The art of design: Implants and CAD/CAM

Some might argue that the art of dentistry has become a casualty of digital dentistry and that artistry is no longer being taught in dental school. Dr. Justin Moody contends, however, that the new technology of CAD/CAM actually enhances the beauty and accuracy of the restorations we place.

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Justin D. Moody, DDS, DABOI, DICOI

Where has the art in dentistry gone? Some might argue that this skill has become a casualty of digital dentistry and that artistry is no longer being taught in dental school. I contend, however, that new technology in our digital age has enhanced the beauty and accuracy of the restorations we place.

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Intraoral scan of a BioHorizons Scan Body using the 3Shape Trios Scanner

When I graduated from dental school in 1997, our media included wax, plaster, gold, porcelain, etc. There was little to no talk of CAD/CAM. But today there is a movement toward scanning, digital design, and milling. This shift to the digital age can’t be denied as we see improvements in efficiency and accuracy as well as economic value.

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Final full contour design of an upper full-arch zirconia bridge

Recently, I spent a day with Jeremy Herbert, co-owner and CAD/CAM manager of ProSmiles Dental Studio in Rapid City, South Dakota. As I watched him design custom healing abutments, hybrid zirconia abutments, and full-contour crowns, I realized that this, too, is the work of an artist. Focused and efficient, he was able to design a beautiful crown faster than a technician of yesteryear could heat up his or her wax pot. Jeremy lives in a world of occlusion, excursions, contacts, emergence profiles, and heights of contour.

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Jeremy Herbert, co-owner and CAD/CAM manager of ProSmiles Dental Studio designing digital dentistry in exocad

Just like dentists, lab technicians take hours of CE and maintain credentials, such as the Certified Dental Technician certification (CDT). Lab technicians spend countless hours reading about new products, materials, and techniques. Also important to consider is the amount of time and effort it takes to maintain and stay current with the various types of scanners, mills, and software that make up the modern digital lab.

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Digital design of a full-arch zirconia restoration on BioHorizons multiunits

The economics of CAD/CAM in the dental office is profound. Intraoral scanning saves time and increases profitability by virtue of its being instant, by allowing in-office milling or direct sending of files to the lab, thus saving on transport time and transit expenses. I find the true benefit to be in the increased accuracy, especially when dental implants are being restored. With CAD/CAM, I have the ability to create the desired prosthetic outcome prior to surgery, develop tissue profiles through custom healing abutments/crowns, and finally deliver the desired clinical prosthetic outcome with few or no adjustments and minimal chair time. CAD/CAM is art, science, and a whole lot of fun—all in one!

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Digital design of a custom hybrid zirconia abutment on a BioHorizons Ti base with Laser-Lok

Author’s disclosure: Dr. Moody is a paid consultant for BioHorizons and ProSmiles Dental Studio.

Justin D. Moody, DDS, DABOI, DICOI, is a diplomate of the American Board of Oral Implantology and the International Congress of Oral Implantologists, as well as an honored fellow in the American Academy of Implant Dentistry. He is an internationally known speaker, founder of the New Horizons Institute nonprofit clinic, director of implant education for Implant Pathway, and on the adjunct faculty at the University of Nebraska Medical Center. Contact him at justin@justinmoodydds.com.

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