Computers; Your Dentist Today

Design your own smile

Will you need a dentist in the future? (I am sure a lot of your do not want to see a dentist in the first place). Lets imagine this; you get into photo cubicle, a photo is taken, then  on the screen you will be given the option to select the color, shape, size and the way you desire from the menu, you check it on your picture , once you are satisfied, click OK, the vending machine will hand you the veneers; wear it and enjoy the pearly smile.

CAD/CAM stands for computer added design/ computer aided manufacture. It is an engineering and computer technology used for decades in automobile industry and had been introduced in dentistry in the last 20 years (Believe it or not most of dental devices invented by engineers).  CAD/CAM is supporting an efficient dental practice with cost effective, time saving, comfortable, and aid in cross- infection control. (Vinothkumar et al, 2011)

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Figure 1: A Ceramic Veneer Created by CAD/CAM

First, I will highlight the most common “traditional” steps that practiced in dental office and dental lab, to create the beautiful smile (veneers, restorations, implants, and ceramic replacements). The dentist will prepare the tooth, and then take impression to create an exact replica in lab. In the dental laboratory, the dental technican will create by carving the desired replacement in wax, and then cast to a metal or ceramic, then fire it in oven. The lab procedures usually take couple of weeks. When it is ready it will be sent to the dentist for final correction and cementation. All the previous complicated steps, and the multiple appointments for preparation, measurements and trial-in, take long time and efforts. Well, not anymore, one-day dentistry is applicable with CAD/CAM.

There is two CAD/CAM system in dentistry classified according to the steps and the location. It could be in dental office or dental lab. The system that supported the one day dentistry is the one in dental office. First the image will be taken with intra-oral camera. This camera is very specific and unique, in-general it should have all those qualities, precision, fast (full mouth image in 3D can be created in two minutes), focus, resistance to fluids and breath.  And the images produced either still or continuous. A still camera will take multiple images which will be stitched together to create the 3D typographical shape. The image acquisition can be taken with laser camera to reflect the light off the tooth structure. Others systems uses a probe with the camera to touch the tooth to achieve the focal length. In the other hand, continuous images or video camera will create the 3D from a video recording the full geometry in one scanning shot. In all the systems the camera is light handheld and easily operated. Furthermore, the pictures will be transmitted, saved and view on the computer monitor. In the screen the patient can see his profile, 3D model of his mouth teeth and the specific tooth/ teeth condition The pre-operative picture of the patient, and the intended post-operative. 3D models can be examined, rotated and viewed from different angles. Interactive animation showing treatment option can be created with few keystrokes.

Figure 2;CEREC CAD/ CAM System

The high resolution images created in raster (bitmapped format). Raster images made of pixels. These high resolution images range in color from 23-32 bits.Some systems' software will change the bitmapped images to vector images (R2V, vectorization). Vector graphics made by lines and shapes which allow further correction or changes in the design. Others may use hybrid forms of combined vector and raster graphics. The analog images will be converted to digital graphics to be displayed. The system software will edit. change, and manipulate the images according to the user performances.(UIC, n.d.). The software database is well structured with normal teeth shapes, the anatomy of the teeth , the occlusion , the prepration measurments in microns, the shades, and the algorithms of the natural teeth sizes and the correllation between upper and lower teeth.

So there is no need for impression, wax-up, carving or heavy oven to create the final restoration. Not to forget the save in time money and staff. Also the dentist can change the  design with a “virtual system” where the dentist can manually by moving the mouse or through ‘‘touch screen” can modify and adjust the restoration before the milling. All these steps can be reviewed and repeated if necessary without the waste of time, material or resources. So if every thing is as required an order will be requested with just a click to start the metal or ceramic (the material used for restorations and veneers) milling. Milling machine is the main part beside the computer and camera to give the sensible final product. Furthermore, the time efficiency feature  is augmented with ability of the CAD/ CAM to receive another order  and design it, while fabrication an earlier processed order.(Potincy DJ, Klim J, 2010)

After milling (which take 5-15 minutes, traditionally in dental lab it takes two days) the dentist can virtually place the restoration on the tooth and check if there is any deficiency or impurities, then  it will be polished and glazed. Then the restorations will be bonded to the teeth and the patient dismissed.

At the end, sorry fellows but still you have to wait for the veneers you want for couple of weeks after your teeth prepared because simply we do not have yet the technology here.

Smile, Life is Good

References:

Thilla Sekar Vinothkumar, Deivanayagam Kandaswamy, and Pallavi Chanana. CAD/CAM fabricated single-unit all-ceramic post–core–crown restoration. Journal of Conservative Dentistry, 2011 Jan-Mar; 14(1): 86–89


CEREC. Retrived at 1st December 2011 from http://www.cereconline.com/cerec/


University of Illinois, Dental Informatics. Retrieved at 28th November 2011, from http://www.uic.edu/classes/dadm/dadm396/Lect2graph05/inform3c104.htm 

Potincy DJ, Klim J.CAD/CAM in-office technology: innovations after 25 years for predictable, esthetic outcomes. Journal of American Dental Association, 2010June; 141, suppl 2,5S-9-S