Digital dentistry: the golden age of computer diagnostics and treatment planning
Digital dentistry CAD-CAM used in prosthetics and microprosthetics of teeth, providing the highest precision and, as a result, comfortable design. Another undeniable advantage of the method is minimum time waiting for the finished prosthesis. In most cases, patients at the Dental Brothers clinic have time to drink a cup of tea - and their prosthesis or microprosthesis is already ready for installation.
Features of digital dentistry CAD-CAM
- CAD-CAM is the computer-aided modeling and computer-aided manufacturing of prosthetic structures directly in the dentist's office, without the need to employ the power of off-line dental laboratories.
- Working with the CAD-CAM system at the first stage involves the use of a digital intraoral scanner, which reads information about anatomical features dentition, oral cavity, facial skull. Based on the data obtained, the computer modeling program will develop a design of a prosthesis or microprosthesis that will be ideal for correcting a specific clinical case.
- “design” information is digitally transmitted to an electronic milling machine, which grinds out a crown, veneer or inlay without human intervention. This equipment works with wide range modern orthopedic materials - solid ceramics, titanium, zirconium.
Manufactured by CAD-CAM technologies the prosthesis does not require preliminary fittings or adjustments: it is guaranteed to be comfortable and match the anatomical parameters as accurately as possible. Ready orthopedic design All that remains is to fix it on the prepared base, and the restoration or correction of the tooth shape will be completed during one doctor’s visit.
Special meaning CAD-CAM system has in the field of implantology: prosthetics on implants has now become faster and of even better quality. When installing an implant with instant loading, the patient is immediately implanted with an implant and an hour later a crown machined on digital equipment is installed on it. Arriving at the clinic with a missing tooth, the patient leaves the doctor with a structure that will last him a lifetime.
Dental treatment and prosthetics at the Dental Brothers clinic
The Dental Brothers digital dentistry clinic invites you to diagnose, treat and restore teeth using high technology. We guarantee that you will solve any problem quickly and efficiently: during one visit, modern veneering is performed, inlays for restoration are installed, permanent crowns are ground and fixed. More information about the capabilities of CAD-CAM technology can be obtained directly at an appointment with orthopedists at our clinic. You can make an appointment by phone or through a special form on the Dental Brothers website.
CBCT and scan protocol
Conclusion
Improvements in digital dentistry are directly dependent on the progress of technology in the computer field, even if they are associated with the development of some special transistor or microchip.
The digital revolution, which continues to gain momentum, began back in 1947, when engineers Walter Brattain and William Shockley of Bell Laboratory John Bardeen invented the world's first transistor, for which they subsequently received a Nobel Prize. Transistors of those times, in addition to being quite slow, were also excessively large, for this reason it was difficult to include such a design in some kind of integrated circuit, not to mention a microchip. Unlike their arch-relatives, the size of modern transistors may not exceed the size of several atoms (1 atom thick and 10 wide), while such elements operate very quickly at a frequency of several gigahertz, and can be compactly placed in the structure of some small board or computer circuit. For example, a Core processor (from the i-series), released in 2010, contains about 1.17 billion transistors (!), although in the mid-70s similar processors could contain no more than 2300 of these structural elements. But this is not the limit. According to Moore's law, every 1-2 years a new microchip is born, which is twice as powerful as its predecessor. It is therefore not surprising that dentistry is currently experiencing something of a boom, with the industry's scanning, analysis and manufacturing capabilities continuing to evolve rapidly. Digital radiography will no longer surprise anyone, because increasingly, doctors are using completely virtual diagnostic and treatment planning protocols, which help achieve the desired results.
One of the innovations that has literally become a routine procedure is the acquisition and analysis of digital prints. First similar procedure tried to carry it out back in 1973, when graduate student Francois Duret at the Claude Bernard University (Lyon, France) proposed making impressions using a laser in order to later use them during complex diagnostics, treatment planning, manufacturing and fitting of future restorations.
Almost ten years later in 1983, Werner Mörmann and Marco Brandestini succeeded in inventing the first intraoral scanner for therapeutic dentistry, which ensured print accuracy of 50-100 microns. The principle of operation of the scanner was based on the capabilities of triangulation to obtain instant three-dimensional (3D) images of teeth, from which future therapeutic structures could be milled. The latter, in the form of inlay-type inlays, were obtained using CEREC (CERamic REConstruction or Chairside Economical Restoration of Esthetic Ceramics), but the constant progress of technology subsequently determined the possibilities for the manufacture of full-fledged single restorations and even entire orthopedic prostheses. CEREC itself has also improved. Thus, a conventional milling machine was upgraded to the CEREC OmniCam system (Sirona Dental), which ensures the most precise designs. Increased attention It is precisely this system that is due to the role of CEREC as a pioneer of such devices on the market, which occupied a leading position for several decades, while other analogues found their feet and improved to the level of an already popular installation. There are currently several fairly accurate and powerful systems for taking intraoral optical impressions and fabricating CAD/CAM restorations, but they all use the same principle of triangulation to form the image. The most famous of them are TRIOS (3Shape), iTero Element (Align Technology), True Definition Scanner 3M (3M ESPE).
Advantages of modern digital systems
All modern digital systems for taking impressions are characterized by high accuracy of replicas of the structures of the dentofacial apparatus, and, of course, complete non-invasive manipulation. Unlike conventional impressions, the resulting images can be easily adapted to all conditions during planning and treatment, and the technique for obtaining them is so simple that it can be learned in a few steps. Thus, these impressions are not only more efficient, but also more convenient for the patients themselves, and also increase profitability dental procedures generally.
Another great advantage is that thanks to digital impressions, the doctor has the opportunity to receive not a negative image of the prosthetic bed, but a real copy of the teeth in 3D format, which can easily be assessed for the presence of shooting defects and the accuracy of individual boundaries.
Also, such prints are only a volume of digital information, which is direct meaning saves physical space both in the dentist’s office and in the dental technician’s laboratory. Studies conducted to compare conventional and digital impressions have shown better accuracy of the latter, while they differ from conventional ones in that they do not need to be disinfected, and there is no need to take into account the time of obtaining the impression in order to minimize the effects of shrinkage and changes in the primary size impression material.
The main advantage of digital impressions is that they can easily be included in the process of comprehensive planning and treatment with the ability to predict future results of dental rehabilitation. Direct copies of teeth and adjacent anatomical structures are visualized in direct projection immediately after the scanning procedure, and a high resolution The obtained images help to assess the condition of existing restorations, defects, the size and shape of edentulous areas, the type of occlusal contacts, as well as the usefulness of the tubercular-fissure closure.
New digital systems, such as TRIOS, CEREC Omnicam, even provide an imitation of the color of the structures of the oral cavity on the resulting replicas, thus helping to more naturally perceive the relief, shape and color of teeth and gums. In addition, such opportunities help the doctor to take a more differentiated and thorough approach to the issue of choosing a restoration material (metal, ceramic, composite), as well as take into account the presence of bleeding and inflamed areas, areas with accumulation of plaque and stone, and take into account color transitions between teeth, which is extremely important for highly aesthetic restorations. Optical impressions are also an effective tool for discussing the initial clinical situation and possible options treatment with the patient himself. After obtaining a three-dimensional image, problems with defective restorations, the influence of factors of abrasion, superocclusion or angulation of teeth on the future result of treatment can be clearly explained to the patient, without waiting for the receipt of plaster models (photo 1).
Photo 1. Occlusal view of the optical impression upper jaw: The image allows detailed examination of the inherent composite and amalgam restorations, the lingual cusp fracture of the maxillary second premolar on the left, the metal-ceramic crown in the region of the maxillary first molar on the right, and the implant-supported prosthesis in the anterior region.
All this encourages the patient to actively participate in the treatment process and conduct an active dialogue with the doctor, understanding everything possible risks and changes in one's own dental status. Digital files of optical impressions are saved in surface tessellation files (STL) format, and, if necessary, physical models can be produced from them using substrate or additive technologies.
Preparing for optical impressions
Like regular prints, they digital analogues are also sensitive to the presence of blood or saliva in the tissue area of the prosthetic bed, so the surface of the teeth must be adequately cleaned and dried before scanning. You should also take into account the effect of surface reflection, the risk of which may be triggered by specific lighting conditions of the working field. The use of light sticks helps to achieve adequate levels of illumination in the area chewing teeth, but at the same time, access of the photocell to this area still remains difficult, and irritation of the palate can provoke a gag reflex.
However, digital impressions are only part of the comprehensive survey the patient, which, among other things, should also include the collection of a general and medical history, the results of the clinical extra- and intraoral examination, as well as a clear understanding of the patient's complaints and his personal expectations regarding the future results of the intervention. It is by analyzing all of the above data that it is possible to draw up a comprehensive treatment plan focused on a specific patient and the characteristics of his clinical situation. The latest technological capabilities help the dentist independently simulate future restorations in the area of defective areas, coordinating the design, contours, position, dimensions, size of proximal contacts and imaging profile with the patient, taking into account individual characteristics occlusion, and thus ensuring that the most adapted and expected temporary structures are obtained.
However, the main limitation of current dental digital technologies is that they are difficult to fully incorporate eccentric jaw movements and the implications of key occlusal determinants for future restoration design. Due to the fact that recording the exact relationship of the upper jaw to the plane of the defective area is a very difficult task, it is also difficult to establish the objective inclination of the occlusal plane relative to the group of anterior teeth at the moment of their physiological closure.
Equally difficult tasks are the analysis of the articular path, the range of transversal movements, etc., that is, the use of digital impressions is also a kind of challenge for the construction of prosthetic structures, taking into account all physiological or changed parameters of occlusion. Obtaining accurate impressions from soft tissues is also very problematic, especially in areas of completely edentulous residual ridges. However, the ability to visualize 3D, as well as eliminating the need for plaster casting and wax-up, significantly speeds up and tailors the treatment process, helping to achieve the most patient-centered dental rehabilitation results.
The digital planning protocol is demonstrated in Photo 2-7. The patient sought help with an edentulous upper right central incisor (Figure 2).
Photo 2. The patient sought help for edentulous lateral incisor. During the treatment, it was planned to make a structure supported by the central incisor and canine.
After analyzing the individual wishes of the patient, the results of a comprehensive examination and the prognosis of future treatment, it was decided to use a fixed lithium disilicate prosthesis as a replacement structure. A virtual model of the future restoration helped determine desired length, width and profile of contact surfaces to achieve the greatest possible mimicry of natural fabrics (photo 3).
Photo 3. Digital mock-up of a prosthesis replacing a missing tooth.
After this, the supporting teeth were prepared (photo 4), and then using the scanning method, virtual impressions of the prepared units and antagonist teeth were obtained, which were further analyzed in a digital articulator (photo 5).
Photo 4. Occlusal view of the optical impression of prepared teeth with retraction threads.
Photo 5. Virtual articulation of optical impressions of the upper and lower jaws.
The optical impression data was also successfully used to analyze in detail the width of the final line of the preparation area, the routes of insertion of the structure, the level of deliberate tissue reduction in the area of the axial walls and occlusal surface, as well as to verify the undercuts, which were marked in red (Figure 6).
Photo 6. Analysis of the optical impression for the presence of undercuts. Undercuts are marked in red on the labial side of the central incisor and on the mesial side of the canine.
Another advantage of digital impressions is that preparation errors can be corrected during the same visit, based on the information obtained during the scan, and then the manipulation can be repeated on the corrected area of the prepared teeth. After this, the digital files are sent to a technical laboratory for the production of future restorations using milling machines. An example of the final design is shown in photo 7.
Photo 7. The restoration obtained from the optical impression is tried on the model.
CBCT and scan protocol
Usage digital capabilities at the stages of diagnosis and treatment planning is not some kind of innovation, but rather is considered as a fairly well-reasoned approach to the rehabilitation of dental patients. For decades, dentists have used specialized software to visualize 3D computed tomography (CT) scans to analyze the growth of anatomical structures. maxillofacial area; joint pathologies; bone architecture; sizes of individual sections of teeth and jaws; positions of vital organs such as blood vessels and nerves, as well as boundaries maxillary sinuses and position of impact teeth; diagnosis of tumors and neoplasms. But, probably, CT diagnostics has the most influential value in preparation for dental implantation and planning of maxillofacial reconstructive surgery. Technological progress has gained new momentum with the development of cone beam computed tomography (CBCT), which, compared to conventional CT, is characterized by reduced level radiation exposure and lower cost of the device. Indeed, the total radiation from a CBCT scan is on average 20% less than from a helical CT scan, and is approximately equal to that from conventional periapical radiography.
CT and CBCT diagnostic results are saved digitally in the standardized DICOM (digital imaging and communication in medicine) file format. In combination with a radiographic template made from a diagnostic wax-up, CBCT data can be successfully used to plan the position and angulation of implants, taking into account the fixation of the future prosthetic structure, based on the existing conditions and volumes of the bone crest (photo 8 - photo 11). Currently, there are two different protocols for implementing radiographic templates into the DICOM data structure for planning future surgical procedures. The first, called the dual-scan protocol, performs the acquisition procedure separately for the surgical guide and separately for the patient, provided that the surgical guide is installed in the oral cavity. Fiducial markers in the structure of the template itself help in the future to quite accurately combine the two resulting images. At the same time, the level of scanning errors is practically reduced to a minimum, and templates can be produced using various adapted software(photo 12).
Figure 8. Use of cone beam computed tomography and specialized software to plan the implantation procedure. The X-ray template together with the CT model was used to plan the future position of the implant.
Figure 9. Use of cone beam computed tomography and specialized software to plan the implantation procedure. The X-ray template together with the CT model was used to plan the future position of the implant.
Figure 10. Use of cone beam computed tomography and specialized software to plan the implantation procedure. The X-ray template together with the CT model was used to plan the future position of the implant.
Figure 11. Use of cone beam computed tomography and specialized software to plan the implantation procedure. The X-ray template together with the CT model was used to plan the future position of the implant.
Photo 12. Example of a surgical template made using a digital dual-scan design.
The second protocol requires only one scan of the patient along with a surgical guide placed in the oral cavity. The obtained data is imported into the implantation planning program without the need for additional processing images. As in the case of the double scanning protocol, the doctor has the opportunity to reasonably plan the position and angulation of the implants, based on the spatial location of the surgical template obtained as a result preliminary diagnostics. Three-dimensional radiographic images obtained using a single-scan protocol can be combined with digital templates for future restorations, which are made based on intraoral optical impressions (or scans of models), using existing natural teeth as markers. In this case, different digital masks can be used graphically for bone, teeth, gums and implants (photo 13 and photo 14), and the use of teeth as fiducial markers significantly increases the accuracy of planning the position of future implants.
Figure 13: Optical impression and digital reproduction were combined with CBCT scan results to position implants during complex treatment. U of this patient a sinus lift procedure is necessary for adequate installation of implants (blue indicates the contours of the teeth obtained from the wax reproduction/optical impression, red indicates the contours of the soft tissues).
Figure 14: Optical impression and digital reproduction were combined with CBCT scan results to position the implants during complex treatment. This patient requires a sinus lift procedure for adequate installation of implants (blue indicates the contours of the teeth obtained from the wax reproduction/optical impression, red indicates the contours of the soft tissues).
Unfortunately, similar marker points in the structure of the surgical template cannot provide the same high level precision. Regardless of the scanning protocol used, the 3D digital imaging, optical scanning and software capabilities provided provide unique tools for future iatrogenic intervention planning in the hands of a skilled dentist. Thus, taking into account the position and contour of the soft tissues, the size and quality of the residual bone crest, as well as the location of the vessels and nerves, the doctor can provide the safest implantation algorithm, while predicting not only functional, but also aesthetic results of rehabilitation. Surgical template Regardless of the protocol for obtaining a scanned image, it ensures the accuracy of implant positioning, eliminating possible operational errors that may arise during surgical intervention. Virtual planning of dental rehabilitation helps the doctor achieve the safest, and at the same time, patient-oriented results in the treatment of aesthetic and functional defects.
Conclusion
Intraoral optical scanners continue to be constantly modified, becoming faster, more accurate and miniature devices that are so necessary in dental practice. Considering the progressive development of 3D imaging technologies and adapted image processing software, it can be firmly concluded that today's dentists live in the golden age of digital technology. Such innovations help achieve more accurate and precise diagnostic results, planning and implementation of iatrogenic interventions, while increasing comfort during dental treatment. Thus, it is extremely important that new digital technologies emerge in a timely manner and continue to develop within the walls dental offices and clinics.
Now all areas of medicine are actively developing: new drugs and technologies are being created for first aid patient and rapid treatment of the disease. In dentistry, digital devices are actively used, with the help of which diagnostic measures and models are being developed for further dental implantation.
Our clinic is equipped with everything necessary equipment for complex treatment of patients, including digital device CAD/CAM. It allows you to first design a 3-D model of a crown or veneer, then create the product using a milling block. We use it for preliminary diagnosis of the oral cavity before the following procedures:
· Restoration and restoration of teeth;
Regular and basal dental implantation;
· Reconstruction of the dentition.
Working with a digital CAD/CAM device looks like this:
1. A specialist takes an impression of a damaged or dilapidated tooth;
3. After this, the milling unit uses the resulting 3-D model to produce a natural crown, which is subsequently fixed in the patient’s mouth.
A digital CAD/CAM device makes it possible to create a comfortable crown or veneer as quickly as possible.
The use of digital technologies is a new standard of delivery dental services. dental clinic Avantis keeps up with the times and offers patients unique procedures and world-class services. We use digital technologies in diagnostics, treatment, and dental prosthetics.
Also, the Avantis clinic offers patients aligners own production, made by 3D printing. Moreover, digital technologies provide an opportunity to look into the future. 3D smile design is a great opportunity to see the result of treatment - be it prosthetics or bite correction - even before it begins. You can discuss the expected result with your doctor and adjust it if necessary.
Digital technologies play a special role in preparing for dental implantation. CT scan included in the required diagnostic minimum. It allows you to obtain three-dimensional images of the maxillofacial area. Computer 3D planning reduces the risk of complications and increases the service life of the implant. Guide templates allow you to install the implant with high precision.
Expensive procedures such as installation veneers or prosthetics always in the zone special attention. It is important to us that the treatment result meets the patient’s expectations. 3D smile design helps to recreate the aesthetics of a future restoration, and CAD/CAM technologies allow you to turn the created 3D project into reality.
Collaboration with the Association of Digital Dentistry
Professor, doctor medical sciences A.N. Ryakhovsky is a member of the Board of Directors of the Digital Dentistry Association. This non-profit organization sets itself the goal of popularizing and widespread implementation of advanced technologies in dental practice. Under the auspices of the Association, the magazine “Digital Dentistry” is published, which is popular in the professional community. Head of the clinic A.N. Ryakhovsky is the author of articles published in the publication.
The objectives of the Digital Dentistry Association are to analyze global experience in the use of digital dentistry, attracting foreign and domestic specialists to train dentists, popularizing advanced technologies, interaction with higher educational institutions and manufacturers of digital technologies and equipment. By collaborating with the Association, Avantis Clinic emphasizes its commitment to digital technologies and continuous development market of domestic dental services.
We use our own software to design your smile
In our clinic, smile modeling is carried out using our own software. It is used in dental prosthetics, during orthodontic treatment and implantation. The innovative Avantis 3D modeling program is in demand on the market, and many dentists have already appreciated its benefits. The use of this technique helps to visualize the result obtained even before the start of treatment, clarify all parameters, and select the most appropriate solution. In our clinic you will receive first-class treatment using the most modern software modules.
Moscow, st. Mishina, 38.
m. Dynamo. Get out of the 1st car from the center, exit the metro, and in front of you is the Dynamo stadium. Go left until the traffic light. By pedestrian crossing go to the opposite side Theater Alley, go a little forward. There is a stop on the opposite side. Take bus number 319. Go 2 stops to "Yunnatov street". Go to the opposite side of the street. To your left is the porch - the entrance to the EspaDent clinic. You're at the place!
Moscow, st. Academician Anokhin, 60
Get out of the first car from the center towards "Akademika Anokhin Street". From the glass doors to the right. Along the forest (on the right hand) along the path for about 250m. to st. Academician Anokhin. Cross to the opposite side of the street and go right, about 250m, to house No. 60. There is a penultimate entrance to the house, a sign “Teeth in 1 day.” You're at the place!
Get out of the metro at the station. Savelovskaya (first carriage from the center). Walk to the end of the underground passage and exit the metro towards Sushchevsky Val street. You walk past the restaurant "Uncle Kolya". Pass under the overpass, then follow the underground passage to the opposite side of the street. Novoslobodskaya. Continue walking along Novoslobodskaya Street for about 200m, past the Elektrika store. On the ground floor of building No. 67/69, the restaurant “Tavern” is located. Turn right, in front of you is a sign “Teeth in 1 day”, go up to the second floor. You're at the place!
Moscow, st. Novoslobodskaya, 67/69
Get out of the metro at the station. Mendeleevskaya (the first carriage from the center). Exit the metro towards the street. Lesnaya. Walk along the street. Novoslobodskaya from the center towards the street. Lesnaya. Cross the streets: Lesnaya, Gorlov tup., Poryadkovy lane. Get to the intersection of the street. Novoslobodskaya from Uglovoy lane. Cross the alley, in front of you is a building, on the facade there is a sign “Teeth in 1 day”. You're at the place!
Moscow, st. Academician Koroleva, 10
You can get there from the metro in 15 minutes. 4 minutes to the tram, 5 minutes by tram and 3 minutes to the clinic. 1st car from the center. Get out of the metro, go to the tram stop and 4 stops on any tram to Ostankino. Get out and return along the park to the road, cross and turn left 80m and you will see a sign on the facade "Center Surgical Dentistry". You're at the place!
Moscow, From the monorail station. st. Academician Queen
Exit the station and follow the street. Academician Korolev (by left hand), go through the Megasphere store to the intersection with the road. Turn right and walk past the forest park to house number 10. On the facade there is a sign "Center for Surgical Dentistry". You're at the place!
Dental clinic "Mirodent" - Odintsovo, st. Youth house 48.
From Art. Odintsovo buses No. 1, 36 or minibus No. 102, 11, 77 - 2 stops to the "Tower" stop. From metro station Victory Park: bus No. 339 to the “Tower” stop. The clinic is located on the 2nd floor of the business center.
Balashikha, Vishnyakovskoe highway, 31
On foot:
From the Nikolskaya platform on the left side of the Vishnyakovskoe highway 9 minutes. After crossing the 3rd line you will see Dixie. Behind it is a 3-story olive building - our dental center.
By transport:
From the Nikolskaya platform, take Bus 22 or Minibuses 1123, 22k, 9k along Vishnyakovskoe Highway one stop to the “3rd Line” stop. Across the street, a 3-story olive-colored building is our dental center.
