Digital Dentistry: When dental sciences encounter Industry 4.0, what should we learn about it?

Chiu Shao-Ting
National Yang-Ming University - Taiwan

Due to the technology innovations in Industry 4.0, digital dentistry has become an iconic transformation in modern dental sciences. Facilitated by Industry 4.0, the ever-advancing technologies like 3D printing, computer-aided design (CAD) and computer-aided manufacturing (CAM) have significantly transformed all fields of dental sciences, and contribute to the optimization in clinical treatment. In spite of the new era in dentistry, what should we learn about the technology innovations as a patient, researcher or clinician? In this article, the technical concepts of digital dentistry and CAD/CAM systems are introduced as an example to discuss the necessary skills for the career development in modern dentistry.

Digital Dentistry: When dental sciences encounter Industry 4.0, what should we learn about it?

Shao-Ting Chiu1,*

1Department of Dentistry, National Yang-Ming University, Taipei, Taiwan
Correspondence: stevengogogo@gm.ym.edu.tw
*This article attaches to the panel - “The necessary skills for career developments”

Abstract

Due to the technology innovations in Industry 4.0, digital dentistry has become an iconic transformation in modern dental sciences. Facilitated by Industry 4.0, the ever-advancing technologies like 3D printing, computer-aided design (CAD) and computer-aided manufacturing (CAM) have significantly transformed all fields of dental sciences, and contribute to the optimization in clinical treatment. In spite of the new era in dentistry, what should we learn about the technology innovations as a patient, researcher or clinician? In this article, the technical concepts of digital dentistry and CAD/CAM systems are introduced as an example to discuss the necessary skills for the career development in modern dentistry.

Keywords: digital dentistry, dental CAD/CAM systems and Industry 4.0


Introduction

As in many other industries, automatic production has gradually introduced to dental technology. A series of innovation about computer-aided design (CAD) and computer-aided manufacturing (CAM) have applied to both clinical dentistry and academic dental research [1,2]. During the process of industry 4.0, enormous fields of technology were created or significantly improved, including machine learning, artificial intelligence, 3D printing, computer vision, 3D reconstruction [2–4]. Instead of their direct usages on the industrial manufacture, social media, and commercial services, the field of dentistry is also influenced by the trend of Industry 4.0 innovation [4–9]. The term ‘CAD/CAM’ has frequently used in the field of digital dentistry [8].

According to [10], all CAD/CAM systems consist of three components:

  1. A digitalization tool/scanner that transforms geometry into digital data that can be processed by the computer.
  2. Software that processes data, and depending on the application, produces a dataset for the product to be fabricated.
  3. A production technology that transforms the dataset into the desired product.

Trends in Digital Dentistry

CAD/CAM systems for dental prosthesis: an example of the industrial transformation in modern dentistry

With the aid of CAD/CAM systems, many dental treatments have been optimized, which provides better health care quality [1,8,11,12]. For example, conventional dental prosthetic restoration usually takes several weeks to design dental dentures, but the current 3D scanning and printing technology can shorten this process less than 1 day [9,13]. Traditionally, dental prosthesis requires the cooperation between a dentist and a dental technician to record the oral impression with wax [13], design the surface structure of dental dentures, and implant into patient’s gingiva. The whole process usually takes several weeks (Table 1.). To say, patients have to attend to a dental clinic several times for the treatment [13,14]. However, if the designed dental denture isn’t accurate, the treatment will require more time and effort of both patients and dentists to accomplish [15].

The improvement of dental prosthetic restorations is the combination of 3D scanning and printing technology [5,7–9]. First, a patient’s oral 3D structure is scanned by an optical scanner and reconstructed to 3D DICOM image (Digital Imaging and Communications in Medicine). Second, a dental implant is designed based on the 3D structure of neighbor teeth. Third, the computer-designed dental implant can be produced by a dental specialized 3D printer within 1 hour. And finally, a dentist can complete the implant operation within a day [14] (Table 1.).

What do CAD/CAM systems of dental implant inspire us about the modern dentistry? First of all, the conventional process of dental implant production was separated into two different professions and locations. One is a dentist and dental clinic, and the other is a dental technician and dental implant factory. Traditionally, these two professions can cooperate and accomplish the treatment in weeks. However, with the aid of 3D technology, the whole process can be conducted by one person, one location and even only one day.

To sum up, the dental CAD/CAM systems have shortened the process and requires minimum experts in the treatment of dental prosthesis.

The transformation of dental occupation: an overview of the influences of dental CAD/CAM systems

One positive perspective of Industry 4.0 is that the value is created from the gains in optimized efficiency, but technology transformation may have pros and cons. One of the challenges is the restructuring of occupations, and some of them may quickly disappear [10].

  1. Compensation effects: The new treatment is improved by the use of smart technologies which may secure the dentists’ job and boost consumer demand with additional income.
  2. Redundancy effects: The use of CAD/CAM systems may also destroy jobs like the dental technician.
  3. Technological unemployment: There are concerns that the redundancy effect from Industry 4.0 will retire some conventional skills, leading to technology unemployment.

The role of organization on the training of digital dentistry

On the other hand, due to CAD/CAM systems, the necessary skill of dentists or dental technicians may be changed. Currently, dental students usually spend most of the time on hands-on experiments, and there is obviously a lack of training of computer-aided procedures [6]. Despite the workflow of advanced dental equipment, the skills of troubleshooting, debugging and computation may be useful. Fortunately, there are commercial organizations working on proposing CAD/CAM systems. CEREC (https://www.dentsplysirona.com) is an educational organization of digital dentistry founded by Dentsply Sirona, a dental equipment company in the US [16]. The organization provides education and training for dentists to understand the hardware and software of CAD/CAM systems.

However, most of the courses cost a lot and the purposes are for advertisement. Another concern is that those skills learned from the commercial organizations are platform-specific. Dental CAD/CAM companies like 3M and Dentsply Sirona provide their products with closed operating systems.

One disadvantage is that there is a lack of integration between those systems. To say, a dentist has better to use products from the same company. Otherwise, the data can hardly transfer from platform to platform. The other disadvantage is that the company has direct control over the software license, update, and data. Therefore, users have to keep buying licenses and catching up software updates which may destroy the system integration [2,15].

High-cost equipment may lead to the centralization of capital in the dental market
The other question of digital dentistry is about the centralization of capital [10]. As many fields influenced by Industry 4.0, the overall production has become decentralized, while the capital is not the case [2]. Traditionally, dentists can earn the majority of interest in dental procedures. However, with the aid of advanced technology, the total interest may be higher in the market (compensation effect), but the interest is more centralized to the provider of dental equipment. That is to say, the accumulation and centralization of capital may lead to the concentration of enormous wealth in few companies which provides dental materials, and dentists may be replaced by advanced dental devices.

In summary, since the dental CAD/CAM system is not the silver bullet to fix all of the clinical problems, dentists still need to pay effort on the clinical training and money for software licenses. The advantage of using digital devices are becoming promising, which can provide a better quality of dental treatment. However, the downside is that the current platforms of CAD/CAM systems are closed and lack of integration. Also, the costly equipment may lead to the centralization of capital in the dental industry.

The necessary skills for dental career development, adjusting to the world of Industry 4.0

Dental education majorly focuses on diagnosis, usage of dental materials and hands-on procedures [2,12]. However, complete engineering training also requires lots of time to get familiar with operation systems, image processing, and CAD/CAM techniques. Therefore, the education of digital dentistry requires a multidisciplinary discipline of both dentistry and engineering. But what knowledge of engineering can improve the usage of CAD/CAM systems as a dental student remains under debate [3].

Dental students and dentists need to know about

  1. The traditional hands-on skills in orthodontics and prosthetics may be replaced or improved by the computer-assisted clinical operation.
  2. The training of computer-assisted clinical operation is significantly different from the conventional procedure. Dentists should pay attention to troubleshooting skills, human-machine interaction, and data processing, which have become crucial in the field of dental education. However, these skills are still missing in dental training.
    Conclusion
    The technological innovations of Industry 4.0 have significantly influenced dental surgery. Digital dentistry and dental CAD/CAM systems (computer-aided design, CAD; computer-aided manufacturing, CAM) became popular in recent years. First, this article describes the influences of the CAD/CAM systems on dental treatment as an example of the transformation in the modern dentistry. Second, the necessary skill of a dental career may include engineering techniques like data analysis, digital image processing, and operating system. Furthermore, troubleshooting skills and debugging with digital devices are crucial for clinical treatment. And the last, the evergrowing cost of dental devices may result in the centralization effect of capital in modern dentistry.

Conclusion

The technological innovations of Industry 4.0 have significantly influenced dental surgery. Digital dentistry and dental CAD/CAM systems (computer-aided design, CAD; computer-aided manufacturing, CAM) became popular in recent years. First, this article describes the influences of the CAD/CAM systems on dental treatment as an example of the transformation in the modern dentistry. Second, the necessary skill of a dental career may include engineering techniques like data analysis, digital image processing, and operating system. Furthermore, troubleshooting skills and debugging with digital devices are crucial for clinical treatment. And the last, the evergrowing cost of dental devices may result in the centralization effect of capital in modern dentistry.
 

Table

 

Picture1

 

Table 1. Phases of implant impression treatment for timing. The duration of the digital implant impression treatment is significantly higher than the conventional implant impression treatment. The duration of each clinical procedure is listed from top to bottom in the flowchart and separated into conventional implant impression and digital implant impression. The durations are shown with standard deviation. This flowchart is modified and replotted from [13].

References

1 Beuer, F. et al. (2008) Digital dentistry: an overview of recent developments for CAD/CAM generated restorations. Br. Dent. J. 204, 505–511
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3 Schleyer, T.K. (1999) Digital dentistry in the computer age. J. Am. Dent. Assoc. 130, 1713–1720
4 Albuha Al-Mussawi, R.M. and Farid, F. (2016) Computer-Based Technologies in Dentistry: Types and Applications. J Dent (Tehran) 13, 215–222
5 Prasad, S. et al. (2018) 3D printing in dentistry. Journal of 3D Printing in Medicine 2, 89–91
6 Garcia, L.T. et al. (2018) Oral health professions: education, responsibilities, and general overview of careers in oral health. In Career paths in oral health (Mariño, R. J. et al., eds), pp. 53–62, Springer International Publishing
7 Wimmer, T. et al. (2016) Complete denture fabrication supported by CAD/CAM. J. Prosthet. Dent. 115, 541–546
8 Stapleton, B.M. et al. (2014) Application of digital diagnostic impression, virtual planning, and computer-guided implant surgery for a CAD/CAM-fabricated, implant-supported fixed dental prosthesis: a clinical report. J. Prosthet. Dent. 112, 402–408
9 Joda, T. et al. (2016) A digital approach for one-step formation of the supra-implant emergence profile with an individualized CAD/CAM healing abutment. J. Prosthodont. Res. 60, 220–223
10 Roblek, V. et al. (2016) A complex view of industry 4.0. Sage Open 6, 215824401665398
11 Branke, J. et al. (2016) Industry 4.0: a vision for personalized medicine supply chains? Cell Gene Therapy Insights 2, 263–270
12 Vlaskalic et al. Orthodontic treatment of a mildly crowded malocclusion using the Invisalign System. Australian Orthodontic Journal
13 Joda, T. and Brägger, U. (2015) Digital vs. conventional implant prosthetic workflows: a cost/time analysis. Clin. Oral Implants Res. 26, 1430–1435
14 Luthardt, R. et al. (2002) Design and production of dental prosthetic restorations: basic research on dental CAD/CAM technology. Int. J. Comput. Dent. 5, 165–176
15 Stanley, M. et al. (2018) Fully digital workflow, integrating dental scan, smile design and CAD-CAM: case report. BMC Oral Health 18, 134
16 Moörmann, W.H. (2006) The evolution of the CEREC system. The Journal of the American Dental Association 137, 7S–13S
 


Address: Department of Dentistry, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112 Taiwan. Phone: +886-937857127
Email: stevengogogo@gm.ym.edu.tw
Author’s disclaimer: The author, Shao-Ting Chiu, was enrolled in Department of Dentistry at National Yang-Ming University, Taiwan as a junior undergraduate student on the date of publishment. This essay was completed by the author’s own effort and attaches to the panel session “The necessary skills for career developments” of International Student Science Fair 2018 (www.issf.vn), Vietnam.
Publish date: October 20, 2018.

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