Dentistry in the digital age
The use of gypsum in dentistry can be traced back to the early-18th century to create moulds for rudimentary replacement teeth. The process has advanced to incorporate silicone, but the practice of inserting a gooey impression and fixing it manually in the mouth endures.
For many dentists, it is an archaic, industrial approach and one they are leaving behind as the profession establishes a digital presence that has been gathering pace for more than a decade.
Dentistry has long moved on from its stark past of conveyer belt filling factories treating a generation raised with poor oral health education. But surveys still show that almost half of us have a fear of the dentist with 12 per cent suffering extreme dental anxiety.
A wave of new dentistry seeks to cure that. It uses digital workflow systems and computer-aided design and computer-aided milling (CAD/CAM) to revolutionise protocols for implants, dentures, crowns, bridges and other oral architecture.
The traditional month-long journey for a crown fitting from moulding to delivery is being replaced by a precision-guided digitised performance that can be completed on the day.
Teeth are scanned with a wireless intraoral scanner feeding information into a computer that displays images for the patient to see and then drives a milling machine to fabricate a crown in the same room.
Early adopters are enthusiastic about their results with greater engagement for patients, who feel a part of the treatment pathway, rather than a captive audience in the dentist’s chair. But the UK lags behind Germany and the United States in uptake with estimates that digital dentistry is only available in around 15 per cent of practices.
The capital expenditure entry costs – around £12,000 for scanning and £70,000 for milling equipment – can be prohibitive and a recent survey by the Eastman Dental Institute at University College London revealed concerns over costs, maintenance, equipment becoming obsolete, training time and a perceived lack of benefit over traditional methods.
We will see this sort of technology in every dental surgery over the next five years
“The majority of surveyed dentists were interested in incorporating CAD/CAM into their workflow, while most believed that it will have a big role in the future,” according to the survey paper in the British Dental Journal. “There are still some concerns from dentists about the quality of chair-side CAD/CAM restorations while the costs are still in the main hugely prohibitive .”
The main uptake has been through private dentistry, but research by the Institute has highlighted a strong return on investment with a digital cost of £21 for a restoration compared to the £200 for conventional impression materials and laboratory technician work.
“Cost and training are important things to get right, but I believe that we will see this sort of technology in every dental surgery over the next five years.”