An Overview about Digital Dentistry

• CBCT

  • Digital Imaging
    • Generate three-dimensional (3D) images
    • Lack of superimposed structures
    • Evaluted structured from 360 degree angle
    • Zero magnification
    • Raw data provided in DICOM (digital imaging and comunication in medicine)
    • Increased radiation dose
    • Only high density objects (bone and teeth) are clearly seen in CBCT images
  • Common Uses of CBCT in dentistry
    • Dental Implant Planning
      • approximately 2/3 CBCT scans ordered are for dental implant purposes
      • highly accurate alveolar ridge width and height
      • Hounsfield unit numbers to measure bone density
      • Precisely identify anatomic feature (maxillary sinus, mental canal, mandibular canal etc)
      • Assist to appropriate emergence profile, implant position and for bone grafting
    • Endodontics
      • Identification of potential accessory canals
      • Identification of root canal system anomalies and determination of root curvature;
      • Diagnosis of dental periapical
  • Growth and development (orthodontics)
  • Oral and maxillofacial surgery

• Digital Impression

  • Conventional Impression
    • volumetric changes
    • expansion of dental stone prone to error
  • Digital Impression
    • with IOS (Intra Oral Scanner) combined
    • with CAD/CAM (Computer Aided design and Manufacturing Technology)
    • easier planning of treatment
    • communication with laboratories
    • reduced operative time
    • storage requirements
    • reduced treatment times
    • patient friendly

• Intra Oral Scanner (IOS)

  • IOS is a medical device composed of a handheld camera (hardware), a computer, and a software.
  • The goal of IOS is to record with precision the three-dimensional geometry of an object.
  • The most widely used digital format is the open STL (Standard Tessellation Language) or locked STL‐like

  

• Mesh Quality

  • High mesh density increased high computing time involved.
  • More dense mesh for high curvatures (incisal edge or gingival sulcus.

  

• Clinical Implication

  • During intraoral scanning, control patient mobility that can lead to scanning by mistake peripheral soft tissues such as the tongue or jaws.
  • The presence of blood, saliva, or gingival fluid
  • The latest IOS also provide color and texture that greatly increase the perception of clinical situations and dental volume.
  • Capturing whole arch/ quadrant, buccal bite scan (able to articulate close to patient’s Intraoral jaw relation)

• Contra indication

  • Inability to access the area with the digital camera

    The camera head is too large or the patient does not have the ability to open wide enough to accommodate the camera head. Sizes and weight of camera heads vary with different systems, but the trend in development is toward a smaller camera size.

  • Lack of patient cooperation

• IOS accuracy

  • Trueness

    • to detect any impression detail and permit the establishment of a virtual3D model as similar as possible to the actual model, and that little or nothing deviates from reality.
    • Overlap with a reference scan to generate colorimetric maps displaying the distances/differences between the surfaces of the IOS and the reference model at micrometric level

  • Precision

    • by overlapping different scans/models taken with the same IOS at different times and again evaluating the distances/differences at micrometric level.

    

  

• Possible workflow Combination

  

  

• CAD/CAM in dentistry

  • Definition

    • An indirect restoration designed by a computer (Computer Aided Design) and milled by a computerassisted machine (Computer Aided Machined)

  • Process

    • Data acquisition

      The images and/or dimensions of the prepared teeth and related structures can be captured using a conventional cast model or digital using IOS

    • Indirect restoration design

      The image is transferred with the help of a software program, to a data processing center, where the images of the dental preparations will form a tridimensional network

    • Construction of the prosthesis

  • Image

    

    

  • Advantages of CAD/CAM

    • increased productivity
    • high level of accuracy
    • decreases labour cost and time for dental technicians
    • standardises the quality of restorations.

  • Disadvantages of CAD/CAM

    • Learning curve
    • High Cost
    • Error in occlusion assessment & still require human input
    • Environmental impact

• Digital Implant Surgery

  • The digital workflow for surgical rehabilitation with dental implants advantage

    • Prevent complications
    • Achieve more predictable outcomes
    • Implant surgery more accessible for dentists and patients alike

  • The digital workflow for implant surgery consists of three steps

    • Image acquisition (CBCT and IOS)
    • Virtual planning
    • Implant placement using surgical guides

    

  • Image

    • File superimposition using software

      

    • Virtual implant planning

      

    • Surgical guide fixation method

      

      

    • Clinical application