Dental Technician and Speaker at ICDE2017, Ian Smith, Takes an Alternative View on the Benefits of Digital Technology

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Digital - still room for improvement?
Dentistry is moving into the digital age and technology is advancing at an ever-increasing rate. The big question is, however, just how accurate is digital technology? Can it claim to truly rival or supersede tried and tested analogue techniques? When it comes to the microscopic details of minimally invasive aesthetic dentistry, in my experience, not quite yet.

Just as digital technology has become a part of everyone’s daily life, it has now become a routine part of the work of a dental laboratory thanks to ease of use, accuracy of fit and the cost benefits it can bring. Preparations can be digitally scanned and emailed to the laboratory, restorations designed and milled, finished and fitted, all without physical impressions or models.

In my laboratory, we use digital technology on a daily basis and it’s a fundamental part of everything we do. Every implant we make is via CAD/CAM and every full arch is digitally made. Digital dentistry is undeniably much quicker and far less labour-intensive than analogue techniques. Today’s clinicians want a faster turnaround of patients, patients want their restorations sooner and labs are now able to meet this demand thanks to the advances of digital technology.

Ultra-precision dentistry
Yet despite everything that digital dentistry can now do, I have found that the technology is not yet accurate enough for the ultra-precision dentistry and fit that I’m currently involved in. I work together with one of the UK’s leading aesthetic and implant dentists, Dr Attiq Rahman, who is turning minimally invasive dentistry on its head.

Attiq’s passion for preserving tooth structure and integrity means he only takes away microscopic amounts - fractions of a millimetre - for preparation of the tooth surface for ultra-thin veneers, thinner than a contact lens, and ultra-thin porcelain crowns. Digital scans can’t yet pick this up this level of detail and digital machines can’t mill to this precision. Fortunately with the analogue techniques and artistic skills of the technician, we still can.

Analogue v digital
The intraoral scans I receive from clinicians are fine – but the problem comes when digital models are then made which can’t capture the same detail as an impression does for surface texture. The surface of a tooth varies greatly, the older the patient the smoother the surface, the younger the patient the more textured the tooth. If a patient loses a single central, to replicate this the impression or scan taken needs to capture surface texture of the adjacent tooth that I’m going to copy.

A digital scan will pick this up to a certain degree, but as the scan is converted to a digital printed model, the way the model is made - printed out layer upon layer forming microscopic vertical lines across the model - doesn’t capture or give an accurate copy of the adjacent tooth. Additionally, with intraoral scans the light causes glare on a shiny tooth and further prevents capturing the micro texture of the tooth surface. This is not great for aesthetic, single unit cases but is absolutely fine for multiple unit arches for posterior teeth where capturing micro surface texture is often less of a concern.

Inaccuracy has the potential to occur on many levels. As soon as an impression is taken in the mouth it’s an inaccuracy, and when a model is cast from that impression, it’s another inaccuracy. Then as soon as that model is worked on by hand it’s another inaccuracy. In my professional opinion, these are the problems that digital technology needs to address.

I’m certainly not trying to put a negative spin on digital dentistry. Digital technology is improving rapidly and these are very exciting times to be a technician. When digital really comes to the fore it won’t just be comparable to analogue, it will definitely take over - it’s just not quite there yet for the type of precision dentistry that we do. I do wonder sometimes about how far behind the dental world is, especially when we can design and build something as incredible as the Hadron Collider working to super-fine microns of accuracy, but we don’t yet have anything like this precision in dentistry.

Join us at ICDE2017
Together with Attiq Rahman, I will be talking at ICDE2017 on predictability and precision in aesthetic dentistry and how we achieve outstanding results using analogue models and techniques. I will explain the techniques we use, the shade matching process, hints and tips for bite registration and impression taking and how these compare to what we found using digital methods. The lecture will highlight and compare the accuracy of fit for indirect restorations and provide details that will enable dental practitioners to confidently make choices with new technology.

Join Ian Smith and Attiq Rahman at the ICDE2017 on 16th - 17th June to learn more about predictability and precision in aesthetic dentistry. Bookings can be made directly via icde.uk, or by calling 0116 284 7880. Places are limited so book your place today to avoid disappointment.

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Ian Smith - Dental Technician, Visage Dental Lab, Glasgow & Ivoclar Vivadent Opinion Leader, Scotland.
www.precisiondentistryglasgow.co.uk