SHOW REVIEW industry The battle between digital and analogue Interview with Dr Galip Gurel, Dr Stefan Koubi & Hilal Kuday an easy task. The main problem was that many dentists couldn’t translate it to the patient’s mouth. We realised that many of our colleagues don’t use mock-ups. They take an impression, send it to the lab and the lab tech- nician prepares a wax-up. Back then, the lab technicians didn’t have much supporting material. They had only a few photographs and a stone model, and they tried to build up the entire case based on that. Nothing was per- sonalised. Everything changed the moment we realised that our IT team could transform 2-D into 3-D. That is how Rebel was born. Thanks to Rebel, we can transform all of this know- ledge into a 3-D digital wax-up, which can be sent to the dentist for 3-D printing, then for impressions and back to the patient’s mouth. This is the chronology of how personalised smile design became a reality. A few years ago, you emphasised the importance of proper communica- tion with lab technicians. Does Rebel help in this matter? Gurel: I think Rebel is an ama z- ing tool for ceramists—and I am not talking only for ceramists like Hilal, who is a superstar and a great profes- sional. For the majority of lab techni- cians, Rebel represents an amazing tool and opportunity to immediately create a 3-D wax-up that not only is aesthetic in their opinion, but also perfectly suits the patient’s facial ap- pearance and personality. At the be- ginning when starting beta testing of this project and giving lectures to dentists and lab technicians, the lab technicians were the fi rst to embrace the idea because it makes their lives much easier. Instead of spending hours carving and sculpting the wax- up without having all the infor- library and you can include as many tooth shapes and forms as you like. And after that, you can play with the software and make some modifi ca- tions. The problem is that most den- tists are not able to experiment with the software because we don’t have the knowledge and ability to do it. That’s the main problem with smile design: the dentists are not able to ex- periment with the software and the lab technicians have one and the same signature. Rebel provides a solution, giving you the advantage of outsourcing the headache of smile design. We have to be realistic: most dentists are not able to use the soft- ware or Keynote properly; we are dentists, not fancy speakers, or we just don’t have enough time to spend hours in front of the computer. The ceramists don’t have the knowledge or ability to create all the different Left to right: Hilal Kuday, Dr Stefan Koubi and Dr Galip Gürel at the Competence in Esthetics event in Belgrade in 2018. © Ulyana Vincheva As I mentioned in our lecture, when you go into Rebel, there are some mandatory fi elds you need to fi ll in, like the facial photographs, the intraoral scanning, the question- naire, and your or your patient’s pre- ferences. For example, if you would like to have a mild surface texture or a strong or smooth one, you need to enter this information into the soft- ware. 90 per cent of the infor mation needed can be entered only by click- ing, nothing further. Some of the data needs to be entered as a text, but this is very limited, so defi nitely I can state that Rebel is extremely user- friendly. From a technical perspective, if you send a case without writing anything, only with the information that has been registered by clicking and se- lecting one of the given options, you will still have a 100 per cent di gital wax-up. Maybe only 5 per cent needs to be entered manually by the clini- cian in order to complete the smile de- sign. As far as I know, to date, this is the only software that instantly gives you a 100 per cent digital 3-D wax-up. mation and parameters needed, with Rebel they can have an accurate wax-up ready in a split second. Of course, they can make some small changes if they like. In my lecture, you saw how amazingly one can translate all details, like surface tex- ture and tooth shape, into 3-D print- ing or CAD/CAM milling in order to be tested in the patient’s mouth even before one starts prepping the teeth. Dr Koubi, what are the benefi ts of digital technology for dentists? Koubi: I would like to briefl y address the previous two questions. Generally speaking, you have two realities. One is the patient’s expecta- tions. Patients would always prefer a customised smile, not a standardised one. And the second one is the tech- nician’s abilities. Most lab techni- cians have a specifi c signature, their own style, and they pretty much re- peat it with every case. I am talking about the majority of technicians, not the top professionals. The beauty of the software is that you have a digital tooth morphologies because there are more than 12,000 different tooth shapes. That is where Rebel comes in; its algorithm supports you in this task. Returning to the question, the benefi t for dentists is that it is so user-friendly—you just plug and play! Rebel saves a great deal of time and gives you a quality product, so it meets every dentist’s needs! Mr Kuday, would you like to add something to this topic? Kuday: As a dental technician, I would like to say that digital work- fl ow is a tool you can always rely on. If you integrate digital technology into your everyday practice, it defi - nitely raises the quality of your work. We dental technicians study anatomy, biology and morphology and are a part of the team, so if dentists don’t respect our work as lab technicians and don’t send us all information needed to create beautiful, nicely fi tting prosthetic restorations, then our hands are tied. Fortunately, I am lucky to work with dental experts The use of digital technologies in dentistry is on the rise, a fact that clinicians Dr Galip Gurel, Dr Stefan Koubi and dental technician Hilal Kuday are well aware of. They are convinced that the use of modern technologies is a growing trend in all areas and to believe that this will not come to the dental clinic would be a big mistake. Ulyana Vincheva, Managing Director of Dental Tribune Bulgaria and publisher of Dental Tri- bune Bulgarian Edition, had the op- portunity to talk with them about their lecture during the 2018 Com- petence in Esthetics meeting held in Belgrade in Serbia on 10 November and organised by Ivoclar Vivadent. They told her of their fascination for digital dentistry and their vision of the near future, in which they be- lieve virtual reality and artifi cial in- telligence will feature. You are three of the world’s top ex- perts in dentistry and you work to- gether as a team, but you are also good friends, right? Koubi: Of course! Nicely done teamwork is only possible among people who like each other. During your lecture you spoke about “the most personalised smile de- sign”. What is the point? Do you believe in the individualised approach for every case, and how does it fi t in with a fully digitalised workfl ow? Gurel: As I explained in our lec- ture, we have been working like this for years. It provides a personal touch. It depends on your intuition how you approach and evaluate the patient and his or her smile. Even with this protocol, you should have some trials. Maybe sometimes the re- sult will be superb; sometimes the pa- tient won’t like it. Our workfl ow was already a personalised smile design, but we didn’t know it until we started our research. When we started shar- ing cases with each other, at fi rst, we selected only the best cases, trying to evaluate which part of the smile design goes with which part of the patient. Does it depend on physical appearance, which we can’t change, or on personality, how the patient wants to be perceived? We frag - men ted all these smiles and tried to ana lyse, for example, on what the tooth axis depends, on what the tooth shape depends. After that, we cross- matched these cases and came out with some results, which we put into a software programme. This software is based on hundreds of algorithms, and most recently, we developed soft- ware that is driven by artifi cial intel- ligence and suggests smile designs that are appropriate for the patient because they go well with his or her facial appearance and his or her per- sonality. That is how we started using this programme. The fi rst stop was the VisagiSmile, which gives us the 2-D design. This programme was amazing for someone who is into aes- thetics. If I show the programme to Hilal or to Stefan, they will under- stand it and transfer it to the patient either as a mock-up or a wax-up, but for majority of the dentists it wasn’t like Drs Gurel and Koubi, who ap- preciate my work in the lab. All of the precious information that they re gister from the patient’s mouth, the questionnaire in Rebel, give us an idea of how to follow nature. At the end of the day, we are a team; we sit down and work together in order to create a beautiful job as partners. Koubi: With Rebel, we are not talking about replacing the lab tech- nician; we are talking about support- ing and assisting him or her. It is very important to keep that in mind. Rebel is a very useful tool to improve the quality of the technician’s work in order to create even more beautiful restorations. Gurel: One other thing: thanks to Rebel, even more dentists who were previously afraid to work in the aesthetic zone will go into aesthetic dentistry. Imagine that every patient who needs an aesthetic treatment is like an empty canvas. You need to create an artwork there and not every dentist is capable of doing that. Rebel gives you the opportunity to create a masterpiece without worrying about how to use Rebel. All other pro- grammes, as Stefan and Hilal have already said, require detailed com- puter knowledge in order to create proper smile designs or a great deal of time to work with digital libraries, to position the teeth and to establish a really aesthetic smile. For the den- tist to be able to achieve a perfect smile with a single mock-up is a completely different story. That’s the beauty and ease of using Rebel. The effect of integrating Rebel into the dental world will not be erasing and replacing all dental technicians. In- stead, it will create a huge commu- nity of dentists doing aesthetic cases, which will increase the number of veneers, crowns and bridges to be made. As an end result, more dental technicians will be needed to cope with the rising needs. You have touched on some advan- tages of digital technology, but what are its limitations? Gurel: Well, there are always limitations. First of all, it won’t work in extremely crowded dentition. We shouldn’t expect miracles. Rebel can cope with cases with a reasonable initial situation, for example minor crowding or minor spacing. It is not mandatory for the restorative tech- nique to be additive for every case. That’s another great advantage of Rebel, meaning that if a part of a tooth is protruding out of the aes- thetic arch, the software doesn’t take that into account. It will place the original shape over the ideal arch position, leaving that part outside. The advantage of this is that in a tra- ditional system in order to put the wax-up into the patient’s mouth we have to fi rst cut the protruding edge of the tooth and then make the mock-up, which means we have al- ready started prepping the teeth and if the patient is not satisfi ed, it will be a problem. With Rebel, you can transfer the mock-up into the mouth 24 38 th International Dental Show 2019