Digital Workflow in Reconstructive Dentistry

CBCTcone-beam computed tomography

CCDcharge-coupled device

CEJcementoenamel junction

CLIPcontinuous liquid interface production

CMOScomplementary metal oxide semiconductor

CNCcomputer numerical control

COSchairside oral scanner

CTcomputed tomography

CTEcoefficient of thermal expansion

DICOMDigital Imaging and Communications in Medicine

DLPdigital light processing

DPIdots per inch

DQEdetector quantum efficiency

DVTdigital volume tomography

EPRelectronic patient records

FDPfixed dental prostheses

FGPfunctional generated pathway

FOVfield of view

FPDflat panel detector (can also mean fixed partial denture)

GDPRGeneral Data Protection Regulation

IGSimage-guided surgery

IOSintraoral scanner

LEDlight emitting diode

LTDlow temperature degradation

MgPSZmagnesium-doped partially stabilized zirconia

MRImagnetic resonance imaging

OCToptical coherence tomography

PACSpicture archiving and communication system

PEEKpolyether ether ketone

PFMporcelain-fused-to-metal

PMTphotomultiplier tube

PSPphoto-stimulated phosphor plate

RDPremovable dental prosthesis

RNCresin nano ceramic

ROIregion of interest

SLstereolithography

SLMselective laser melting

SLSselective laser sintering

STLStandard Tessellation Language

TFTthin film transistor

TIFFTagged Image File Format

TMJtemporomandibular joint

UVultraviolet

VDOvertical dimension of occlusion

Preface

Innovations and their introduction as products for users seem to be the steering wheel of contemporary industry. The domination of technology and tech-driven companies is not surprising. Apple, Google, and Microsoft have been progressively expanding their development and production capabilities to cover areas not primarily related to their main revenue streams. A good example is the burgeoning smartphone industry. Obviously, all major IT companies are now involved in this business. It is needless to mention that this industry has not only opened the way for a great number of hardware development companies, but has also enabled millions of small start-up software and application development companies and individuals to pair their innovations with the major players. It is clear today that it is all about innovation and small, yet unique cutting-edge ideas and their implementation in the proper environment (team, funding, and support). A small search online reveals countless start-ups with very promising innovations.

The picture is quite similar in health sciences. Innovations are being continuously introduced with the ultimate goal of achieving better and faster patient care. In dentistry, the digital revolution has already arrived. Words like scanning, machining, milling, printing, CAD, and CAM are being used on a daily basis. As the avenue of innovations is endless, the current technologies available are all considered blueprints for future developments. Although research and development are ongoing in the field of digital dental medicine, the activities seem to be mainly based on existing dentistry-derived technologies and led by the idea that “we need to do it as well.” A good example is intraoral scanners. Though not new, intraoral scanners are being introduced continuously by nearly every dental company. A critical comparison between the available scanners clearly shows that the implemented technologies in all current scanners are, to a large extent, very similar. Despite continuous introduction of new versions of intraoral scanners, it is amazing that the application spectrum has not been expanded to cover the important indication of full-arch scans, and the complete digital workflow is still lacking. Clearly, “out of the box thinking” is needed in dentistry.

D igital Workflow in Reconstructive Dentistry is the result of efforts made by the academic team at the Department of Prosthodontics, University Hospital of Freiburg. It aims to build a fundamental understanding of the general principles, science, and clinics of digital dental medicine. The information provided within these pages summarizes the various components of the digital workflow in reconstructive dentistry and discusses their advantages and disadvantages. Moreover, insights are provided about upcoming, game-changing technologies. By reading this book, students, clinicians, and researchers will gain and enhance their knowledge about digital dental medicine and identify the areas they need to focus on next in order to integrate the available technologies in their daily work. Clearly, the path of digital dental medicine will not stop here.

We would like to thank all contributors for their dedication to make this book a reality. Much appreciated is the work of the outstanding lab technicians, namely Udo Plaster, Manfred Pörnbacher, Ulrich Lamott, and Wolf Wörner. Likewise, the support and exchange of information with companies, manufacturers, and developers helped tremendously to refine the information provided by this book.

Wael Att Siegbert Witkowski Jörg R. Strub

Contents

Contributors

List of Abbreviations

Preface

1Digital Workflow in Reconstructive Dentistry: An Introduction

Introduction

What is the Digital Workflow?

Data Acquisition

Data Processing/Planning and Treatment Planning

Execution of Treatment or Fabrication

References

2Intraoral Scanners: Current Status and Future Applications

Introduction

Overview of the Digital Workflow

Intraoral Scanners

Data Acquisition Techniques

Efficacy of IOS Systems

Requirements of IOS Systems

Clinical Application of IOS Systems

Implant Capturing Technology Via Photogrammetry

Current Indications and Future Possibilities of IOS Systems

CASE EXAMPLE

Active Clinical Treatment

References

3Laboratory Desktop Scanners

Introduction

Software and Workflow

Accuracy

Conclusions

References

4Optical Face Scanners

Introduction

Scanning Technologies

Applications of Face Scanners in Dentistry

CASE EXAMPLE: DIGITAL WORKFLOW OF FULL-MOUTH IMPLANT-SUPPORTED FIXED DENTAL PROSTHESES

Introduction

Case Description

Acknowledgments

References

5Digital Radiographic Imaging

Introduction

From Analog to Digital

Digital Receptors

Intraoral Digital Imaging: Direct Digital Imaging

Intraoral Digital Imaging: Indirect Digital Imaging

Extraoral Digital Imaging Techniques

Flat Panel Detectors

Extraoral Tomography

Extraoral Projection Radiography

Cone-beam Computed Tomography

Summary and Future Developments

Further Reading

References

6Virtual Registration, Mounting, and Articulation

Introduction

Positioning of the Jaws in the Virtual Space

Concepts of Virtual Articulation

Basic Virtual Articulation

Advanced Virtual Articulation (Nonreference-based Mounting)

Individual Virtual Articulation (Reference-based Mounting)

Real-3D System (Biomechanical-based Systems)

How Far are We From Achieving an Accurate and Patient-relevant Virtual Articulation?

Creating the Occlusion in the CAD

References

7Digital Assessment Tools and Data Manipulation

Introduction

Application in Dentistry

Classification of Digital Assessment Tools

Digital Esthetic and Facial Analysis

Photo Software and Presentation Software

Treatment Planning and Expectation Software

Smile Design Software

Analysis/Evaluation Tools for Digital Charting

Digital Practice

Future Perspectives

Conclusions

References

8Computer-guided Implant Planning and Surgery