By Paul Feuerstein, DMD
Walk into any dental office lab, and you'll find boxes and boxes of old models stockpiled along with active cases. When the lab runs out of room, these old models are put in larger boxes with labels and stored in another area. Eventually, they make their way to the doctor's home, headed to the basement or garage. Orthodontists can multiply this problem by a factor of 100.
Help has arrived! I found two dental companies – emodels and Orthocad – and an industrial company – 3shape – that can take an impression or an existing stone model and create a 3D virtual model that can be stored on a computer. Dentists can view the models, turn them in any direction, and even articulate them on the screen. More amazing is that with some software, an orthodontist can actually section the model and move the teeth on the screen.
It is hard to let go of years of touching and feeling plaster. Can you really analyze and look at patients on a computer screen? According to orthodontists Jay Reichheld and his brother, Steve, who both practice in northeastern Massachusetts, the answer is "yes!" They are enthusiastic converts. With this software, they can manipulate these models right on the computer screen, take precise measurements, and, even more amazing, integrate them with scanned ceph radiographs. Utilizing this software not only is efficient for dentists, but it also has an immediate "wow" impact on patients as well. Note: if the practitioner still wants to use the actual models, a hard copy can be made by the services and sent to the office.
As we have seen with Invisalign, this type of technology can morph an orthodontic case and display the final outcome and then actually construct the sequential appliances to get that result. For more conventional orthodontics, these new 3D- model companies have software that not only will calculate the placement of brackets, but construct a stent that can be used to align them right on the teeth, ready for bonding.
How will this expand to the general practice? We have already seen what can be done with imaging software – changing shapes and colors of teeth, closing up spaces, etc.
Some offices send models to a lab for a diagnostic wax-up after looking at these results. In the future, this could be done with 3D models.
A new company, Zcorp, manufactures a "printer" that can take a 3D computer file and construct a model right in an office. At present, the model (which is actually made of cornstarch!) costs less than $10 to make and takes a couple of hours.
Zcorp is actually in the business of commercial product design, such as auto engine parts and running shoes. The possibility for using this printer with dental model software looms bright.
Thinking ahead, there is already a method allowing simple model construction from 3D images, such as CT scans and MRIs. Imagine implant treatment-planning with a skeletal model on the screen or in your hand.
The next logical step is to fabricate dental restorations from these models. We already know what the CEREC III can do and Sirona is looking at these added possibilities.
For lab-based CAD, we have seen PROCERA's single copings and three-unit bridge frames. Cynovad, makers of the Pro 50 and Waxpro, which scan models, separate dies, construct wax patterns on the computer screen, and actually create the wax-ups. NewTom9000, from ZeroBase, is a device that produces 3-D X-rays of teeth and jaws For more information, go to www.zerobase-usa.com.
Dentsply has recently introduced a new CAD/CAM 3D system called Cercon, which makes zirconium oxide copings for metal-free restorations. These are currently lab models, but the future can only be imagined. The logical extension would be to bring this technology right into the office.
Check out the following Web sites here for a peek at the future: dentalemodels.com; orthocad.com; 3shape.com; and zcorp.com.
One last word of advice: don't buy plaster by the barrel!
Dr. Paul Feuerstein installed one of dentistry's first computers when he placed a system in his office in 1978, and he has been fascinated by technology ever since. For more than 20 years, he has taught courses on technology throughout the country. He is a mainstay at technology sessions in New England, including annual appearances at the Yankee Dental Congress, and has been a part of the ADA's Technology Day since its inception. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a Web site (www.computersinden tistry.com) and can be reached by email at firstname.lastname@example.org.