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20 Implant Tribune Asia Pacific Edition | 10/2016 OPINION “Dentists cannot blindly rely on the computer-guided approach” An interview with Prof. Daniel Wismeijer, The Netherlands Technologies such as cone beam computed tomography (CBCT), intra-oral scanners and CAD/CAM techniques have introduced a com- puter-guided workflow into den- tistry, specifically implantology. While a computer-guided ap- proach can make treatment more precise, safe and predictable, it requires a practised, experienced and focused practitioner to im- plement a digital workflow. At the recent EAO congress in Paris, Dental Tribune spoke with Prof. Daniel Wismeijer from the Nether- lands about the problems that implantologists are still facing in using digital technologies and the future of computer-guided im- plant surgery. Dental Tribune: Prof. Wismeijer, with the emergence of new digital technologies, novel treatment ap- proaches have become available to dentists—particularly in the field of implant dentistry. While some implantologists embrace these new technologies, others are still sceptical of them. Why do you think that is? Prof. Daniel Wismeijer: Novel technologies do not only affect implantology; they introduce dig- itisation into other areas of dental practice too. Consider the appli- cations of intra-oral scanners and CEREC (Dentsply Sirona) ma- chines and the use of new technol- ogies in planning and designing customised implant superstruc- tures. While some dentists use quite a lot of these tools, others do not use them at all and leave everything up to the dental tech- nicians. This largely depends on the dentist and his or her attitude towards digital technologies and digitisation in general—be it at home or in the dental practice. Then, of course, dentists have to invest in this sort of technology, as well as learn it and be prepared to unlearn their current practices. This too depends on the dentist: is he or she ready to use new tech- nologies or would he or she prefer to stick with what he or she had learnt previously? On the one hand, we see many young dentists start working with these new tech- nologiesimmediatelyandthereby become very experienced in new treatment approaches. On the other hand, dentists who are more experienced in established treat- ment protocols are, of course, less inclined to unlearn the old and start learning the new technolo- gies. Inthe“Emergingtechnologies:Head to head” session at the EAO con- gress, you will be talking about computer-guided implant surgery. What advantages does such surgery offer? Has it already proven itself in research and clinical practice, and what results can it achieve com- pared with free-hand surgery? In my opinion, guided surgery helps dentists become increas- ingly precise in our work. Digital technologies are proving them- selves in implant dentistry and I think that they are improving with time. If the practitioner can plan up front where he or she wants to place an implant and what sort of superstructure he or she wants to put on top of that, and if he or she can also place the implant in that exact position and implement a superstructure that fits precisely, that will show that we have come a long way. However, we are not there yet. There are still certain problems we have to deal with, problems in precision, problems in combining all the tools needed for guided implant surgery and the limita- tions of these tools. For example, in order to plan the position of an implant and its superstructure exactly, we have to superimpose CBCT scans and intra-oral scans using software. Factors such as voxel size and the absence of clear landmarks by which to superim- pose the different scans correctly can affect precision and cause deviations between the planned and the realised positions. I am not saying that free-hand surgery is more precise; however, the free- hand surgical approach may in some cases be more rewarding, as at least then the practitioner knows what he or she can expect and what his or her limitations are. So what can dentists do to better implement a digital workflow in implant treatment? Dentists have to know that they cannot blindly rely on the computer-guided approach. They stillneedtogettheirheadsaround the technology first and stay fo- cused while using it. Moreover, they have to accept that there is a learning curve and that comput- er-guided surgery will not work 100 per cent the first time it is applied. In my lecture, I will be discuss- ing the variables that influence the precision of the guided sur- gery workflow and what dentists are able to do to overcome asso- ciated problems. Primarily, they have to become comfortable with the different tools and software packages and gain experience in working with them. In the long run—and I think that we are not so far away from that now—com- puter-guided surgery is a treat- ment approach that will probably be much more precise than plan- ning and placing implants with- out any guidance at all. How will digital technology further change implant dentistry in the future? One of the tools that I will be demonstrating during my pres- entation is a dynamic navigation system that provides real-time guidance based on the patient’s CBCT scan. During surgery, the dentist sees the planned implant position on a screen while sensors track the drill and the patient’s jaw and the system provides visual and tactile feedback to en- sure that the dentist drills exactly at the planned osteotomy site. Dynamic navigation systems like this one are the next step towards robotisation in implant dentistry. From there, it will not take much to develop a comput- er-steered robot arm that calcu- lates whether the drill is in line with the planning and, supervised and handled by the dentist, drills the osteotomy. In various surgical disciplines, for example neurosur- gery, operations are already being performed using robotic technol- ogies, as they are able to perform much more precisely than the human hand alone. It is only a matter of time until these tech- nologies enter dentistry as well. Thank you very much for the inter- view. AD Prof. Daniel Wismeijer