International Journal of Dental and Health Sciences Review Article Volume 04,Issue 03

PROSTHODONTICS IN THE DIGITAL AGE: A REVIEW Aditya Sharma 1, Shashidhara H. S. 2, Vijayalakshmi C. R.3, Karishma Jagadeesh4 1. PG Student, Deptt. of and Implantology, College of Dental Sciences, Davangere, Karnataka, India 2. Professor, Deptt. of Prosthodontics and Implantology, College of Dental Sciences, Davangere, Karnataka, India 3. PG Student, Deptt. of Prosthodontics and Implantology, College of Dental Sciences, Davangere, Karnataka, India 4. PG Student, Deptt. of Prosthodontics and Implantology, College of Dental Sciences, Davangere, Karnataka, India

ABSTRACT: Digitalization is the integration of digital technologies into everyday life by the digitization of everything that can be digitized. All aspects of life are getting digitalized in the present time, including . From the introduction of computer-aided designing/computer-aided manufacturing into dentistry in the 1980s to the application of digital impressions, cone beam computed tomography and jaw tracking devices presently, dentistry and specifically Prosthodontics have entered the digital age. The present review aims to highlight the various areas of prosthodontics where digitization has had an impact and the various advantages it has over conventional techniques. For discussion these advancements have been discussed under the clinical and laboratory aspects. There is an endless scope of digitization and technological advancements in prosthodontics. With future research going on in the areas of optical coherence tomography, nano- optics, lasers and 3-D printing technology, the future of digital dentistry is bright. Key-words: Digitization, Digital Technology, Virtual Dentistry, Advances in Prosthodontics, CAD/CAM, CBCT, Digital Impressions, Stereolithography

INTRODUCTION

Innovation and improvement in oral therapeutic technologies such as the acid health and the techniques used to etch technique and osseointegrated diagnose, prevent, and intervene in . Today, therapeutic providing optimal oral health is a interventions involve digital diagnostic, continuous process. Dentistry can be treatment planning, and prosthesis dated back to the eighteenth century, design/manufacturing techniques that when impressions meant use of waxes are revolutionizing patient care. [5] and plaster of Paris[1]; and the dental equipment consisted of hand driven and In the clinical aspect, digitization has later water driven motors. From then revolutionized imaging and diagnostic there’s been a long journey to achieve options. While the information gleaned the contemporary paraphernalia.[2,3,4] from a dental radiograph is substantial, Dentistry’s earliest innovations were there are limitations associated with the [6] highlighted in diagnostics (e.g. use of a two-dimensional image. Cone ) and followed by prevention beam computed tomography (CBCT) (e.g., understanding of biofilm-mediated provides images of high contrasting disease and the discovery of fluoride’s structures and is therefore particularly role in caries prevention). Recent well-suited towards the imaging of decades have seen innovation in osseous structures of the craniofacial area. The use of CBCT technology in

*Corresponding Author Address: Dr. Aditya Sharma. E-mail: [email protected] Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 clinical dental practice provides a time, minimized error potential and number of advantages for maxillofacial better quality assurance. [9] The present imaging. [7] review aims to highlight the effects of digitization on various aspects of Impression making, an important tool in prosthodontic treatment and the treatment planning as well as prosthesis advantages that it has over conventional fabrication, conventionally involves the techniques. use of impression materials like elastomers and elastic impression DIGITIZATION IN PROSTHODONTICS materials. Digital impression making, on the other hand, requires the operator to The evolution of digitization in the field scan the teeth and tissues with an of prosthodontics can be categorized in intraoral scanner. The resulting the following way: impression is automatically stored as 1. Diagnosis and Treatment Planning: digital data and is much more accurate.[8] a. Imaging techniques On the laboratory side, computer-aided b. Digital impressions design/computer-aided manufacturing c. Occlusion and jaw movement (CAD/CAM) of prosthetic crowns/bridges analyzers is available. Development in the field of d. Jaw Tracking devices CAD/CAM gained momentum in the e. Patient management software 1980s. The first CAD/CAM prototype was 2. Clinical Procedures: patented by Dr. Duret in 1984. a. Removable prostheses Conventionally, prosthesis fabrication b. Fixed prostheses includes making a wax pattern, investing, c. Implants casting, ceramming and finishing of the d. Maxillofacial prosthetics /bridge. A CAD/CAM machine 3. Laboratory Procedures: enables the technician/dentist to plan, a) Computer-aided fabricate and deliver the prosthesis with designing/computer-aided the help of digital software and manufacturing (CAD/CAM): additive/subtractive manufacturing. i. Subtractive manufacturing CAD/CAM technology, stereolithography, ii. Additive manufacturing: rapid prototyping, use of virtual a) Stereolithography articulators etc. has digitized the lab b) Inkjet-based systems or 3-D Printing procedures. [9] c) Selective Laser Sintering d) Fused Deposition Modeling The modern dental practice has endless b. Virtual articulators options for preserving oral and DIAGNOSIS AND TREATMENT stomatognathic health and can provide PLANNING next to natural aesthetics with an enhanced approach, reduced treatment Imaging Techniques

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Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 The introduction of panoramic are comparable to the conventional CTs radiography in the 1950s and its and may be displayed as a full head view, widespread adoption throughout the as a skull view, or as localized regional 1970s and 80s heralded major progress views. [10] The uses of CBCT technology in dental radiology. Digital panoramic are in[11]: radiography systems became available by 1995. However, both intraoral and 1. Diagnosis. extraoral procedures suffer from the 2. Clinical applications. same inherent limitations of all planar 3. Clinical evaluation of treatment two-dimensional (2D) projections. outcomes. Numerous efforts have been made Digital impressions towards three-dimensional (3D) The philosophy for today’s traditional radiographic imaging and while impression materials began in the mid- computed tomography (CT) has been 1930’s with the introduction of available, its application in dentistry has reversible hydrocolloids. By the 1950’s been limited. The introduction of CBCT polysulphides were introduced and for specifically dedicated to imaging the the first time an elastomeric material maxillofacial region heralds a true was employed. Though an improvement paradigm shift. [7] in reproducing the characteristics of CBCT is accomplished using a rotation in prepared teeth, there were still inherent which a pyramidal- or cone-shaped x-ray problems. Consequently, digital beam is directed towards an area x-ray approaches were created to circumvent detector on the other side of the the traditional obstacles of the existing patient’s head. Cone-beam geometry has impression materials. inherent quickness in volumetric data The first optical impression unit was acquisition and uses a comparatively less introduced by Sirona Dental Systems expensive radiation detector (Figure 1). under the CEREC name. The principle is Herein lies its potential for significant based on a “point and click” technology cost savings and reduced radiation which strings together a number of exposure. [7] individual pictures of the same object. It has been reported that the total More recently, 3M ESPE introduced the radiation is approximately 20% of Lava C.O.S. (Chairside Oral Scanner) conventional CTs and equivalent to a full system. The main improvement to the mouth periapical radiographic exposure. original digital scanner was the use of CBCT can therefore be recommended as 3D-in-motion technology. This a dose-sparing technique compared with technology, in contrast to the “point and alternative standard medical CT scans for click” systems, captures continuous 3D common oral and maxillofacial video images and displays these images radiographic imaging tasks. The images in real time on a touch screen monitor

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Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 (Figure 2). Once the image is captured 5. Digital impressions can be stored and stored, it is then electronically indefinitely as data in a computer transferred to the dental laboratory. and thus help in recordkeeping. Subsequently, models for the case are 6. Virtual models can be obtained. fabricated using stereolithoghraphy, Occlusion and Jaw Movement Analyzers which allows the technician to complete the restoration. [12] Occlusion analyzing systems are available to measure occlusal forces and quantify There are two classifications of digital how well balanced a patient's occlusion devices[13]: is. Conventionally, strips of articulating paper are used to indicate contacts in  CAD/CAM devices that include an occlusion. These, however cannot: intraoral digital scanner for capturing impressions of the prepared teeth, as  differentiate between centric and well as synchronized units for both eccentric contacts and, designing and milling the restorations  cannot predict the magnitude and from blocks of ceramic or composite direction of occlusal forces. materials The T-scan (Tekscan) and Dental Prescale  Dedicated intraoral digital scanners Occluzer (Fuji Film Co.) are two such that capture data that can be sent to systems for occlusal analysis which bring laboratories and other facilities, objective precision measurement to the where stereolithic or milled models largely subjectively analyzed discipline of and dies are created from the data, occlusion. which are then articulated and sent to dental laboratories for the custom T-Scan System fabrication of the restorations. Since its inception in 1984, this Advantages over conventional technology has undergone much impressions: evolution over the past 30 years 1. Digital impressions eliminate the beginning with T-Scan I, then T-Scan II for uncomfortable experience of making Windows, to T-Scan III with Turbo a physical impression. recording, to the present day version 2. Digital impressions are an incredible known as T-Scan 8. teaching and evaluation tool because Present day Computerized Occlusal tooth preparation can be checked Analysis technology records and quickly and corrected in real time. displays for clinical interpretation, tooth 3. The image on the monitor shows if all contact timing sequences and tooth the needed data has been captured contact, fluctuating relative occlusal before sending it to the lab. force levels, which occur during 4. Disinfection of impressions is a non- functional mandibular movements. issue with a digital system. These occlusal data measurements are

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Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 recorded intraorally with an ultra-thin, occlusion. Numerous approaches have mylar-encased sensor that is connected been reported to record mandibular to a computer workstation via a USB movements. Conventionally interface. This sensor is placed between prosthodontists use interocclusal wax a patient’s teeth to record changing records for condylar guidance settings. tooth-tooth contact interactions. The However, the accuracy of this method is displayed relative occlusal force and questionable. Electronic pantographs timing data aids in the examination and were introduced in 1983 to minimize treatment of occlusal abnormalities on errors occurring in the transferring natural teeth, dental prostheses, and procedure and to improve the efficiency. dental implant prostheses.[14] The Denar Cadiax is one such system. It eliminates the need to rely solely on T-Scan Applications in Implant inter occlusal or average settings to Prosthodontics: program the articulator and enables precise recording of all jaw movements. The occlusal forces that are applied to an [16] implant prosthesis can be a potentially destructive factor in shortening the Jaw Tracking Devices potential longevity of any implant prosthesis. Poorly directed and non- If transitional occlusal contact points on uniform occlusal loading will torque a dentition during functional jaw prosthesis and apply stresses that may movements can be observed graphically, ultimately result in prosthetic failures. it will dramatically improve the With the aid of the T-Scan Occlusal realization and evaluation of dental Analysis System, occlusal forces that are occlusion for both research and clinics. applied to an implant prosthesis can be This technology is now available with the quantitatively represented for improved help of jaw tracking devices. correction through occlusal adjustments. Visualization of occlusion requires a [15] three-dimensional configuration record of the maxillary and mandibular Denar Cadiax System dentitions and six-degree-of-freedom jaw movement data with a 10 Using the information resulting from the micrometre accuracy level.[17] patients’ jaw movements, dentists can reproduce occlusal surface forms of the Planmeca 4D Jaw Motion System restorations in accordance with the patients’ teeth and available This is a CBCT integrated solution for restorations. These data can also be used tracking, recording, visualising and for articulator settings, improving of the analysing jaw movements in 3D. With diagnosis and treatment of Planmeca 4D Jaw Motion, it is possible to temporomandibular joint disorders measure and record the movement path (TMDs), and analysis of the patients’ of one or more points of interest in a 3D 663

Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 image. For occlusion analysis, digital available systems like AvaDent (AvaDent dental models can be aligned with a Digital Dental Solutions) and Dentca CBCT image. These jaw tracking devices (Dentca, Inc.). [18] can also be used to study the occlusal contacts. Jaw movement data obtained The entire digital CAD/CAM process from these devices can be super- consists of the following appointments: imposed onto virtual 3-D models 1. Impressions. (obtained by scanning actual patient 2. Jaw relation records. models) and the resulting data is used to 3. Occlusal plane orientation. calculate the minimum distance between 4. Tooth mould and shade selection. the maxillary and mandibular occlusal 5. Maxillary anterior tooth positioning surfaces. [17] record. Patient Management Software 6. Placement of dentures. The AvaDent denture technique uses an Dental practices usually employ the Anatomical Measuring Device (AMD) services of auxiliary staff for practice and that can be adjusted to the desired patient management. Software are occlusal vertical dimension and then available that can enable the dentist or used to maintain that dimension while auxiliary staff to manage everything centric relation is recorded using the entirely via a computer system. This incorporated gothic arch tracing plate allows a completely paper-free practice. and stylus. The AMD is also used to determine the correct amount of upper MOGO is one such Dental Practice lip support, the position of the maxillary Management software. Powered by the six anterior teeth, and the desired Microsoft Cloud, it provides features like mediolateral orientation of the occlusal appointment booking, clinical charting, plane. In addition, there is an occlusal eReminders, imaging, paperless practice, plane orientation ruler that can be business reports and word processor. inserted into the maxillary AMD and AeronaClinic, by Aerona Software Ltd, is used to record the alignment of the another cloud based Practice maxillary AMD with the interpupillary Management solution which is web line to make it possible for the computer based. program to align the maxillary teeth with the interpupillary line. [18, 19] CLINICAL PROCEDURES The CAD/CAM process offers significant Removable Prostheses advantages to the dental practitioner Recently, CAD/CAM technology has and the patient[18]: become commercially available for 1. It is possible to record all the clinical fabrication of complete dentures with data for complete dentures in one the introduction of commercially appointment (one to two hours). 664

Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 2. Clinical chair time is reduced software. It has satisfactory long-term considerably, thereby providing the results. A recent iteration of the system opportunity for a more cost- can fabricate not only original inlays and effective set of appropriately onlays, but also crowns and the accurate complete dentures. cores/frameworks of FPDs in both clinical 3. A repository of digital data remains and laboratory settings. [20] available that allows for more rapid fabrication of a spare denture, a Advantage of the CEREC system: replacement denture, or even a 1. CEREC technology makes it possible radiographic or surgical template to produce and integrate ceramic that aids in the planning and restorations in a single placement of dental implants in the appointment. future. 2. Unlike other materials such as 4. The digital data are associated with amalgam or gold, ceramic is more a specific practitioner, it is more biocompatible and has tooth-like likely that patients will return to the physical and esthetic qualities. dentist who fabricated their first 3. Digital impressions are more digital denture when future comfortable for patients than treatment is needed. traditional impressions. 5. Because the denture base is 4. Time-intensive occlusion fabricated by machining, adjustments are not required. polymerization shrinkage of the The success rate of CEREC restorations is resin is eliminated, and the fit of the as high as 95.5% following a period of 9 denture base is superior to that of years[21] and 84% after 18 years. [22] conventionally fabricated denture bases. Implants Fixed Prostheses For implant placement, conventional Prof. Werner H. Mörmann and Dr. Marco dental panoramic and periapical Brandestini, at the University of Zurich in radiography are often performed with 1980, attempted to use new technology the patient wearing a radiographic to fabricate ceramic crowns in a dental template simulating the preoperative office clinically at the chairside of prosthetic design. However, these patients. This led to the development of imaging techniques do not provide the Chairside Economical Restoration of complete three-dimensional (3-D) Esthetic Ceramics, or CEramic information of the patient’s anatomy. In REConstruction (CEREC) system (Figure addition, conventional surgical templates 3). have been fabricated on the diagnostic cast that will direct the bone entry point The CEREC system has been continually and angulations of the drill, but they improved in terms of both apparatus and neither reference the underlying 665

Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 anatomical structures nor provide exact Maxillofacial Prosthetics 3-D guidance.[23, 24] Much early work regarding digital To overcome these limitations in dental advancement in maxillofacial prosthetics implantology, current research has been involved making an anatomical form dedicated to developing techniques that using rapid prototyping (RP) processes can provide optimal 3-D implant such as stereolithography or laminated positioning with respect to both object manufacture. This research, prosthetic and anatomical parameters. however, did not attempt to integrate The introduction of CT, 3-D implant the RP technologies into existing planning software, and CAD/CAM prosthetic practice or was limited to the technology has undoubtedly been an production of an anatomical form that important achievement in this field. The was used as a pattern for replication into digital CT (also including CBCT) images more appropriate materials via derived in this way can be converted into secondary processes such as silicone a virtual 3-D model of the treatment moulds or vacuum casting. [25] area. This provides the practitioner with a realistic view of the patient’s bony Later research attempted to use RP anatomy, thus permitting a virtual methods to produce moulds from which execution of the surgery in an ideal and prosthesis forms could be moulded. precise prosthetically driven manner.[23] Other researchers attempted to exploit the ability of the ThermoJet (3D Systems Different approaches have been Inc.) process to produce prosthesis forms introduced to transfer this planned in a wax material that was comparable to digital information to the clinical the waxes used in the typical prosthetic situation. Mechanical positioning devices laboratory5. Recent advances in or drilling machines convert the technology, including a new generation radiographic template to a surgical of CT scanners and 3-D model-making RP template by executing a computer systems, facilitate the production of transformation algorithm. Other facial prostheses. [25] approaches include CAD/CAM technology to generate In one case report, the patient’s ear was stereolithographic templates (Figure 4) scanned using CT. Magics RP or bur tracking to allow for (Materialise) image ware was employed intraoperative real-time tracking of the to provide interactive segmentation of drills according to the planned trajectory. the 3-D anatomy. The midline of the face The so called navigation systems was used as the axis of symmetry, and visualize the actual position of the the image of the normal ear was surgical instrument in the surgical area extracted, mirrored, and placed on the on the reconstructed 3-D image data of side of the face with the deficiency. By a the patient on a screen. [23, 24] laminated object manufacturing (LOM)

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Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 system, a paper ear model was made. aided design and computer-aided Silicone was used to make a cavity block manufacturing (CAD/CAM) technology. of the paper ear by vacuum casting. In dentistry, the major developments of Then, according to the patient’s skin dental CAD/CAM systems occurred in the color, pigment was added into the 1980s. elastomer. Elastomer was poured into the silicone cavity to create a silicone There were three pioneers in particular auricular prosthesis. [6] who contributed to the development of the current dental CAD/CAM systems. Design and fabrication of auricular Dr. Duret was the first in the field of prostheses by CAD/CAM is dental CAD/CAM development. From advantageous, since a highly skilled 1971 he began to fabricate crowns with technician is not required to sculpt a wax the functional shape of the occlusal ear. The whole process is undertaken surface. He then developed the Sopha solely on the computer, and the patient System, which had an impact on the later can see the result on the screen before development of dental CAD/CAM the ear is fabricated. In addition, the systems in the world. The second is Dr. digital image and silicone mould can be Moermann, the developer of the CEREC preserved. The latter is durable and system. He attempted to use new permits multiple pourings. This is technology in a dental office clinically at important, since a replacement is usually the chairside of patients. The emergence required every two years because of of this system was really innovative discoloration of the pigments in silicone because it allowed same-day ceramic elastomer. [26] restorations. When this system was announced, it rapidly spread the term LABORATORY PROCEDURES CAD/CAM to the dental profession. The third is Dr. Andersson, the developer of Computer-Aided Designing/Computer- the Procera system. At the beginning of Aided Manufacturing (CAD/CAM) the 1980s, he attempted to fabricate Owing to the increased demand for safe titanium copings by spark erosion and and esthetically pleasing dental introduced CAD/CAM technology into materials, new high-strength ceramic the process of composite veneered materials have been recently introduced restorations. This was the application of as materials for dental devices. Since CAD/CAM in a specialized procedure as these materials have proved to be part of a total processing system. This inimical to conventional dental system later developed as a processing processing technology, new center networked with satellite digitizers sophisticated processing technologies around the world. Such networked and systems have been anticipated for production systems are currently being introduction into dentistry. One solution introduced by a number of companies to this is the introduction of computer- worldwide. [20] 667

Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 All CAD/CAM systems consist of three The data of the construction can be components: stored in various data formats. The basis therefore is often standard triangle 1. A digitization tool/scanner that language (STL) data. The CAD software transforms geometry into digital data can be used to design copings and bridge that can be processed by the frameworks, crowns and bridges, computer. inlays/onlays/veneers, customized 2. Software that processes data and, implant abutments, implant bridges and depending on the application, bars, surgical implant placement guides produces a data set for the product and provide virtual diagnostic wax-ups. to be fabricated. RPD frameworks can also be designed 3. A production technology that with CAD. transforms the data set into the desired product. The CAM process The Digitization Process The actual coping or framework can be Most of the current commercial fabricated via two methods (Figure 5): CAD/CAM systems available for the fabrication of crowns and FPDs use a  Subtractive manufacturing stone model as their starting point. The  Additive manufacturing surface of a stone model is measured using various measuring tools to obtain Subtractive manufacturing[27]: the digital data that represent the morphology of the target tooth. These The construction data produced with the measuring tools are called digitizers and CAD software are converted into milling scanners. A variety of methods of strips for the CAM-processing and finally digitizing have been investigated and loaded into the milling device. Processing developed. The methods currently devices are distinguished by means of available for practical use are a contact the number of milling axes: probe, a laser displacement gauge and a 1. 3-axis devices line laser beam with a CCD camera[20] [27] and optical scanners. 2. 4-axis devices

The CAD process 3. 5-axis devices

Three-dimensional data are produced on Additive manufacturing[29]: the basis of the master die. These data are processed by means of specialized Subtractive methods have some dental design software. After the CAD- limitations in comparison with additive process the data is sent to a special techniques. Rapid prototyping (RP) milling device that produces the real techniques, the so-called “generative geometry of the object[28]. manufacturing techniques”, exhibit the 668

Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 potential to overcome the described parts from showing through peri- shortages. RP simply consists of two implant tissue. phases: virtual phase (modelling and 7. Latest innovation in CAD/CAM simulating) and physical phase systems allows occlusion to be viewed (fabrication). The chief benefit of RP and developed in a dynamic state. techniques is models that can be The application of dental CAD/CAM produced with undercuts, voids, intricate systems is promising, not only in the field internal geometrical details and of crowns and FPDs, but also in other anatomical landmarks. fields of dentistry. There is no doubt that the application of CAD/CAM technology Classification of RP technologies in in dentistry provides innovative, state-of- [29] dentistry : the-art dental service, and contributes to the health and Quality of Life (QOL) of 1. Stereolithography people. 2. Inkjet-based system 3. Selective laser sintering Virtual Articulators 4. Fused deposition modeling A few advantages of using CAD/CAM Innovative research in the field of Virtual technology are[28]: Reality (VR) has found applications in the field of prosthodontics with several 1. Applications of new materials – high articulator designs which are used for strength ceramics that are expected fabrication of restorations compatible to be the new materials for FPD with the stomatognathic system. The frameworks have been difficult to transition from numerous mechanical process using conventional dental articulator designs to recently developed laboratory technologies. virtual articulators is a major 2. Time effectiveness. breakthrough in the development of the 3. Reduced labour. articulator design[30]. 4. Quality control. 5. Scanning an image and viewing it on a Virtual articulators are also called as computer screen allows the dentist to “software articulators” as they are not review the preparation and concrete but exist only as a computer impression, and make immediate program. They comprise of virtual adjustments to the preparation condylar and incisal guide planes. Guide and/or remake the impression if planes can be measured precisely using necessary. jaw motion analysers or average values 6. By using CAD/CAM zirconium implant are set in the program like average value abutments, light transmission into the articulator.[30] gingival sulcus is allowed, thus preventing the grey of opaque metal 1. The virtual articulators are able to design prostheses kinematically.

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Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 2. They are capable of simulating human Advances in digital imaging, computer mandibular movements, by moving aided design, internet communication, digitalized occlusal surfaces against digital manufacturing and new materials each other. have undoubtedly simplified the diagnostic process and improved 3. They enable correction of digitalized treatment outcomes. In clinical practice, occlusal surfaces to produce smooth digital technology has impact over and collision-free movements. patient motivation, practice management and clinical treatment The virtual articulator is a precise procedures. Imaging techniques like RVG software tool that deals with the and CBCT help to visualize the anatomic functional aspects of occlusion along structures in a more detailed and precise with CAD/CAM systems substituting way. Digital impression systems enable mechanical articulators and thus accurate and fast recording of avoiding their errors.[30] impressions which are immediately FUTURE PROSPECTS stored as data. Occlusion analyzers help to evaluate the occlusion and diagnose Continued research is required for better occlusal problems, which is not possible dental productivity. Research in areas with conventional techniques. On the like optical coherence tomography (D4D laboratory side, digital technology has Technologies) would allow creating a greatly enhanced the accuracy and sliced image of the tooth or other decreased the time and cumbersome structures. It could be used for potential procedures required to produce quality caries diagnosis, tooth crack location, restorations and prostheses. Using CAD/CAM imaging, subgingival margin CAD/CAM systems, the clinician can location, periodontal diagnosis, soft upload data (impressions, prepared tissue analysis, and more[9]. Upcoming tooth virtual models, case photographs) 3D printing technology (RepRap, directly to the lab technician, who can MakerBot, Robo 3D) and advancements then provide suggestions and the in lasers (Fidelis plus III Er:YAG laser) and treatment can be altered accordingly. It nano-optics also show promise. The time is beneficial for the lab technicians too as isn’t far when the clinician or dental it enables them to conceptualize the assistant will be controlling procedures prosthesis better and have an idea via a computer while a robotic system beforehand. If used well, these digital performs the actual procedure. advancements can redefine the way dentistry is practiced and help to provide CONCLUSION: better treatment results, thereby achieving the utmost for the profession.

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Sharma A. et al, Int J Dent Health Sci 2017; 4(3):659-673 FIGURE 1: : A CBCT scanner; The scanner collects data and reconstructs it, producing what is termed a digital volume composed of 3-D voxels of anatomical data that can then be manipulated and visualized.

FIGURE 2: A digital impression system consisting of an intraoral scanner connected to a workstation with a computer display; A virtual model is obtained through the scan on which a prosthesis can be designed.

FIGURE 3 :The CEREC 3 system (Sirona) can fabricate inlays, onlays, crowns and the FIGURE 4: A guide template for precise implant cores/frameworks of fixed dental placement designed using specialized implant prostheses. planning software and fabricated using stereolithography.

a b

FIGURE 5: Subtractive manufacturing by milling (a) and additive manufacturing by stereolithography (b).

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