Digital Dentistry. Группа авторов

This derives from the need to name new inventions, and when these ascend to a well‐known state, so does the correlated terminology. A widespread example of this lexicon expansion is the “digital” concept which, in the last century, underwent a huge increase in usage and meaning as an unswerving consequence of modern computing.

However, contrary to what is customary in technology, the term “digital” is by no means a new word. With its etymology in the Latin word digitus, meaning finger or toe, “digital” has come a long way since. In the fifteenth century, the word was used to identify Arabic numbers from 1 to 9 and 0 as digits. It was not until the twentieth century that the term became widespread and gained significance. In the 1930s and 1940s, the existing analogue computing devices which computed data with the normal decimal system were replaced by new machines which functioned with data represented as sequences of discrete digits.

      In the late 1970s, electronics using the digital concept were no longer limited to research institutions and companies. As their cost dropped, the general public started to have access and myriad information sources and equipment were converted to the digital era. From a simple CD to a more complex digital sensor camera, radiovisiography or 3D scanner, the world was changed forever.

      The construct of “digital” did not stop with machine development but acquired a broader meaning. It has evolved to encompass everything linked to digital or computer technology, as well as to describe any computer‐mediated equivalent of an object or entity that exists in the palpable world. Daily uses of this concept are digital shopping carts and digital books, among others. Not only ordinary objects but also professions, expertise fields, and whole organizations acquire the digital connotation when they embrace technology (either hardware or software) for their activities. Examples of this are the many references to digital dentistry or the thriving European Academy of Digital Dentistry that quickly became one of the most respected and widespread scientific societies in the dental field.

      Although the twentieth century was overflowing with the word “digital” as the most significant technological innovation in human history, it is predictable that the twenty‐first century renders the word “digital,” but not the concept, obsolete. As digital becomes the norm, the need to identify it as such becomes archaic. Fields like digital dentistry will overrun the previous model as all dentistry becomes digital, thus eliminating the need for an alias. Similar to the previously named “digital computers,” so digital wax‐ups, digital photography, and many more entities will lose the superfluous prefix.

      Having discussed the past, present, and future general notions of digital, it is imperative to clarify the current concept of digital dentistry, as it may not comply with the ingrained notion promoted and labeled by the industry. Although more widely marketed in oral rehabilitation and surgery fields, digital dentistry has a vast predominance in endodontics, cariology, periodontics, orthodontics, and occlusion, among others. Nowadays, it is clear that digital dentistry encompasses all areas and not only the well‐marketed misconception of “digital” as a synonym of CAD‐CAM dentistry, a common buzzword in oral healthcare. CAD‐CAM technology presents a vast sea of innovation opportunities and is undoubtedly one of the drivers of development in modern dentistry. Nonetheless, according to the concept regulated by the European Academy of Digital Dentistry, “Digital dentistry encompasses any and all scientific, clinical or laboratory techniques and/or procedures with the purpose of examining, diagnosing, treating, assisting directly or indirectly in the treatment, production of medical devices or any other techniques used by dentists and dental technicians to better pursue the goal of improving patient treatment, comfort and outcome, as well as the healthcare professional's work environment.”

      Taking the aforementioned concept, it is perceivable that dentistry areas such as endodontics present an even higher digitalization than other more well‐known digital fields, as endodontists dwell in a fully digitalized workspace where all clinical procedures are performed with the aid of technology – diagnostics with 2D or 3D radiology, microscopes and cameras, apex finders, ultrasonic technology for accessing root canals, static and dynamic endodontic guides, instrumentation with highly advanced digital motors, irrigation activation techniques, and warm obturation methods.

      The mandatory multidisciplinary approach in digital dentistry renders the task of defining a clear historical timeline impossible, as innumerable events, developments and clinical or laboratory fields are involved and intertwined in the modern concept.

      However, focusing on oral rehabilitation and the developments in computer‐aided design and manufacturing, the first CAD‐CAM systems in dentistry date to 1971 when Dr François Duret introduced them in his DDS graduation thesis “Optical Impression,” but the technology had been used since the 1960s in the automobile and aircraft industries.

      In 1984, Dr Duret patented a CAD‐CAM device, which was presented at the Chicago Dental Society Midwinter Meeting of 1989, where a dental crown was fabricated in a record time of 4 hours. In parallel, Dr Werner Mormann worked on the development of a digital scanning system to be used by the general dentist, which was branded CEREC 1 and launched in 1985. This innovative system was composed of a three‐dimensional digital scanner and milling machine which, when combined, would allow dentists to produce chairside ceramic inlays and onlays in single appointments.

Since then, the technology has greatly improved and dentists and dental technicians experience a time when CAD‐CAM can produce results that resemble pure magic, which is what happens when technology is advanced enough. The next two chapters of this book will cover CAD‐CAM technology and available procedures in depth.

      The advent of 3D printing is revolutionizing several dentistry fields, improving the quality and precision of surgical techniques, and gaining a massive preponderance in restorative dentistry. The term 3D printing defines a manufacturing process in which additive techniques are used to build objects one layer at a time, in contrast to milling techniques that require a material block to be ground to the final desired shape.

      Engineer Charles Hull introduced the first 3D printing technology in 1986 with his patented stereolithography (SLA) system and 4 years later, Scott Crump patented the fused deposition modeling (FDM) technique. Widely used in a multitude of manufacturing fields for the last 30 years, 3D printing with newly developed materials is on the verge of radically changing general medicine and dentistry. From the production of surgical guides, study casts, mock‐ups, temporary indirect restorations, occlusal splints, and orthodontic aligners to the more recent production of long‐term resin restorations, complete dentures and even titanium dental implants, this additive technology is thought to be the future of CAM, with some much anticipated innovations in materials and techniques that will soon allow ceramic restorations to be printed with higher customization possibilities and lower raw material waste.

      With the advent of diagnosis, patient and case documentation, treatment planning, novel treatment techniques and more recently throughout the workflow in oral rehabilitation, digital dentistry is a reality with a promising future. However, much more is yet to come and other fields such as artificial intelligence (AI) will play a major and currently unimaginable role in overcoming all known boundaries. Already considered a rising field, AI technology in dentistry has been the focus of serious research. Software with deep learning capabilities is already helping to improve orthodontic treatment outcomes, caries diagnosis, diagnosis and prediction of periodontal diseases, risk assessment of oral cancer, treatment plan suggestions, patient data analysis, and smile design, among others.

      Companies like Pearl, Smilecloud, and LM Instruments, among many others, lead the development of new tools and software capable of autonomously predicting pathology, suggesting treatment plans or providing solutions to improve clinical management and maximize cost‐effective approaches, as well as patient safety.

      Within its many limitations and shortcomings, digital dentistry is an unavoidable new reality. However, it should not be considered as a means of solving all problems and dentist/dental technician errors, but rather as a tool to maximize and improve processes already performed adequately.

      Since the dawn of time, technology has brought forth what lies inside each of us in a sense that both mediocrity or greatness may emerge. Indubitably, a careful and knowledgeable