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ePaper created 2018-05-16, 11:45:19 | version 1.38.0
associated with an overall loss of bone volume, which means that the rate of re- sorption is higher than the rate of growth of the new bone. In my opinion, the approach is different today. I chose to use biomaterials with a very low substitution rate, which means that they do not resorb or resorb very slowly in order to retain the volume. It is important to preserve the volume, particularly in the esthetic re- gions. Generally, this is done by proteinase scintigraphy or by synthetic materials. The best combination in my opinion is the combination of hydroxyapatite with tri- calcium phosphate. esthetics and performing the correct risk assessment and the correct treatment planning. Q: What are the benefits of the integration of the dental digital workflow and photogra- phy for the prosthetic workflow? What about the interfaces? A: As for the digital workflow, I think that 3-D planning, virtual planning and guided surgery give dentists the possibility of creating a digital 3-D image of the patient. In the beginning, we started with computed tomography and now we are able today to combine different digital files: the image Q: What is the evolution of dentistry as a whole? A: There are two things: minimal invasive- ness—every surgeon or prosthodontist will become more advanced—and digitaliza- tion. Digitalization of society, medicine and dentistry has given us major advantages in diagnostics, allows better treatment plan- ning and facilitates minimal invasiveness. On the other side, digitalization is about individualization, creating customized 3-D-printed implants or bone substitutes made of synthetic materials and custom- ized 3-D ceramic reconstructions. Additive manufacturing techniques are still in the Q: What is your favorite instrument when it comes to minimally invasive therapy? A: Generally speaking, when I think of min- imally invasive surgery, of course it is 3-D planning, so cone beam computed tomog- raphy (CBCT)-guided surgery. At the mo- ment, I see a lot more development and interest in the minimally invasive prosthet- ic approach, which I find very exciting. There are no-prep veneers that can be fabricated from different materials, such as feldspathic ceramic and glass-ceramic. It is impressive that we can achieve beau- tiful results with less anesthesia, less pain, less need for provisionals and less invasive therapy. I can only see advantages with minimally invasive therapy. Q: What is the esthetic challenge in implant dentistry? A: The greatest challenge is definitely the predictability of the pink esthetics. The challenge is the prediction of the inter- action of the hard tissue and soft tissue. The key is the correct risk assessment in every single case, the correct treatment planning. We also have to keep in mind that the surgical way is not always the best and the most predictable way. For exam- ple, in a high-risk situation, one should rather consider a prosthetic option. Let’s use the example of a large tooth in an esthetic region. This is a high-risk situation and proper assessment needs to be con- sidered. It might be more predictable to use a prosthetic solution that proposes the use of pink ceramics instead of a staged surgical approach. In summary, the challenge is the predictability of the pink “What really makes a di(cid:3)er- ence in medicine and dentistry are the small details, tips and tricks that can only be taught in practical courses” of the bone, the CBCT image with an optical scan and the virtual prosthetic set- up can be seen together with the face of the patient. We are now able to create a digital patient, which allows us to perform better treatment planning. The transfer of the information is not yet ideal, however, because we are still often stuck between one step and another. There’s still progress to be achieved. With regard to photography, it is really the standard for today’s procedure plan- ning. When it comes to the prosthetic part and the shade selection, photography is irrelevant in this part of the treatment. Photography is not yet entirely predictable for shade selection, but of course there are techniques, filters, references and so on with spectrophotometers, but personally I think in situations with high esthetic de- mand, I prefer to have direct contact with the technician; it is still the gold standard. beginning phase, but will become more and more interesting, as there are unlimited applications and possibilities. Q: What makes hands-on courses such as the Tribune CME Clinical Masters Program so special when it comes to promoting expertise in esthetics in implant dentistry and the dig- ital workflow? A: What really makes a difference in med- icine and dentistry are the small details, tips and tricks that can only be taught in practical courses. There is one more ele- ment, which is as important as the prac- tical part, and that is the emotional part. The emotions are fundamental when deal- ing with people; it’s clear that we need to understand how to deal with patients and how to explain and propose treatment. Knowledge of these aspects can only be transferred by face-to-face contact in a workshop. Interview Digital Workflow in Esthetics issue 2018 — 27