Dr Alif Moosajee discusses the significance of digital dentistry advancement over the past 25 years, and the necessity of using CEREC in your practice.
CEREC is older than Dentistry.co.uk!
Even though Dentistry.co.uk is celebrating its 25 year anniversary, CEREC has actually been around for over 35 years.
It goes without saying that things have changed over that time. It’s become a far more sophisticated technology.
Core to its principal has always been to have a method of acquiring information about the patient’s mouth (an acquisition unit or digital scanner). This is so that restorations can be designed and manufactured for the patient while they wait.
As far as the patient experience is concerned, it is leaps and bounds above having an impression made and having to wait for a second visit in order to have the restoration fit.
However, I think it’s fair to say earlier iterations of the technology were crude. They often resulted in restorations that were technically inferior to what labs could provide at the time.
Although, as mentioned, things have changed and improvements have been made. Today the accuracy, ease of data acquisition and sophistication of the software have all come together. They provide an experience that is second to none for both the patient and clinician.
That is why the arguments against ‘going digital’ are now much harder to align with. This has resulted in more practices and clinicians adopting a digital workflow.
It is now the norm to be a digital dentist or dental professional. Before, however, those who adopted a digital workflow were seen as the outliers.
So let’s go into a little bit more detail as to what adopting a digital workflow means for those people who are involved in its usage.
Digital benefits for the clinician
We touched on the fact that when you do a crown with CEREC you only need one appointment rather than having two separate appointments for preparation and fit. This obviously makes the treatment far more efficient for the clinician.
I used to book 50 minutes for a crown prep and then 20 minutes two weeks later for the fit. So, it would stand to reason for me that I would book an hour and 10 minutes for a CEREC treatment. This is so that I’ve got time to do the prep and fit.
However, I don’t need to spend time temporising the tooth or indeed spend time waiting for local to work and removing the temporary (as I would on the day of fit). This means I end up taking less clinical time then I used to.
What I now find is I frequently finish well within the allocated time. I’m also left with about 10 to 15 minutes in the middle of the appointment when the crown is milling. This is time that I can use either for admin or for seeing an emergency or another patient if I have to.
So you can see how this has greatly improved my efficiency. Not to mention improving the convenience for the patient.
Another benefit for me is that I now have total control over the complete workflow. I’m no longer reliant on a technician who may or may not have the same vision for how the restoration should look. I am able to design and tweak the restoration to ensure that I am perfectly happy with it before I fit it.
I have also found that the fit of the restoration is far better. Also, the amount of adjustment I need is far reduced when compared to when I used to receive work from the laboratory. This is a result of a conventional impression and analogue workflow.
‘I now have total control’
This has really improved the confidence I have for providing indirect restorations which has led me to feel far more confident about doing bigger and bigger cases. Now I know that the basic things with respect to fit, contacts and occlusion will take care of themselves. So, I am happy doing quadrants, arches and full mouths knowing that there won’t be big problems with remakes.
The software has also been designed really nicely to allow me to have functions like biocopy and ‘copy and mirror’.
‘Copy and mirror’ allows me to utilise the shape of a contralateral tooth in order to drive the design of the tooth that I’m working on. I find this is excellent for upper centrals and upper lateral where we know that symmetry is key to giving us the chance of a beautiful result.
Biocopy is also a lovely function which allows me to copy the pre-op position to ensure that the restoration I get is exactly the same.
This is really nice if we want to copy an existing crown or to copy the shape of a tooth if it’s a cobalt-chrome abutment for example. But it’s also extremely useful if we decide that the patient is happy with a wax up or a provisional smile design that we’ve created. This is because if we have made adjustments to these then we can copy those adjustments into the final restorations we do.
I feel this has brought a degree of control to bigger cases which I never felt I had before introducing CEREC to my clinical practice.
Digital benefits for the patient
For patients I have found that the feedback I get again and again is how they much prefer being able to have the full treatment done in a single visit. It is so much more convenient for them. I think they often comment on how they are so happy that they no longer have to have impressions done.
The other thing I have really noticed for the benefit of patients is that sometimes I was unhappy with the fit, contacts or occlusion after waiting two weeks to fit a restoration. I would often find myself desperately trying to modify and adjust the crown in order to fit it.
Often with patients waiting in the waiting room for me and the expectation of the patient who has waited for two weeks for this crown to be fit, I would become stressed. I wonder if this resonates with my colleagues that, with this stressed mindset, one often makes decisions which in the cold light of day seem poor.
I have often looked at crowns that I have hacked to pieces but still cemented in. When viewed six months later when I next examine the patient, I wonder how I ever let myself fit that into my patient’s mouth.
I have found that my tolerance for sub standard restorations has now reduced. It is now at the point where, if I can’t fit a crown after making a couple of very small adjustments within a minute or two, I’m already looking to understand why the crown is not right. I will then make preparations to scan again and re-make the restoration.
‘I’m no longer compromising on the quality of restorations’
I think this is one of the best elements about making the crown in-house. This is because if things don’t fit you can go right back to the drawing board and make sure they do fit the second time.
This means I’m no longer compromising on the quality of restorations that I do for my patients.
One of the newer things we can now do with the CEREC workflow is to print in the house. One of the things I like to print is a digital try in of a smile design. This can be done at the very start of treatment, long before you’ve had to do any tooth preparation or indeed, anything irreversible.
I found that this is such a lovely thing to do if we are thinking about a new smile for the patient. This is because it allows us all to preview how it looks in the patient’s mouth with the context of the lips and the rest of the face framing that new smile.
It gives us all the chance to critique the proposed plan long before we commit to any treatment. If we realise that patients are not happy at this stage then we have the opportunity to tell them that we may not be able to meet their expectations long before it’s too late.
Equally if patients are happy at this stage then we have a very clear blueprint to work toward. I find that it eliminates much of the stress when providing a new smile for your patient. I think it’s one of the most powerful communication and consent tools we have in dentistry today.
Digital benefits for the practice
If I swap hats from dentist to practice owner, I can look back and say that introducing CEREC to my practice shortly after I bought it has been one of the best decisions I made.
When one takes over a practice where patients have been happy with the outgoing principal, there is a huge element of fear. You are hoping that you can keep patients happy and satisfied so that they won’t leave you after you have spent all of this money on purchasing their goodwill.
Introducing CEREC conveyed a clear message to my patients that we were here to improve the quality of treatment to our patients.
As mentioned before, patients love the convenience. They really engage nicely with the technology that we brought in. They could clearly see how it was benefiting not only the quality of the treatment that we did, but also the quality of the experience they had at the practice.
Investing in the technology also meant that the dentists and the nurses were very happy to work in that environment. They could see that the leadership in the practice was doing all they could to improve the offering for patients.
Ultimately, CEREC was a fantastic vehicle for differentiating ourselves as a practice from other practices in the area. This is because it was easy to demonstrate that we were different in the way that we could provide dentistry for our patients.
Looking to the next 25 years
I think the future for digital dentistry is very bright, especially with new technologies that I’m sure we’re going to see in the next 25 years or even sooner.
I am very excited about how intra oral scanners will become even more powerful. They will not only be able to acquire information about the shape of teeth but also more information about the colour.
In future we will be able to acquire a perfect three-dimensional copy of a jaw. We will also able to 3D print teeth with porcelain, providing all the colour and character.
If we can provide these three-dimensionally printed restorations, they will make the dentistry we provide for our patients almost indistinguishable from their natural teeth. This is because of the chromaticity and value which has been acquired from the scan, as well as our ability to create life like and realistic restorations.
It will make that beautiful experience of fitting a restoration and having it disappear into the smile, simple, predictable and an every day occurrence.
The future in dentistry is bright and the future is certainly a digital one.
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