, the doctor can provide the safest implantation algorithm, while predicting not only functional, but also aesthetic results of rehabilitation. The surgical template, regardless of the protocol for obtaining the scanned image, ensures accurate positioning of the implant, eliminating possible operational errors that may arise during surgery. Virtual planning of dental rehabilitation helps the doctor achieve the safest, and at the same time, patient-oriented results in the treatment of aesthetic and functional defects.
Conclusion
Intraoral optical scanners continue to be constantly modified, becoming faster, more accurate and miniature devices that are so necessary in dental practice. Considering the progressive development of 3D imaging technologies and adapted image processing software, it can be firmly concluded that today's dentists live in the golden age of digital technology. Such innovations help achieve more accurate and precise diagnostic results, planning and iatrogenic interventions, while increasing comfort during dental treatment. Therefore, it is critical that new digital technologies emerge promptly and continue to develop within the walls of dental offices and clinics.
Moscow, st. Mishina, 38.
m. Dynamo. Get out of the 1st car from the center, exit the metro, and in front of you is the Dynamo stadium. Go left until the traffic light. Go along the pedestrian crossing to the opposite side of Teatralnaya Alley and walk a little forward. There is a stop on the opposite side. Take bus number 319. Go 2 stops to "Yunnatov street". Go to the opposite side of the street. To your left is the porch - the entrance to the EspaDent clinic. You're at the place!
Moscow, st. Academician Anokhin, 60
Get out of the first car from the center towards "Akademika Anokhin Street". From the glass doors to the right. Along the forest (on the right hand) along the path for about 250m. to st. Academician Anokhin. Cross to the opposite side of the street and go right, about 250m, to house No. 60. There is a penultimate entrance to the house, a sign “Teeth in 1 day.” You're at the place!
Get out of the metro at the station. Savelovskaya (first carriage from the center). Walk to the end of the underground passage and exit the metro towards Sushchevsky Val street. You walk past the restaurant "Uncle Kolya". Pass under the overpass, then follow the underground passage to the opposite side of the street. Novoslobodskaya. Continue walking along Novoslobodskaya Street for about 200m, past the Elektrika store. On the ground floor of building No. 67/69, the restaurant “Tavern” is located. Turn right, in front of you is a sign “Teeth in 1 day”, go up to the second floor. You're at the place!
Moscow, st. Novoslobodskaya, 67/69
Get out of the metro at the station. Mendeleevskaya (the first carriage from the center). Exit the metro towards the street. Lesnaya. Walk along the street. Novoslobodskaya from the center towards the street. Lesnaya. Cross the streets: Lesnaya, Gorlov tup., Poryadkovy lane. Get to the intersection of the street. Novoslobodskaya from Uglovoy lane. Cross the alley, in front of you is a building, on the facade there is a sign “Teeth in 1 day”. You're at the place!
Moscow, st. Academician Koroleva, 10
You can get there from the metro in 15 minutes. 4 minutes to the tram, 5 minutes by tram and 3 minutes to the clinic. 1st car from the center. Get out of the metro, go to the tram stop and 4 stops on any tram to Ostankino. Get out and return along the park to the road, cross and turn left 80m and you will see a sign on the facade “Center for Surgical Dentistry”. You're at the place!
Moscow, From the monorail station. st. Academician Queen
Exit the station and follow the street. Academician Korolev (on the left), go through the Megasfera store to the intersection with the road. Turn right and walk past the forest park to house number 10. On the facade there is a sign "Center for Surgical Dentistry". You're at the place!
Dental clinic "Mirodent" - Odintsovo, st. Youth house 48.
From Art. Odintsovo buses No. 1, 36 or minibus No. 102, 11, 77 - 2 stops to the "Tower" stop. From metro station Victory Park: bus No. 339 to the “Tower” stop. The clinic is located on the 2nd floor of the business center.
Digital dentistry is a direction of modern dentistry that uses less and less painstaking manual labor. Creating prosthetics or implants has always been the most labor-intensive process. It required the doctor to have serious practical skills in geometry and drawing in order to manually enter the coordinates of all points. Now dental mechanics and orthodontists, surgeons and implantologists use dental CAD/CAM systems. Digital methods and special programs are used in treatment, prosthetics, and tooth extraction.
Digital technologies in dentistry need information
Manufacturing dental restorations without an accurate initial description is unrealistic. Reading information and converting it into digital format is performed by special devices. Let's figure out what is needed to implement digital technologies in dentistry.
Digital radiographs
X-ray diagnostics are needed to visualize bones and teeth, and visualize the results of treatment and prosthetics. And all this without films, dark rooms, hours of waiting and a fair amount of radiation.
With Denta you can manage your dental clinic from your phone and tablet
Radiographers use special sensors that transmit images to a computer screen. This image can be enlarged - the diagnosis becomes more accurate. In terms of radiation exposure, a digital radiograph is 4 times more advanced: 1 image corresponds to 4 regular ones.
Intraoral (intraoral) camera
An intraoral camera takes precise pictures of the teeth and surrounding structures. Often, having seen tooth defects with his own eyes, the patient is more responsible about the prescribed treatment and oral hygiene.
Digital scanning of the inside of the mouth
Provides information in three-dimensional format and allows you to accurately plan surgical procedures and prosthetics. Based on these images, a 3D model of the dentition and soft tissues around them is formed.
Optical scanners create a digital map of teeth and a digital impression of them. Using a digital color map, you can select the exact color of the aesthetic restoration.
Digital impressions have made the use of impression material a thing of the past: you don't even have to touch your teeth. The patient can calmly close his mouth and not be afraid of attacks of vomiting and nausea. The doctor carefully studies and adjusts the parameters of these impressions, bringing them to perfection while they are still in virtual form.
Laboratory scanning of models
Sometimes an intraoral scanner cannot be used. In this case, you can go the other way, which will again lead to scanning.
Using traditional methods, make impressions of the oral cavity and dentition, and make plaster models based on them. And only then scan them in a laboratory scanner and get virtual models of the jaws.
Cone beam computed tomography (CBCT)
A 3D tomograph provides a three-dimensional image of the anatomical structures of the jaws and face. With him, implantology and periodontology gained vision, because a flat image of a three-dimensional object was always inaccurate. For endodontics, accurate data on the length, thickness and shape of the tooth canal or bone shape is important. Information from the computed tomography center works without the patient. The orthodontist sees the space in the bone in the direction of possible tooth movement. The orthopedist sees through both dental tissue and pulp and easily determines the depth of preparation for a crown, veneer or filling.
Implants are no longer placed blindly, and many problems associated with their unsuccessful placement have gone away.
CAD computer design
When the scanner produces digitized information, the CAD system begins to visualize it on the monitor screen. One of the most popular such systems is Dental CAD. CBCT data and photographs of the oral cavity are combined, analyzed and embodied in a 3D model of the dentition. Such virtual models are indispensable for dental restoration and during the entire implantation process.
The services offer the doctor all possible options for tooth restoration; he just has to choose the most optimal one. The degree of human intervention in the operation of a CAD/CAM system can vary from minimal user adjustments to significant design adjustments. Planning for dental rehabilitation proceeds “from the opposite direction”, starting with demonstrating the final result, which completely satisfies both the doctor and the patient.
Digital smile design is now commonplace. You can even go one step further: order temporary dentures, try out your new smile live and understand how comfortable it is. And only then the doctor will begin to work with the teeth in reality.
At this stage, online consultations in real time are often used. An interesting program is ImplantAssistant. She will help discuss and resolve many aesthetic or functional issues, and eliminate unnecessary visits to the clinic by the patient.
CAM-computer production management
Crowns, veneers, inlays, abutments, bar systems for implant prosthetics, bridges and implants are materialized thanks to computer technologies, united by one term - CAM. The German CEREC machine can produce all these types of restorations from temporary materials. This is very convenient if you want to check, for example, diction with a new crown shape or evaluate the practicality of a complex design.
When the virtual model of the future restoration is ready, the software converts it into a set of commands. Then they are transferred to the CAM module - a dental 3D printer. It replaces the milling machine, which is still popular and widely used. But the casting method is rapidly becoming obsolete. 3D printers are used in orthodontics, surgery, prosthetics and implantology.
Invisible aligners for correcting bites
Previously, this cosmetic defect was removed by plates, then by braces, now transparent aligners (aligners) are increasingly gaining popularity. They are similar to covers, the inner surface of which exactly repeats the shape of the entire dentition, taking into account its micro-mobility, and exerts constant constant pressure on it. Aligners do not damage the enamel and allow teeth to move correctly inside the jaw. During the entire course of treatment, the shape of the trays is adjusted in order to increase the required pressure more and more each time.
Aligners are produced using thermoforming technology in pressing devices under vacuum or pressure, using polymer plates of a certain thickness. When heated, the plates become plastic and make it possible to duplicate simulated or real objects of various shapes by pressing in the apparatus. In this case, the object of duplication is “digital” models of jaws, which are made according to individual casts of the clinic client. At this stage, the production of aligners is widespread in the USA, Korea, Mexico, Germany, Italy, and the UK. Since 2012, aligners have been produced in Russia.
Implantology
In a critical situation, in case of complete destruction of a tooth for which it is no longer possible to make a crown, an implant can be used. When installing it, there are often problems such as drilling to a greater or lesser depth or at the wrong angle, as well as inaccurate positioning. The price of a mistake is a forced wait for bone tissue restoration from 2 to 12 months.
This is where a 3D printer comes to the rescue, such as PALTOPPilotSurgicalGuide, which produces a surgical template. Based on CT data, the program itself selects the correct orientation of the cut for the future implant and creates special landmarks (bushings) that are inserted into the template. Having installed it in the patient’s mouth, the implant surgeon will quickly and accurately drill holes at the desired angle along these landmarks. The template will provide a complete overview of the surgical field, control of the depth of immersion into the bone and the success of implant healing.
Implants usually have a symmetrical shape and a round cross-section, and so do standard abutments. The abutment is located between the crown and the implant. However, the cross-section of natural teeth is not round, but asymmetrical. In order not to modify the standard abutment manually, “by eye,” computer modeling and manufacturing are also used.
Realizer50, 3Shape machines, and the Russian Avantis system are suitable for direct production. The parts printed with their help are monolithic and homogeneous, and there are no pores in the crowns. Even for the administration of anesthetic, the digital device TheWand is now used. It slowly, gently, and painlessly injects the anesthetic medication. The feeling of pain from a needle cannot be compared with the slight feeling of liquid pressure on the tissue.
20.04.2018
Information technologies are firmly established in all spheres of modern life; they could not help but find their application in the field of dentistry. Even the terms “dental informatics”, “computer dentistry” and others appear.
Digital technologies can be used at all stages of dental treatment - from filling out and maintaining medical documentation forms to simulating clinical situations and proposed treatment plans, and so on.
Automated design and production of dentures.
The theoretical foundations of this technology appeared in the early 70s of the 20th century. To designate computer-aided design systems in the world, it is customary to use the designation CAD (Computer-Aided Design), and for production automation systems - CAM (Computer-Aided Manufacturing).
Technology is developing in two directions. The first is individual CAD/CAM systems that allow you to work within one medical institution, sometimes even in the presence of the patient right in the dentist’s office. The main advantage of individual systems is the speed of production, but for full-fledged operation you still need the entire complex of equipment, which costs a lot.
The second option is centralized CAD/CAM modules, which require the presence of a production center that produces a wide range of designs for various workstations. This option allows each dentist not to purchase a manufacturing module. However, its disadvantage is that the entire range of events cannot be carried out in one visit, and delivery of the finished structure becomes more complicated and more expensive. After all, the production center may be located in another city or even country.
The basic operating principle of all modern CAD/CAM systems has remained unchanged since the 1980s and includes several stages:
1) collecting data on the surface relief of the prosthetic bed using a special device with further digitization of the received information and bringing it into a form acceptable for computer processing;
2) creating a virtual model of the future design using a computer and taking into account the dentist’s wishes;
3) manufacturing the prosthesis itself based on data obtained using the device.
There are differences in the technologies for implementing all these stages, but they themselves remain unchanged.
Data collection stage
The main differences between systems can be detected precisely at the data collection stage. Reading information and converting it into digital format can be done using mechanical and optical digital converters. The optical impression is three-dimensional - each point on the surface has clear coordinates in three planes. The device that creates such impressions is a light source and a photosensor that converts the light reflected from the object into a stream of electrical impulses.
Mechanical data scanning systems read information with a contact probe that moves along the surface of an object according to a given trajectory.
Stage of computer modeling of the design
Today, the manufacture of objects without a preliminary accurate description is impossible. This stage of creating prostheses was previously the most labor-intensive and required the doctor to have serious skills in geometry and drawing. It was necessary to manually enter the coordinates of all points. All manufacturers of dental CAD/CAM systems have strived to simplify and visualize this process as much as possible. Therefore, modern systems begin building an image on the monitor screen as soon as they receive digitized information from the scanner. And then special programs offer the doctor possible options for tooth restoration, from which you can choose the most acceptable one. The degree of human intervention in the operation of a CAD/CAM system can vary from minimal user adjustments to significant design changes.
Direct production of the restoration
When the model of the future restoration is ready, the software converts the virtual model into a set of commands that are transmitted to the CAM module. The production module produces the designed restoration. The earliest systems produced prosthetics by cutting from a finished block using diamond or carbide burs and discs. Excess material was removed. With this method, it is possible to create a finished form of a complex configuration, but it is quite difficult, and a significant part of the material is wasted. Therefore, “adding” methods for producing dental restorations have emerged and have also begun to find application in CAD/CAM systems, in which complex structures can be produced without wasting material.
Application of CAD/CAM systems
CAD/CAM systems do more than just help make dentures. They can also be used in surgical practice to make surgical templates that facilitate the correct placement of dental implants during operations.
There are also automated systems that are used to train dental students and dental technicians. They are called dental simulators, and they accelerate the acquisition of skills in restoring and preparing teeth.
IT technologies are used at all stages of dental care, so timely training of specialists who are proficient in such technologies is an important condition for their implementation in dentistry.
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