Steven Pigliacelli, CDT, MDT, explains how in-lab scanners and intraoral scanners have evolved—and it's time to make the transition to digital dentistry.
I remember my early days working as a preparatory technician in the '80s: I was 16 or 17 years old, and one of my job duties was etching Maryland bridges. This was a new restorative option that required extra steps to etch metal wings. It was a long process involving a machine with an etching bath.
I remember being at a dental seminar, sitting next to an older, grumpy dental technician who was complaining about how he didn't believe in "this etching nonsense." He argued, "I just take a high-speed and drag it over the wings."
I also remember when dentists began leaving the old copper-die systems and moving toward polyvinyl impression materials. For me, this was a dream since it was easier to pour and Pindex a stone model. The transition didn't only make things easier; it quickly became necessary because it was nearly impossible to find the correct acid and plate for the copper-die system since it was no longer being produced. However, many dentists were reluctant to change. In fact, until a few years ago, I knew a handful of dentists who still used copper bands. One, in particular, refused to change over, no matter what facts were presented to him. He refused to modernize anything-from his prep design to the final cementation options. His motto was, "If it was good in 1962, it's good now."
Unfortunately, this just isn't true. Due to his shallow preps and copper dies, achieving a good fit was difficult. His cement procedure was off the wall and geared toward outdated materials. One of his procedures was a subject of debate between us: He would do single copings, do a solder pick-up, do a bisque-bake firing and glaze, use temporary cement, and then wait six months to see if he had washout under the bridge. If there was washout, he would section and do a post-solder pick-up. Half the time, the bridges ended up getting stripped and soldered, and new porcelain was applied. Needless to say, when he updated his technology and materials, I was relieved by the reduction of remakes and difficulties.
CAD/CAM dentistry in the form of in-lab scanners, such as Procera (Nobel Biocare) or Lava (3M ESPE), used for in-lab or off-site milling has been around for quite some time. Milled abutments and zirconia crowns are a standard in the industry. Intraoral scanning has also been around a long time, and it has been controversial for just as long. You might ask: Is it the same quality? Is it cheaper or more expensive? What lab do I use? Do I use a lab at all? Perhaps these fears were legitimate in the past-even I was once quite doubtful of intraoral systems, based on my exposure to many of the earlier systems. The lab CAD/CAM systems that had been a part of my lab since the early '90s were closed systems (closed systems are those that only work with certain other products). Some of the prevailing problems with intraoral scanning were the need for powder on the teeth, the question of the scan's reliability, the size of the wand, the choice of labs to use, the expense, and the issues associated with closed systems. But many changes have been made to soothe these fears. The manufacturers of the existing systems have worked out a lot of the bugs through trial and error. In the last decade, a breakthrough in open-architecture systems has emerged.
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The best way to describe closed and open systems is to compare them to Apple products, which were and, in many ways, still are a closed system of products. Only Apple-brand software and hardware worked with the Apple computer, limiting your usage of the computer, particularly if you wanted to use software that was made for PCs. The same goes for various printers and peripheral hardware. In the early days, only Apple printers worked with Apple computers. On the other hand, PC computers are open architecture. The beauty of the PC was always the amount of software to choose from, which was offered by many different vendors since almost any printer or peripheral hardware could be incorporated with the PC.
Now, in-lab scanners, such as those manufactured by 3Shape, are open architecture. They can scan and design numerous restorative options, and the scan files can be sent via the Internet to milling centers around the globe. The scan files can also be sent to milling and 3-D printing machines in the lab. The current generation of intraoral scanners, which includes Trios (3Shape), PlanScan (Planmeca), iTero (Align Technology), etc., are open-architecture systems, enabling dentists to work with any lab they want. They can design the majority of case options, the wands are a fraction of the original size and getting smaller, and software upgrades are always available. I'm not saying it will be any cheaper or easier to go digital-because it won't be. In fact, due to the learning curve, it will probably take more time and be more difficult for a while. However, if you do it, you will be at the forefront of the wave of new technology.
The best analogy I can give about the transition to digital dentistry is to compare it to the time when PCs transitioned from using the 586 to the Pentium microprocessor. If you look at the precomputer days, compared to today, many things were actually easier and cheaper to do. Writing invoices with carbon paper did not require electricity, a computer, antivirus software, an operating system, word-processing or business software, a backup drive, power supplies, Internet costs, etc. But could you imagine living without computers today?
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Today's digital dental technicians are the Pentium generation. On a printed timeline of dentistry, you will see a line marking this year to illustrate our official transition to digital dentistry. Scanners are selling at a rate that is increasing tremendously, and as scanner usage grows, the need for other materials fades. Even if you don't convert, you might not be able to work the same way due to availability. Just like the grumpy guy and the Maryland bridge and the guy with the copper dies, your systems might still work, but it might not be very long until they stop making the material you currently use to take impressions. The technology is here, and it's time to take the step into the digital dentistry age.
Steven Pigliacelli, CDT, MDT, is a faculty instructor in postgraduate prosthodontics at New York University. He manages Marotta Dental Studio and directs the GPR and Prosthetic Resident Rotation there, an intensive educational program that focuses on the value of the technician/dentist relationship. He has published in dental journals, and he lectures and performs hands-on demonstrations at study clubs and seminars.
