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and doubts, we know more than ever that only science can overcome old concepts and preconceptions.
Like me, you the reader will be able to reduce doubts and opinions based on concepts that are often outdated, and face the new, with KNOWLEDGE.
Ronaldo Hirata DDS, MS, PhD
Assistant Professor of Biomaterials NYU
Private practice in Curitiba, Brazil
International lecturer with more than 150 papers and four books published
Preface
As dental professionals, we should always make sure that our knowledge and skills are up to date to improve our ability to care for our patients. In the current congresses and symposia, a number of exhibitors have been demonstrating technological products to be used in most areas of dentistry. On social media, it is also common to see professionals showing interesting clinical results after using these new products and related techniques. Even in dental research, we can see many new articles and even some new scientific journals focused on digital dentistry.
As a young professor who had just come back from Harvard University to Brazil in 2015, I was very excited to bring the new methodologies to the dental clinic of my family in São Paulo. My main research interest at that time, however, was magnetic resonance imaging in dentistry. Furthermore, as a clinician, I was dedicated almost solely to implant dentistry and was not fully convinced about the benefits of image‐guided surgeries. Similarly, my father was already performing CAD‐CAM crowns, but still using conventional impressions with the polyvinyl siloxane materials that he always loved to use.
Three years later, I met some of the opinion leaders of digital dentistry, who are now very good friends of mine. We were lucky that dentistry in Brazil has always been very well developed and respected. As a result, several congresses and conferences brought us opportunities to see new courses and exhibitors, always with the most novel and exciting technologies and techniques for digital workflow in dentistry. Several clinicians were doing an amazing job in applying the new technologies to enhance predictability in performing the principles of dentistry, which were actually the same. Despite everything seeming so promising, I realized that the train of digital dentistry was still at the station as regards research and evidence‐based knowledge. At that point, I changed the main focus of my research to CAD‐CAM and digital dentistry, and since then I have been in love with the topic.
After obtaining clinical and scientific knowledge on CAD‐CAM, and talking to expert friends, I began to wonder: what if we had a book in the form of a step‐by‐step guide to provide evidence‐based knowledge of the techniques that professionals might want to perform using these new tools to improve their practice? In addition, what if this could come along with an atlas of clinical cases, performed by me, my father, and the professionals that I have always admired in digital dentistry?
As a result of a huge team effort, this book aims to help colleagues who are dentists, dental technicians, and other members of the dental team to improve their skills to promote patient care. We did our best to try to help our community here. On the other hand, we know that several techniques and approaches are still being developed and investigated. So, this book shows what we know so far, and what we have been doing with the existing tools, techniques, and knowledge, rather than trying to define what is the best approach for every clinical situation. There are three initial chapters describing basic knowledge of CAD‐CAM and eight other chapters covering all applications of digital dentistry. Since we also want the new methods to benefit all patients in a collective and inclusive way, there is also a chapter on the role of digital dentistry in preventive dentistry and public dental health. The final chapter is basically an atlas of clinical cases performed by the experts whom I have admired most in the field.
I really hope this book can be useful at some point in all our dental practices, and I thank all my co‐authors and my team at the University of Malta for all the support that I have received.
Thank you very much,
Professor Arthur R.G. Cortes
Chapter 1 Introduction to Digital Dentistry
Renan L.B. da Silva, Jun Ho Kim, Roberto A. Markarian, Rui Falacho, Djalma N. Cortes, Alan J.M. Costa, and Arthur R.G. Cortes
SUMMARY
This chapter will discuss all the terms and definitions that the dental professional needs to know to understand the procedures discussed in the following chapters. Such definitions include abbreviations and general concepts of digital imaging and digital workflow. The chapter also presents a history of the use of CAD‐CAM in dentistry in the last two decades, and the basic knowledge required plus ideas and alternatives to start with digital dentistry.
1.1 Definitions
Digital dentistry is the term used to describe the different modalities of dental treatment workflow that are mostly performed with the use of digital technologies. Several digital methods have been incorporated to dental practice to replace conventional methods and techniques in order to enhance treatment planning and predictability of execution. Nowadays, digital dentistry is considered a whole field of study within dentistry. As with any other field of study, digital dentistry involves a learning curve to be mastered and used in the clinical routine. Ultimately, the dental professional is responsible for using existing digital tools appropriately for patient treatment. In other words, the basic theories of dentistry are still the same and should be very well known by the professional, who will be able to use these new digital tools to enhance predictability in executing the treatment plan.
In order to become familiar with digital dentistry and take advantage of its benefits, it is required to learn a series of important concepts and abbreviations. The most important of these are discussed below.
1.1.1 Three‐Dimensional Imaging
Conventional two‐dimensional (2D) imaging modalities usually have several limitations such as image distortion, magnification, superimposition of anatomical structures, and lack of three‐dimensional (3D) information for diagnosis and planning. In this context, 3D imaging modalities such as cone beam computed tomography (CBCT), intraoral and facial scanning systems provide 3D digital images for dentistry [1–3]. CBCT imaging allows for visualization and assessment of bone structures with high diagnostic accuracy and precision. For CBCT images, the professional needs to understand image acquisition parameters, since the quality of the image affects the quality of the work in digital dentistry. There are several CBCT acquisition parameters, such as field of view size (FOV), peak kilovoltage (kVp), milliamperage (mA), and voxel size. Each of these parameters has an influence on CBCT quality [2–5].
Intraoral and facial scanning can capture 3D patient images that can be used for digital treatment planning systems (Figure 1.1). The software will then develop a digital representation of the 3D object surfaces available, which will be automatically converted into 3D images composed by wireframe models.
Any 3D images can be rendered and edited in the 3D space, before being converted and saved in a specific file format [5]. As discussed in the next chapter, three file formats are commonly used in digital dentistry: OBJ, STL, and PLY. These files are based on the geometric reconstruction of objects by vectors, triangles or polygons, considering their positioning in a 3D space. After all data is ready, it is possible to store the shape of a model and other details such as color or texture.