Application of Computer Technology in Prosthodontics

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The recent fusion of advanced computer technology with traditional prosthodontic methodologies has marked an evolution in the design, fabrication, and fitting of artificial tooth replacements.

This new approach in fabricating prosthodontics sets unprecedented standards for accuracy, efficiency, and patient satisfaction.

Some examples of digital applications used in prosthodontics are:

  1. Digital radiography
  2. Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM)
  3. Intraoral Scanning and Digital Impressions
  4. Digital smile designing
  5. Virtual articulators and digital facebows

Digital Radiography

Digital radiography is a form of X-ray imaging where digital X-ray sensors are used instead of traditional photographic film. This technology offers several advantages over conventional radiography, including:

Faster Processing: Images captured using digital radiography are available almost immediately, eliminating the need for film development. This speeds up the diagnostic process and allows for quicker treatment planning.

Lower Radiation Exposure: Digital X-ray systems typically require less radiation to produce an image of similar contrast to conventional radiography. This reduction in exposure is beneficial for patient safety, adhering to the ALARA principle (As Low As Reasonably Achievable) to minimise radiation doses.
Enhanced Image Quality: Digital images can be enhanced, and manipulated for better treatment planning and implant placement, increasing the chances of a successful restoration with longevity.
Ease of Storage and Sharing: Digital images can be easily stored in electronic health records and shared with other healthcare providers without the risk of losing or damaging physical films. This facilitates better communication and collaboration among dental professionals.
Environmental Benefits: By eliminating the need for chemical processing and film, digital radiography is more environmentally friendly.

Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM)

CAD/CAM prosthodontics are fabricated using digital images obtained from intraoral scans, CT scans and digital radiographics. These images allow technicians to craft virtual designs of dental restorations, including crowns, bridges, veneers, and more, with an unprecedented level of precision and customisation.

example of CAD/CAM for Dental prosthodontics

The materials used in CAD/CAM processes have been specifically chosen for their durability, biocompatibility, and aesthetic qualities. Innovations in material science have expanded the range of options available, including high-performance ceramics, polymer composites, and metal alloys, each selected to match the functional and aesthetic demands of different types of prosthodontic restorations.

Advantages of CAD/CAM Systems

Reduced Appointments: The efficiency of CAD/CAM allows for fewer visits to complete a restoration, saving time for both the patient and the dentist.
High Precision and Accuracy: These systems offer superior precision in creating restorations, ensuring a better fit and longevity.
Improved Restoration Quality: CAD/CAM technology enhances the strength, fit, and aesthetics of restorations.
Faster Design and Fabrication: The digital process accelerates the design and creation of dental restorations by shortening or eliminating steps.

Limitations of CAD/CAM Systems

Initial High Cost: The upfront investment in CAD/CAM systems is significant, which may be a barrier for some dental practices.
Learning Curve: Mastering the technology requires time and additional financial investment in training, which can be considerable when deciding to use CAD/CAM systems.

Intraoral Scanning and Digital Impressions

An intraoral scanner is a handheld device used to create highly accurate 3D digital impressions of a patient’s dentition. This method is an alternative to taking an analogue impression, and oftentimes is preferred over traditional methods due to its convenience.

intra oral scanner used to take digital dental impressions

Advantages of taking Digital Impressions:

Time Efficiency: Digital impressions are more time-efficient and cost-effective than traditional impressions. Despite advances in dental technology, the major time saving is not from the scanning itself. Instead, the savings come from not needing to create physical models afterwards. With digital impressions, there’s no need to make stone casts or plaster models. These digital impressions can be sent directly to the dental lab virtually, eliminating all need for physical delivery.

Better Communication: Intraoral scanning improves how dentists and dental technicians work together. Right after a scan is done, the dentist can send it to the lab by email. The technician can then check the quality of the impression immediately. If the impression isn’t good enough, the technician can ask for a new one right away. This means there’s no need to wait or have the patient come back for another visit. This process makes communication between the dentist and technician quicker and more efficient, ensuring better results without any delays.

Disadvantages of taking Digital Impressions:

Difficulty in Detecting Sub-gingival Margins: Optical impressions with intraoral scanning sometimes struggle to accurately capture the deep edges of prepared teeth, particularly in areas requiring precise aesthetic placement beneath the gum line or in cases of bleeding. Traditional impression materials, by contrast, can physically manipulate the gum to reveal hidden areas, a capability that intraoral scanning lacks. However, effective techniques like using retraction cords to expose the tooth’s edge and maintaining good oral hygiene can improve the accuracy of optical impressions, even in difficult cases. Achieving a high-quality optical impression also depends on thorough tooth preparation, patient oral hygiene, and the quality of temporary restorations.

The Learning Curve: One notable disadvantage of adopting intraoral scanning technology in dental practices is the learning curve associated with its use. Transitioning from traditional impression methods to digital scanning requires clinicians and dental technicians to acquire new skills and adapt to different workflows. This learning process can initially slow down procedures and may temporarily affect productivity as practitioners become proficient in handling the equipment and interpreting the digital impressions. Moreover, the quality of outcomes heavily depends on the operator’s skill level, meaning that achieving consistently high-quality scans demands both training and experience. This initial investment in time and education can be a barrier for some practices, especially those with limited resources or those hesitant to disrupt established routines. However, once overcome, the benefits of digital impressions, such as improved efficiency and accuracy, often outweigh the initial challenges.

Digital Smile Design (DSD)

Digital Smile Design for Dental Prosthodontic Restoration

In prosthodontics, Digital Smile Design (DSD) serves as a powerful tool for planning and executing treatments involving dental prostheses such as crowns, bridges, veneers, dentures, and implants. At its simplest, DSD is a process of rendering a digital impression of your ideal smile. It presents a collaborative environment by enabling dentists and patients to work together, embodying a patient-centric strategy for designing and implementing dental restorations.

Virtual Articulators and Digital Facebows

Virtual Articulator for Digital Design

Virtual Articulators and Digital Facebows
A Virtual Articulator and a Digital Facebow are digital tools in dentistry that simulate jaw movements and capture the spatial orientation of dental arches, respectively. They allow for the digital transfer of the upper dental arch’s position directly from the patient, enabling dental professionals to work in a digital environment without traditional physical casts. This technology enhances the accuracy of prosthodontic and restorative treatments by using real patient data to analyse occlusion and jaw relationships, significantly reducing the limitations of mechanical articulators.

Increased Accuracy: These digital tools provide precise simulations of jaw movements and the spatial orientation of dental arches, leading to more accurate diagnosis and treatment planning.
Efficiency in Treatment Planning: By eliminating the need for physical models and traditional articulators, these technologies streamline the workflow, saving time for both the dental professional and the patient.
Enhanced Communication: The visual and digital nature of these tools facilitates better communication between dental professionals and labs, as well as between dentists and patients, improving the overall treatment experience.
Predictable Outcomes: Utilising real patient data for simulations allows for the prediction of treatment outcomes with greater confidence, leading to higher patient satisfaction.
Reduced Material and Storage Needs: The digital workflow minimises the need for physical storage of models and reduces the materials required for traditional impressions and articulations.
Collaborative Treatment: These technologies enable easier collaboration among dental specialists and laboratories by sharing digital models and treatment plans, ensuring a comprehensive approach to patient care.

In conclusion, bringing computer technology into prosthodontics has greatly improved how we make and fit dental replacements like crowns, bridges, and dentures. This tech, including digital scans, CAD/CAM systems, and digital smile design, offers more accurate, efficient, and pleasing results for patients. While there’s a learning curve for dentists getting used to these new tools, the benefits, such as quicker procedures and better fitting dental work, are clear. As dental professionals continue to adopt these technologies, we’ll see even better care and outcomes for patients.

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