In the March edition of Renfert Flashlight this column covered the topic of how analog and digital design/fabrication options link up. On the one hand, interlinking technologies can simplify the workflow for prosthetic restorations considerably. Yet on the other hand, it places new demands on the knowledge and abilities of dental technicians. But no matter what is new, their understanding of the anatomy of the masticatory system continues to form the basis for fabricating correctly functioning, esthetic prosthodontics.
Some consider the accomplishments of modern prosthetic design software programs very impressive or even fascinating. Ready-stored frameworks as well as teeth can be selected, positioned with the click of a mouse and moved within the dental arch. The positioning and axial inclination of the teeth can be adjusted as required. This leaves little to be desired where designing prosthetic restorations virtually is concerned as many software programs include ready-stored libraries of teeth, tooth molds and designs. And that’s not to mention self-designing biomimetic CAD restorations!
But isn’t there something missing? Will it be possible in future to design removable and fixed prosthetic restorations virtually as in a catalog relying almost totally on the knowledge of those who supplied the input for the CAD software?
The answer is: Yes and no. That is, “Yes” if the user trusts this design data totally and assumes that they will match the planned restoration without having to be changed or extended. But the answer has to be “No, that won’t work”, if dental technicians want to customize the restoration to meet patients’ specific needs. This includes, for example, mimetic and phonetic characteristics which are best perceived by meeting the patient personally. And photographs or facial scans, which perhaps mirror the patient’s smile, also provide a useful insight into the patient’s personality. Last, but not least, study models still provide important information for the restoration, such as the contours, positioning and surface texture of the teeth. These models may possibly reveal wear facets which provide a clue as to any specific bite conditions. All of this information can be used for creating “add-ons” for complementing the design suggestions made by the CAD software libraries.
Those dental technicians who take pleasure in observing things will have the most success with these “add-ons” because it is they who will discover the proportions of the teeth and their axial alignment among all the information available on the patient. And they will notice the course of the smile-line and, together with the interdental papillae, its influence on the red/white esthetics. By integrating this and other characteristics into their work, they will achieve a degree of customization which cannot be achieved by CAD software alone. Like this, owing to their anatomical understanding of the face, jaws and teeth, these dental technicians will be able to create patient-tailored, custom restorations bearing their own personal mark. This arises from their knowledge and abilities as well as the use of all design software variables, which is far removed from all “autopilot” CAD designs, which are also possible.
In future computer-aided designing of prosthetic restorations is bound to become even easier. It would be good if thoroughly trained dental technicians able to evaluate at least the functional and esthetic coherence of part and/or fully automatically software-designed restorations were to remain available who could customize them if desired.