Analogue v Digital – the big debate by Lee Culp

Digital pioneer and headline speaker at ICDE2017, Lee Culp CDT, discusses what a digital lab truly looks like in the 21st century.

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I have been involved in digital dentistry now for over 35 years, and whilst we have seen many restorative materials and techniques come and go in that time, the digital revolution is now pushing boundaries that can make almost anything possible in laboratory prosthesis production.
In my early days, evolving CAM software allowed us to produce original copings, copy milling for abutments, wax ups and we saw the introduction of zirconia, at that time purely as a framework material. The game changer for me was chairside CAD/CAM, allowing us to make a full contour tooth and when I saw this in action for the first time I knew straight away that digital technology was going to be the future. However there was only enough power and software to create one tooth at a time.
We have now advanced digitally from producing single crowns to where we are today with full mouth and multiple restorations. In partnership with leading dental manufacturers materials, workflows, processes and software have now evolved to allow us to do literally anything you can imagine.
100% digital for better communications
My laboratory, Sculpture Studios in North Carolina, USA is completely digital. Nothing is done by hand except to finalise the restorations at the end of the digital process. All our treatment plans, diagnosis, imaging, fabrication and communication is entirely digital.
When we talk about digital we think primarily about CAD/CAM, the ability to design and produce something. However, digital dentistry also encompasses the technology we have for communication and our communication between the client and patient has never been more powerful. It’s no longer just a phone call to change or adapt, it’s now 3 dimensional, sharing virtual images on computers with our clients in real time, even incorporating the faces of patients onto our 3D designs. The digital workflow, from start to finish, gives us the ability to share function, aesthetics, diagnosis and treatment plans for truly aesthetic results, - it’s never been better and it’s the most amazing part of what we do.
The most exciting factor surrounding these technologies is not, however, only in the potential applications of these technologies, but in the fact that these applications are currently being developed today, and some are even in the final stages of development. These advancements are not, therefore, something that will “eventually” emerge in the market, they are realities that are currently being released to further revolutionise the quality of dental care that is being delivered in modern restorative dentistry.
Industry perception and challenges
The overall perception that the entire dentistry profession is now turning digital, is somewhat wide of the mark. Personally, I consider a ‘digital lab’ to include ‘everything digital’ - eliminating all analogue processes. Very few labs today are truly engaged in a fully digital workflow. Labs may have a scanner and milling machine and call themselves digital, but there are still metal technicians and waxers performing an analogue job, along with an analogue job title.
A lot of the challenges we see today are not ‘technological’ challenges - they are ‘people’ challenges. Digital technology is not here to replace the technician; it’s simply changing the role of the technician and retraining them to accommodate a digital platform. We need to educate and encourage the profession in what can be achieved with digital from a business aspect; how efficient and predictable it is to implement from treatment planning to final restorations, therefore giving the ability to do more work and become more profitable.
There’s also a concern amongst technicians that we are losing the creativity and artistry of traditional brush and hand skills in the digital process. In my view, artistry is artistry whether you hold a brush or a mouse, we are just choosing a different medium to create that art.
From a cost perspective, there is also understandable concern about the initial investment in digital technology, with a popular misconception that labs needs to purchase an entire digital system/process in one go. This is not the case. My recommendation is to invest in the best scanner and software your budget will allow, but start off by outsourcing your scans to a milling centre. Once the monthly milling centre costs begin to match the monthly payment for a new milling machine, then it’s time to purchase the mill – in essence, it’s a very easy transition.
Looking ahead
The evolution of digital in dentistry is an opportunity to provide more efficient methods of communication and fabrication, whilst retaining the individual creativity and artistry of the skilled dental technician. Digital technology simplifies the steps to creating CAD/CAM restorations and will continue to enhance the close co-operation and relationship of the dentist/technician.
In June this year, I will be presenting at Ivoclar Vivadent’s ICDE2017 event where I will discuss the evolution from hand waxing to digital design, using the diagnostic wax-up and provisional restorations, and their digital replicas to guide us in the creation of CAD/CAM restorations. This exciting presentation will offer delegates a unique insight into the replication of natural aesthetics while focusing on proper function and occlusal harmony using CAD/CAM technology. Participants will learn a format for achieving that often-elusive goal of pleasing the patient, clinician, and technician alike with creative ceramic artistry and predictable restorative dentistry.
If you are looking to get ahead in the world of digital dentistry join Lee Culp at the ICDE2017 on 16th – 17th June to hear about the endless possibilities in digital dentistry. Bookings can be made directly via, or by calling 0116 284 7880. Places are limited so book your place today to avoid disappointment.
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Lee Culp, CDT, is the CEO of Sculpture Studios, a dental laboratory, research and product development centre for new and innovative diagnostic and restorative and digital applied applications to surgical and restorative dentistry.
He is a leading resource/inventor for many of the materials, products, and techniques used in dentistry today, and holds numerous patents for his ideas and products. Lee has gained international recognition as one of today’s most exciting lecturers and innovative artisans in the specialty of digital dentistry, dental ceramics and functional aesthetics.