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Lab Tribune Middle East & Africa Edition

lab tribuneDental Tribune Middle East & Africa Edition | November-December 2014 3D < Page 2D aspects of digital dentistry, not only among technicians but also among all members of the mod- ern dental team. Dr Alessandro Agnini: Yes, this iswhytherearemoreeventslike the Dental Technician Forum at IDEM Singapore and other simi- lar events around Asia, just like one sees in Europe and the US. We were here in Singapore last November for the CAD/CAM conference and we will be back again later this year for another. How did you find your Asian audiences at IDEM Singa- pore? We (Asians) have a repu- tation for being very shy when it comes to asking questions; did you have many questions or much feedback?” Dr A. Agnini: Actually, we had quite a few questions from the floor and via the SMS system they used for the Dental Techni- cian Forum. The audience can text any questions they have to a number and we can answer them after the presentation dur- ing the Q & A session. Dr A.M. Agnini: “The SMS sys- tem worked really well because people could ask us anything and often they asked us about something we had not had time to cover in the presentation or had not included because we were not sure whether it would interest people. With such ques- tions, we thus could cover such topics too.”. It has been suggested that Asia might not be as quick to adopt digital technologies as Europe and the US because skilled la- bour costs here are still com- paratively low, so there are not the same savings to be made by giving some of the technicians’ jobs to machines. Do you think that is true? Dr A.M. Agnini: One cannot just replace a technician with a ma- chine. In Europe or anywhere else, one still needs a dental technician who is well trained in using all these new digital technologies; it is not easy for anyone to use these new digital technologies for the first time. One needs a great deal of train- ing to fabricate a final restora- tion that is precise, predictable and of the same quality as that achieved via traditional proto- cols and craftsmen technicians. Software can help the clinician, the technician and the patient, but on its own cannot solve the problem; one still needs a skilled person behind the machines to tell them what to do. Dr A. Agnini: The machine does not know what to do; it cannot look at a restoration and see where we need more sup- port, or whether a molar needs to be done this way or another way. We need a person with the skills, knowledge and training to decide how to shape this frame- work if we are to achieve the outcome of long-term predict- able restorations. But now, a well-trained and knowledgeable technician us- ing CAD/CAM can dramati- cally improve his or her pro- ductivity. Dr A. Agnini: That is true, one advantage of CAD/CAM is one can speed up production. Anoth- er advantage for the dental tech- nician is that one can reduce the variables without reducing the quality. The third advantage is that it can level the playing field between technicians and make standards more homogeneous. Before, especially for large res- torations, the technicians’ skill with their hands was crucial in producing high-quality restora- tions, but with new technologies perhaps technicians who are less skilled in traditional manual manufacturing techniques can produce high-quality restora- tions. While everyone agrees that digital dentistry is the way of the future, there does seem to be one area where not every- one agrees. Everyone agrees that the first two steps of the process, that is the acquisition of data via some form of scan- ning and CAD, are essential, but when it comes to the CAM component, there seems to be a divergence of opinions. One of the other speakers at IDEM Singapore, Mr Rik Jacobs, seems to think that 3-D printing can already cope with most laboratory manu- facturing and, once the lat- est biologically compatible materials currently being de- veloped have been tested and approved, 3-D printing will be able to do everything, includ- ing implants. Do you see that happening or do you think precision milling will be with us for many years to come? Dr A. Agnini: We do not have much experience with 3-D printing machines. For sure, they will one day revolutionise the future of dentistry, but right now I do not think they can match the precision achieved by milling machines. For the time being, I think milling machines are a gold standard that will be difficult to surpass. As scanning and CAD/CAM technologies, and especially the software that links the three stages, improve, do you think more dentists or at least the larger dental practices will start to do more manufactur- ing in-house rather than using external laboratories? And if that is the case, what can lab- oratories and technicians do to retain their customers? Dr A.M. Agnini: The in-house milling process is a hot topic nowadays in dentistry. Every- thing has to begin and end with the quality of the final restora- tion in mind, and that will al- ways have to be the deciding factor. Today, the clinician has the option of organising his or her work as he or she prefers, but doing everything by him- self or herself is, in our opinion, something that is not convenient or practical. It is a different matter if the cli- nician has in his or her clinic a well-trained dental team who canmanagethedigitalworkflow from beginning to end. Such a team would have to include an expert dental technician de- voted to studying and mastering all of the latest digital possibili- ties. Only this way can this qual- ity be achieved and the clinician be satisfied from a business and economic standpoint. Another solution is to team up with an external expert labora- tory that can design, customise and produce the prosthetic ele- ments. This way, one does not have to invest in the initial start- up costs involved in setting up a dental laboratory. In summary, on the one hand, the craftsmanship of the dental technician cannot be replaced by digital dentistry; it will still be necessary to work with someone in-house or externally who is capable and up-to-date with the technology. On the other hand, if the dental laboratories want to keep themselves in business, they have to incorporate the lat- est digital solutions into their practice, understand and invest in them, and work out how to make the most of them. It is the only way dental laboratories will survive this digital dentistry era. “The buzzwords at this year’s IDEM Singapore were defi- nitely “CAD/CAM” and “3-D printing”, but what do you predict the buzzwords will be in 2018?” Dr A. Agnini: I think in 2018 the buzzword will be “full digital workflow”, meaning a completely predictable digital process, and “full-arch rehabili- tation”. Today, it is still too early to manage complex cases with the intra-oral scanner; the aver- age error is still too large. Fig. 1. Drs Allesandro Agnini and Andrea Mastrorosa Agnini Figs. 2 & 3. Digital workflow by Drs Agnini Fig. 4. Surgical guide made with 3-D printer (Objet Eden260V, Stratasys) on the model. Fig. 5. Surgical guide made with 3-D printer (Objet Eden260V, Stratasys) in patients mouth. “... one still needs a dental technician who is well trained in using all these new digital technologies...” “One needs a great deal of training to fabricate a final restoration that is precise...”

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