today IDS Cologne Show Preview

n Dentistry has come along way since our colleagues were forced to use foot powered drills and mix amal- gam from its bare components. Mod- ern day dental equipment and mate- rialsareatthecuttingedgeofmedical and dental innovation, and it’s shows such as the International Dental Show (IDS) where the developments of the future are announced. Modern dentists no longer have merely a straight probe and a dental drill at their disposal. We now have scans, 3-D images, growth factors and an al- most unlimited choice of materials available to use. In writing this piece, I made a tough decision to focus on what I be- lieve to be key areas of dental innova- tion. It is in these areas of imaging, CAD/CAM technology and growth factors that I believe are going to be important in the dental surgery of the future. CAD/CAM Computer-aided design/compu- ter-aided manufacturing has had a presence in dentistry for nearly 20 years. However, only it is only in the last ten years that developments have really made a difference in the reliability, ease of use and function- ality of these devices. We now have CAD/CAM machines (e.g., CEREC, iTero, Lava) that can scan an entire arch,designandfabricateall-ceramic restorations in the practice. The pop- ularity of chairside CAD/CAM units hasneverbeengreater.Thematerials that we are able to use in conjunction with CAD/CAM scanners have gone from monolithic, one shade blocks to multi-layered, all-ceramic, lithium- disilicate constructions that can be sintered and finalised in as little as 15 minutes. The appearance of these restora- tions, although still needing a well- trained (and artistic) dentist, could be said to be on par with certain lab-based fabrications whilst main- taining the advantages of being a chairside single visit restoration. CAD/CAM technology is now almost universally used in the fabrication of dental implant abutments and bars, reducing construction times, designs and fit. Dentists are now beginning to use chairside CAD/CAM devices to restore dental implants without the need for any impressions. CBCT 3-D scanners and CAD/CAM integration Conebeamcomputedtomography 9CBCT)scansarenowcommonplacein dentistry, particularly in implant den- tistry where Grondahl (2007) found that40percentofallCBCTscanswere taken for implant treatment. Where 3-D scans were reaching a shortfall was in actually relaying the informa- tion obtained into the mouth during the surgical procedure. One recent in- novation has been to overlay scans of thepatient’sownteethandsofttissues onto the CBCT scan data. This gives an accurate representation of the hard and soft tissues and their relationship to each other. For example, an implant canbeplannedintheimplantsoftware with the angulation of the implant taking into account the ideal position of the final crown, which can also be shown in the CBCT scan. In order to do this previously, the dentist would have to make a study modelandthenwaxuptheidealfinal restoration contour, ensuring some barium sulfate within in the wax in orderforittoshowupinthescan.This was both costly and time consuming. Recent developments have allowed one to take an intra-oral scan using a suitable device, such as a CEREC or iTero machine, and overlay this with the CBCT scan. No models, no wax ups; the procedure is almost instant and can be done with the patient in the chair. As a patient education tool, this visual format is invaluable, allowing patients to fully un- derstand the proposed work and its execution. Takingthisonestep further, guided implant surgery now allows us to not only plan implant placement using ideal restoratively driven protocols, but actually allows us to make a guided surgical stent, made in-house or by a lab, and place the im- plant through the stent. Studies have found that thisisanaccuratetreat- ment modality that can be reliably executed. Flapless surgery with immediate temporisa- tion has the ability to revolutionise the pa- tient journey and help us to meet their expectations. Facial scanners A small but rapidly developing area of digital dentistry is facial scan- ners. These are in their infancy at the moment, with a lot of companies still trying to iron out the bugs in the machines. Their potential applica- tions in the field of plastic surgery, facial aesthetics, orthodontics, im- plant surgery and orthognathic sur- gery are endless. I have been fortunate to see a prototype facial scanner from Sirona and even managed to have my face scanned (Figs. 1 & 2). The detail achievablewiththeseunitsisimpres- sive. Once this information is com- bined with 3-D scans, teeth scans and jaw articulation, a fully working and movable representation of the pa- tient’s head can be compiled on the computer screen. Allowing for treat- ment planning and assessment to be carried out without any need to see the patient. One application of this may be in developing countries, where various experts from around the world can examine complicated facial reconstruction cases without them actually seeing the patient. Asalreadymentioned,theopportuni- ties for patient education are huge, and with procedures such as plastic surgery and orthognathic surgery being so difficult to properly consent for, facial scanners will greatly aid clinicians. Growth factors Available for a long time in medi- cine and dentistry, growth factors have been the reserve of PhD stu- dents and professors until recent- ly. The resurgence of the usage of platelet rich plasma (PRP) has come about with added research showing that using PRP can greatly improve osteoblastproliferation(Parmar2009) and accelerate soft-tissue healing. Companies are now offering clinical courses for dentists to make, produce and use PRP in their own surgeries within 15–30 minutes. The main ad- vantage of PRP is that it’s free; is ob- tained from the patients’ own blood, thus removing the risk of rejection; and can be made in vast quantities. As more research is published, cou- pled with simpler production kits, PRP use will increase in all aspects of invasive dental surgery. The above is just a short de- scription of what is being developed for the future. Dentistry has never been so intertwined with technology. The next ten years will prove to be exciting and I eagerly await to hear, seeandusethenewtechnologiesthat are being developed today. 7 Dr Nilesh R. Parmar runs a successful five-surgery practice close to London and is a visiting implant dentist to a central Londonpractice.Hismainareaofinterestis in dental implants and CEREC CAD/CAM technology. science & practice12 Show Preview IDS Cologne 2013 EASYFOR Implants is a brand made in Italy, which is different from the low-cost products, that are widely deployed in the Italian implant marketplace. Quality of the product and a restrained sale price in relation with the most renowned companies. UNIQUE for availability of product, from the mini-implant to the zygoma fixtures SAFE conical connection and platform switching, guarantee of implant- abutment-tissue stability PREDICTABILITY of the result ERGONOMIC each component is designed to the last details to make easier the team work DISCOUNTS ON ON-LINE PURCHASES. DELIVERY GUARANTEED IN 36 HOURS. do the right holdItalian EXCELLENCE at the right price Easyfor Srl I Tel. +39 331.455.32.35 I info@easyfor.it I www.easyfor.it Easyfor CONICO For a reliable fixture-abutment connection, suitable for post extraction and immediate load sites. Easyfor CILINDRICO Best for all-on-four treatments and for removable prosthesis on implants with stabilizing bar, over 98% success. Easyfor D3-D4 The double-threaded taper gradually progressive condenses bone, spongy trabeculation, during insertion. EasyforD3-D4 35th International Dental Show Cologne, 12-16 March 2013 HALL 11.3 - STAND K060 AD 5 Fig. 1 5 Fig. 2 CAD/CAM and growth factors— Key areas of dental innovation By Dr Nilesh R.Parmar,UK 5 Dr Nilesh R. Parmar