Dr. Russell GiordanoWe’ll continue to see increasing use of digital technology until, ultimately, every fabrication step is done on the computer.
The dentist will scan the patient’s mouth with an intraoral camera to generate a digital impression, use a digital facebow to check occlusion and record movements, create a digital bite registration and take the shade using a digital shade-taking system. The laboratory will work with that digital data to create the opposing dentition, a virtual articulator and the final restoration. Technicians will know exactly what the dentist wants in terms of function, shape and esthetics; this completely digital process will eliminate the need for physical impressions and solid casts and remove much of the guesswork between the dental team members.
All of these elements are here now but what’s needed to make it more of a reality are advances in virtual articulation software. Manufacturers are working on these developments and, in fact, Sirona’s CEREC software already has some virtual articulation capabilities.
Rapid prototyping
Laboratories are already experiencing the benefits of rapid prototyping technology with 3-D printers from Imagen, EnvisionTEC and 3D Systems and we’ll continue to see this material-saving technology proliferate. Looking 10 to 15 years down the road, technicians will be able to layer restorations with different types of “ink”—ceramics, polymers or metals suspended in solution—to print frameworks and full contour restorations. They’ll be able to combine functionally graded materials for maximum restoration design; for instance, layer a high-strength material in high-stress areas and then apply a more esthetic ceramic or polymer, or fabricate a custom implant in one piece.
Resin improvements
I expect to see improvements in composite resins with further developments in the use of nano particle fillers and alternative resins that minimize polymerization shrinkage. This will lead to additional improvements in wear resistance, color stability and stress resistance. With these more resilient composites, technicians will be able to fabricate larger restorations that won’t deform or decay. There’s also research being done on “smart materials,” such as self-healing resins that contain a monomer and catalyst that are released when a restoration cracks and work to repair the crack. Other smart materials may release fluoride when the pH drops to a certain level or contain antibiotics that are released to combat bacteria-causing tooth decay or periodontal disease.
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