Today, I don’t have any CAD/CAM products in my office. As a start-up practice with only two years under our belts, we just don’t have an extra $100,000 lying around to invest in equipment like that. But I believe that is going to change much sooner rather than later.
I think that we are about to see something amazing happen in dentistry and it won’t take some incredible leap of technology.
Here’s my view of the future: patients will elect to have a preliminary extra-oral cone beam scan of their dentition and surrounding structures to be stored on file for later use. Imagine this scenario:
Bob presents to your office with a missing molar. Some dentist extracted it last year and now Bob is ready to replace it. You contact Bob’s former dentist and have his preliminary cone beam CT scan e-mailed to you. Sure enough, Bob still had his molar when he had the scan done years ago. From this original scan, you use your software to choose the position of the implant and design an abutment based on the original contours and position of the molar. A click of the mouse and your CAM machine sets to milling your surgical guide. After the implant is placed and integrated, another couple clicks of the mouse and you have an abutment and crown ready to go. Bob’s new tooth looks just like his old one.
Why an extra-oral scan? Because it allows us to capture the alveolar bone and vital bits of anatomy. Intra-oral scans, which are not cone beam CT, only capture supragingival structures. That will not be sufficient for planning things like implant surgeries. Also, the current powdering process required for intra-oral scanners is a bit clumsy for me. Sure, it works for a few units of crown and bridge, and some scanners out there don’t require powder, but it is still a bit technique sensitive.
Now keep in mind that this preliminary extra-oral scan will not replace the full-mouth series. We will still rely on digital radiographs to detect caries, periodontal disease, and pathology on a routine basis. The radiation from cone beam scan is just a little too high for annual use.
When would we need a second scan? Imagine that Bob’s extractions didn’t go so well and there’s a large bony defect. If we believe the anatomy has changed significantly since the preliminary scan then we may wisely choose to get another digital peek at the bone. But we would still use the preliminary scan to learn the original contours and position of the missing molar. We simply compare the two scans (preliminary and new) in our software and make our decisions.
But this concept is not limited to implants! What if Bob still has his molar and it just fractured off some cusps? We can prepare the tooth for a crown, take a “digital impression” with an intra-oral scanner, translate that data to the preliminary scan, and manufacture a restoration with the missing contours filled in. Current in-office CAD/CAM systems design restorations based on a memory bank of dental morphology. We then tweak the suggested design to better suit the patient’s needs. The difference is that Bob’s crown would be based on his original tooth.
This isn’t science fiction. We can be there in… five years? Less? We already have the CAD/CAM hardware and software on the market to make this happen. We just need to integrate. The companies that will lead the way will do so by removing proprietary restrictions. The data from one scanner must become compatible with the milling unit of another, and so on. Seamless integration will be the catalyst that brings CAD/CAM into every dental office.
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