According to Dr Eoin O’Sullivan and his dental technician Angelo Zuccari Plini, accurate, predictable results and better communication between the doctor and laboratory are two key features of digital workflows. They shared their experience on the iTero™ Digital Excellence Series webinar – Going Digital in 2024: Elevate your daily practice.
Sharing the example of a restorative case, they explained why and how they use digital tools and the benefits they bring to the doctor, laboratory, and patient. ‘With analogue workflows, getting work back from the lab can sometimes be like opening a mystery box – there can be a degree of unpredictability at times. The benefit of digital tools is to reduce that unpredictability,’ advised Dr O’Sullivan. ‘That’s what allows all the different components of the digital workflow to start talking together and to unleash the full potential of digital. It is far more than simply taking impressions. It improves our collaboration by enhancing our communication, by improving predictability and improving the efficiency of our respective processes, and ultimately allowing us to work together in a much more efficient way.’
The case study centred on a patient who had fractured a front tooth, which needed immediate composite bonding repair, followed by a more permanent crown. To enable this, Dr O’Sullivan and Angelo Zuccari Plini realised they faced several challenges, including communication of the fine nuances of shade detail and surface characterisation of the crown to ensure it blended perfectly with the patient’s existing dentition.
This was where an intraoral scan made the difference because much more information could be gathered than with a traditional analogue impression. The scan also recorded the occlusion and opposing dentition in one piece of data, in both colour and monochrome, which enabled every tiny detail to be clearly visible, including the margins. Angelo said, ‘Monochrome offers a much more defined view. I always suggest looking at digital impressions in monochrome to identify discrepancies in your prep that you may want to retouch.’
“Monochrome offers a much more defined view. I suggest looking at digital impressions in monochrome to identify discrepancies.”
He also explained that because the iTero scanner allows photographs to be added to the patient prescription as part of the same data set as the intraoral scans, laboratories have everything they need under the patient’s name in one place and accessible at any time. The iTero scanner also comes with a suite of digital tools, including near-infrared imaging (NIRI) technology, which enables clinicians and laboratory technicians to clearly see any translucent areas to replicate the correct shade in the finished restoration.
Dr O’Sullivan added that an initial overview scan of the full arch can be blended with other scans for a more detailed understanding of treatment considerations and needs. He also stressed the importance of the initial scan, suggesting that webinar participants conduct the ‘most generous acquisition’ to obtain as much data as possible because the lab will need to merge all the impressions to achieve the final restoration. ‘Just try to have a good flow of acquisition. Do not rush it because that does affect definition’, he advised.
Dr O’Sullivan also pointed out that in a traditional analogue workflow, these would now be sent to the laboratory, potentially by post or courier if the lab was close enough. ‘Either way, that precious impression, the only record of what you’ve done, is now being transported to the laboratory, and there is potential for things to be lost or damaged. In a digital workflow, the analogue impression is replaced by an STL file, of which you can have multiple copies, which you send directly to the laboratory.’
He also referred to the latest iteration of the iTero-exocad Connector™, which brings together all the various apps and platforms dentists use to communicate with their laboratories: ‘This is a huge game changer because it means you don’t have to keep track of multiple things.’ He also stressed that a digital workflow allows practices to use any digital lab worldwide: ‘Suddenly, you have freedom. Geography is no longer a limiting factor.’
The digital workflow also allows changes to be made to the initial prep easily. Dr O’Sullivan noted, ‘In this case, Angelo was able to point out I needed a little more space … and he was able to clearly show me exactly where he needed that space. I was able to make the appropriate modifications, rescan the patient, and send it back to
the laboratory.’ Then Angelo could use exocad WebView – an app for tablets, smartphones, or computers – to share the restoration designs with Dr O’Sullivan.
‘I can see exactly what Angelo has designed and look at every aspect to ensure it’s what I’m expecting and that nothing has been lost in translation. I can then either approve it or get back to him.’
Angelo added, ‘This has also taken some liability away from the lab because we’re able to technically show limitations so the doctor can decide … and that’s how it should be – for the clinician to take responsibility and appreciate the benefits of what the laboratory is doing.’
Conclusion
In conclusion, they both stressed that the benefit of a digital workflow was minimising the steps needed to complete treatment, removing much of the unpredictable nature of treatment planning, all while supporting the interaction and communication between dental practice and laboratory in one ‘smooth and seamless process’.
SOURCES
1) Kordaß B, Lotze M: Aufbiss, Zähne und Gehirn. In: Böhme H, Slominski B (Hrsg): Das Orale. Wilhelm Fink Verlag, München, 2013
2) Kordaß B, Ruge S. Lösungsansätze für einen Virtuellen Artikulator. wissen kompakt 2018; DOI 10.1007/s11838-018-0075-1
3) Ruge S, John D, Kordass B. Perspectives for the CAD/CAM world on the visualization of a digital occlusion during mastication. J Craniomandibular Function 2013; 5:163–75
4) Hugger A, Kordaß B: Handbuch Instrumentelle Funktionsanalyse und funktionelle Okklusion. Wissenschaftliche Evidenz und klinisches Vorgehen. Quintessenz 2018, S.234-248
NOTES
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