Supporting Oral Health Through Innovation

Over the years, innovations in dentistry have changed the way oral health professionals manage patients. In modern dentistry, digital technology has provided new diagnostic tools, documentation capabilities, and manufacturing technologies that enhance oral health professionals’ abilities to provide optimal care. The aim of this paper is to illustrate the expanding scope and advantages of digital technology in contemporary dental practice.

DIGITAL OPTIONS

Oral health promotion begins with identifying patients’ oral health risks and behaviors.¹ This enables clinicians to obtain relevant diagnostic information. Keeping complete and accurate records is not only important, it is required by law. Digital technology has made record keeping simple. Clinical records can be collected in digital formats using one of several electronic dental records. Medical and dental histories can be obtained remotely and evaluated prior to a patient’s in-person evaluation.

A current limitation of electronic dental records is that they are largely incompatible with existing electronic health records. With the growing emphasis on the association between oral health and systemic health, the need to communicate easily and accurately with physicians, nurses, pharmacists, and other allied health professionals increases every day. Thus, the integration of electronic dental records with electronic health records should be promoted interprofessionally.²

Digital technology contributes to assessing community needs by providing the basic documentation necessary to better understand the incidence and prevalence of diseases, as well as the factors that represent risks to individuals who comprise communities. The management and utilization of large data sets are emerging as powerful tools to aid both clinicians and policy makers. Fully integrated electronic oral and health care records will facilitate faster and more complete communication between clinicians, payers, laboratories, and researchers.³

Intraoral photography is useful for documentation and patient communication, as it can be performed in real time.⁴ Seeing images of their own mouths can be a remarkable motivator for patients. Such images facilitate discussions regarding patients’ needs at the time of treatment planning. Digital photographs can also be incorporated into esthetic treatment planning, in which patients can envision the beneficial effects of therapy before treatment begins.⁵ As part of the digital dental record, intraoral and peri-oral photographs facilitate longitudinal assessments of oral health and improve communication between dental team members. Finally, intraoral photography contributes to the integrity of dental records from medico-legal perspectives.

More than 30 years ago, the concept of digital crown manufacturing was introduced to replace many traditional clinical and laboratory procedures

Digital radiographic imaging systems eliminate the burdens of emulsion-based chemistry and potential errors in film processing. However, digital radiography represents significant capital expenditures. Other reported barriers include problems integrating with other software systems, increased technical errors, and the sizes and comfort of intraoral sensors.⁶ A major advantage of digital imaging is electronic file management. Maintaining digital images as part of electronic dental records is now recognized as central to optimal record keeping in contemporary dental practice. Furthermore, the proliferation of flat panel monitors in dental operatories permits immediate visualization of images that can be magnified and shared with the patient and clinical team.

The advent of three-dimensional (3D) imaging systems has afforded new advantages to clinical practice. Cone-beam computed tomography (CBCT) provides clinicians with important diagnostic information, especially useful for implant planning, oral maxillofacial and orthodontic treatment planning, and endodontic diagnostics. CBCT images are often fundamental to the communication and planning needed for complex, multistep dental procedures.⁷ These images can support communication among health care providers and laboratory technicians. The Digital Imaging and Communications in Medicine, or DICOM file format has been adopted for dentistry, providing a common output file format that may be imported and reformatted by a number of software programs. While most patients will not require 3D imaging for routine dental care, 3D images may facilitate planning and provide intra-operative guidance for more complex procedures, such as implant placement and third molar extractions.

More than 30 years ago, the concept of digital crown manufacturing was introduced to replace many traditional clinical and laboratory procedures. Advanced optical technologies and greater computing power enabled optical scanning, 3D imaging, and on-site manufacture of milled ceramic, hybrid, and resin restorations within hours of tooth preparation. Today, multiple intraoral scanning hardware systems are able to quickly and accurately obtain anatomic information. These can be linked directly to restoration design and manufacturing systems or sent to laboratories for remote design and manufacture.⁸ Although it remains to be determined how surface-scanned 3D images will be stored in a common file format, surface-scanned images already offer opportunities for clinicians to build more complete patient records that can be longitudinally evaluated.

Intraoral surface-scanning is an alternative to conventional impressions. Scanners have proven to be accurate replacements for elastomeric materials in some situations. Today, scanners are commonly used to provide intracoronal (inlay, onlay) and extracoronal (crown) restorations, small fixed dental prostheses (especially provisional restorations), and orthodontic appliances.⁹ Continued development is focused on the scanning of partially and completely edentulous patients in order to facilitate digital clinical work flows that complement existing digital laboratory work flows for removable partial denture frameworks and complete dentures. One factor that has contributed to the value of intraoral scanners as impression-making devices has been the continuous improvement of milled materials. Milled lithium disilicate or zirconia restorations are inexpensive and provide good esthetics and marginal adaptations. Additional developments in materials and milling technologies will likely provide even greater clinical advantages for digitally manufactured ceramic crowns. Also, if ceramic crowns are not indicated, metal crowns can be manufactured using the same design software. It is now possible to create most intracoronal and extracoronal restorations using the digital technology widely available in dental laboratories.¹⁰

Intraoral scanning is the front end of one of two clinical work flows. The first approach, known as “scan and mill,” involves the scanning and immediate milling of a restoration for delivery within a single appointment. The advantages of immediacy and the absence of provisionalization are obvious. The relative disadvantages are the need to acquire the necessary skill set and the time needed to deliver high-quality milled restorations. The second approach is referred to as “scan only.” This involves scanning a preparation and sending the data to a laboratory for production of the desired restoration. Advantages of the scan-only technology are the leveraging of laboratory expertise to create remarkable restorations, avoiding the capital expenditures and space requirements needed for computer-aided design and computer-aided manufacturing (CAD/CAM) equipment, and preventing the loss of the valuable clinical time needed to design and mill the restorations.

An alternative to intraoral scanning of prepared teeth is to obtain conventional elastomeric impressions by pouring conventional stone models that are then scanned by desktop scanners. This approach is widely used in dental laboratories, and many crowns are manufactured via this route. Specialty practices, such as orthodontics and prosthodontics, may use desktop scanners to store digital files instead of stone casts, input 3D images into CAD/CAM software programs, and better communicate with laboratories and manufacturers.

CONCLUSION

Available digital technologies represent second- or third-generation products that are evolving with the advancements of computer technologies and clinical demand.11 New emphasis on the electronic health records and a growing recognition of the value of a complete digital representation of patients’ intraoral conditions will continue to promote innovation. Emerging trends in mobile health, patient-reporting, and patient-based outcomes will further emphasize the importance of complete digital records. The value of digital information that includes 3D representation of the oral conditions will become increasingly commonplace, improving the daily management of patients’ oral health.

References

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From Dimensions of Dental Hygiene. July 2016;14(07):28,30.