The latest advancements in digital dentistry

March 31, 2017

Digital technology is constantly changing-even within the last 12 months.

In the first issue of Digital Esthetics, the cover story was on the latest advances of digital technology. Of course, the tricky thing about technology is that it changes-and it changes constantly. So now, almost a year after the debut issue, what are the latest developments in dental technology?

What’s it doing to the lab-practice workflow? What new possibilities and challenges are coming into focus thanks to process digitalization? Digital Esthetics asked a group of experts-some interviewed in the original cover story, some not-to find out what’s changed in the last year.

In the original article, it was noted that workflow maturation depended on several components all working together, and Justin Marks, CDT agrees. “The process of knowing how to do digital manufacturing is becoming more refined because of two things,” he says. “First: software, scanning, and manufacturing companies are coming together and presenting a process for how to make a denture with their products. Second, there are a lot of pioneers at the lab level who have experimented enough that they know how to do it on their own.”

When we last visited this topic, experts said that we would see a big change coming to the area of digital dentures. Trends in technology seem to be proving them right. While 3D printing has been on the market in dentistry for years, the advancement of other technologies such as milling units and restorative materials have the focus right now. Scanning is getting more detailed. Milling is getting more efficient. Materials are increasing in esthetics and strength. But as these technologies continue to be perfected, maturity in 3D printing will be the focus over the next year or two as new printing materials become available.

“There has been a huge boom toward both clinicians and laboratories getting involved in 3D printing,” says Mark Ferguson, CDT. “It had previously been cost prohibitive, but with advancements in materials and hardware, it’s gotten easier. Multiple things have come together to put things at a faster trajectory of advancements than you would normally see.

“Generally, when you’re looking at advancements in machines or computers, everything is going to get twice as fast every 18 months or two years. With 3D printing, you had that trajectory, but with the hardware and materials it was able to go even faster.”

While the market isn’t being flooded with new materials and technologies, it is still an exciting time in dentistry, says Dr. John Flucke. “We’re not seeing radical changes, but we are seeing some new companies coming into the market,” says Dr. Flucke. More companies bring more competition, and therefore, more innovation in the form of fine-tuning, as “huge changes aren’t as easy to come by,” he says.

Some of those tweaks include offering higher resolution printers that offer more detail and accuracy, says Ferguson. “That has been caused not just by hardware, but by materials,” he says. “The hardware, depending on the printer type, can get to a certain point, but the material has to have a grit size that is small enough to allow the resolution and accuracy to get to that higher level. That happened with 3D printing in the last year.”

Another benefit of fine-tuning available technologies and products is the subsequent decrease in cost.

“New materials in printing came out over the last year: and perhaps they weren’t new, but were new to dental as they reached the threshold of accuracy and resolution that we require, which is higher than that required in other industries,” says Ferguson. “But instead of $150,000 for the machines, you’re spending as low as $5,000 or $20,000, which makes it a much more affordable and attractive piece of equipment for laboratories and clinicians.”

“There are a lot more options for desktop and sub-$10,000 printers,” says Justin Marks, CDT. “At a more refined level, there’s a race to print long-term products instead of just prototyping,” he says.

The race is hindered by the lack of new printing materials for use in dentistry.

“In the last few years, there haven’t been any changes in printing materials because the material selections are limited,” says Marks.

Making 3D printing more accessible has certainly changed the workflow, and although there is an interesting conversation taking place on the role of the lab technician in the future, many believe that the lab of the future will be as strong as ever.

“In some ways, it’s probably disrupted [the workflow] in that dentists are controlling more because some of the printers are so easy to use,” says Ferguson. “Dentists might think, ‘Why use a lab when I can print it in the office?’ But it’s enabled a more digital workflow, which for dentists and labs that want to be in that environment, there’s easier communication through 3D PDFs, STL viewers, and things like that. It’s as easy as sending an email when you have some of the softwares in place.”

“Labs and dentists are using more 3D printers because of the cost reduction and scanning equipment,” says Marks. “Dentists can perform surgeries faster, plan cases faster, and they can do all of the treatment planning with their 3D printers. They can print models and surgical guides. Whether that’s good for the lab industry is another story. That’s taking work from some commercial labs, and though I continue to see it grow, I don’t see it replacing lab techs at all. I think there is a certain amount of planning and procedural work that a dentist is willing to do; i don’t think they’re willing to operate a full lab, which they’d have to do.”

“The collaboration on all of that is going to continue to improve,” says Dr. Flucke. “There are more collaborative software packages coming along that will allow for a lab to show the mockup and ask the dentist what they think before they create the final restoration. Some of these have been around for a while but have been clunky. They’re getting better and better.”

Digital dentures

“I think there’s going to be some really big advancements with materials for digital dentures coming up,” says Ferguson. “What’s really exciting is how the design software is making things even easier for digital dentures with a variety of different workflows. Designing a digital denture and then working toward what we saw with crown and bridge manufacturing, where you’re designing quicker than you could before, but you’re getting 80 percent done in half the time so that you can spend the same amount of time you normally would on the last 20 percent. It’s going to enable dental technicians to be more productive, especially with milling: fixed dentures with the pectin as a light, strong material that offers some flex. The fixed denture arena is really exciting right now: you’re getting more crown and bridge technicians who are able to work on the denture side by turning those cases into crown and bridge cases and digital has certainly led in that respect as well.”

Scanning and model-less crowns

“There have been some advancements with the design software that the public has become more aware of that help to get toward model-less crowns, but it’s really kind of a back and forth,” says Ferguson. “With advancements on the scanner side, I think there’s still a comfort level for most people to prefer to have a model.

“I think what it’s been has been more software upgrades, in terms of the ability of the software to handle the scan data. The companies that sell them are recommending a better PC and better graphics cards, and that actually makes the data more accurate because the computer can handle the onslaught of data better. There has been nothing groundbreaking in the new hardware that’s come out. I don’t think the new hardware has tried to be groundbreaking; it’s been finding its place based on the economics of it. You’re not finding new scanners that are more expensive - instead, you’ll see new ones that let you save a bit of money.”

Economics play a huge role, says Ferguson. In order to increase their acceptance, there must be an economic incentive for those otherwise uninterested in technology to make the purchase.

And then there are those who are impressed by the technology.

“The digital impressioning side of it has gotten so much better, easier, faster, and more reliable that I’m just blown away,” says Dr. Flucke. “The way the systems take the pictures now is amazing. You pass the wand over the teeth and the photos start appearing on the screen as if by magic. If you miss a spot or there’s not enough detail, you can see an image on the screen that’s a hole, and you go back over that area. It knows where it is and fills that area in automatically. That’s improved workflow greatly. In my office, we have cut the amount of time that they spend getting these images in half, maybe more.”

CAD

Improvements in software extend into the CAD arena as well.

“We’ve seen advancements in the ability of the design software to design dentures the same way, but have different types of manufacturing, where you can use denture teeth or mill your own,” says Ferguson. “It’s more that people are finding tools that the software has had but they didn’t realize were there.

“The software could do digital diagnostic wax-ups for years, but nobody was doing it or cared about it because there wasn’t an economical way to manufacture your wax-up. With these printers coming out, you have the perfect storm of technology from two sides coming together to create something that becomes very popular.”

Manufacturing

“Some of the bigger advancements I’ve see with manufacturing have been new inventive ways to get to the final results faster,” says Ferguson. “Look at the milling of e.max blocks for single-unit restorations. In the past, the software has just gone through and ground the entire block away, where Amann Girrbach has something that does a cutting path to cut the end of the block that won’t be needed. You’re saving your burs and not grinding as much ceramic away. In terms of rest, you’re chopping off a good bit of it which is going to save you a good amount of time. At the end of the day, I’ve seen that the materials are what they are, and it may not be new advancements, it’s just being put in the hands of more people and becoming more accessible.”

Esthetics

According to Marks, the advancements in esthetics come from having a combination of natural-looking, strong, and long-lasting restorations.

“It used to be that if you did esthetics, it was one of the things where the porcelain or glass you were using could be fragile, and you needed a bulk of that tooth structure to be glass or porcelain,” he says. “We’ve seen esthetics go way beyond what they were before. Now with zirconia, we’re getting closer to the ideal. We’re getting that amazingly strong material that will take the everyday wear of the mouth and be beautiful. We’re riding the wave of that right now.”

Collaboration/Communication

“More people are seeing that the software hasn’t been as user friendly, or they haven’t been exposed to it,” says Ferguson. “Software has been out for years that people don’t know about or chose not to use. Whether that software has changed to keep up with the times, I don’t know. People are looking for that iPhone app experience where it’s easy to use and it just becomes another tool that you’re using all the time. In the past, some haven’t been as easy to use. That’s nobody’s fault, it’s just the reality of the way tech has grown and gotten faster and better outside of dental that affects dental.”

Mousetrap products

Aside from improving software to make technology run smoother and improve communication between professionals in the industry, experts are seeing small improvements in everyday products.

“One company that stands out to me right now is DentLight, a small Texas company that does interesting things with cameras and magnification and curing lights,” says Dr. Flucke. “It’s a small company but they have these cool mousetrap products where they’re taking existing technology and making it work better. They have a curing light that has two sides on it so it cures buccal and lingual at the same time. We’re definitely in a phase now where we’re improving things.”

Conclusion

After years of what seemed like an influx of innovative technology, the industry can take a breath. Professionals can use this time to get a better command of the software they use every day. But this lull shouldn’t be wasted.

“What I’ve been pushing through my own company as a lab owner and encourage people to do is think about how your future lab will incorporate any or all of these technologies,” says Marks. “Unless you’re planning to retire in 5 or 10 years, you need to look at all of these technologies.”