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Impression-Less Dentistry

Remember getting braces as a kid?

The process started with molds of your upper and lower jaws, a process that in dentistry is called “impressions!’ You probably remember the goopy mess, the gagging, and the less-than-pleas­ant taste. Not the best way to start a multi-year commitment to orthodontic treatment! The dental “impression” remained virtually unchanged for 60+ years–until very recently. Thanks to the digital revolution, impressions are rap­idly being replaced by digital intra-oral scans.

The sole purpose of a dental im­pression is to transfer information about a patient’s dentition to the laboratory where it can be processed at a later date. Once the impression was complete, it was “poured up” with a stone slurry, much like plaster, creating a “model.” Now, there was a replica of the patient’s teeth in the dental laboratory, waiting for whichever step happened next: or­thodontic consultation, crown or bridge fabrication, cosmetic treatment plan­ning, and so on.

Today, digital intra-oral scanners have mostly replaced this technique. With one chair-side computer/digital scanning unit, a dentist can very ac­curately capture images of a patient’s upper and lower teeth in 30 seconds or less. No gagging, no putty, no odor. The images are extremely accurate, and the data can be viewed in 3D like any other CAD-CAM file. The digital “model” can be stored indefinitely, and it will never clutter up the office! It can be instantly exported to any laboratory in the world for implant, crown, bridge, night guard, or denture fabrication. Gen­eral dentist and specialist can hold on­line treatment-planning sessions with the digital model and plan dental treat­ments down to the micron!

The most common application right now is chair-side fabrication of dental crowns and bridges. The image cap­tured with the scanner is coupled to a CAD-CAM mill which fabricates a dental crown on-the-spot. The second most common application is night-guard fabrication. In this case, while the scan is performed chair-side, the file is ex­ported to a laboratory that makes the night-guard. Perhaps the most import­ant application is pediatric dentistry. When it comes time to make a child’s orthodontic retainer or spacer, a quick scan is often all that is necessary! The area of dentistry that is expanding most quickly now is implant dentistry. When a patient is preparing to undergo den­tal implant surgery, a CT scan is often performed. This image can be merged with the intra-oral scan, creating a 3D view of the patient’s teeth overlaid with the bone. Virtual dental implant sur­gery can be performed on the computer screen, then exported to a lab for further processing, all before any actual surgery has been performed!

Overall, impression-less dentistry greatly enhances the dental patient ex­perience. It allows for very high quality and accurate dental treatment, fast turn­around time and better dental provider collaboration. Who knows what another 5 years of technological advancement will bring?

Christopher J. Root

DMD MAGD

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