Dental Tribune Pakistan Edition No.5, 2016

CLINICAL PRACTICE 2016 Pakistan Edition DENTAL TRIBUNE 7 September craftsmanship? Are you extremely uncertain and waiting to see what happens or do you lack the required knowledge of economics or marketing to also embark on the path of digitisation? The fact is that anyone who fails to have an open mind about digital technology will no longer have a major player role among the dental labs. The more dental practices invest in digital workflow and exchange relevant data, the more dental labs h a v e t o a d a p t a n d s e r v e i t technologically. It is still the responsibility of dental labs to support the dentist, and hence the patient, by providing optimal process chains. That is why dental labs should regard digitisation as an opportunity. From stand-alone solutions to value chains t o w a r d s At the beginning of the digital dental world there were stand-alone solutions, single work steps, but nowadays there is more and more consideration of complex dental lab processes that can be implemented on a totally digital basis. It all started with implant n a v i g a t i o n , d i g i t a l f u n c t i o n diagnostics, and the production of aesthetic dental restorations in the form of crowns and bridges, and nowadays these have already become mainstream, so to speak, in an innovative, modern-day dental lab. The next step in a dental world that is becoming increasingly digital is a d v a n c e m e n t t h e consideration of entire value chains— including the process of making full dentures. Backward planning for full dentures—the digital value adding process in reverse! While in the past the introduction of digital technologies chiefly aimed at indication-related solutions for individual work steps, the focus of digital dental technologies is now on entire value adding processes. One of the last groups of topics and areas of indications, which, in digital terms, has so far only been dealt with in passing, is total prosthetics. Here in particular, though, there are innovative digital approaches that will simplify and speed up production. This is where pioneering digital revolutions are accounting for yet another milestone in digital dental technology. The future scenario is depicted in Figure 6. After all, total prosthetics does not merit the reputation of being an ‘unloved child’. For dentists and dental technicians it still does not have the same level of importance as other prosthetic restorations. But why? It is certainly not due to the fact that patients are so difficult, or total prosthetics generally is so unattractive to dentists and dental technicians. On the contrary. Production of a precision- fit, functional and aesthetic prosthesis is often a major challenge to dentists and dental technicians. Especially because with edentulous patients important information is frequently missing to be able to achieve an optimal reconstruction of the jaw and mouth. The main reason is rather that the dentist’s and dental technician’s services to be rendered for a full denture are both extensive and elaborate and the fee chargeable for the service cannot cover the costs incurred. In Germany, between 300,000 and 400,000 full dentures are still being made every year. And according to expert opinion, the figure will tend to remain constant in years to come owing to a longer life expectancy and sociodemographic change. With an average total fee rate of approx. €1,000–1,400 per full denture this market segment has a volume of over €300 million—and that only applies to Germany. Consequently, total prosthetics still ranks as one of the most important areas of prosthetics. T h e c o m p l e x i t y o f t o d a y ' s production process for a full denture is illustrated by the following flow chart. Production of a conventional prosthesis is currently based on complex interaction between the dentist, dental technician and patient. In an idealised process flow, there are at least five appointments for the patient and dentist, which can take several days or even a few weeks. From the very first appointment the work starts to be dispatched, from the first impression, functional impression and occlusal record to the first wax model, until, after much to and fro between the dental practice and the dental lab, the final denture can be fitted in the last appointment. The dentist's net treatment time in the chair can then total about 2.5 hours. Quite often another one to two more appointments are required. Per appointment there is a calculated preparation and follow-up time of at least 5 minutes so if there are five appointments another 25 minutes have to be added on. Consequently, dental practice time soon totals 3 hours or more for a full denture. At the dental lab end, the level of complexity is even higher. From initial model impression taking to final completion the dental lab can expect to have dental lab work amounting to 6–8 hours. This does not include pick- up and delivery times for commuting between the dental lab and the dental p r a c t i c e . E v e n a f t e r d e n t u r e incorporation there is often rework, which is time-consuming and not included in the service fee. The conventional workflow (Fig. 5) for making a full denture therefore positively cries out for an approach to address the last bulwark of the conventional dental process chain and make a digital solution available. The future of the full denture is digital That is definite. Although nowadays there are ways of simplifying individual work steps with a scanner and a CAD/CAM milling machine (prosthesis baseplate or basing arches made from industrially prefabricated blanks), consideration of the process chain as a whole has so far been missing. This is the approach adopted in the following illustrated solution with a full denture based on completely digital development and production. The entire solution concept is based on the principle of backward planning. In real terms this means that a full denture completed by a master craftsman is customised to suit the patient's oral situation, with just one appointment! Very soon the production of a full denture will take place in a fully digital process—from digital impression taking to production, completely devoid of dust and plaster. Unfortunately the digital scanning systems available at present are not yet able to provide the option of comprehensive collection of oral situation information in a single appointment, but it is definitely only a matter of time. Until then the jaw relation, palate, centric relation and aesthetics will be recorded by analogue means and then transferred to the digital system. By this method, all the data for making the prosthesis later is collected in just one appointment. The process is followed by comparing the digital data with a prosthesis database, selecting the appropriate milling blanks with previously polymerized dental arches, and the modelling of the gums, which vary from patient to patient. After transferring it to the CAM module all that has to be done is mill the respective maxillary/mandibular pair. That is followed by finalisation in the dental lab and a second appointment at the dentist's for the purpose of incorporation. The finished product is a functional, precision-fit, highly aesthetic dental restoration of master craftsmanship quality, made in Germany! This new future-oriented method called Baltic Denture System uses digital technologies to make the production of a full denture economically profitable again for the dental practice and the dental lab, for the first time in years. Despite digitisation, market participants remain the same and the value adding process takes place within the familiar, implemented structures. Digital technology as an option for additional business With the aforementioned method of production and by focusing on a small number of analogue processes in the dental lab there is more scope for new lines of business for dental labs. The dental lab of the future will no doubt regard itself increasingly as a partner and service unit for its dentist and be capable of taking ‘troublesome’ issues off his hands. In addition, the dental lab can manage the data stream for its client to ensure optimal results. Another field of activity that presents itself as a result of digital techniques is that of dental aesthetics! One example is the concept of lächeln2go (smile to go), which, with its Fig 7: BDLoad (maxillary and mandibular milling blank in occlusion, available in various sizes) before milling process. Fig 8: BDLoad (maxillary and mandibular milling blank in occlusion, available in various sizes) before milling process. Fig 9: Process-integrated BDCreator CAD Software. Fig 10: BDLoad, during milling process. Fig 11: BDLoad, after milling process. Fig 12: BDLoad, after milling process. volunteers, first developed the concept of dental aesthetics as a new line of business. What is impressive is the use of a two-dimensional aesthetics check that makes it easy to record dental status and aesthetic deficits. Conclusion It remains to be seen who the winners and losers of increasing digitisation will be. The fact is that we are not yet at the end of optimal digital workflow. It is still important to modernise and develop digital processes. However, the opportunities are quite clearly in the majority, and due to optimisation in the process chain the resulting work has a higher Continued on page 15

Dental Tribune Pakistan Edition No.5, 2016

Pages Overview