The state of dental technology in 2018

August 21, 2018

Article

Taking a look at current technology trends in the dental industry - and what the future holds.

As former British Prime Minister Benjamin Disraeli once said, “Change is inevitable. Change is constant.” While that quote may hold personal meaning for some, it’s quite apropos for the business world. In order for an industry or sector to grow and thrive, change must take place. Often, technological advancements serve as a driving force for that change.

Dentistry is a prime example of how technology is changing the scope of an industry. From advancements in 3D printing to digital impressions to cloud-based software, technology is molding every aspect of the dental industry.

We spoke with several industry experts to get their perspective on the greatest areas of change that have shaped the current state of dental technology and what this growth means for the future of the industry.

Digital impressions

Digital impressions have made a big impact on the industry, especially for dentists doing chairside dentistry. Intraoral scanners currently on the market are engineered to produce highly accurate and detailed scans, leading to higher clinical success rates and streamlined workflows. Patient comfort is also enhanced since there’s no need to bite into a tray of gooey impression material.

Dr. John Flucke, technology editor for Dental Products Report, considers digital impressions one of the largest areas of advancement for the dental industry.

“The chairside units have evolved tremendously,” says Dr. Flucke, who has a private practice in Lee’s Summit, Missouri. “Back in the day, most took a series of individual pictures that were taken by using a foot pedal to capture the image. While those worked adequately, the speed and convenience factor was lacking.

Now, the units take hundreds or thousands of images automatically in a matter of seconds, pulling in tons more data that allows the software to create renderings that are so accurate, it’s almost beyond comprehension.”

Many scanners can also determine if and where data is missing and indicate to the clinician where to add to the scan. “This allows for a pretty much seamless acquisition,” Dr. Flucke says. “Many offices are reporting full dual-arch scans being accomplished in easily less than five minutes.”

Digital impressions also aid in articulation, and Dr. Flucke says he’s optimistic about the implications of this technology.

“I’m looking forward to being able to merge CBCT imaging with the .STL files created by digital impression systems,” he says. “Imagine virtually articulating a complicated case and working out the entire occlusal scheme by rendering it in 3D on a screen. We are already reaping the benefits of digital impression systems that require very minimal adjustments based on simple articulation. If we could articulate virtually and work out all the occlusal components on an exact replica of the patient’s existing masticatory scheme, adjustments could well be a thing of the past.”

3D printing

It’s no secret that 3D printers are one of the hottest pieces of technology in the dental industry. While dental labs are currently utilizing this technology more than private practices, Gideon Balloch, dental product lead at Formlabs, says he’s been surprised by the volume of dentists who are using 3D printers.

“Formlabs has only been selling into the dental industry for two-and-a-half years,” Balloch says. “We were kind of expecting that we would be paying most of our attention to dental labs for a really extended period of time, and the long-term future would be heading toward greater use of technology in the actual dental practice. We were kind of surprised to find that actually we’ve seen a ton of adoption with dentists and it’s growing very quickly.”

The most practical implementation of 3D printing at the moment, Balloch says, is the practice lab.

"Practices are still working with three or so dental labs, but on a couple of different indications they’ve decided that 3D printing makes sense for them, so they do that in-house,” he explains. “Sometimes they work with a lab on the design, sometimes they do everything including the design themselves. It’s a very nuts-and-bolts, approachable solution that’s not totally changing the makeup of their practice.”

One of the biggest developments when it comes to 3D printing has been materials and the availability of different resins.

“You have companies coming out with materials where you can print a denture base,” says Matt Alles, digital solutions marketing manager for Straumann North America. “You can actually print a denture base, mill out the teeth and then you can just bond them onto this 3D printed denture base and characterize.”

“The real advancement is going to be the printing of restorations,” Dr. Flucke adds. “Once a material is developed that is as strong and esthetic as current options, the floodgates will be wide open.”

3D printers on the market today are also taking less time to print. Take Straumann printers, for instance, that can print two surgical guides in just 15 minutes, Alles says. Being able to print surgical guides during an appointment can give patients some much needed comfort.

“When you just show them a drill and the implant and you say we’re going to drill into your bone and place an implant, it can kind of scare you,” Alles says. “With guided surgery, you can print that guide and show the patient what you’re doing.

“The time of the 3D printers is getting very impressive where you’ll have surgical guides within 15 minutes. You can really almost do immediate placement-guided surgery in one day if you wanted to do so,” he adds.

3D printing is making digital dentistry more affordable as well, Balloch says, especially when it comes to splints or occlusal guards.

“3D printing in a practice lab situation can really make a huge difference because there’s a slight improvement in fit, which drives better comfort, but the bigger difference really centers more around that fact that if the technology is in the practice, then the practice can offer that at a lower price to their customers and they can prescribe it at a much higher rate,” he says. “If you talk to any sort of general dentist out there and you ask them what percentage of people need night guards, they’ll say something in the high majority. But when you ask them how many patients did they actually place occlusal guards with, they’ll say something below 10 percent.

“The reason for that is that type of treatment is often not covered by insurance,” he continues. “It’s often a very large out-of-pocket cost. But by having that technology in the practice lab, the users that we’ve seen have been able to offer these technologies more often to their customers and it’s a better way to drive a higher percentage of treatment to people who need it.”

Dental software and cloud-based computing

While many people may think of technology in terms of equipment, software also plays a major role. And with more and more applications in our lives utilizing the cloud, it’s no surprise that dental software would follow suit.

Mike Uretz, a dental software and electronic health records (EHR) expert and the founder of DentalSoftwareCompare.com and DSOconnect.com, says that cloud-based computing is leading the technology front, particularly due to the growth of DSOs and multi-location groups.

“Cloud-based computing is becoming more and more popular partially because the growth and the need for it in DSOs and groups,” Uretz says. “One of the main reasons is because of all the locations and the need to aggregate information throughout the organization, including the increasing use of analytics to manage group operations. Cloud-based computing helps with that. In the medical software industry over the past few years, we saw the multi-location groups lead the way in adoption cloud-based technology, and I believe we will see the same trend in dentistry.”

Cloud-based computing also allows for the easier integration of third-party plugins and applications, which enhances the software’s functionality.

“We’re starting to see more ability for images to be held in the cloud and accessed anywhere and be more closely integrated into the electronic health records portion of your software,” Uretz says. “Instead of having to separately access the software of your imaging devices and then back to your dental software, everything is integrated together.”

In addition to being able to access important information wherever they’re located, dentists may also see some cost savings when it comes to cloud-based computing since they no longer need IT people on staff.

“With cloud-based computing, you basically have a 24/7 IT department that is managing your servers, your information, and these people are experts at it. Because of that, cloud-based computing also gives you subscription models. Instead of a major outlay upfront, you’re paying each month like you would a utility.”

The design of the software itself has evolved too. More clinicians are now using smartphones, tablets and laptops to access both practice management and clinical information, so vendors are investing more time and money in the user interface.

“They have to design the software so that it will be easy to use on different devices,” Uretz says. “It’s the design of the software that’s changing. As we get more technologically advanced and the developers have better tools to use, you’re getting more user-friendly designs.”

Finally, Uretz points out that just as electronic health record (EHR) technology has become a critical mainstay in medicine, we’re now seeing more dental software vendors invest money and resources integrating EHRs in their dental software applications. This is leading to more efficient clinical workflows and better patient care.

Milling

Milling units have evolved in multifactorial ways, Dr. Flucke says, and because of this, there are currently some outstanding milling units on the market. Open source mills in particular are giving dentists the flexibility they need.

“Open source mills allow any acquisition unit to export their .STL files to their mill of choice,” Dr. Flucke says. “Current 5-axis mills are capable of creating almost any dental prosthetic in a variety of materials, including but not limited to wax, zirconia, PMMA, glass ceramics, lithium disilicate and Lava™ Ultimate (3M Oral Care).”

Developments in milling are going in two directions, according to Steve Braykovich, president and CEO of Axsys Dental Solutions. The first is toward very high speeds and low chip cross-sections. The second direction is toward high feeds and low depths of cut at moderate cutting speeds to increase metal removal rates.

“Tooling and machining dynamics play a significant role in achieving longer cutting tool life and accuracy while maintaining high-quality surface finishes with reduced chipping and thinner restorative margins,” Braykovich says. “Tool manufacturers are working in both directions to offer optimum solutions to customers based on application and machine capabilities.”

Significant improvements have also been made in open-source CAD/CAM software and computer computational performance.

“Capabilities that used to be available with high-end, industrial-centric hardware and software are slowly working their way into open-source solutions for the dental industry,” Braykovich explains. “This is largely due to the emergence of customized dental CAM solutions from industrial CAM software publishers whose products contain algorithms and software features with decades of testing against highly sophisticated industrial, high-speed, multi-axis machining applications. Additionally, dental CAM software with less real-time cycles, based on ‘home-grown’ or purchased core technology, are improving through the natural software development cycle related to use over time.”

Because of these recent advancements, there’s been an impact on workflows, Braykovich says, whether it be crown and bridge, fixed partial dentures, removable appliances or surgical-guide fabrication. However, an understanding of the product’s capabilities, operation and place in the workflow is crucial for clinicians to comprehend.

“To successfully integrate CAD/CAM technology into their practices, clinicians should start with an understanding of what functions are of value now as well as the capabilities they seek for future expansion of services,” Braykovich says. “At the end of the day, implementation can save clinicians time and money, increase operational efficiency and better control costs while significantly increasing the quality of care provided to their patients.”

Patients can also reap the benefits of milling technology, from faster turnaround times to fewer office visits to more comfortable and durable restorations.

“The precision of today’s mills combined with the precision of the latest acquisition units allow for the creation of prosthetics that have a better fit and require fewer adjustments than traditional techniques,” Dr. Flucke says.

Clinical software and electronic health records

As DSOs and multi-location groups continue to change the landscape of the dental industry, Uretz says there’s going to be a shift toward integrated single databases. Rather than holding information at each separate office location, all of the clinical and patient information will be stored in a single database.

“With an integrated single database, you have all the information - clinical, administrative and financial - at your fingertips in one place,” Uretz says.

Traditionally, dental software supported basic functions such as scheduling, insurance and billing. But with the introduction of EHRs, many software vendors are now investing heavily in clinical and EHR technology.

“What you’re starting to see happen now is a big movement toward vendors investing in the clinical and electronic health records side of things,” Uretz says. “Some of the things that you’ll see now are electronic prescribing, which has been around for a long time, but it’s really starting to take hold more. And even though it’s not big right now, we’re starting to see vendors looking at including diagnostic codes.

“We’re also starting to see better and more secure messaging portals and ways to communicate from patient to practice or group, group or practice back to the patient, or practice to practice,” Uretz adds. “That leads to better communication, better care and reduced liability.”

Some of the newer software even includes analytics and business intelligence tools. This is especially helpful for groups with multiple locations as it allows them to develop a better understanding of the areas in which they’re doing well along with the areas in which they need to improve.

“The benefit of analytics is better cash flow,” Uretz explains. “Dentists can be more successful financially because you can analyze trends, you can look at scheduling. From an operational standpoint, using some of the newer tools helps you to run a more efficient practice or group.”

Looking toward the future

While the current state of dental technology may seem impressive enough, there are already new innovations and applications on the horizon.

Dr. Flucke predicts that data mining and artificial intelligence will be big players in the not too distant future.

“I’m currently working with a company that is using artificial intelligence to help read bitewings,” he says. “Having the ability to work with an impartial third party when performing diagnosis is a serious disruption to the traditional way we diagnose. I’m all about maximum disruption if it provides better care.”

When it comes to 3D printing, Alles says permanent crowns are on the top of everyone’s mind.

“I believe within the next year to three years, we can have a permanent crown from a company. When you’re talking about chairside dentistry, I think that’s the development that’s going to be coming out,” he says.

Taking things one step further, Alles highlights the fact that researchers have 3D printed cartilage with an EnvisionTEC printer. He predicts that same technology will one day be applied to crowns.

“Companies will look into can I actually print a crown that has DNA in it that can be accepted by the body as a natural tooth and maybe not even have an implant,” he says. “So, you’ll have that root structure still in place and you can print a crown with that DNA and have it get absorbed into the body.”

As for milling, Braykovich expects future developments to provide more refinements and advancements in machine construction, controls, tooling, work-holding, CAM software and automation.

“I believe we are not far from a multi-platform CNC machine combining additive and subtractive technologies along with the specialized software required to support its operation,” he says. “These integrated machines and software are currently available at some level in the industrial space and it is likely we will see more of them in the dental space in the future. This could be fueled by the ever-advancing field of material science, which will continue to bring new products that could lead to milling machine and processing challenges, as well as new disruptive technologies and opportunities.”

While new technological advancements will shape the future of the dental industry, in order for change to truly take place, companies must collaborate with one another. Balloch believes greater collaboration will take place as new developments are made across the industry in terms of digital dentistry.

“In the last three years, 3D printing has gone from being sort of way back behind a lot of the other technological developments in terms of digital dentistry and it’s sort of caught up. Now, we’re right there with some other very innovative companies at the leading-edge of changing standards of care and changing different types of indications to be digital,” Balloch says.

“In order to continue changing the industry and improving standards of care through digital dentistry, there’s going to have to be not just improvements in 3D printing but also improvements in software and improvements in scanning in order to deliver the types of changes that we are currently delivering for current 3D printable applications.