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CAD/CAM - international magazine of digital dentistry

devicestorestoredentalimplantswithouttheneed for any impressions. _CBCT 3-D scanners and CAD/CAM integration Cone beam computed tomography (CBCT) scans are now commonplace in dentistry, particularly in implant dentistry where Grondahl (2007) found that40percentofallCBCTscansweretakenforim- plant treatment. Where 3-D scans were reaching a shortfall was in actually relaying the information obtained into the mouth during the surgical pro- cedure. One recent innovation has been to overlay scans of the patient’s own teeth and soft tissues ontotheCBCTscandata.Thisgivesanaccuraterep- resentationofthehardandsofttissuesandtheirre- lationship to each other. For example, an implant can be planned in the implant software 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 model and then wax up the ideal final restoration contour, ensuring some barium sulfate within the wax in order for it to show up in the scan. This was both costly and time consuming.Recentdevelopmentshaveallowedone 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 understand the proposed work and its execution. Taking this one step further, guided implant sur- gery now allows us to not only plan implant place- mentusingidealrestoratively drivenprotocols,but actually allows us to make a guided surgical stent, made in-house or by a lab, and place the implant through the stent. Studies have found that this is an accurate treatment modality that can be reliably executed. Flapless surgery with immediate tempo- risation has the ability to revolutionise the patient journey and help us to meet their expectations. _Facial scanners A small but rapidly developing area of digital dentistryisfacialscanners.Theseareintheirinfancy at the moment, with a lot of companies still trying toironoutthebugsinthemachines.Theirpotential applications in the field of plastic surgery, facial aesthetics, orthodontics, implant surgery and or- thognathic surgery are endless. Ihavebeenfortunatetoseeaprototypefacialscan- ner from Sirona and even managed to have my face scanned (Figs. 1 & 2). The detail achievable with these unitsisimpressive.Oncethisinformationiscombined with3-Dscans,teethscansandjawarticulation,afully working and movable representation of the patient’s headcanbecompiledonthecomputerscreen.Allow- ing for treatment planning and assessment to be car- ried out without any need to see the patient. One ap- plicationofthismaybeindevelopingcountries,where various experts from around the world can examine complicatedfacialreconstructioncaseswithoutthem actuallyseeingthepatient.Asalreadymentioned,the opportunitiesforpatienteducationarehuge,andwith procedures such as plastic surgery and orthognathic surgerybeingsodifficulttoproperlyconsentfor,facial scannerswillgreatlyaidclinicians. _Growth factors Availableforalongtimeinmedicineanddentistry, growthfactorshavebeenthereserveofPhDstudents and professors until recently. The resurgence of the usage of platelet rich plasma (PRP) has come about with added research showing that using PRP can greatly improve osteoblast proliferation (Parmar 2009)andacceleratesoft-tissuehealing.Companies arenowofferingclinicalcoursesfordentiststomake, produce and use PRP in their own surgeries within 15–30 minutes. The main advantage of PRP is that it’s free; is obtained from the patients’ own blood, thus removing the risk of rejection; and can be made in vast quantities. As more research is published, coupled with simpler production kits, PRP use will increase in all aspects of invasive dental surgery. The above is just a short description of what is being developed for the future. Dentistry has never been so intertwined with technology. The next 10 years will prove to be exciting and I eagerly await to hear, see and use the new technologies that are being developed today._ I 11 special _ dental innovations I CAD/CAM 2_2013 Dr Nilesh R.Parmar runs a successful five-surgery practice close to London and is a visiting implant dentist to a central London practice. His main area of interest is in dental implants and CEREC CAD/CAM technology. He can be contacted at drnileshparmar@gmail.com More information can be found on his website, www.drnileshparmar.com;Twitter:@NileshRParmar; or Facebook:Dr Nilesh R.Parmar. CAD/CAM_about the author