|Year : 2017 | Volume
| Issue : 1 | Page : 3-11
Digitized dentistry: Technology that peaked up the professionality of dental practitioners
Farouk M Sakr1, Kais G Al Obaidy1, Mansour Q Assery2, Jamal A Alsanea3, Abdul Nasser I Adam4
1 College of Pharmacy and Allied Medical Sciences, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
2 Deanship of Post Graduate Studies, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
3 College of Dentistry (Females), Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
4 Department of Basic Sciences, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
|Date of Web Publication||14-Feb-2017|
Farouk M Sakr
Riyadh Colleges of Dentistry and Pharmacy, P. O. Box 84891, Riyadh 11681
Source of Support: None, Conflict of Interest: None
Computer-aided facilities have been realized to improve medical diagnosis and consequent treatment in terms of precision, cost-effectiveness, and shorten the procedures time. A variety of dental restorative aspects including diagnosis, rehabilitation, and maintaining of patients with complex clinical conditions have been dramatically improved through the nowadays employed digitized techniques compared with conventional procedures. This review overviews the ways of how digitization could improve dentally related aspects and to discuss the educational procedures needed to acquire such an approach in dental practice. An electronic search was conducted using specifically related keywords. The relevant and most appropriate articles for systematic reviews were selected.
Keywords: Computer-aided design/computer-aided manufacturing, dental impression, dental practice, digitized dentistry, prosthodontics
|How to cite this article:|
Sakr FM, Al Obaidy KG, Assery MQ, Alsanea JA, Adam AI. Digitized dentistry: Technology that peaked up the professionality of dental practitioners. Saudi J Oral Sci 2017;4:3-11
|How to cite this URL:|
Sakr FM, Al Obaidy KG, Assery MQ, Alsanea JA, Adam AI. Digitized dentistry: Technology that peaked up the professionality of dental practitioners. Saudi J Oral Sci [serial online] 2017 [cited 2021 Mar 2];4:3-11. Available from: https://www.saudijos.org/text.asp?2017/4/1/3/200137
| Introduction|| |
Digital technologies have been progressively introduced in almost all modern life aspects including computer design, medical diagnosis and treatment, banking, digital photography, communication, information/database storage, tools and equipment design, mapping, drug design, food inspection, games, animations, and many more to mention. The implication of digitization has been extended in the past few decades to affect the scientific discipline of general dental practice with a centered focus on prosthodontics-related procedures. This new era in dental practice is termed as digital dentistry that can be defined as the use of any dentally related technology or device built in digital or computer-controlled elements rather than that operated electrically and/or mechanically alone.
Regarding the history of dental practice, early dentures were carved from a single block of wood. Further progression advocated the use of waxes and plaster of Paris as impression materials. In the meantime, dental equipment was hand-driven, and later water-driven motors were developed.
It has been a long journey since the 18 century where dentures were made of gold, porcelain, and vulcanite until the introduction of acrylic resins and elastomeric impression materials and the use of advanced mechanical tools for tooth manipulation. As time goes by, endless growth in research has paved for many other successful options in dental practice including oral health preservation, reducing treatment time, minimized error, and providing better quality assurance. Removal and fixed prosthodontics were also established as being the two main treatment modalities. Computerized digital technology has made digital imaging a superior alternative to conventional film imaging in many aspects and paved the way for computer-aided design/computer-aided manufacturing (CAD/CAM) technology to be applied in dental practice.
The CAD/CAM technologies were initially used in cars and aircraft designs before being patented for dental applications in 1984. Since then, the technology has been diverted into an intraoperatory restoration (using prefabricated ceramic monoblocks) and paralleled by advanced CAD/CAM systems for commercial production and dental laboratories.,,, The progressive application of the CAD/CAM technologies in dental practice has resulted in fare accurate manufacturing of prosthetics and consequent greater accuracy of dental restorations., 3, ,,,
The CAD/CAM strategy included production automation and optimization of restorations quality using high-performance biocompatible materials such as zirconia and lithium disilicate ceramics. It has been believed that the continuous evolution of CAD/CAM ceramics is expected to possibly making single sitting restorative dentistry a reality during the 21st century.
With the fast evolution of digital technology, the dentist needs to be updated with this array of developments. Few systematic reviews were found regarding the fast-growing effect of digital technology in prosthodontics. Such reviews would help the dental fraternity to be refreshed with the latest and futuristic vision.
The pronounced impact of digital technology in on general dental practice and specifically prosthodontics has dictated to explain its influence under number of parameters including:
- The clinical aspects
- Laboratory procedures
- Student training
- Practice management
- Patient motivation
- Dental research.
| Search Strategy|| |
An electronic search was conducted for online journals and MEDLINE/PubMed relevant articles from 1990 to 2015, with keywords such as digitization in dentistry, digital, technology, CAD/CAM, virtual technology, recent developments, digital radiographs, and contemporary dental practice; a search was also performed of the references of the review articles and most relevant papers.
| Selection Criteria|| |
The selection included literature suggesting the use of digital techniques in areas of dentistry such as clinical, laboratory procedures, dental training, patient motivation, and related researches. The reviewed literature helped assimilate the advanced trends for patient's benefits, in addition to the progress in dental professionality by providing convenient practice for dentists. To achieve the above points, it is found necessary to explore all available options. Among these options, digitization opened a new avenue in dental practice and will eventually become an integral part of contemporary prosthodontics in a condition that future prosthodontics procedures being based on digital technologies. The current review has further elaboration in each of its aspects.
| Results of Search|| |
With the advanced applications of digitized technologies in dental practice, dental practitioners were convinced that integration of computers could ease the procedures of busy dental practice and consequently improve productivity and accuracy of dental restoration.
Patient's computer monitoring could be attained after the application of the intraoral camera. In addition, the availability of software has also augmented the role of chairside computers by successfully integrating clinical features with corresponding administrative functions. Digitized dentistry (DD) also included important aspects of clinical features, patients, and treatment procedures in addition to financial and management procedures.
Digitized dentistry impacts on clinical practice
Digitization has pronounced impact over dental practice management, patient motivation, and clinical treatment procedures. It has been implemented in many dental procedures including digital radiographs aiding in diagnosis, CAD/CAM technology, digital shade matching, prosthesis fabrication, rapid prototyping, and stereolithography for maxillofacial, digital face bows, virtual articulators, and many others to mention. All are examples of digitization which provide a high level of predictability, more convenience dental practice, and less number of sittings. Further to that, the introduction of computer-aided dental implant including their design and fabrication is becoming a further prime integral part in clinical practice.
Digitized dentistry impacts on training and education
The availability of wide varieties of audiovisual aids has provided effectually practical education and training to dental students due to better presentation of the studied subjects. This type of easy learning could be attained through the World Wide Web sites and visualizing dentistry-related YouTube videos. More interestingly, learning through virtual software like the virtual dental patient (CANDIDE ™, PERIOSLIM ™) provides effective learning with the true feeling as being working on an existing patient.
Traditionally, surgical trainee learns to conduct surgery under the supervision of expert surgeons. This procedure has been proved costly, time-consuming, and with variable effectiveness. On the contrary, the availability of virtual reality simulator has been a reliable option to provide standard surgical training and assessing the competency of surgeon in an ethical way.,,
Virtual reality dental training gives access for dental students to practice on three-dimensional (3D) virtual reality oral cavity. Students wear special glasses with head tracking cameras on their edges that allow the movement of the image relative to the student's head position so that they can virtually examine the teeth from different angles as being real through a 3D jaw image on the computer screen. Students can sense touch and force of the drills and other instruments in a virtual reality through the application of “Haptic Technology” (the science of applying touch tactile sensation and control). The advantages of this learning simulation are numerous including the possibility of repeating various operations, committing no mistakes on patients in addition to the ease of student performance evaluation, and low cost of training.
| Virtual Reality Computer-Assisted Simulation System and Student Evaluation|| |
The application of a virtual reality computer-assisted simulation system (VRCAS), namely, the DentSim technology (DentX Ltd., Australia), showed effective capability in evaluating students' preparation through computer tracking. Students learn their procedures at a faster rate and proved to acquire their skills in significantly shorter time compared to traditional procedures.,
A comparison of the efficacy of the VRCAS with that from the noncomputer-assisted simulation system (CNCAS) showed no statistical variations in the quality of the tooth preparations in both systems; however, the CNCAS students received five times more instructional time from faculty than did the VRCAS students. However, it was indicated that the VRCAS should not be used without a direction from a faculty instructor.
Digitized dentistry and virtual articulators software
They comprise virtual condyle and incisor guide planes that can be precisely measured by a jaw movement analyzer. Virtual articulators are kinematically able to design prostheses as having the capability of simulating the mandibular movement by moving digitalized occlusal surfaces against one another and able to correct digitalized occlusal surfaces to allow for collision-free movement. Virtual articulators calculate the sites where the opposing teeth come in contact during mandibular animation so that the specific masticator movement of the patient could be simulated. Studies on virtual articulator showed a good visualization of the number of position of the dynamic contacts and proved to be precise for the full analysis of occlusion in a real patient.
Virtual drilling systems in dental practice
The availability of digitized virtual drilling systems has aided dental students in getting practiced with handling many procedures associated with dental drilling. This digitized technique has proved efficient in teaching restorative procedures, tooth preparation, sutures, and other implant-related surgeries with the feel of working on a patient without any risk., One stated consideration was that this digitized procedure is expressed to be inferior to traditional methods of teaching due to lack of patient interaction.
Digitized dentistry impacts on dental research
Scientific research is fundamental for the continuous development of dentistry as a professional science. Despite the fact that contemporary old techniques still form the basis of scientific dental research, yet, the research quality outcome has been enhanced on by newly adopted digitized technique and led to new development in material science, introduction of latest equipment, and enhanced dental treatment techniques. Computers and variety software have been a great assist in research studies. Data, discussions, and conclusions from web-based studies and surveys have been listed in literature., These retrospective studies or opinion-based researches provide enhanced subject research methods worldwide, and these surveys were found to be 38% less on cost compared to traditional surveys.
The use of CorelDraw and Adobe Photoshop software allows evaluation of photographs for anthropometric (measurement of size and proportions of human body) and tooth ratios., Using 3D digital optical technique, laser digitization of dental casts is employed to evaluate for the accuracy of the adopted cast formation technique. This 3D digitized technique provides significantly higher measurement accuracy compared with manual measurements.
The application of computerized/software digitization has been incorporated in what is known as finite element analysis (FEA)-based models. FEA is used for analysis and design of complex structures based on force and displacement relationships. This technique has been employed to analyze the stresses transferred by different materials, their mechanical properties, effect of variable designs on dentofacial structures, implant loading and their placement and many other options.,,,
Another area where digitization has helped in research is the use of Digital Instron (is a test equipment designed to evaluate the mechanical properties of materials and components) for material testing, retention testing devices, use of software for anthropometric, cephalometric, and esthetical ratio studies.,
Digitized dentistry and computer-aided design/computer-aided manufacturing-aided restoration
Compared with the traditional casting procedures, the CAD/CAM technology showed significant impact on the fabrication of dental prostheses.,, The technique has improved the fabrication accuracy of prosthetics along with their biocompatibility and longevity, in addition to reducing labor complications and manufacturing cost. However, these advantages are to be reasoned with the initial high cost of the CAD/CAM technology and required staff training. The considerable inability of the CAD/CAM system to recognize the functional movements has led to manually trim the occlusal surface of the prostheses to suit their movements in the mouth or articulator. A software of digitalized virtual articulators representing jaw movement is, therefore, to be integrated with the CAD/CAM system during the fabrication of the prostheses for improvement.
| The Computer-Aided Design/computer-Aided Manufacturing Digital Procedure and Complete Denture Fabrication|| |
This digital technique is different from conventional complete denture procedures. The CAD/CAM requires impressions that record the intaglio and cameo surfaces shapes of the complete denture bases while identifying suitable phonetic and muscular locations for the placement of prosthetic teeth. The information can then be scanned and transferred to a CAD software program; then, casts are created and the denture teeth are virtually arranged into appropriate positions in the virtual denture base. The obtained data are then sent to a milling machine for complete dentures fabrication. Advancements in computer-aided technology in complete denture fabrication have currently resulted in their commercial availability with shorter clinical protocols.
Advantages of computer-aided design/computer-aided manufacturing digital procedure
- All clinical data for complete dentures can be recorded in one brief appointment and consequently lead to considerable reduction in chair-side time
- Accuracy and precision of the CAD/CAM technique compared to traditional procedure
- It preserves obtained digital data to allow for spare denture fabrication or replacement or even providing radiographic or surgical template that aids in future planning and placement of dental implants.
| Digitized Dentistry and Material Testing|| |
Testing of dental materials has become more efficient with advanced digitized testing instruments such as the Digital Instron machine which is a material testing machine including material tensile strength, compression fatigue, rheology, and structure. Similarly, there has been development in impact testing machines. All are improved testing machines that allowed for better and accurate understanding of material properties.
The introduction of what is called the FEA is based on force and displacement relationships for analysis and design of complex structures. It incorporates a computer model of a material or design that can be stressed and endured to differing amount and direction of force and the effect analyzed. This has in research to analyze the stresses transferred by various materials, their mechanical properties, effect of different designs on dentofacial structures, implant loading and their placement, and other endless options.,,,
| Digitized Dentistry in Diagnosis and Treatment Planning|| |
Dental X-rays have been an important diagnostic aid considering that good treatment begins with the right diagnosis. Digitized radiography has been proved by many investigators as being superior to the traditional radiograph in disclosing the defects affecting dental caries., The computerized digital sensitivity allows for the use of hundreds of gray levels (up to 1024) that enables the practitioners to distinguish the earliest changes that could affect the dental caries hard tissues, especially in areas of low contrast, for example, detection of incipient (the initial stage to appear) caries at the interproximal areas. This digital system offers immediate viewing of highly desirable images during implant procedures, postplacement, and patient education. The system is immediate and neat as being independent on the use and maintenance of missy chemicals and dark rooms for image developments. Obtained digitized images can be enhanced using the intuitive software for easier reading and diagnosis, comparison, and subsequent viewing.
Electronic distribution and storage of digital images allow for better communication between practitioners and third-party benefit companies in addition to the decreased radiation exposure by fewer images retakes. 3D radiographs have been identified as the fourth dimension of endodontic treatment planning as they improve the preoperative visibility of lateral canals, presence/absence of additional canals, and knowing all possible about the given tooth anatomy before any invasive procedure.,,,
Incidentally to say, is that, software related obstacles that need overcome for the use of computers in dental radiography include the alteration of an image to remove artifacts or scratches needs to be documented and cannot be relied on as an evidence in the legal sense. Another consideration is that the high cost of these systems does not encourage many of the practitioners; however, some newly introduced equipment with a reasonable price has aided in a transition from traditional to computerized radiography.
Radiovisiography (RVG) is a multi-component system  that enables the operator to capture colored images through an intraoral camera from the patient mouth and transfer of this image to a computer screen. The images on a computer can be zoomed, rotated, cut, or edited; or further manipulated-enhancement, contrast stretching, and reversing. Newer versions of the intraoral cameras are <50 g in weight and the illumination for image capture is light-emitting diodes which give adequate white illumination to comply with darkness inside the mouth rather than the no longer used fiber-optic which is affected by aging. Radiation exposure is reduced with RVG when compared to conventional radiography and with the introduction of the cone-beam computed tomography (CT) has further helped in reduction of radiation exposure by nearly 10–30 times less than that of a conventional CT radiograph.
| Digital Radiography and Temporomandibular Joint Examination|| |
The study of temporomandibular joint (TMJ) - its functioning, pathophysiology, and disorders has been enhanced as an advent of digital radiography. Other than the conventional plain film modalities, an array of contemporary options available for TMJ imaging is CT with cone-beam technology, magnetic resonance imaging, and nuclear imaging including single-photon emission CT and positron emission tomography. These advancements improve the understanding of this complex joint and its pathology, ultimately leading to improved treatment outcomes. Refinement in magnetic resonance technology like (1) use of new alloys for lighter weight permanent magnets with reduced operating costs; (2) gradient coil technology for more rapid image acquisition leading to the possibility of true cine magnetic resonance; and (3) smaller, more powerful computers for more rapid data processing have implications over anatomic and physiologic assessments of the joint along with reduced costs.,,
| Digitized Dentistry and Dental Implant Procedures|| |
A variety of advanced imaging modalities have been recommended to assist the dental practitioners in assessing potential sites for implants. Developments in cross-sectional imaging techniques such as spiral tomography and reformatted CT have become increasingly popular in the preoperative assessment and planning for dental implant. Radiographs are used to evaluate bone quantity, quality, density, and esthetic site assessment for implant placement. Digital panoramic imaging is recognized as being one of the earliest and most sought after noninvasive procedure.,
| Digitized Dentistry and Dentist/patient Interaction|| |
Dental photography has been an assist for patient education and esthetic treatment planning. Digitized software makes it possible to visualize posttreatment effect, variation of tooth form, color, shape, size, etc., these are utilized for many web-based studies to survey opinions of dentists and nondentist population., Digitized photographic records are easier to store, can be viewed at various angles, and easily measured. Regular photographic records, at all dental visits, could be a great help to examine the aging changes such as occlusal vertical dimension, tooth color, and facial changes. The use of digital photographs is explored in areas of maxillofacial restoration and restoring other maxillofacial defects such as mandibulectomy., Software such as Adobe Photoshop and CorelDraw allows potential for the digital subtraction photography, which improves detection of caries, periapical lesions, bone changes, periapical healing, following an endodontic treatment as early as 2 months.
| Digitized Dentistry Impact on Diagnosing and Treating Occlusal Errors|| |
Problems arising from occlusal origin constitute great difficulties to analyze due to the complexity of the human occlusal system., Systems such as TekScan (T-scan) and MatScan permit for the accurate study of occlusal contacts and the forces created, examining slightest occlusal interferences, significant in full-mouth rehabilitation and implant-protected occlusion. An automated computerized sensor for analyzing dental occlusion has been introduced since the year 1988. It aimed to register the patient occlusion on a thin patented 60 μ thickness disposable sensor to record instantaneously the patient bite in terms of location, timing 9, and force of every tooth in contact. A computing system uses these records to make an actual simulation of the patient occlusion on a monitor, assuming the different situations possible during centric, eccentric, and functional movements to eventually providing both qualitative and quantitative assessment of occlusion. This system was termed as the T-scan and has advantages such as simple operation, dynamic viewing of occlusion, timed analysis of force during various positions of teeth contact, and the possibility of permanent documentation and monitoring of the occlusal condition after various treatment protocols. Besides being presented as a valuable method for clinical evaluation and understanding of the occlusal problems, the system is also proved an important tool for teaching purposes. There are now up to the 4th generation of this system with many improvements using 100-μ thin sensor and software to analyze and display the timing and force of the patients' bite in 2D and 3D graphics.
| Diagnosis of Musculoskeletal, Mandible, and Temporomandibular Joint Disorders|| |
Detailed observation of mandibular motion and TMJ functions provides the basis for diagnosing musculoskeletal disorders of the jaws and to monitor the progress in prosthodontic treatment functional results. Study of mandibular kinematics permits detection and assessment of TMJ functional irregularities arise from internal obstacles such as a displaced articular disc. Jaw tracking devices (e.g. K6 Diagnostics) are used to study jaw movements and consequent occlusion which may be microtraumatic for TMJ disorder., The elevated muscle activity associated with malocclusion-directed nociception (sensory nerve response to harmful stimuli) can be detected with surface electromyography (EMG).
An EMG device, namely, BITE STRIP ™, can record muscle activity for some hours and provides useful information in nocturnal bruxism. All these techniques mainly revolve around the aim of studying the stomatognathic system (the mouth, jaws, and closely associated structures) as accurate and precise as possible. Computerized pantographs such as Cyberhoby articulator can be used for restoration of deteriorated dentitions.
| Digitized Dentistry in Treatment and Associated Laboratory Procedures|| |
Dental impression is an indispensable procedure in prosthodontics. The use of digital impressions technique has tremendously improved this procedure by omitting the use of traditionally used impression materials and their related inaccuracies. Digitally recorded impressions allow for their multiple uses without loss of accuracy in addition to having the advantages of omitting the need for disinfection, being beneficial in patients with the hypersensitive palate and aiding in further shortening of the chairside time for CAD/CAM restorations.,, Optically digitized technology also allows 3D images to be scanned with a 3D scanner coupled with computerized milling machines for processing restorations.
A wide variety of digitized systems are employed including the E4D scanner which has a separate scanning and milling unit with automated internet communication; its scanner utilizes a red light laser to create a 3D model.
The digitalized ICEverything ™ integrated DentaLogic ™ software takes pictures of teeth and gingiva before and after tooth preparation with registered occlusal registration with easy margin detection viewing.
The CEREC AC digital impression gives dentists the choice of implementing in office fabrication or sending the digital images with CEREC CONNECT directly to the laboratory, where the restoration can either be milled directly or a model can be created for traditional fabrication of the restoration. Its scanner operates using visible blue light (light-emitting diodes) with shorter wavelengths than previous CEREC models, hence increasing the accuracy of the scan with more rapid image acquisition than with previous models due to the continuous capturing of a series of images by the scanner once in position. The CEREC MC XL is an advanced model with integrated milling center that could create full contour crowns in 6 min.
Other systems used for chairside digital impression are the Lava Chairside Oral Scanner (C.O.S.) and the iTero scanner, the latter utilizes parallel confocal imaging to capture a 3D digital impression of the tooth surface, contours, and gingival structure. Light emission from the scanner does not need to be held a set distance from the tooth and keeps scanning even when touching the teeth and enables the detection of angled contours. The various digitized impression systems are varied in their degree of requirements for powdering before scanning.
The CEREC system requires a coating of reflective powder on the dry preparation before scanning while; light powdering is required when using the Lava C.O.S. system. On the contrary, the iTero system does not require powdering. Optical impressions and other digital records can be much-needed information for the functioning of forensic dentistry.,, Impressions with LAVA ™ C.O.S. have been used for assessment of gingival contour and compared with traditional clinical indices such as modified gingival index and bleeding index.
| Digitized Dentistry and Tooth Shade Replication|| |
Tooth shade replication is another area of digital application. This has always been prone to inter- and intra-operator variations. Digital imaging and tooth shade matching decrease the inter-operator and intra-operator variability and also ease the communication with the laboratory., Visual shade matching is now being overrun with variable methods including photography, colorimeters, and spectrophotometers (shade match, shade vision, shade eye, and clear match) which give more consistent shade and a near life effect with color mapping of selected tooth.
| Digitized Dentistry and Patient Motivation|| |
Good sense of understanding can be created between the dentist and his dentally oriented patients to help reduce their dental fear and impose trust and education regarding their oral health conditions. These intensions can be achieved by the use of intraoral camera, education software, videos, 2D and 3D imaging of different dental procedures.,, Such digitized procedures enable the dentist to annotate the image and place a variety of operational objects such as crowns, implants, abutments, and bone grafts to explain to the patient the idea about the dentist treatment plan. This digitized procedure is termed as the on-the-spot consultation that builds trust, save time, and would contribute for pronounced patient motivation.
| Digitized Dentistry and Practice Management|| |
Computerized database technologies are used to solve management problems such as limited storage space for patient records and their plaster casts. These are very much minimized by converting these items to 3D digitized virtual models. Furthermore, the utilization of the newer digitized communication techniques has made conferencing, and communication becomes significantly easier among the involved dental team.
| Discussion|| |
Digitized technologies have overwhelmed civilization with countless and stunning applications in unlimited aspects of life. Digitized procedures have recently been linked with dental practice through computer-based technology and virtual application reality software that allows dental practitioners and students to easily simulate and sense the actual patient's status.,,,,
Progressively increased digital applications are employed in dentistry and became essential tools in the field of training, education, and research related to clinical and dental practice. Examples of the various digital applications are the digital photographs, radiographs together with the use of virtual articulators and digital face bows for planning and fabrication of prosthesis, or for processing of restorations with the use of CAD/CAM technology, stereolithography, rapid prototyping, etc.
Dentally oriented clinical research has been enhanced through a wide variety of digitized applications including dental software, digital recording of jaw motion, virtual patient programs, FEA, Digital Instron, and similar. Dental practice would be more convenient for both dentist and their patients if the above technologies are wisely implemented.
| Future Scope of Digital Dentistry|| |
Progressive application of digitization in different aspects of dental practice will pace the future of the contemporary dentistry. Research in areas such as optical coherence tomography (D4D technologies) would allow creating sliced image of the tooth and other dental structures. It could be used for potential caries diagnosis, tooth crack location, CAD/CAM imaging, subgingival margin location, periodontal diagnosis, soft tissue analysis, and many more.
Currently employed digital impressions are extremely sensitive to face movements which make it difficult to scan preparations intraorally; however, newer developments are expected to give more consistent results. The evolution 4D system is expected to have intraoral data capture capabilities. Available CAD/CAM systems can capture data from models, using mechanical or optical digitizers of various types. Other areas to be explored include use of virtual articulators and digital face bows to facilitate the automatic design of the occlusal surface.
| Conclusion|| |
DD and its related computer-aided design technologies for digital manufacturing and discovery of new dental materials have shown pronounced impacts on the diagnostic process, practice management, and improved the outcome of dental treatment procedure. In addition, dental teaching and research are significantly simplified with substantial enhancement in patient care and motivation.
Digital procedures in dental practice include digitized radiograph that aid in diagnosis, digital CAD/CAM ceramics that maintained for better esthetics and function with less number of sittings, simplified and eased maxillofacial prosthesis fabrication by rapid prototyping and stereolithography. Worthy to mention that digitization still provides a high level of predictability and convenience and even less number of clinic settings.
Applying digital technology on student teaching/practice, advanced research, patient motivation, laboratory procedures has helped in the enhancement of treatment techniques, development of quality dental materials. The introduction of latest digital equipment still permits for advanced and effective methods of research.
The main concern regarding digital technologies is their high costs; however, researches continue to make these technologies in reach of the dental practitioners. In addition, digital technologies require comprehensive practical training and continued education for the dental students and practitioners to be self-contained with the many uses of these technologies. Proper applications of digital technologies will considerably help attaining the highest professionalism and better treatment results.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Artopoulou II, Montgomery PC, Wesley PJ, Lemon JC. Digital imaging in the fabrication of ocular prostheses. J Prosthet Dent 2006;95:327-30.
Birnbaum NS, Aaronson HB. Dental impressions using 3D digital scanners: Virtual becomes reality. Compend Contin Educ Dent 2008;29:494-505.
Badra H, Radi A, Aboulela A. The effect of ultra-suction system on the retention of mandibular complete denture. Egypt Dent J 2010;56:101-9.
Kelly JR, Benetti P. Ceramic materials in dentistry: Historical evolution and current practice. Aust Dent J 2011;56 Suppl 1:84-96.
Miyazaki T, Hotta Y. CAD/CAM systems available for the fabrication of crown and bridge restorations. Aust Dent J 2011;56 Suppl 1:97-106.
Rekow ED, Silva NR, Coelho PG, Zhang Y, Guess P, Thompson VP. Performance of dental ceramics: Challenges for improvements. J Dent Res 2011;90:937-52.
Brewer JD, Wee A, Seghi R. Advances in color matching. Dent Clin North Am 2004;48:v, 341-58.
Brosky ME, Pesun IJ, Lowder PD, Delong R, Hodges JS. Laser digitization of casts to determine the effect of tray selection and cast formation technique on accuracy. J Prosthet Dent 2002;87:204-9.
Buchanan LS. Endodontic treatment planning in the fourth dimension. Dent Today 2010;29:104, 106, 108.
Carvalho FB, Gonçalves M, Tanomaru-Filho M. Evaluation of chronic periapical lesions by digital subtraction radiography by using Adobe Photoshop CS: A technical report. J Endod 2007;33:493-7.
Brennan J. An introduction to digital radiography in dentistry. J Orthod 2002;29:66-9.
Kaur I, Datta K. CEREC – The power of technology. J Indian Prosthodont Soc 2006;6:115-9.
Gerson LB, Van Dam J. A prospective randomized trial comparing a virtual reality simulator to bedside teaching for training in sigmoidoscopy. Endoscopy 2003;35:569-75.
Gurusamy KS, Aggarwal R, Palanivelu L, Davidson BR. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev 2009:CD006575.
Moorthy K, Munz Y, Jiwanji M, Bann S, Chang A, Darzi A. Validity and reliability of a virtual reality upper gastrointestinal simulator and cross validation using structured assessment of individual performance with video playback. Surg Endosc 2004;18:328-33.
Child PL Jr., Christensen GJ. Digital radiography: An improvement? Dent Today 2010;29:100-2.
Chew MT, Koh CH, Sandham A, Wong HB. Subjective evaluation of the accuracy of video imaging prediction following orthognathic surgery in Chinese patients. J Oral Maxillofac Surg 2008;66:291-6.
Gutmann JL. The maturation of science within dentistry: The impact of critical milestones and visionary leaders on contemporary achievements. J Hist Dent 2009;57:109-22.
Gutmann JL. The evolution of America's scientific advancements in dentistry in the past 150 years. J Am Dent Assoc 2009;140 Suppl 1:8S-15S.
Weaver JM, Lu M, McCloskey KL, Herndon ES, Tanaka W. Digital multimedia instruction enhances teaching oral and maxillofacial suturing. J Calif Dent Assoc 2009;37:859-62.
Marras I, Papaleontiou L, Nikolaidis N, Lyroudia K, Pitas I. Virtual Dental Patients: A System for Virtual Drilling. In: Multimedia and Expo, 2006 IEEE International Conference on, 2006. p. 665-8.
Rosenstiel SF, Land MF, Rashid RG. Dentists' molar restoration choices and longevity: A web-based survey. J Prosthet Dent 2004;91:363-7.
Wagner IV, Carlsson GE, Ekstrand K, Odman P, Schneider N. A comparative study of assessment of dental appearance by dentists, dental technicians, and laymen using computer-aided image manipulation. J Esthet Dent 1996;8:199-205.
Schleyer TK, Forrest JL. Methods for the design and administration of web-based surveys. J Am Med Inform Assoc 2000;7:416-25.
Ali Fayyad M, Jamani KD, Agrabawi J. Geometric and mathematical proportions and their relations to maxillary anterior teeth. J Contemp Dent Pract 2006;7:62-70.
Wong NK, Kassim AA, Foong KW. Analysis of esthetic smiles by using computer vision techniques. Am J Orthod Dentofacial Orthop 2005;128:404-11.
Clelland NL, Lee JK, Bimbenet OC, Gilat A. Use of an axisymmetric finite element method to compare maxillary bone variables for a loaded implant. J Prosthodont 1993;2:183-9.
Sakaguchi RL, Borgersen SE. Nonlinear finite element contact analysis of dental implant components. Int J Oral Maxillofac Implants 1993;8:655-61.
Sevimay M, Turhan F, Kiliçarslan MA, Eskitascioglu G. Three-dimensional finite element analysis of the effect of different bone quality on stress distribution in an implant-supported crown. J Prosthet Dent 2005;93:227-34.
Geng J, Yan W, Xu W. Application of the Finite Element Method in Implant Dentistry. Berlin: Springer; 2008. p. 3-6.
Christensen GJ. Impressions are changing: Deciding on conventional, digital or digital plus in-office milling. J Am Dent Assoc 2009;140:1301-4.
Dayalan M, Jairaj A, Nagaraj KR, Savadi RC. An evaluation of fracture strength of zirconium oxide posts fabricated using CAD-CAM technology compared with prefabricated glass fibre posts. J Indian Prosthodont Soc 2010;10:213-8.
Gärtner C, Kordass B. The virtual articulator: Development and evaluation. Int J Comput Dent 2003;6:11-24.
Gössi DB, Gallo LM, Bahr E, Palla S. Dynamic intra-articular space variation in clicking TMJs. J Dent Res 2004;83:480-4.
Sevimay M, Usumez A, Eskitascioglu G. The influence of various occlusal materials on stresses transferred to implant-supported prostheses and supporting bone: A three-dimensional finite-element study. J Biomed Mater Res B Appl Biomater 2005;73:140-7.
Jackson PH, Dickson GC, Birnie DJ. Digital image processing of cephalometric radiographs: A preliminary report. Br J Orthod 1985;12:122-32.
Richardson A. A comparison of traditional and computerized methods of cephalometric analysis. Eur J Orthod 1981;3:15-20.
Miles DA. The future of dental and maxillofacial imaging. Dent Clin North Am 2008;52:917-28, viii.
Pickens RD. Management of digital image data raises sticky legal issues. Diagn Imaging 1986;8:150-2.
Mouyen F, Benz C, Sonnabend E, Lodter JP. Presentation and physical evaluation of RadioVisioGraphy. Oral Surg Oral Med Oral Pathol 1989;68:238-42.
Guttenberg SA. Oral and maxillofacial pathology in three dimensions. Dent Clin North Am 2008;52:843-73, viii.
Lewis EL, Dolwick MF, Abramowicz S, Reeder SL. Contemporary imaging of the temporomandibular joint. Dent Clin North Am 2008;52:875-90, viii.
Elian N, Ehrlich B, Jalbout ZN, Classi AJ, Cho SC, Kamer AR, et al.
Advanced concepts in implant dentistry: Creating the “aesthetic site foundation”. Dent Clin North Am 2007;51:547-63, xi-xii.
Anil S, Al-Ghamdi HS. A method of gauging dental radiographs during treatment planning for dental implants. J Contemp Dent Pract 2007;8:82-8.
Lund JP. Occlusion: the “science-based” approach. J Can Dent Assoc 2001;67:84.
Szentpétery A. Computer aided dynamic correction of digitized occlusal surfaces. J Gnathol 1997;16:53-60.
Maness W. Automated sensor takes clean bites. Dent Today 1988;7:19-22.
Kinuta S, Wakabayashi K, Sohmura T, Kojima T, Mizumori T, Nakamura T, et al.
Measurement of masticatory movement by a new jaw tracking system using a home digital camcorder. Dent Mater J 2005;24:661-6.
Mohl ND, McCall WD Jr., Lund JP, Plesh O. Devices for the diagnosis and treatment of temporomandibular disorders. Part I: Introduction, scientific evidence, and jaw tracking. J Prosthet Dent 1990;63:198-201.
Christensen GJ. Will digital impressions eliminate the current problems with conventional impressions? J Am Dent Assoc 2008;139:761-3.
Christensen GJ. The challenge to conventional impressions. J Am Dent Assoc 2008;139:347-9.
Strub JR, Rekow ED, Witkowski S. Computer-aided design and fabrication of dental restorations: Current systems and future possibilities. J Am Dent Assoc 2006;137:1289-96.
Newby EE, Bordas A, Kleber C, Milleman J, Milleman K, Keogh R, et al.
Quantification of gingival contour and volume from digital impressions as a novel method for assessing gingival health. Int Dent J 2011;61 Suppl 3:4-12.
Jarad FD, Albadri SS, Mair LH. The use of objective digital matching to achieve an esthetic composite restoration. J Clin Dent 2008;19:9-13.
Feuerstein P. Can technology help dentists deliver better patient care? J Am Dent Assoc 2004;135 Suppl: 11S-6S.
Levine NL. XCPT ®
(accept) software: The future of case-analysis and patient acceptance of treatment planning. Dent Implantol Update 2006;17:25-9.
Feuerstein P. Paul Feuerstein, DMD, discusses the newest trends in technology for 2012. Dent Today 2012;31:17.
Maestre-Ferrín L, Romero-Millán J, Peñarrocha-Oltra D, Peñarrocha-Diago M. Virtual articulator for the analysis of dental occlusion: an update. Med Oral Patol Oral Cir Bucal 2012;17:e160-3.