digital international No. 1, 2023

Cover / Editorial / Content / News / Why is Slow Dentistry calling for a system reform of the hiring process in dental practices? / Intra-oral scanners in the dental office The countless benets for both clinicians and patients and the practical aspects of digitalisation / Digital workflow for 3D-printed complete dentures / Exploring novel technologies for improved efficiency / Applications of digital technology in dental surgery—an overview / Elimination of titanium-base abutments and utilisation of the Rosen screw to improve screw-retained prostheses / Using digital software for effective root canal therapy / 4D dentistry—Clinical application / Transforming dentistry with groundbreaking technologies - Lifelike restorations with a micro-layer of porcelain / Manufacturer news / Artificial intelligence: A gift to dentists / AI and its applications in advanced dentistry / Study highlights how artificial intelligence can be used for detection of caries / Dental imaging market: Product innovation to stimulate demand / Artificial intelligence and augmented reality in implant planning / Ethical guidelines missing in field of dentistry and AI, researchers say / Implant Solutions World Summit 2023 - Cutting-edge implant science and innovation / Meetings / Submission guidelines / Imprint

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issn 2193-4673 • Vol. 4 • Issue 1/2023

digital

international magazine of digital dentistry

opinion

Intra-oral scanners
in the dental office

trends & applications

Exploring novel technologies
for improved efficiency

AI supplement

Artificial intelligence:
A gift to dentists

1/23
including

supplement

[2] =>

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ClearCorrect®, the Straumann
Group’s flagship orthodontic
brand, is excited to announce
new products and clinical
features, an improved digital
workflow, added support, and
treatment planning services
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complex cases.

To become a partner
or learn more visit:

clearcorrect.com

Acc.1249_en_01

[3] =>

editorial

Dr Scott D. Ganz
Editor-in-Chief

Digital, analogue or both?
Recently, a clinician was having an issue with a digital
workflow. A fully edentulous patient required a complete maxillary denture. Using an intra-oral scanner, the
maxillary edentulous arch was digitised. The surface
was captured in full colour. The idea was to then use a
recently acquired 3D printer, wash station and polymerisation unit to create a physical model using the specific
die and model resin. To accomplish model fabrication,
the surface data STL file was imported into the printer
software. Using the native printer software, the 3D design was to be positioned on the build platform and printing supports generated. However, the file only contained
a single surface layer. An important step had not been
taken: closing the scan and adding a flat base. The resultant print would have contained only a single layer and
not a complete model. The missing steps could have
been generated on the intra-oral scanner software prior
to exporting the STL file or by the printer software if it
had this capability.
Why print the resin model in the first place? The
clinician wanted to use the 3D printer and specific
resin to obtain a physical model of the maxillary arch
on which to design and fabricate an analogue custom
impression tray, avoiding the need to pour a stone
model. The next patient visit was scheduled for intraoral border moulding with the custom tray to achieve
a seal with the analogue impression material. This
was all to avoid dental stone! Is this truly a digital
workflow or a cumbersome amalgam of analogue and
digital?

If the clinician was fully versed in the laboratory phase of
the digital workflow, there would have been little need to
create a physical model. Once the intra-oral scan had been
completed, a closed virtual model could have been fabricated as previously mentioned. Using free readily available
software like Meshmixer (Autodesk) and the virtual model,
a custom tray could have been easily designed which
would mimic the analogue version. Therefore, instead of
printing a physical model, which would necessitate a significant volume of resin (even if hollow), only the actual
tray would need to be printed, saving both time and resin.
Of course, this is still a mixture of analogue and digital
workflows. The rationale for a custom impression tray
was to create an accurate representation of the maxilla to
achieve a better fit of the resultant complete denture.
The point of this story is to acknowledge that, despite
the huge jumps in technology, there are still gaps in the
educational process of how to achieve, or work effectively
towards, a fully digital workflow. In the meantime, clinicians
will continue to make an effort to utilise new protocols, but
the tried-and-true conventional analogue methods will
remain for many years to come. To learn more about the
state of the art in the digital dental universe, please delve
into this first issue of digital for 2023. I hope that you will
enjoy the extra section on artificial intelligence!
Respectfully,
Dr Scott D. Ganz
Editor-in-Chief

1 2023

[4] =>

| content
editorial
Digital, analogue or both?

03

news

page 18

“Connect To The (Work-)Flow”
Digitisation—key for the next 100 years of dental practice
and the dental laboratory
4D dentistry with MODJAW Tech in Motion
Introducing Dentaverse, a virtual reality platform

06
08
10
12

opinion
Why is Slow Dentistry calling for a system reform
of the hiring process in dental practices?
Intra-oral scanners in the dental office

14
18

trends & applications
page 30

Digital workflow for 3D-printed complete dentures
Exploring novel technologies for improved efficiency
Applications of digital technology in dental surgery—an overview

22
26
30

user report
Elimination of titanium-base abutments and utilisation
of the Rosen screw to improve screw-retained prostheses
Using digital software for effective root canal therapy
page 60

34
40

industry report
4D Dentistry—Clinical application
Transforming dentistry with groundbreaking technologies

44
48

manufacturer news

52

supplement
AI logo courtesy of
BAIVECTOR/Shutterstock.com.

Cover image courtesy of
MODJAW (www.modjaw.com).
1/23

issn 2193-4673 • Vol. 4 • Issue 1/2023

digital

including

international magazine of digital dentistry

supplement

Artificial intelligence: A gift to dentists
56
AI and its applications in advanced dentistry
60
Study highlights how artificial intelligence can be used for detection of caries 62
Dental imaging market: Product innovation to stimulate demand
64
Artificial intelligence and augmented reality in implant planning
66
Ethical guidelines missing in field of dentistry and AI, researchers say 68

meetings
Implant Solutions World Summit 2023
International events

70
72

about the publisher

opinion

Intra-oral scanners
in the dental office

trends & applications

Exploring novel technologies
for improved efficiency

submission guidelines

73

international imprint

74

AI supplement

Artificial intelligence:
A gift to dentists

04

1 2023

[5] =>

© MIS Implants Technologies Ltd. All rights reserved.

PERFECT
MATCH

DESIGNED FOR ACCURACY. MAKE IT SIMPLE
The 3D printed template is designed with an open-frame for maximum visibility, irrigation
and accessibility from all angles without the need for removal. MGUIDE is a keyless system,
designed for single handed procedures, eliminating the need for unnecessary tools.
Learn more about MIS at: www.mis-implants.com

[6] =>

| news

“Connect To The (Work-)Flow”

Amann Girrbach connects the workflow of
laboratories and dental practices for restorations
By Amann Girrbach
“Connect To The (Work-)Flow”—with this motto Amann
Girrbach summarises the essence of the company’s
strategy in its International Dental Show (IDS) campaign:
to connect treatment processes in dental laboratories
and dental practices intelligently, simply and end to end
in a perfect dental workflow. Visitors to IDS 2023 will have
the opportunity to experience this live in approximately
640 m2 of exhibition space. The complete digital workflow and individual product highlights and innovations
will be made tangible on-site.

interwoven to allow users to concentrate fully on their
work. Our goal is to combine analogue and digital
steps, products and services in a safe and open system,
to ultimately make everyone’s daily work easier through
high reproducibility of work and to create better patient
care,” explained Dr Wolfgang Reim, CEO of Amann
Girrbach.
At the newly designed booth, new digital standards in
dental technology will be showcased and demonstrated,
and attendees will be able to engage with product
experts.
Under the umbrella of the motto “Connect To The (Work-)
Flow”, Amann Girrbach would like to invite interested
parties to become part of a movement that connects
and benefits collectively from digital achievements.
“We are familiar with dental practice and all its hurdles and
see it as our task not only to provide excellent products
but also to optimise the entire workflow right through to
numerous service offerings,” Dr Reim emphasised.

IDS is the leading trade fair
for the dental industry and will
be held in Cologne in Germany
from 14 to 18 March. Here, Amann
Girrbach will be showcasing an
optimised and integrated end-to-end
process chain for dental restorations.
“As the open workflow company in the dental industry,
Amann Girrbach will introduce visitors to digital workflows
spanning the entire work process. We aim to holistically
connect dental laboratories and dental practices for the
benefit of patients, since we believe that in a perfect dental workflow everything is smart, simple and seamlessly

06

1 2023

With innovations such as the AG.Live workflow
management platform and the interdisciplinary Ceramill Direct Restoration
Solution system, the company is
consistent in pursuing this objective. “We enable users in dental practices and laboratories
to do something that a single
product alone cannot achieve:
we deliver an open overall system with established analogue
and innovative digital products
that ensures significant time- and
cost-savings,” Dr Reim noted—all to
make the dentistry of tomorrow better today, for dental laboratories, dental
practices and patients.

Editorial note: All the latest information on Amann
Girrbach’s IDS participation and the trade fair itself
can be found regularly on the campaign homepage,
ids.amanngirrbach.com, and in the IDS newsletter. Visit the
Amann Girrbach booth (#C040/D041) in Hall 1.2 at IDS.

[7] =>

simply.TRIOS 5
Intraoral scanning that simply makes sense

Hygienic by design for minimal risk of
cross-contamination. Smaller and lighter
than ever for next-level ergonomics. And
a ScanAssist engine with intelligent-alignment
technology that makes precision scanning
effortless, every time.

[8] =>

| news

Digitisation—key for the next
100 years of dental practice and
the dental laboratory
Dr Christian Ehrensberger, Germany
Digital technology has continually changed many working processes in the dental practice and laboratory in the
past 20 years, and patients have enjoyed the increasing
benefits of high-quality dentistry resulting from digitisation. Digital dentistry will be one of the main focuses of
the 40th International Dental Show (IDS), which is celebrating its 100th anniversary. For example, attendees will
be able to learn about the expanding applications of
intra-oral scanners and developments such as automatic
blank changers to make fabrication of CAD/CAM restorations more effective. For many years, IDS has acted
as fuel for dental progress. From 14 to 18 March, visitors to IDS will be able to experience the development
of the next 100 years in Koelnmesse’s exhibition halls in
Cologne in Germany.

Targeted chairside prostheses
and intra-oral scanners with a wide range
of applications
The number of fabrication options is increasing in the
dental practice: crowns, inlays and more can be fabricated chairside or quickly sent to the practice laboratory.

2
Fig. 1: Digital technologies offer increasingly more opportunities for dental
practices and laboratories. (Image: © Koelnmesse/IDS Cologne) Fig. 2:
A wealth of opportunities are on offer at the International Dental Show—
like nowhere else in the world. (Image: Koelnmesse/IDS Cologne/Thomas Klerx)

This often allows the patient to be treated in a single
appointment, even with three-unit zirconia bridges,
and ever more patients place great value on the increased convenience this affords. It is an advantage
to have an integrated digital procedure that includes
a high-speed milling system and speed sintering
furnace.

1 2023

[9] =>

news

Intra-oral scanners are often at the centre of the entire
workflow, and their range of indications is expanding.
Full-mouth scans, individual jaw scans, mucosal scans
and scan matching are now all feasible. The limits of
intra-oral scanners are also being explored. Currently,
those include the capture of deep subgingival preparations and the direct translation of an intra-oral scan
into functional movements, as required for the fabrication
of digital dentures, for example.
Intra-oral scanners achieve the accuracy of elastomeric
impressions and are even superior when it comes to

3
Fig. 3: Dentistry has tradition! At the 40th International Dental Show, celebrating
its 100 th anniversary, visitors will be able to learn about current state-ofthe-art technology. (Image: © Rheinisches Bildarchiv Köln)

Pioneering digital dental laboratories—
the opportunity of globalisation
Owing to globalisation, distance now plays a lesser role
in the working relationship between dental laboratories
and dental practices, and it is becoming easier to work
with the desired laboratory partner. For example, a Bavarian
laboratory can now work with dentists in SchleswigHolstein or provide quality prostheses to dentists in Brazil.
This option is becoming increasingly popular, since dental laboratories are often significantly more digitally advanced than some dental practices. As a communication
forum, IDS provides an excellent opportunity to connect
with existing contacts and establish new ones.

Off to IDS
The state-of-the-art technology of proven and innovative
concepts and products for the entire digital workflow will be
on display at the 40th IDS. The world’s leading dental trade
fair will provide in-depth information that will help private
dental practices and laboratories to make well-informed
decisions when choosing their desired direction.
Editorial note: Please scan this QR code for the list of references.
single-tooth restorations and smaller-span bridges.1, 2 In
future, they will also provide considerable support for
dentists regarding preliminary examinations. For example,
intra-oral scanners that measure fluorescence could be
used to score caries.3
More basic intra-oral scanners and those with multifunctionality should be compared regarding their suitability for private dental practice. Depending on the
practice’s size and professional orientation, the acquisition
of several scanners should be considered.

contact

Dr Christian Ehrensberger
Schwanthalerstr. 27
60594 Frankfurt am Main
cu_ehrensberger@web.de

1 2023

[10] =>

| news

4D dentistry with MODJAW
Tech in Motion
An interview with Dr Maxime Jaisson and Antoine Rodrigue, MODJAW
MODJAW is a French company that offers next-generation
digital dentistry solutions. In March 2019, it introduced
MODJAW Tech in Motion, a state-of-the-art system that
allows dental professionals to track jaw motion in real
time. In this interview, Dr Maxime Jaisson, chairman and
co-founder of MODJAW, and Antoine Rodrigue, CEO and
co-founder, discuss the benefits of using MODJAW Tech
in Motion to improve treatment outcomes.

bilitation? First, from an aesthetic point of view, finding the
right orientation of the occlusion plane will help balance the
prostheses within the patient’s face. Then, from a mechanical point of view, good equilibration of prostheses in static
and dynamic positions will have a central role in harmoniously distributing the occlusal forces and indirectly protecting the underlying implants. The occlusion preserves
the prostheses, and the prostheses preserve the implants.
This is particularly important with implant-supported fixed
prostheses, as proprioception is lost and the mandible is
guided by muscular memory. If the impact on the functional
occlusion is drastic, there may be some consequences for
acceptance and perceived comfort.
What is the level of integration of MODJAW with the
most commonly used prosthetic CAD software?
Dr Jaisson: MODJAW is an open system and was designed to make data accessible to all dental technicians.
All static data is available in STL format and can be transferred to CAD software. All dynamic data, such as the
patient’s jaw movements, can be exported to exocad
software to help design restorations and to better control the dental morphology. We are continually working on
integrations with other CAD/CAM software and are happy
to announce that the movement records from MODJAW
will be available in 3Shape Dental System.

1
Fig. 1: MODJAW co-founders Antoine Rodrigue (left) and Dr Maxime Jaisson.

What are the main clinical applications of MODJAW?
Rodrigue: The strength of the MODJAW Tech in Motion
system lies in how it combines real-time static and dynamic
patient data for patient evaluation and treatment purposes.
MODJAW recordings give an extensive view of the patient’s
clinical situation. Getting all the static and dynamic parameters, such as dynamic tooth contact mapping, helps the
practitioner to detect premature contacts and deflective
occlusal contacts, understand the guidance and identify
tooth wear, any malocclusion or even temporomandibular
joint disorders. The data obtained from MODJAW Tech in
Motion can also help to customise dental care for the patient.
This applies to both simple and complex cases and all
specialties, including adhesive dentistry, removable and
fixed prosthodontics, implantology and orthodontics.
What are the benefits of using MODJAW in prosthetic
rehabilitation?
Dr Jaisson: We could look at the question this way: why
is it so important to consider occlusion in prosthetic reha-

1 2023

Can we say that MODJAW is a personalised virtual
articulator?
Rodrigue: We see MODJAW Tech in Motion more
like a virtual patient platform that allows aggregation
of all data, from intra-oral scanners and 3D models
to CBCT and facial scans. Immediate visualisation of
the jaws in motion is a powerful communication tool.
The patient gets to see himself or herself from a brandnew perspective, the clinician can explain the situation
and the patient can better understand the treatment
suggested by the clinician. The COVID-19 crisis taught
us one thing: we need to drastically decrease the number
of visits to the clinic for the patient. This means that,
to be efficient, we have to obtain all the data at the first
visit, including the jaw motion. This would allow us to
maximise the work done to achieve predictable results.
In the end, MODJAW helps orient dental professionals so that they know where they are, where to go and
how to get there. This is the missing link in today’s
workflows in order to gain confidence and simplicity in
treatment.

[11] =>

[12] =>

| news

Introducing Dentaverse,
a virtual reality platform
that is changing the future of dentistry
By Jeremy Booth, Dental Tribune International

2
Fig. 1: Martin Ravets, founder and CEO of Dentaverse. Fig. 2: Dentaverse is a virtual environment where users can interact with one another, attend and
host events and even present and learn about dental treatments and products. (All images: © Dentaverse)

On 1 December last year, dental professionals from
around the world gathered for the launch of a new, virtual reality (VR) environment called Dentaverse. Based
on Web3 technologies, Dentaverse aims to create a
meeting point for the global community of dentists, dental students and dental industry professionals. According to its founder and CEO, Martin Ravets, the platform
has the potential to bridge the gap between physical
and virtual oral care and to overcome the barriers of time
and distance in order to create a truly inclusive international dental community.

connected DTI’s editorial office in Leipzig in Germany
with Dentaverse’s headquarters in Brussels in Belgium.
Popularised during the SARS-CoV-2 pandemic, streaming
and video call platforms can only take connectivity to
a certain point. Commenting on the immersive experience that Dentaverse offers—including through the
use of VR headsets—Ravets said: “If we were meeting there, we would have eye contact and you could
see and follow my gestures and body language, and
I yours. It would be a completely different type of
interaction.”

Dental Tribune International (DTI) spoke with Ravets just
hours before the launch using video call technology that

Let us take a step back and explain exactly what
Dentaverse is. Popular community-based web tools—
such as Instagram and LinkedIn—underpin the platform,
and these are mixed with new Web3 technologies,
like blockchain, metaverse and cryptocurrency payment,
in order to create a virtual environment where users
can interact with one another, attend and host events,
and even present and learn about dental treatments
and products.
Fig. 3: Dentaverse Lounge Club booth at Dentex Dentalia 2022 in Brussels, Belgium.

12
3

1 2023

[13] =>

news

Ravets says that, although Web3 technologies may not be
widely used by dental practices currently, they will quickly
become standard working tools. “Right now, it is similar to
the late 1980s and the 1990s,” Ravets explained. “We were
told that websites would become an essential tool for presenting your practice, to share information. And the same
thing happened again around 2010 with social media when
we were told that communication and networking would be
reinvented. These technologies are now so commonplace
that we cannot imagine working without them. It will be the
same with technologies like digital assets and blockchain,
simply because these technologies really allow people to
do a lot of great things.”

The immense potential of virtual interaction
Ravets believes that connecting the global dental community will help to create a better future for dentistry, particularly given the immense potential of virtual interaction
in the realms of connectivity and education. He explained:
“What it means for dentists, for example, is that they
can organise and attend workshops, thereby exchanging
knowledge and experiences in real time. Imagine the following scenario: for a certain complex dental procedure,
a dentist in Turkey could consult with an expert in South
Korea in real time, simulate and practise the procedure,
and learn the fine details of a specific technique, receiving
feedback and direction from his or her peers.”
More broadly, the technology is well positioned to build
a strong international dental community that includes
dental students and clinicians and enables networking
between the two groups. Ravets asked: “How exciting
would it be for students to get acquainted with their
future mentors or colleagues while still in university, to
already secure an internship position through connections
in the Dentaverse environment? Quite simply, it creates
a place to connect, to grow and have fun, and to shape
the dental industry of tomorrow together with like-minded
individuals.”

Is the future of dental education
and events already here?
Dental education and gatherings were largely shifted online
in 2020 and 2021, owing to travel restrictions and lockdowns. This development increased the acceptance of
online tools, and Ravets and his team are thus particularly
excited about what Dentaverse could offer in these areas.

4
Fig. 4: Dentaverse Membership 4K Club NFT 3D animation, available
on Opensea (www.opensea.io/collection/dentaverse) and Dentaverse
(www.dentaverse.io).

at how online dental education is today and how it could
be improved. In addition to the manual work and physical
classes at the university, cameras record what students
do on the frasaco phantom head, and this is streamed.
Student can rewatch these streams, and the use of this
technology increased a lot during the pandemic. Using
Dentaverse, a university can really know whether students have attended and listened to a virtual class, and
it can allow students to do a lot of virtual test training.
It is much more fun for the students and really is a totally
different method in which students can connect with
each other anytime. That is how we are approaching this,
collaborating with the university to take streaming from
2D to a 3D communication tool.”
Developing Dentaverse has been a labour of love for
Ravets—a young entrepreneur who feels equally at home
in the dental and digital worlds. When it comes to innovation, he says that dentistry is on the cusp of great advancement. He explained: “Usually, growth and innovation in
the dental industry occur mostly through the introduction
of more ergonomic equipment or better treatment techniques. However, Dentaverse brings a fresh angle to dental collaboration and adds new tools for spreading dental
education and creating an inclusive international community. Digital solutions bridge the gap between physical
care and virtual care, enabling healthcare providers and
educators to overcome the barriers of time and distance.
For this reason, I consider Dentaverse to be an important
milestone in the future of dentistry.”

Here, solutions are being created in partnership with
manufacturers, institutions and event organisers. Ravets
explained: “We have a partnership with Saratoga and we
have been working together for the past months, looking
Fig. 5: First world VR dental hybrid event on 1 December 2022 between
Dentaverse headquarters and the virtual platform.

1 2023

[14] =>

| opinion

Why is Slow Dentistry calling
for a system reform of the hiring process in dental practices?
Dr Huthaifa AbdulQader, Switzerland
The dental industry is doing its best to forestall the increasing rates of employee turnover and attrition amidst
inflation in a post-pandemic world. Clinic owners are facing
a bewildering conundrum of applicant shortages and misfits, staffing needs beyond the norm and patients’ continued demand for excellence. To stem the flow, it is important
for clinic owners and practitioners to equip themselves with
the tools to identify employee burn-out and to cultivate
strategies to shape culture.
A major cause of turnover in the dental profession is “quiet
quitting”, a global phenomenon that has become widely
popularised. It is thought to be largely linked to the pandemic and its aftermath. However, the Slow Dentistry
Global Network (SDGN), a Swiss non-profit organisation,
is proposing a deductive argument and an approach that
addresses the root cause of this phenomenon.
Slow Dentistry—a modern-day work philosophy—places an
emphasis on seeing an appropriate number of patients per day.
Our research indicates that many clinics around the world
utilise a business model that relies on seeing an excessive
number of patients per day, leading to a multitude of problems.
The movement advocates for a stress-free operatory environment that is crucial for the well-being of the patient, practitioner
and practice as a whole. It is based on four cornerstones:

1 2023

1. room disinfection;
2. informed consent;
3. proper anaesthesia; and
4. the use of dental dams.
These cornerstones revolve around an all-encompassing
hallmark: personal congruence. From dental practitioners’
perspective, congruence refers to living in such a way that
their blueprint of how they should be practising and their
reality of how they practise is completely harmonious.
SDGN asserts the premise that the more congruence is
cultivated within a person, the more self-awareness and
self-confidence develop.
The ultimate ramification of not following this growth mindset is a cycle of desperation hiring. The “Great Resignation”
predicted by Anthony Klotz is slowly becoming a reality.
Experiences connected to the COVID-19 pandemic have
opened the eyes of many to the value of family time, pursuing passion projects and, most importantly, consciously
detecting chronic stress and early stages of burn-out.
Lockdown-induced solitude juxtaposed the old-fashioned
rushed style of dental care. This created a situation where
younger practitioners had the opportunity to enjoy their
work in a way that was previously prevented by the nature

[15] =>

opinion

of profit-driven dental practice. In addition to many fresh
graduates who are very scared and anxious to enter the
workforce, the up-and-comers have needs that are not
satisfied by the doctrine embraced by their employers, thus
leading to a toxic workplace culture—the main cause of
quiet quitting.
The aforementioned four cornerstones of Slow Dentistry
correspond to four pillars of personal congruence:
1. emotional intelligence;
2. conscious communication;
3. healthy responsibility; and
4. impeccable agreement.
Our philosophy matches each pillar of personal congruence to the corresponding value of each cornerstone.
The complexity of this suggested coalescence is far beyond a straightforward elucidation. The aim of this article
is to outline these factors and show how aligning and engaging the skill set, efficiency, talent and attitude of team
members can result in a positive workplace culture.
Commercialised volume-based dentistry has led to an
increased exposure to low-grade stress, which negatively
affects the employee even prior to arriving at the clinic.
Many dental employees who previously struggled quietly with
stress have provided testimonials for SDGN. They reported
that they felt stuck in their workplace and were afraid
that their opinions would be dismissed or met with retaliation. The attraction–selection–attrition model proposed by
Benjamin Schneider explains this situation with a psychological theory which suggests that employees base their person–
organisation fit perception on the values portrayed in the
workplace.

optimise the employment process in dentistry. It is the first
stage of system reform.
The Slow Dentistry Job Board is a complementary stage to
the Slow Dentistry Experience. Both stages will formulate
a hiring strategy where both parties follow the same guidebook. There is a current lack of a unified system of linking
applicants to job providers in dentistry, and SDGN aims to
gather like-minded dentists who share the advocated
ethos on the same platform. This will drastically diminish
turnover rates, resulting in fewer costs, higher productivity
and greater knowledge preservation for dental practices.
Desperation hiring fills a position with the wrong person,
which means a host of problems later. Safeguarding

SDGN is establishing training programmes and advocacy
campaigns to effect change. These programmes target
both the younger generation who are transitioning from
university to the workforce and the older generation who
are agonised by chronic exhaustion and burn-out. These
programmes will nurture a universal contemporary approach
towards shaping culture to eventually forge real relationships and co-create alignment within the workplace.
The Slow Dentistry Experience (SDE) is a tutorship programme aimed at providing pre-employment training and
development opportunities for young dentists at top Slow
Dentistry-certified clinics around the world. Exclusive externships, internships and mentorships will be offered that
fully explore Slow Dentistry’s ethos and that build a unified,
stress-free relationship between the employer and the
employee, which ultimately promotes a healthy work–life
balance. The Slow Dentistry Experience is for those who
seek inspiration and empowerment in their work and
deeply believe in their ability to radically change dental care
worldwide. This programme is planned to facilitate and

simply.TRIOS 5
lntraoral scanning that simply makes sense

Hygienic by design for minimal risk of
cross-contamination. Smaller and lighter
than ever for next-level ergonomics. And
a ScanAssist engine with intelligent-alignment
technologythat makes precision scanning
effortless, every time.

[16] =>

| opinion

turnover is a process not a policy and is an investment
not a quick fix.
A community platform with a networking hub will be
launched where dental professionals at all points of their
careers can communicate with each other in one place.
Nurturing the next generation in the nuances of Slow
Dentistry is expected to generate a resilient workforce
with a high degree of self-awareness. The first element of
success in dealing and communicating with the dental
team and patients is self-confidence, which develops from
heightened self-awareness.
Slow Dentistry places more value on the concept of seeking instead of chasing. It promotes the journey over the
destination by advocating for No Half Smiles—a philosophy
proposed by Dr Miguel Stanley, a major proponent of
ethically based treatment planning rather than financial.
The more we learn how to reject quick fixes demanded by
patients and enact sound, comprehensive treatment plans,
the sooner practitioners will start to put themselves first,
creating internal harmony. This harmony cannot be attained without having already developed self-confidence.
The emotional and financial aspects of workplace management are the least taught subjects in dental schools, if
taught at all, meaning that many young professionals graduate with low self-esteem. SDGN will create a coaching
programme to introduce interested dentists to the Slow
Dentistry values. The programme will educate young dentists entering the workforce on the principles of innovative
leadership by co-creating a customised management style
with the operating team, one that aligns with the needs,
values and culture of the workplace and attracts patients
seeking complete healthy smiles.

1 2023

Slow Dentistry’s financial model is the ultimate hedge
against indebtedness. Its management style characterises
a steadier pace towards financial growth. It garners target
patients over a longer period, which ultimately balances out
the financial gap that was created by seeing an appropriate
number of patients per day. This approach will save the
new generation of dentists from falling into possible failure
patterns and guide them to foster a well-thought-out mindset for a successful future that satisfies their aspirations.
It will not only sustain the careers of those who prefer to
keep working as practitioners, but also expedite the transition from practitioner to clinic director for those who
possess leadership personality traits.
Battling quiet quitting and attrition can only be avoided
by embracing Slow Dentistry’s philosophy and eliminating
a toxic culture, burn-out, misfits and favouritism in the
workplace. The more congruent we are, the higher our
self-awareness will be and ultimately the more selfconfident we will become to preserve our mental health.
A sustainable dental practice is a Slow Dentistry-certified
practice.

about
Dr Huthaifa AbdulQader
General secretary of the Slow
Dentistry Global Network

www.slowdentistryglobalnetwork.org

[17] =>

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[18] =>

| opinion

Intra-oral scanners in the dental office
The countless benefits for both clinicians and
patients and the practical aspects of digitalisation
Dr Ahmad Al-Hassiny, New Zealand

scanner to take a digital impression and CAD/CAM system
for the fabrication of the crown.6
Drs Werner Mörmann and Marco Brandestini recognised
the potential of this market and developed a similar system in 1983 at the University of Zurich, independent of
Dr Duret’s work. In the same year, they created the first
CEREC prototype unit (Sirona Dental Systems; Fig. 1).7, 8
The very same CEREC that many dentists around the
world utilise today was first envisioned so long ago.
Since their earliest inception, IOSs have been optical in nature,
utilising laser or structured light technology. The optical impression made by an IOS is carried out by taking a scan inside
the patient’s mouth of the target teeth or gingivae directly.
The light projected from the IOS reflects off the soft and hard
tissue into a sensor in the IOS, which is then converted into
a digital impression by software. The software then creates
a 3D image of the surface of the prepared tooth, the gingiva, the
antagonistic tooth or the patient's occlusion (Fig. 2–4).9
1
Fig. 1: Drs Werner H. Mörmann and Marco Brandestini proudly presenting a
CEREC prototype in 1986.8

Introduction
Dentistry is undergoing a radical transformation. The use
of intra-oral scanners (IOSs) instead of traditional physical impressions is gaining more and more ground. Virtually
all disciplines of dentistry, including prosthodontics, orthodontics, conservative dentistry, implantology and oral
surgery, can benefit from the multitude of advantages of
the digital workflow.1–3 The adoption of digital technologies
and IOSs, in particular, has skyrocketed across the globe.
The uptake of these devices is as high as 40%–50% in
some mature markets, and it is expected to continue
to rise globally.4 It can be concluded that digital dentistry is
no longer the future but the here and now.
While scanners have surged into mainstream dentistry relatively recently, CAD/CAM technology was introduced to
dentistry in the 1970s.5 Its history dates back to 1973, when
Dr François Duret proposed the idea of optical impressions
for application in dentistry. Ten years later, he demonstrated
the first crown produced using a patented electro-optical

1 2023

As opposed to laboratory scanners, IOSs are designed to
obtain digital impressions directly in the patient’s mouth.
Therefore, their design has been limited by the shape
of the oral cavity, and the general appearance of these
scanners across all the different manufacturers does not
vary significantly (Fig. 5).

Benefits of IOSs
The benefits of intra-oral scanning compared with conventional impressions are endless. These advantages are
well established both in literature and by the thousands of
anecdotes provided by clinicians worldwide. Adopting the
use of intra-oral scanning in the practice is a no-brainer.
The benefits of using an IOS in the practice include improved clinical efficiency, improved comfort for patients
and ease of use for the clinician.10, 11 Intra-oral scans are
much faster and, with the right training, easier to carry out
than a physical impression.12 A full-arch intra-oral scan
can be carried out within 45 seconds confidently with a
modern scanner by an experienced user.
Patients also far prefer intra-oral scans to physical impressions.
This is logical and self-explanatory. When an IOS is used,

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opinion

Figs. 2–4: Examples of full-arch intra-oral scans taken with an intra-oral scanner.

patients are less likely to gag, and the entire process of having
the impression taken is more efficient and less messy. Using an
IOS also has a wow factor. Patients are extremely impressed
by this technology when shown it.11 This can help improve
communication and build patient rapport and trust (Fig. 6).
Further benefits include the ease of storage. No longer do
you need to have cupboards full of stone models. A digital
file is easy to store and, more importantly, easy to share.
By using an IOS, you open the door to a world of possibilities by being able to utilise the various design services all
around the world. This is all possible because it is much
easier to send a scan file in an email to a laboratory on the
other side of the world than to try send it a stone model.
Multiple studies have compared the accuracy of conventional impression techniques with that of digital impressions. The latest studies have concluded that digital
scans have comparable accuracy13 or are even superior14
to physical impressions. However, it is important to note
that not all scanners are made equal, and some devices are
unable to maintain accuracy in scanning more complicated
structures, such as edentulous arches, or in scanning for
full-arch implant prostheses.15
With all the advantages of IOS, what are the downsides?
Well, the reality is just two considerations. The first is investment cost, which as an industry I think we just need to
accept, as the undeniable fact is that using an IOS will
make dentistry so much better for you and your patients.
It will make dentistry more enjoyable for you. After all, you
have to spend money to make money.
The second consideration is training. Clinicians need to
be aware that, although using an IOS is much easier now
than ever before, it still requires some training and practice. Think about your first physical impression compared
to now. Thankfully these days with modern IOSs, it is much
easier to learn. I can confidently train our new graduate
dentists to become very proficient with an IOS within two

to three weeks. It just takes some time, training and effort,
but it is worthwhile and you will never look back. My advice for buying an IOS is to make sure that your supplier
provides adequate training and support, otherwise check
out the website of the Institute of Digital Dentistry (https://
instituteofdigitaldentistry.com/) for an entire library of online
courses that will teach you everything you need to know.

Market pressure and changes
Over the past 15 years, we have watched the IOS market
grow increasingly competitive. Back then, there were only
two main IOS options, CEREC and E4D (now under the
Planmeca brand). Now, there are over 15 IOS manufacturers and many more scanners, since this figure does
not include all the white-label products. The IOS market
has completely blown up.
With this increase in competition and market pressure,
we have seen an unprecedented reduction in scanner
prices, which is beneficial for clinicians everywhere.
As I mentioned, it is well established that the main barrier
to adopting intra-oral scanning is cost,16 so the decrease
in prices is driving adoption rates of intra-oral scanning.
Fifteen years ago, the entry price for an IOS was at least
US$60,000. Nowadays, it is a fraction of this, the cheapest
entry-level scanner being around US$8,000.

TRIOS 5 (3Shape)
TRIOS 5 was officially launched in September 2022 (Fig. 7).
It was a complete upgrade compared with the previousgeneration models, TRIOS 4 and 3. TRIOS 5 is a complete
redesign and engineered inside and out. According to the
manufacturer, this IOS will take scanning to the next level.
Unlike TRIOS 4, which was an incremental improvement on
TRIOS 3, TRIOS 5 has an entirely new optical engine and build.
3Shape said it has made more than 50 improvements in
the TRIOS 5 compared with older generations. Like usual

Fig. 5: A range of different intra-oral scanners available on the market today. (Image courtesy of © iDD, institute of Digital Dentistry)

19
5

[20] =>

| opinion

6
Fig. 6: An example of patient engagement when using the TRIOS MOVE (3Shape). (Image courtesy of © iDD, institute of Digital Dentistry)

for 3Shape products, it looks incredibly stylish and hightech. The best part is the cost. TRIOS 5 has a recommended retail price of US$26,000. It being a premium
scanner, this is the cheapest price a TRIOS flagship product
has ever been released at—a sign of the (market) times.
With the release of TRIOS 5, the company has also taken
the opportunity to rethink its other scanner prices to stay
competitive. There is now a reduction in cost of all other
TRIOS models. For example, TRIOS 4 with the wireless
pod is now around US$22,000 (recommended retail price).
Additionally, just like other TRIOS scanners, TRIOS 5 has a
subscription-free option.
One of the most interesting changes in TRIOS 5 is that it is
completely calibration-free. Dentists will no longer need to be
concerned about calibrating the scanner before the next patient comes through the door. TRIOS 5 is also 30% smaller and
20% lighter than TRIOS 4, having a total weight (with a battery)
of 299 g, making it one of the lightest scanners on the market.
The company has also invested heavily in its battery technology, so TRIOS 5 requires only one battery per day, the

company says. This is a welcome improvement, as the battery life of TRIOS 4 was not good. The company says that
the user can scan up to 33 patients or scan for 66 minutes
per battery. The batteries also have fast-charging capability, enabling the user to charge the battery up to 80% in
60 minutes and fully within 2 hours (Fig. 8).
Finally, the major focus last year for many companies was
hygiene. In a post-pandemic world, this will be more important than ever before. TRIOS 5’s closed scanning tips
are a completely new design. These are different to all
other TRIOS scanning tips, and the focus is making them
hygienic and preventing cross-contamination. They are also
cheaper and can withstand up to 100 autoclave cycles.
TRIOS 4 smart tips have not made a return in TRIOS 5.

Practical aspects of digitalisation
There are many things to like about the new TRIOS 5 scanner,
but what about actually applying this technology in the
dental office? For starters, a dentist needs to take the
plunge and invest, accepting that the pros far outweigh
the cons. The next step is installation and training. Choose
a reputable company and distributor that will offer great
installation and onboarding services. If you buy a TRIOS 5,
this will come in two forms, either the TRIOS MOVE cart or
the laptop version. Both are very easy to install.
The next step is training. When using an IOS, it is crucial to
follow recommended scanning protocols or scanning strategies set out by the company. Following correct scanning
protocols gives users a methodology with which to ensure

Fig. 7: TRIOS 5.

[21] =>

opinion

the most efficient way to scan and minimises the risk of
incorrect stitching of images, which results in inaccuracies.
Scanning now is easier than ever before with powerful artificial intelligence (AI) in most devices that effectively guides
the user, can identify and remove soft tissue artefacts, and
filters scan data to only capture what is important. Scanning protocols have also seen improvements. For example,
3Shape introduced ScanAssist technology, which utilises
AI to stitch together data regardless of the strategy used.
8

Coating the oral cavity in scanning powder is no longer
necessary with modern scanners. Although, owing to the
optical nature of the scanners, wet and very shiny surfaces
can still be a little tricky to capture, these factors are often managed inside the mouth, for example with adequate
moisture control or changing the angle of the scanner to
prevent light reflection into the sensor.
Almost all modern IOS have some sort of mechanism to
prevent condensation on the scanner tip while scanning,
such as an external or built-in heater or fan. These factors
enable scanning within the oral cavity for a long time
without having to stop.
The reality is that, with modern scanners, getting into digital
dentistry has never been easier. My recommendation is
to take the plunge. You do not want to fall behind, and the
sooner you start learning how to use this technology the
better.

Market trends
The IOS market has changed significantly over the past
15 years, from single-shoot cameras to scanners that take
thousands of images per minute and high-tech AI. Looking
into the future, the market trend of IOS seems to be moving
towards wireless, battery-powered scanners with removable scanning heads rather than traditional wired ones with
fixed scanning heads that require cold disinfection. This is
evident in some of the latest major releases in the market,
such as TRIOS.
The main market trend we are now seeing is related to software improvements. There has been a significant push by
companies to improve their software as a point of difference compared with the multitude of other devices on the
market. IOSs are moving away from being just an impression replacement tool to being seen as a valuable tool to be
included in patient examination as a communication and
treatment planning aid. There are many software modules
included in scanner software by prominent companies.
These modules include orthodontic simulators, smile design simulators and patient monitoring over time. With the
rise of 3D printing in dentistry, we are also seeing companies include a model builder module in their IOS software,
which enables the scans to be made into printable models
easily and efficiently.

Fig. 8: TRIOS 5 with a battery pack inserted at the back of the scanner.

There is no doubt in my mind that, in the future, most of the
advancements we will see will continue to be in the software
space, especially in the realm of AI and better workflows with
other devices that are being adopted in the clinic, such as
3D printers. Although milling machines were never adopted
widely in the dental office (again mainly because of cost),
3D printers are much cheaper and enable clinicians to move
some production in-house. This is proving to be an exciting area
of dentistry, and the scanner companies are taking notice,
many creating integrations with popular 3D printers.

Conclusion
There has not been as much advancement in the industry
from a technological point of view like there has in the past
ten years. Dentistry is completely changing, and with the
advent of AI diagnostics, intra-oral scanning data, 3D printing
and CAD/CAM software, it is not inconceivable that how we
diagnose, plan treatment and execute treatment will radically
change in the next five to ten years. If you do not have a scanner
yet, it is time to accept the inevitable and invest. The Institute
of Digital Dentistry provides on its website a multitude of free
resources to help you choose the right scanner for you. It is
indeed a very exciting time to be a dentist!

Editorial note: Please scan this QR code for
the list of references.

about
Dr Ahmad Al-Hassiny is a global
leader in digital dentistry and intra-oral
scanners, carrying out lectures as a
key opinion leader for many companies
and industry. He is one of the few in
the world who owns and has tested all
mainstream scanners and CAD/CAM
systems in his clinic. Dr Al-Hassiny
is also the director of the Institute of
Digital Dentistry, a world-leading digital dentistry education provider
with a mission to ensure dentists globally have easy and
affordable access to the best digital dentistry training possible.

1 2023

[22] =>

| trends & applications

Digital workflow
for 3D-printed complete dentures
Dr Fernando Gérman, Spain

Digital dental workflows are no longer a promise of the
future, but the reality we live in today. The entire work protocol from diagnosis to treatment has digital elements, even
though there are still gaps when it comes to the complete
digitalisation of the dental office.
Do you consider yourself a digitised professional because
you have an intra-oral scanner? That is only a small but very
significant part of the framework, especially when it comes
to a full digital workflow for a complete or partial denture.

Phases of the CAD/CAM process in
digital dentistry and 3D dental prostheses:
Methodology
The methodology used for CAD/CAM involves optical scanning of the jaw without the need for alginate and employing
those scans in design software to design and 3D-print dental
appliances with maximum accuracy.
By using the digital STL file from the design process, we can
realise the denture or bridge we see on screen. To do this,
we need a high-speed scanner (Fig. 1) for complete marginal
definition of soft and hard tissue. We use the Medit i700.
The same efficiency is also provided by the Medit i500.
We also need an adequate bite registration that allows us to
determine the vertical dimension and correct intermaxillary
relation for the positioning of the prosthesis, whether complete or partial, based on the centric relation and the peripheral tissue (mucosa and lips). We need an automatic means
of sending all the scan data to the associated laboratory or
a design program to interpret the scanned data and design
the prosthesis ourselves. Finally, once the prosthesis has
been printed, we must follow a protocol that guarantees
a material with the required characteristics of resistance,

1 2023

polishing and final finishing for better adaptation and durability in the patient’s mouth. Naturally, the digital method also
requires time and training that in the medium to long term will
allow us optimal results.
Steps for a complete scan of an edentulous patient
1) We start with a complete scan of the upper jaw from the
retromolar area to the palate and palatal rugae. It is important to have some particular anatomy that differentiates one
side from the other so that the software does not confuse
the scanned sides and cross-reference the information.
The tissue of the vestibular part must be retracted and
separated for better fit of the future printed prosthesis.
Although it is complex, it is essential, and in fact there are
techniques that result in a better-quality scan to achieve
this peripheral sealing.
2) We then continue with the scanning of the lower jaw, from
the posterior region, as well as the upper jaw, passing
along the plateau or gingiva-covered alveolar ridge to
the opposite side. It is important to be able to obtain a
good extension of the lower jaw in the same way as in the
upper jaw so that the denture can be fully extended for
a better fit.
3) Next, we obtain a bite registration to establish the relationship between the upper and lower jaws, whether dentate
or edentulous.
Starting the 3D-printing process
At this point, after taking scans of both arches, we send
the STL file to and transform it into a printable model using
the Model Builder software (Medit), which provides us with
a suitable structure for classic models with a base and
articulators. Afterwards, it can be sent to the SprintRay printer
in two different ways, depending on the user’s preferences
and experience:

[23] =>

trends & applications

1) Sending to RayWare Cloud: Printing of the lower and
upper jaw models is a user-friendly process thanks to
an artificial intelligence (AI) program which arranges the
designs in the best way possible automatically on the
build platform for fast and optimal printing. In this case,
the scan files must be saved on the PC and uploaded to
the SprintRay Cloud program.
2) Using RayWare Desktop: From the same Medit app, the
scan files are uploaded to the printing program directly.
In this case, the user must arrange the designs on the build
platform for good retention and print quality. This program
provides the possibility of adding supports and deciding
on the print position, based on the user’s training.
Obtaining the jaw models
With both methods, we will have the scanned jaws ready
for the fabrication of the bite registration to record the intermaxillary relations. Having models of the jaws enables
creation of a base plate for a classic occlusal rim (Fig. 2)
that provides:
– the bite registration;
– the occlusal dimension;
– the relationship between the jaws; and
– the future size of the teeth and prosthesis in relation to
the patient’s lips (facial profile).
Once we have both jaw models printed and the base plate
with adequate wax registration, we mark reference points
on the wax that we are going to scan with a marker or
coloured composite (Fig. 3) and scan both registrations in
the bite sequence.

Viewing the prosthetic design
and understanding the STL files
Our laboratory designs the prosthesis digitally, and we receive the prosthetic design for our inspection and control.
The design can be viewed on a mobile device (Fig. 4) or on
our computer to check and make any necessary changes.
Once we have received these images and approved the
design, we receive an STL file that can be sent to the
SprintRay printing system to print via RayWare Cloud or via
RayWare Desktop.
Once we receive the final STL file, we download it to our
computer. The file contains the design of the dental pieces
that can be grouped in a single block (Fig. 5) or separated by
segments. These pieces will be the ones that we will cement
to the printed denture base. The file also contains the design
of the denture base with detailed anatomy, as traditionally
done in wax denture design systems. In this case, the details
will be digitised, imitating the gingiva and roots. Later, we will
be able to provide more detail with stains and colours that
mimic the gingiva in a more natural way (Fig. 6).
Printing the prosthesis
The STL file that we have on our computer is sent to RayWare
Cloud for adaptation and placement, through an AI process, on
the virtual platform that appears on the program’s screen (Fig. 7).
We must classify the parameters (Fig. 8) for printing and
follow the intuitive steps that the program prompts, such as:

Once we have obtained all this data according to the
scanning techniques of the sequence protocol guided by
the Medit program, we will be able to send it to the laboratory for final design.

1) the name of the patient or the print job;
2) the type of material that will be used for the printing of the
base or the teeth;
3) the quality of the surface finish, smoother for structures with
a more detailed finish and less detailed for a faster print;
4) the type of support that will fix the structure to the platform; and

1 2023

[24] =>

| trends & applications

5) other details that we can customise or leave as the program default.
When the printing process is started, the time that it will take
is shown, as is the amount of resin to be used and other data
that will later be saved in the RayWare Cloud file.
For the manufacturing of the dental pieces, SprintRay offers material that has similar wear and tear properties to those of a natural
tooth. The material is called SprintRay Crown (Fig. 9). For the base
of the prosthesis, there are different colour options that provide
a similar chroma depending on the gingival colour we choose.

high-precision propeller and innovative alcohol delivery method,
this system can complete a full two-stage wash and dry cycle
in less than 9 minutes, meaning that the dentist or assistant
does not need to be manually involved in the process.
Post-processing: Polymerising in ProCure 2
The pieces must be polymerised with an ultraviolet light that
closes micropores and gives the prosthesis the texture and
uniformity necessary to obtain a surface of adequate rigidity
and/or flexibility according to the characteristics of the material used. That is where ProCure 2 (Fig. 12) fits into the digital
workflow, offering an easy and automated program requiring
less than 5 minutes with preset profiles for each approved material. With ProCure 2, no manual manipulation of light intensity
or duration of the polymerising process or heat is necessary.
Assembly and finishing of the prosthesis
Now we assemble both the base of the prosthesis and the
teeth in order to use the same resin that we have in the tray
to cement the two together. The constructed piece is then
placed in ProCure 2 for final fixation.

After printing
When the printing is finished, the platform will be lifted out of the
resin tank and the piece will be finished. We will only have to remove
the supports that held the prothesis to the print platform (Fig. 10).
If RayWare Cloud was used, the supports will be a mesh or
net that can be removed easily by hand, greatly improving
the process of finishing the prosthesis, unlike other systems
that require support removal with pliers and cutters because
they are very thick and leave a residue on the prosthetic
structures, requiring polishing. That is why we use RayWare
Cloud, as it provides us with supports that are very easy to
remove without leaving any residue.
Post-processing: Washing and drying
The liquid resin that remains on the printed pieces must be
washed off thoroughly. For this, SprintRay has an automatic
washing and drying system that ensures that the printed piece
is free of resin residue, ready for polymerisation and finishing.
SprintRay Pro Wash/Dry (Fig. 11) is the first multistage automated wash and dry system designed for dental 3D printing,
offering the speed, cleanliness and ease of use that the digital workflow demands. Thanks to its high-powered motor,

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Subsequently, we polish the final product using classic polishing pastes and various polishing brushes, finishing with the
fabric brush that gives it a special final shine (Figs. 13 & 14).
The work can be finished by glazing it with a GC glaze and
polymerising it again in ProCure 2 or with a common composite polymerising lamp that gives a brighter finish. It should
be noted that there are different stains or flowable composites
that can be used to further customise the prosthetic finish.

Conclusion
Although the digital workflow of 3D-printing complete
prostheses may seem complex and lengthy at first, process
automation with the latest technology means that dental
clinics that embark on this new and wonderful adventure
have only benefits to look forward to in the long run.

about
Dr Fernando Gérman completed
postgraduate studies in implantology
at New York University in the US.
He is director of the Dentinova dental
practice in Barcelona in Spain and of
Dentinova Academy (www.dentinova.es).
He is a key opinion leader for SprintRay
Iberica, a speaker for ETK Implant and
a Medit instructor at Dentinova Academy.

[25] =>

BECOMES

[26] =>

| trends & applications

Exploring novel technologies
for improved efficiency
Dr Les Kalman, Canada

Fig. 1: Design for crown for tooth #11, facial view. Fig. 2: Design for crown for tooth #11, lingual view. Fig. 3: Design for crown for tooth #11, internal view.

Introduction
For all dentists, it is a professional duty to provide safe,
quality and competent oral healthcare to patients.1 Clinicians
strive to do this by learning new information, practising
newly acquired skills and implementing new workflows.
As digital dentistry continues to evolve and expand, dentists need to further explore various technologies, as it has
become apparent that it is possible to maintain or elevate
the standard of patient care.2 Many dental technologies
may provide superior accuracy,3 improved efficiency4 and
an enhanced experience for the clinician and patient.5
The dental profession will also need to re-evaluate and
modify workflows, in order to limit its carbon footprint and
environmental impact.6 Employing technological workflows
may result in a more sustainable approach to healthcare.7

Efficiency and sustainability can be negatively affected
by inaccurate workflows. Consider the unfortunate event
of a prosthodontic remake that is clinically unacceptable.
This can be a challenging situation for both the patient
and clinician to endure, as it results in an unproductive appointment, inefficient use of time and additional expenses.8
In addition, the environmental impact can be significant,
owing to the non-productive use of resources (e.g. electricity
and disposable materials) and carbon emissions from
both the patient commute and the return and delivery of the
prosthodontic remake.9
There have been several developments in digital dentistry
that have modernised workflows to improve efficiency,
cost and the overall dental experience. There may also be
additional efficiencies in terms of fabrication time, material
requirements and cost. These factors may also help improve the overall sustainability of dentistry. This report will
illustrate three technologies: 3D-printed zirconia anterior
indirect restorations, a digital dental colour identification
and communication app, and 3D-printed latticed zirconia
implant bars.

Novel technologies

5
Fig. 4: Design for veneer for tooth #22, facial view. Fig. 5: Design for veneer
for tooth #22, lingual view.

1 2023

3D-printed zirconia
Zirconia has traditionally been used in the posterior region,
owing to its high strength.10 Zirconia has recently experienced a resurgence as an alternative material for the anterior region, for use in veneers11 and crowns owing to its
strength, translucency, minimal preparation requirement11
and the ability of layering material after milling.12

[27] =>

Fig. 6: Virtual patient crown case. Fig. 7: Virtual patient veneer case.

Zirconia is essentially milled through subtractive manufacturing. That is, the prosthodontic unit is fabricated from
a larger piece of zirconia. The milling is completed with
drills through a CAM workflow. This approach has been
the standard, but may have disadvantages, especially in
terms of sustainability.13
3D printing, or additive manufacturing, was used for the
fabrication of an anterior crown and veneer. The workflow
involved using dental software (exocad) to digitally design
a crown on tooth #11 (Figs. 1–3) and a veneer on tooth #22
(Figs. 4 & 5). The prosthetic designs were based on
two separate patient cases (Figs. 6 & 7), which were part
of a larger study that will be published in the near future.
The patient models were originally scanned (Straumann
CARES 3, Straumann), and digital files were subsequently
created. The prosthetic designs were then sent to a facility
as STL files and printed in zirconia.

ceramic technology (Lithoz) using LithaCon 3Y 210
ceramic material (Figs. 8–14). The powder composition of
the material is 3 mol% yttria-stabilised zirconia, and the
material has a reported four-point bending strength of
935 MPa and surface roughness (Ra) of < 1 µm. The prosthetic units underwent de-binding and sintering and were
delivered for in vitro evaluation. The crown and veneer were
ordered as triplets (three prints of the same file), for assessment. There were no noticeable differences between the
units, based on macrophotography. These units were also
not stained or glazed, but this process will be explored in
an upcoming investigation.

The STL files were not subject to digital modification (the
prosthetic units were printed directly from the STL files),
and the designs were printed with a lithography-based

Colour identification and communication app
The assessment of dental colour or shade remains a
challenge in dentistry. One study has indicated that the
accurate determination of colour only occurs about 49%
of the time in dental schools.14 Moreover, colour is often
limited to that of enamel, there being little focus on
mucosal colour, as related to full-arch prostheses. It must
be stressed that the inaccurate determination of colour is
inefficient and has a negative impact on sustainability.

Fig. 8: 3D-printed crown for tooth #11, facial view. Fig. 9: 3D-printed crown for tooth #11, lingual view. Fig. 10: 3D-printed crown for tooth #11, proximal view.
Fig. 11: 3D-printed crown for tooth #11, internal view. Fig. 12: 3D-printed veneer for tooth #22, facial view. Fig. 13: 3D-printed veneer for tooth #22,
lingual view. Fig. 14: 3D-printed veneer for tooth #22, proximal view.

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[28] =>

| trends & applications

16

15

17

18

Fig. 15: Dental colour identification and communication software homepage. Fig. 16: Digital colour identification sensor. Fig. 17: 3D-printed crown colour result.
Fig. 18: 3D-printed veneer colour result.

A novel digital workflow using SmileShade (Fig. 15) was
employed as a demonstration to identify and communicate
the colour of the 3D-printed anterior prostheses. The software was activated on an iPad and paired with the wireless
Bluetooth sensor. The sensor was placed over the facial
surface of the crown and veneer (Fig. 16), and it recorded
the colour and then transmitted the information back to the
iPad. The process took approximately 3 seconds. Dental
colour was expressed as an objective output in CMYK,

19

20

RGB, LAB and HEX colour models and as a VITA shade
(Figs. 17 & 18). The high dynamic range micro colour
sensor has an automatic temperature control and interdevice repeatability of < 1 ∆E. The software will also feature
IPS e.max shades in future.
On the software’s data input page, the operator has the
option of entering all pertinent data related to the project
and/or patient (Fig. 19). The software combines this

21

Fig. 19: Dental colour identification and identification software data input options. Fig. 20: 3D-printed crown colour data set. Fig. 21: 3D-printed veneer colour data set.

28

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[29] =>

Fig. 22: 3D-printed zirconia implant bar. Fig. 23: Lattice structure incorporated into a 3D-printed bar. (Image courtesy of ADEISS) Fig. 24: Soft-tissue implant
model, 3D-printed latticed zirconia implant bar and a compatible Ivotion (Ivoclar) complete mandibular denture.

information and the colour identification data for complete
colour communication (Figs. 20 & 21).
3D-printed latticed zirconia implant bar
Non-metal treatment options in implant dentistry have
become increasingly popular,15 based on patient preferences and recent advances in materials and technologies. 3D-printed zirconia, the same material and process
described for anterior indirect restorations, may also be
employed for the fabrication of implant overdenture bars
(Fig. 22). Moreover, owing to the nature of additive manufacturing, complex geometries can be incorporated into
structural designs. Consequently, our current investigation explored the incorporation of a lattice structure into
a 3D-printed zirconia implant bar (Fig. 23). With this approach, there is an opportunity to save material, time and
cost, positively affecting efficiency and sustainability.
The same workflow as previously described was used for
the latticed implant bar. An STL file was sent for fabrication
(Lithoz), and several identical implant bars were produced
by additive manufacturing (Fig. 24). These bars will be
tested for fit and strength and published in the near future.

Discussion
The 3D-printed crown and veneer were comparable in
appearance to conventionally manufactured (milled) zirconia
restorations (study in progress). The prostheses seemed
very durable and fitted well with the model. Of particular
interest was that the printed prostheses were nearly identical to the designs submitted, strengthening the need for
accurate digital design. The 3D-printed implant bar demonstrated similar characteristics, and results will be published
in the future. The colour identification and communication
software provided a simple workflow and accurate and
objective results. Further software modifications are in
progress in a comparison study.
3D printing has made significant advances, especially regarding the fabrication of zirconia prostheses. The additive
manufacturing workflow seems to provide significant advantages, in terms of material used, fabrication time, efficiency
and cost,16, 17 all in a seemingly more sustainable approach.18
Similarly, digital dentistry provides a virtual workflow that
saves time and cost and provides an improved experience
for the clinician and patient. Subsequently, this results in

a more sustainable approach to the delivery of treatment.6
Additional research is required to evaluate physical properties and clinical outcomes and to establish metrics to better
understand the possibility of sustainability.

Conclusion
There are numerous technologies that are novel and innovative in dentistry. Clinicians and technicians should try to be
open-minded in exploring and assessing these technologies
and consider how their clinical workflow may be modified.
Many technological tools not only maintain the standard of
care, but improve accuracy and efficiency, elevate the dental
experience and may have a positive impact on sustainability.

Conflict of interest
The author is involved with externally funded research to
explore 3D-printed zirconia crowns, veneers and implant
bars, through collaborative research with Lithoz. The author
is the inventor and co-owner of the colour identification and
communication software mentioned in this article.
Acknowledgements
The author would like to acknowledge the following for
support and guidance: the International Congress of Oral
Implantologists’ Implant Dentistry Research and Education
Foundation, the American Academy of Implant Dentistry
Foundation, Lithoz, Alien Milling Technologies, Red Square
Labs, Research Driven and Dr Yara Hosein.
Editorial note: Please scan this QR code for the list of references.

about
Dr Les Kalman is an educator and
medical device researcher focusing on
additive manufacturing and software.
He is a fellow of the Academy of
Osseointegration, American College
of Dentists and Academy for Dental
Facial Esthetics and a diplomate
of the International Congress of
Oral Implantologists. He is the recipient
of an Alumni of Distinction Award from the Schulich School
of Medicine and Dentistry at Western University in London
in Ontario in Canada and a CES Innovation Awards honouree.

1 2023

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| trends & applications

Applications of digital technology
in dental surgery—an overview
Drs Edgard El Chaar, Sherman Farahani & Yoonah Danskin, USA

Fig. 1: A 20-year-old female patient with excessive gingival display and wear of the incisal edges required both an aesthetic restorative treatment and aesthetic crown lengthening.
Fig. 2: Cross cut of the maxillary left premolar showing the merging of the intra-oral scan with the CBCT scan using coDiagnostiX software and showing thick buccal bone.
Fig. 3: Cross cut of the maxillary right central incisor showing the merging of the intra-oral scan with the CBCT scan using coDiagnostiX software and showing thin buccal bone.

Introduction
Digital technology in the dental industry has grown rapidly
in the post-COVID world, constantly reaching new heights
of achievement. Besides its extensive use in prosthetic
dentistry, digital technology has a wide application in dental

surgery. Owing to increased federal funding and corporate
investment during the pandemic,1 the current digital dentistry market size of US$4.2 billion is expected to grow to
US$16.3 billion by 2032.2 Many solo practices have much
to gain from application of digital technology in surgical
dentistry, but this is yet to be fully realised. This is reflected
in research databases. A PubMed search regarding research in digital dentistry yields more than 16,000 results
for the term “restorative digital impressions”, while the term
“dental 3D printing” yields 2,188 results. In contrast, the term
“digital dental implants” yields only 1,174 results.
The success of surgical treatment is dependent on clinicians’
thorough understanding of key principles of wound healing, as
well as on effective preparation and application of the chosen
treatment modality. It is important to understand what digital
technology can do for clinicians in dental surgery. This article
will provide an overview of how digital technology can improve
the success of crown lengthening, immediate implant placement, bone augmentation and full-mouth restoration.

Aesthetic crown lengthening
6

7
Fig. 4: An open flap was raised buccal of teeth #24–26 to perform an ostectomy
and osteoplasty to create the biological width but also to reduce the buccal thickness
and reduce the tissue rebound. Fig. 5: Post-op frontal view shows the result of resective
therapy completed with a flapless approach in the anterior region. Anterior area did
not have thick bone according to CBCT, and therefore, could be done with a flapless
approach. Fig. 6: Failing tooth #21 that had drifted buccally owing to the periodontal
condition. Fig. 7: Digital treatment planning involving digital extraction of tooth #21,
planning the implant and designing the surgical guide using coDiagnostiX software.

1 2023

Although digital photography and renderings of predicted
aesthetic outcomes are able to help us in planning for
aesthetic crown lengthening, they are not always able to
predict soft-tissue response after surgery. Therefore, surgical accuracy remains a challenge.
Soft-tissue rebound occurs when there is thick buccal
bone and thick overlying gingiva. Merging of an intra-oral
scan with CBCT imagery for planning of an aesthetic crown

[31] =>

Fig. 8: Using CARES software to synergise with coDiagnostiX in order to design a temporary crown. Fig. 9: Surgical guide in place after tooth #21 had been extracted.
Fig. 10: Implant placed as planned and the surrounding gaps grafted. Fig. 11: 3D-printed tooth planned in the CARES software luted to the abutment after the implant
had been placed. Fig. 12: Frontal view of the provisional prosthesis screwed to the implant. Fig. 13: Occlusal view of the provisional prosthesis screwed to the implant.

lengthening procedure can achieve two goals: it allows for a
full understanding of the patient’s periodontium and its bony
and soft-tissue relation and architecture and for digital planning and fabrication of 3D-printed surgical guides for precise
resective surgery. If the patient has thick buccal bone and
thick overlying gingiva, we can predict greater soft-tissue
rebound after healing, and therefore we can plan for more
aggressive resective therapy.3, 4 We can also inform the patient of the possible need for secondary surgical procedures
in the future, reducing the risk of disappointment or dissatisfaction. In this case, we determined the issue early on
(Figs. 1–3). We decided to execute an open-flap approach,
reduce the buccal plate and stabilise the soft tissue, resulting
in an aesthetic and sustainable result (Figs. 4 & 5).

positioned 3–4 mm apical to the gingival margin and anchored
in 3–4 mm of native bone to achieve primary stability. The implant planning and eventual position must be prosthetically
driven, to allow for fabrication of a screw-retained restoration.7

Immediate implant placement

Prerequisites for successful immediate implant placement
include adequate interproximal bone, thick phenotype and
an apical topography of the extraction socket that is amenable to implant anchorage.8 For precise implant placement,
guided surgery utilising digital planning software and a
3D-printed surgical guide can be excellent tools. Immediate
provisionalisation preserves the gingival scallop. Digitally
synchronising virtual implant placement with prosthetic
software will allow for fabrication of an accurate printed or
milled resin provisional prosthesis, producing excellent aesthetic results and reducing dental chair time.9

The immediate implant placement procedure has been successful in both the anterior and posterior areas.5, 6 However,
the implant must be positioned lingual to the buccal plate
with a minimum 2 mm gap. Additionally, the platform must be

In the following case, tooth #21 exhibited external root resorption; therefore, it was planned to be extracted followed
by immediate implant placement and provisionalisation with
a 3D-printed screw-retained provisional prosthesis (Fig. 6).

Fig. 14: Frontal view of the final crown. Fig. 15: Occlusal view of the final crown. Fig. 16: 3D-printed rendering of areas #12 and 13. Fig. 17: Area waxed to the
desired volume. Fig. 18: Template created of the desired volume to pre-cut the titanium mesh. Fig. 19: Titanium mesh pre-cut using the template.

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| trends & applications

Fig. 20: Titanium mesh stabilised in place after the mineralised cancellous and cortical allograft had been layered inside the mesh. Fig. 21: Removal of the titanium
mesh at eight months. Site ready to receive the two dental implants. Fig. 22: Implant planning on coDiagnostiX software was synergised with CARES software to
determine the right depth that would lead to the best emergence profile of the future restorations. Fig. 23: 3D-printed guide in place for the guided implant placement.

to fit the exact implant position (Fig. 7). The tooth was
extracted, and the implant was placed with the aid of the
surgical guide, and the printed resin provisional prosthesis
was luted to the temporary abutment and screwed on to
the implant (Figs. 8–13). The patient was able to receive
a final screw-retained restoration with a well-preserved
gingival scallop in four months (Figs. 14 & 15).
24

Advanced bone augmentation

Fig. 24: Smile view of the final restoration. Fig. 25: Intra-oral buccal view
of the final restoration.

The digital implant placement was planned using
coDiagnostiX (Dental Wings) and synchronised with CARES
prosthetic design software (Straumann). This extensive preparation resulted in two critical components: a 3D-printed
surgical guide and a resin provisional prosthesis fabricated

Whether the augmentation is to be horizontal, vertical or a
combination of both, the criteria for successful bone augmentation are based on space creation, space maintenance and
graft stabilisation. The surgical team must assess the defect
in order to properly diagnose it, make a template of the area
to establish the required volume, and determine where and
how to stabilise that space for optimal success.

Fig. 26: Occlusal view of the digital planning for the six immediately placed implants and the immediately seated provisional prosthesis sitting over the reduction
guide. Fig. 27: Frontal view of the digital planning for the six immediately placed implants and the immediately seated provisional prosthesis sitting over the
reduction guide. Fig. 28: Occlusal view of the implants placed after the site had been flattened using the reduction guide as an indicator and as an anchoring
base for the implant placement guide and then for the temporary restoration. Fig. 29: Temporary restoration attached and adjusted. Fig. 30: Initial photograph
of the patient when he presented. Fig. 31: Photograph after implant placement in the maxilla and mandible and delivery of the provisional prostheses.

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[33] =>

trends & applications

In 2019, we introduced the advantages of 3D printing in conjunction with a titanium mesh and augmentation entirely with
allograft.10 We were able to reduce the average surgery time
by more than 25 minutes thanks to 3D-printed models of the
defect. Keep in mind that some cases in that study were completed by residents, which affected the length of time. With an
experienced surgeon, however, this could be a great benefit.
This procedure is demonstrated here by way of a case of
an advanced bone augmentation scenario (Fig. 16). It was
generated primarily using coDiagnostiX implant planning
software. The volume was built with wax, and a template
was created to aid in trimming the titanium mesh, which
was eventually placed over the defect filled with a combination of mineral cancellous and cortical allograft layered on
top (Figs. 17–19). After eight months of healing, the site was
exposed, the titanium mesh was removed, and the dental
implant was placed using a 3D-printed surgical guide.
The process was prosthetically driven by first designing
the restoration in CARES, which was then synchronised
with the coDiagnostiX planning, allowing for proper prosthetic contouring of the resultant restorations (Figs. 20–23).
These efforts resulted in a successful aesthetic and functional prosthetic outcome (Figs. 24 & 25).

Full-arch implant-supported restoration
Traditionally, patients with terminal dentition were given options
for fixed implant-supported restoration with a stage involving
either a removable or fixed provisional prosthesis. The former option is a delayed loading approach, in which all the
hopeless teeth are extracted, implants are placed and a complete denture delivered while the implants osseointegrate.
The latter option strategically maintains an adequate number
of hopeless teeth with proper distribution to support a fixed
provisional prosthesis while the implants osseointegrate
underneath. All approaches required numerous dental visits
and significant laboratory fees and, importantly, presented
emotional challenges to the patient. With digital technology
and the all-on-X treatment modality, it is possible to provide
an immediately loaded full-arch prosthesis in a predictable
and precise manner that is streamlined. Digital technology has
allowed surgical and prosthetic teams to plan treatment for
such full-arch cases in a truly fully prosthetically driven manner
(Figs. 26 & 27), allowing for planned smoothing of the different
bony levels to create the proper prosthetic space (Fig. 28) and
fabricating a milled fixed provisional prosthesis that can be
connected to the implants in a precise and effective manner
at the time of surgery. This reduces the uncertainty and stress
associated with such cases while also providing the patient
with not only choice but also hope, making for a life-changing
experience for the patient (Figs. 29–31).

Conclusion
Digital technology, whether utilised for surgical or prosthetic
purposes, should be embraced and fully utilised in our daily

practice. We must advocate for it to reap the benefits
it provides to us, our patients, our offices and our team.
The overview of the possibilities of digital surgical workflows
provided in this article shows how digital technology can improve the success of crown lengthening, immediate implant
placement, bone augmentation and full-arch restorations.
This is just the tip of the iceberg. Technology is constantly
evolving, and artificial intelligence and robotic and navigation
systems are making headway and becoming a more integral
part of our daily practice. It is time to fully embrace digital technology and digital dentistry.
Editorial note: Please scan this QR code for
the list of references.

about
Dr Edgard El Chaar is a clinical
professor in the Department of
Periodontics at the University of
Pennsylvania School of Dental
Medicine in Philadelphia in the US
and a former clinical associate professor
in the Department of Periodontology
and Implant Dentistry and former director
of the Advanced Education Program
in Periodontics at the New York University College of Dentistry
in the US. He has a thriving private practice in New York City
that specialises in dental implants and periodontal disease.
He is the founder of EEC Institute, a continuing education
and research institution in New York City focused on the
advancement of clinical periodontics and implant dentistry.
Dr Sherman Farahani is an
experienced prosthodontist and
an adjunct clinical instructor in
the Department of Prosthodontics
at the New York University
College of Dentistry in the US.
He works in a private dental
practice in New York City.
Dr Yoonah Danskin received her
bachelor’s degree in neuroscience from
Johns Hopkins University in Baltimore
and her DDS from the University of
California, Los Angeles, both in the US.
She received postdoctoral training in
general practice residency at the
Yale New Haven Hospital in Connecticut
and received a certificate in dental
oncology fellowship at the Memorial Sloan Kettering Cancer
Center in New York, both in the US. She received noteworthy
training in periodontics and surgical implantology at the
New York branch of the Veterans Affairs hospital as the only
periodontics resident in her class. During this time, she completed
academic training in periodontics at New York University.

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| user report

Elimination of titanium-base abutments
and utilisation of the Rosen screw
to improve screw-retained prostheses
Drs Dan Rosen & Gregori M. Kurtzman, USA
the abutment to the implant may loosen, requiring access to
be created through the restoration or destruction of the restoration to access the screw and tighten it. Screw-retained
restorations circumvent the potential subgingival inflammation related to residual cement by eliminating intra-oral
cementation of the restoration to the abutment. Also, should
the screw loosen or the restoration require removal for
periodontal maintenance or another reason, an access hole
at the occlusal or lingual portion of the restoration permits
access to the fixation screw. The composite, as well as cotton
pellet or PTFE tape, sealing the access hole is removable,
and the screw can be tightened or removed.
1
Fig. 1: Screw-retained restorations utilising a titanium-base abutment have the
zirconia portion of the restoration luted to the abutment, which is then fixated
intra-orally to the implant either directly or to a multi-unit abutment on the implant.

Introduction
Screw-retained restorations, whether single units or hybrid prostheses, have become widely used when restoring implants. These have several benefits compared with
cemented restorations. Cemented restorations have the
potential to leave residual cement subgingivally in the sulcus,
thereby possibly causing inflammation and resulting in bone
loss around the implant crestally (peri-implantitis). Additionally, with a cement-retained restoration, the screw attaching

Traditionally, for screw-retained restorations, a titanium-base
abutment (Ti-base) is placed on a laboratory analogue on
the model at the laboratory. The restoration is then fabricated to seat over the Ti-base and is luted to the Ti-base with
a resin cement (Fig. 1). This is sent to the practitioner, who
inserts it, tightens the fixation screw (Fig. 2) and then seals the
access hole with either a cotton pellet or PTFE tape and then
composite. Problems are unfortunately found with Ti-base
restorations. The restoration may separate under function
from the Ti-base it was luted to. One cause of this is insufficient height of available Ti-bases from the implant manufacturers, so less surface area is present where it is luted
to the overlying ceramic restoration. When the prosthesis
presents with separation between the Ti-base and ceramic
of one or more units, the treatment is to re-lute the crown
to the Ti-base intra-orally. This can be a challenge because

Fig. 2: Screw-retained restoration with a conventional screw attaching a titanium-base abutment to the multi-unit abutment. Fig. 3: Hybrid prosthesis from which
a titanium-base abutment had detached and remained intra-orally on the implant. The abutments were still connected to the prosthesis at the other three implant sites.

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[35] =>

user report

Fig. 4: Conventional prosthesis seated on a multi-unit abutment fixated with a screw. Fig. 5: Under loading, stress is concentrated at the thinnest portions
of the zirconia at the multi-unit abutment (arrows). Fig. 6: A fracture results due to exceeding the zirconia loading capacity at the thin portion adjacent to
the multi-unit abutment. Fig. 7: Structural failure results, causing loss of zirconia adjacent to the multi-unit abutment. Fig. 8: Zirconia is thicker with the use
of the Rosen screw. Fig. 9: With the Rosen screw, stress points observed in conventional hybrid restorations or screw-retained single crowns are positioned
in thicker portions of the zirconia (arrows), improving fracture resistance of the material.

the crown may not fully seat on to the Ti-base, increasing occlusal contact on the implant restoration, which may require
occlusal adjustment of the restoration or, if minor and not
felt by the patient, may result in increased loading on the
implant and subsequent bone loss over time. Additionally, if left
intra-orally, residual cement can lead to periodontal issues
as reported with cementable implant restorations. To avoid
this, once the crown has been recemented on the Ti-base
intra-orally and the cement has set, the restoration is removed, the cement cleaned from the junction of the Ti-base
and ceramic, and the restoration then reinserted intra-orally.
This is a time-consuming procedure chairside. With regard
to a hybrid prosthesis, the entire zirconia portion of the prosthesis may separate from all of the Ti-bases intra-orally, necessitating re-luting on to the Ti-bases intra-orally. In some
clinical situations, one or more of the Ti-bases may separate
while the others remain connected intra-orally (Fig. 3). This
may not be detectable by the patient and will essentially decrease the number of implants supporting the prosthesis,
and the units that have had Ti-base separation will allow
micro-movement in the vertical access. This may lead to
other units undergoing Ti-base separation.
Laboratories have attempted to eliminate the use of Ti-bases,
having the zirconia contact directly to the multi-unit abutment
(MUA) with no metallic component in the prosthesis at the
connection (Fig. 4). The fixation screws for the implants on
the market have a flat bottom designed to seat in the Ti-base.

This causes stress concentration at the bottom of the screw
head, where the zirconia is thin (Fig. 5). As stress continues,
fracture may result at the thin portion lateral to the MUA or
restoration margin, leading to restoration failure (Figs. 6 & 7).
These screws also do not create tensile load when placed
into the implant with or without a Ti-base present, leading
to potential screw loosening, even when torqued to the manufacturer’s specifications with a torque wrench.

Fig. 10: Compatibility chart for the 1.4 mm Rosen screw. Fig. 11: Compatibility chart
for the 1.6 mm Rosen screw. Fig. 12: Compatibility chart for the 1.72 mm Rosen screw.

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14
Fig. 13: Tissue side view of a hybrid prosthesis fabricated without titaniumbase abutments to utilise Rosen screws to connect the prosthesis to the
multi-unit abutments intra-orally. Fig. 14: Occlusal view of a hybrid prosthesis
fabricated without titanium-base abutments to utilise Rosen screws to
connect the prosthesis to the multi-unit abutments intra-orally.

The Rosen screw
To overcome those inherent problems associated with Ti-bases
(separation of the Ti-base from the restoration), screw loosening
and elimination of the Ti-base with use of conventional screws
and resulting restoration marginal fracture, the Rosen screw
(www.rosenscrew.com) was developed. The Rosen screw
eliminates the use of Ti-bases so that nothing is luted within
the restoration that may separate under function over time. Depending on design, this screw can connect the screw-retained
restoration to MUAs on the implants or directly to the implants
with no intermediate MUAs present. This increases the thickness
of the zirconia, decreasing its fracture potential under loading.

The Rosen screw has a tapered head, eliminating the flat bottom of conventional screws (Fig. 8). When the screw is threaded
into the implant through the restoration, lateral tension locks the
restoration to the implant, providing tensile load and eliminating potential screw loosening under functional loading (Fig. 9).
The geometry of the screw head locks the prosthesis and can
be achieved with hand tightening alone without use of a torque
wrench. The screw can be used for prostheses fabricated from
resin, PMMA, graphite or zirconia. Screw cost is comparable
with other screws offered by the various implant manufacturers. Rosen screws are available in three sizes, colour-coded
to make identification visually easy—1.40 mm (blue), 1.60 mm
(gold) and 1.72 mm (silver)—and are compatible with most
implants available on the market (Figs. 10–12).
Libraries are available for design of the restorations in-office
or in-laboratory for milling to accommodate use of the Rosen
screw (https://rosenscrew.com/libraries/). These include
exocad, Imetric4D, Pic Dental, Zirkonzahn and 3Shape.

Restorative examples
With regard to hybrid restorations, the prosthesis is designed
to fit to the MUAs, providing thicker material over the MUAs to
resist fracture potential under loading (Fig. 13). The occlusal
view of the hybrid prosthesis looks similar to that for which
Ti-bases have been used, having a small access hole over
each implant on the prosthesis (Fig. 14). Radiographically, the
design demonstrates an intimate fit to the MUAs and increased
prosthetic material surrounding the MUAs for improved fracture resistance of the prosthesis (Figs. 15 & 16).

Case example
15

A 54-year-old male patient presented desiring implants to
replace failing dentition in both arches. Examination and radiographs confirmed that the remaining dentition was in poor condition (Fig. 17). Treatment was discussed with the patient and
would include extraction of the remaining dentition, placement
of six implants in the maxilla and six implants in the mandible,
and restoration with screw-retained hybrid prostheses in both
arches, utilising a digital workflow with Imetric (Imetric4D).
16

17
Fig. 15: Mandibular PMMA hybrid prosthesis retained on implants with Rosen
screws. Fig. 16: Maxillary PMMA hybrid prosthesis retained on implants with
Rosen screws. Fig. 17: Panoramic radiograph of the initial situation.

1 2023

The patient returned for surgical treatment of the maxillary
arch, which consisted of extraction of the remaining dentition
under local anaesthetic and placement of Tuff implants (Noris
Medical Inc) into six sites. MUAs were placed on the implants
and the soft tissue closed with sutures. Impression copings were
placed on the MUAs and an impression taken of the arch using
a Rosen tray that articulated with the teeth in the mandibular
arch. A provisional maxillary hybrid prosthesis was fabricated
without Ti-bases and attached intra-orally with Rosen screws.
For the mandibular arch, the patient was treated at another
appointment, during which the extractions were done and
six Tuff implants were placed. The implant placed in the
site of the mandibular left second premolar had insufficient

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insertion torque so could not be immediately loaded with
the provisional hybrid prosthesis. Like with the maxillary
arch, MUAs were placed on the five implants that would be
loaded and an impression taken with a Rosen tray to fabricate
an immediate provisional mandibular hybrid prosthesis. The
provisional prosthesis was fabricated without Ti-bases and
attached intra-orally with Rosen screws.
The patient returned after three months of integration for
finalisation of the prostheses. During that time, the patient
had suffered a minor stroke, and it was thus decided not to
subject him to surgery to uncover the buried implant, particularly since the mandibular prosthesis was functioning well
on the five implants that had been loaded. The provisional
hybrid prostheses were removed, and an impression was
taken of the implants and healed soft tissue for fabrication of the final zirconia hybrid restorations. The provisional
restorations were reinserted, and the impressions sent to
the laboratory for fabrication of the final prostheses. The
zirconia hybrid prostheses without Ti-bases were returned
from the laboratory, and the patient returned for insertion
(Figs. 18 & 19). The provisional prostheses were removed (Fig. 20)
and the zirconia hybrid prostheses inserted intra-orally and
fixated with 1.4 mm Rosen screws that were tightened by
hand. The screw access holes were then filled with a piece
of PTFE tape and sealed with a flowable composite resin and
light-polymerised. The occlusion was checked and adjusted
as needed, completing the treatment (Fig. 21).

Conclusion
Screw-retained restorations may present with issues related to marginal fracture of the prosthetic material, separation of Ti-bases from the overlying restorative material
and screw loosening. The Rosen screw eliminates those issues with its tapered screw head design and elimination of
the use of a Ti-base. The screw may be tightened by hand
without the need for a torque wrench, and sufficient tensile
load is present to prevent screw loosening. Rosen screws
are designed for use with splinted implants either in a bridge
or full-arch hybrid prosthesis. The screws cannot be used
in single-unit screw-retained crowns, as the MUA offers no
anti-rotational mechanism between the crown and MUA.

21
Fig. 21: Final zirconia hybrid prostheses in the maxillary and mandibular
arches retained with Rosen screws.

18a

18b

19a

19b

20a

20b

Figs. 18a & b: Maxillary zirconia hybrid prosthesis shown from the tissue
side (a) and occlusal side (b). Figs. 19a & b: Mandibular zirconia hybrid
prosthesis shown from the tissue side (a) and occlusal side (b).
Figs. 20a & b: Maxillary (a) and mandibular implants (b) after removal
of the provisional hybrid prostheses.

about
Dr Dan Rosen is an international lecturer
and educator on subjects related to implant
dentistry and prosthetic rehabilitation
with implant-supported restorations.
He maintains a private practice in
Los Angeles in California in the US
and mentors dentists in surgery and
treatment related to implants. He can be
reached at danrosendds@gmail.com.
Dr Gregori M. Kurtzman is in
private general dental practice in
Silver Spring in Maryland in the US.
He has earned fellowships in the
Academy of General Dentistry (AGD),
American Academy of Implant
Prosthodontics, American College
of Dentists, International Congress
of Oral Implantologists (ICOI),
Pierre Fauchard Academy, Association of Dental Implantology
and International Academy for Dental-Facial Esthetics;
masterships in the AGD and ICOI; and diplomate status
in the ICOI. He has lectured internationally and has published
over 800 articles globally, several e-books and a textbook.
He can be reached at dr_kurtzman@maryland-implants.com.

1 2023

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[39] =>

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| user report

Using digital software for effective
root canal therapy
Prof. Adj. Philippe Sleiman, Lebanon
with different scenarios for which I used the DTX Studio
Clinic dental imaging software (DEXIS) to create a digital
model and a road map for me to follow clinically.

Case 1

2
Case 1—Fig. 1: Pre-op radiograph, showing a very complex root canal system
and a calcified pulp chamber. Fig. 2: Horizontal cross section taken from
the i-CAT scan (DEXIS) showing total calcification of the root canal orifice at
the level of the cemento-enamel junction, in comparison with the first molar.

Introduction
Root canal anatomy is often complex. Traditional 2D radiographs can give us an idea about the anatomy and its complexity or indicate whether we are dealing with a retreatment
or calcification, but only 3D vision can provide the necessary accuracy. In this article, I will be sharing with you cases

This patient attended in an emergency owing to sharp pain
in a second maxillary molar. This was confirmed upon clinical examination. A standard radiograph was taken (Fig. 1),
showing a very complex anatomy and calcified pulp chamber.
The history of this tooth, as described by the patient, was
that an inlay had been placed on it and discomfort developed after a while that had lasted several years untreated.
On check-up, he had been told that everything was fine.
I asked for an i-CAT scan to be taken in order to better
understand what was going on. Studying the horizontal
view of the 3D image, the level of calcification in the pulp
chamber compared with the pulp chamber of the first molar
could be seen clearly (Fig. 2).
The endodontic mode in the new DTX Studio Clinic
software allows the addition of many views and sections

Fig. 3: Endodontic mode in DTX Studio Clinic tracing the anatomy of the canals and providing an approximate working length in different colours for each canal.
Four separate roots are shown.

1 2023

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user report

Fig. 4: 3D reconstruction of the canals in different colours, showing the detailed length segment by segment for each canal. Fig. 5: The Sleiman sequence
of shaping using the Traverse and ZenFlex files. Fig. 6: Elements IC for obturation with the continuous wave compaction technique and backfilling.

and adjustment of the thickness of the sections in
order to check the level of calcification. An additional
benefit is that it allows tracing of the internal anatomy
of the roots, individually and together. When tracing the
root canals, a colour can be selected for each canal.
This is of great benefit for visualising the internal anatomy
(Fig. 3).
With this software, a 3D model of the tooth with the canals
traced with their approximate working lengths can be visualised, giving us an idea of what to expect (Fig. 4). For example, in this case, the average working length was around
27 mm for this second maxillary molar with four canals and
this kind of anatomy—I call these cases a double espresso
because they are a bit of a challenge. For example, the distal
canal had a sharp curve like a hook at the apex. All this data
can help in choosing a file sequence for the shaping and
cleaning of the root canal system. Traverse and ZenFlex
files (Kerr Dental; Fig. 5) were used to shape the canals. In
the distal root, the 30/.04 file was not used in the last 2 mm,

in order to avoid any misshaping of this area. The irrigation
was performed according to the Sleiman sequence of
irrigation (published in roots magazine 1/2014). 3D obturation
of the canals was performed with the elements IC obturation system (Kerr Dental; Fig. 6). Obturation was completed,
and the immediate postoperative radiographs showed that
all the canals were filled and sealed (Figs. 7a–c).

Figs. 7a–c: Immediate post-op radiographs showing 3D filling of the root
canal system at different angulations.

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[42] =>

8b
Case 2—Figs. 8a & b: Pre-op radiograph showing the calcified pulp
chamber and radiolucency in the furcation area (a). The fistula facing
the coronal part of the root canal (b).

Using the endodontic mode in DTX Studio Clinic (Fig. 9),
each slide and cut were examined, searching for the reason for the fistula of the mandibular molar. A possible
cause of the fistula may have been the complex of lateral
canals seen in the coronal part of the distal root (Fig. 10).
Root canal therapy was initiated using the Traverse and
ZenFlex files in the same sequence as that used for Case 1,
and 3D obturation with elements IC was performed
(Fig. 11).

Case 3

Case 2
The same patient had a fistula in the buccal area at the
furcation level of his mandibular molar, resulting from
occlusal contacts being too high and not being adjusted
after placing the inlay on the maxillary molar (Fig. 8).
This had caused activation of substance P that then
created the calcification in the maxillary molar and the
irreversible inflammation of the mandibular molar—
micro-trauma effects.

The third case highlights the artificial intelligence incorporated into DTX Studio Clinic, one feature of which is automatic tracing of the mandibular canal. In this case, it was a
very helpful feature to have. The patient was suffering from
irreversible pulpitis of a mandibular third molar. He wanted
to save the tooth at any cost because did not want to have
an implant (the molar was an abutment tooth for a bridge).
The radiograph showed the roots of the molar overlapping
the mandibular canal (Fig. 12). A 3D radiograph was taken,

11a

11b

Fig. 9: Endodontic mode in DTX Studio Clinic in different sections for analysis of the case. Fig. 10: Horizontal view of just 0.5 mm in thickness showing a complex
system of lateral canals in the coronal part of the distal canal. Figs. 11a & b: Bone reconstruction with DTX Studio Clinic showing a bone defect in the coronal
area (a). Immediate post-op radiograph showing the lateral canals filled in the coronal part of the distal canal (b).

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user report

Case 3—Fig. 12: Pre-op radiograph, showing the intimate relationship between the mandibular canal and the molar. Fig. 13: Tracing of the trajectory of
the mandibular canal. Fig. 14: Endodontic mode of DTX Studio Clinic showing different sections of the area and the relation between the mandibular canal,
traced by the software, and the roots of the molar. Fig. 15: 3D reconstruction showing that the nerve bypassed the buccal area and only touched the middle
part of the mesial canal. Fig. 16: Immediate post-op radiograph.

and on this, the software traced the mandibular canal overlapping the molar in the panoramic view. The endodontic
mode revealed that the canal bypassed the buccal area,
slightly touching the mesiobuccal canal (Figs. 13–15).
The radiograph taken immediately after the root canal
therapy, performed through the crown, showed complete
obturation of all the canals (Fig. 16).

Conclusion
Using digital imaging software can significantly improve
the outcome of root canal therapy by providing additional
information about the complex anatomy of the root canal
system. Modern dental imaging software such as DTX Studio
Clinic allows visualisation of the complexity of the root canal

system with great accuracy—I liken it to a map which
I can follow during treatment. This map makes endodontic
treatment more predictable and effective.

about
Prof. Adj. Philippe Sleiman is an
assistant professor at the Faculty
of Dental Medicine of the Lebanese
University in Beirut in Lebanon and an
adjunct professor at the Adams School
of Dentistry of the University of North
Carolina at Chapel Hill in the US.
He can be contacted at
profsleiman@gmail.com.

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| industry report

4D dentistry—Clinical application
Drs Maxime Jaisson, Marion Paris & Ouassim Salmi, France

Introduction

and aesthetic planes. The third challenge is the design of the
occlusal anatomy such that it respects the patient’s specific
movements and envelope of function (functional area).4

Digital dentistry is accelerating with the improvement and
use of CAD/CAM in daily dental practice.1 Many techniques
and associated therapies are necessary for full-mouth rehabilitation, making it a great challenge for both the practitioner
and the dental technician. Such treatment requires the establishment of a prosthetic project that will serve as a guide
throughout, from the implant surgery to the final prosthesis.

The description of a case of extraction and immediate implant placement will be used here to demonstrate the application of the MODJAW Tech in Motion system. Treatment
was driven by the patient’s wish to regain a harmonious and
pleasant smile, as well as masticatory function (Figs. 1–3).

The MODJAW system

MODJAW Tech in Motion is a Class I medical device composed of hardware and software based on the combination of 3D technology (3D models from intra-oral scanners)
and motion capture techniques (Figs. 4 & 5). A set of minimally invasive sensors are placed on the patient’s face,
without interfering with function. A high-precision, high-
frequency (120 Hz) infrared optical camera records the
patient’s movements and integrates them into the patient’s
intra-oral scans (Fig. 6).5, 6 For the first time, this enables us
to see what is happening in patients’ mouths.

Figs. 1–3: Initial situation.

The main objective of full-mouth rehabilitation is to restore
the dentition by establishing new occlusal architecture and
forms at the correct vertical dimension while maintaining the
health and harmony of the entire stomatognathic system.2, 3
From this perspective, the MODJAW Tech in Motion system
completes the digital workflow by recording the envelope
of function of a patient and ensuring a predictability of a
treatment plan, especially in the case of immediate loading.
It helps to overcome three main challenges encountered in
full-mouth rehabilitation. The first challenge is the validation
of a therapeutic mandibular position and its transfer to the
laboratory. The second challenge is respecting the occlusal

The software design is intended to optimise the user experience. The practitioner can manipulate the 3D models
on the computer’s touch screen. The acquisition interface
is divided into three main panels (Fig. 7):
– On the left are all the functions for interacting with the
3D models of the patient. The features are divided into
three modules: ACCESS, ADVANCED and AESTHETIC.
– In the middle are the recorded movements and the replay
functions for for analysis by the dentist after the patient leaves.

5
Fig. 4: MODJAW Tech in Motion system. Fig. 5: MODJAW hardware. Fig. 6: MODJAW trackers.

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industry report

Fig. 7: MODJAW software. Fig. 8: Facial scan of the patient, matched with the 3D models and the CBCT scan. Fig. 9: Segmented CBCT scan. Fig. 10: Motion
applied to the segmented CBCT scan.

– On the right are the trajectories of three anatomical
points (right condyle, left condyle and subnasal point)
in the three spatial planes.
The repeatability of MODJAW recordings has been found
to be good to excellent.7 It is important to note that the
precision of the system directly depends on the input data
(3D models from intra-oral scanners, CBCT scan and
facial scan).

Creation of a dynamic digital twin

The choice is made according to parameters such as
the smile line, the position of the lips, the smile and the
bipupillary line (Fig. 11). Once the aesthetic evaluation has
been done and validated, the chosen library is exported as
a 3D model to the laboratory (Fig. 12).

Functional evaluation
The following records were registered with MODJAW Tech
in Motion:

Digital twins are digital prototypes or replicas of the patient. Real-time jaw motion of the patient adds a layer of
dynamic information, essential for offering a personalised
treatment.8

– open and close;
– protrusion;
– left and right laterotrusion;
– centric relation;
– speech; and
– mastication.

The data collection is begun by taking intra-oral scans to
obtain the 3D models of the actual maxillary and mandibular situation in static occlusion (maximal intercuspal position). In addition, 2D photographs and a facial scan capture
extra-oral and intra-oral information for documentation and
education and act as a reference for before and after treatment comparisons.1

After the first step of recording has been done, a dynamic
evaluation is conducted using the MODJAW software.
It helps to identify two pieces of information: the mandibular
position and the functional envelope of the patient can be
preserved, as described later.

A CBCT scan is performed to gain 3D visualisation of
the craniofacial structures for examination and treatment
initiation (Fig. 8). The benefits of a CBCT scan in the oral
and maxillofacial surgery field include diagnosis of bone
pathology and developmental anomalies. In implantology,
a CBCT scan permits the area surrounding the future implant to be investigated, along with evaluation of the height,
width and quality of the alveolar bone and awareness of the
surrounding anatomical structures.2
All the data mentioned is collected and imported into the
MODJAW software to record the mandibular kinematics
of the patient and to get closer to creating a dynamic
digital twin (Figs. 9 & 10).

The mandibular position was evaluated by recording the
centric relation. The patient was guided into centric relation
using the bimanual guided Dawson technique, to record
open and close movements of small amplitude so that the
condyles remained in pure rotation (Fig. 13).12 The trajectories
of the inter-incisal point in a frontal and sagittal plane and

Aesthetic evaluation
Numerous software programs (e.g. DSD, Smilecloud and
SmileFy) are available to obtain an aesthetic preview of
the prosthetic project for communication with the patient
and promotion of acceptance of the proposed therapy.9–11
The aesthetic evaluation and planning in this case were
performed on the Smilecloud platform. It offers adap
tative libraries, providing hundreds of possible designs.

Fig. 11: Evaluation on the Smilecloud platform. Fig. 12: Exported 3D model
of the tooth library. Fig. 13: Analysis of the patient’s centric relation. Fig. 14:
Analysis of the patient’s jaw motion: sharp and symmetric masticatory
pattern and the teeth still guiding.

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| industry report

Figs. 15 & 16: 4D wax-up including tooth libraries and jaw motion. Figs. 17 & 18: Surgical planning in exoplan. The design was by Federico Manes, and it was produced by Uli Hauschild
Dentaldesign. Fig. 19: Transfer pieces were used to stabilise the guide. Fig. 20: Implant placement with Summers’ guided technique. Drill sleeves were used to guide the osteotomy.

the left and right condyle in the sagittal plane showed a
reproducible CR that coincide with maximal intercuspation
position (MIP).
The analysis of the tracing of the inter-incisal point in the
frontal and sagittal planes and the left and right condyles in
the sagittal plane showed a reproducible centric relation that
coincided with maximal intercuspal position.
The second evaluation checked the patient’s envelope
of function by analysing the border limit movements
(open/close, protrusion and laterotrusion) and the masticatory pattern. It showed a good guidance and a
perfect correlation between the interincisal point path and
the left/right condylar path. The analysis of the mastication showed a good masticatory pattern, very well guided
by the residual teeth and a sharp and symmetric masticatory pattern on the left and right condylar trajectories
(Fig. 14).
Therefore, it was decided to keep the current mandibular
position and the functional envelop of the patient for the
prosthetics design. In order to do that in a digital workflow,
all the static and dynamic patient data was exported from
MODJAW as standard files and imported into exocad.

Treatment planning:
Prosthetic and implant planning
MODJAW data provides the dental technician with the
following necessary information to design in exocad:
– the mandibular position in the three spatial planes;
– the patient’s jaw motion to adapt the occlusal mor
phology and the occlusal plane while respecting the
functional curves of Spee and Wilson;

– the border limit movement to adjust the anterior guidance according to the protrusion and laterotrusion
recorded; and
– the masticatory movements to adjust the cusps of the
posterior reconstruction.
With the collection of this information, an optimal and balanced prosthetic design according to the chosen occlusal
concept can be achieved.13 The prosthetic project is called
a 4D wax-up because of the use of the dynamic movement
in the design process (Figs. 15 & 16).4, 14
Once this 4D wax-up has been created and validated, it becomes the reference that will guide each step of the implant
planning. Thanks to the superimposition of the 4D wax-up
on the CBCT scan in exoplan (exocad), the implants are
virtually positioned in an ideal position (Figs. 17 & 18).
While the implant placement was planned, a virtual extraction
of some teeth on the initial model allowed the design of
several guides. For each arch, two guides were created.
The first guide had mixed mucosal and dental support. The
idea was to keep the necessary teeth to maintain the guide
and place the first implants, because a guide with dental
and mucosal support offers more precision than one with
only mucosal support (owing to possible mobility).15 A second guide was designed on a fully extracted model to allow
the surgeon total access to the last implant site.
By exporting the 4D wax-up and the position of the implants, the dental technician has the necessary information
to create the temporary prosthesis, including aesthetic and
functional recommendations to guide the healing process
in the best way. The surgeon receives the surgical protocol from the planning, as well as the surgical guide and the
prosthesis ready to be screwed in.

Figs. 21 & 22: Prostheses with holes for connecting the abutments. Fig. 23: Mandibular prosthesis attachment in occlusion.

46
21

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industry report

Figs. 24 & 25: Occlusal validation. Fig. 26: Final situation.

Surgical phase and immediate loading
After anaesthesia, the first teeth were extracted. The first
guide was used to place the first implants in the mandible
and maxilla (Fig. 19). After that, the residual teeth were extracted, and the second guide was fixed on the implants already in place to continue placement of the other implants.
For the maxilla, bone augmentation was not planned. There
was still the possibility of managing implant placement with
osteotomy preparation and crestal access according to the
Summers’ technique (Fig. 20).16, 17 The sleeves of the surgical
guide led the osteotomy preparation in sites #16 and 26.18
After all the implants had been placed, the Variobase
(Straumann) and temporary abutments were screwed in.
The prostheses had already been milled ahead of surgery
(Figs. 21 & 22). On the maxilla, a support on the palate
allowed us to stabilise the prosthesis and connect it in
the correct situation. We then injected composite to attach it to the temporary abutments. For the mandible, the
prosthesis was attached in the same manner in occlusion
(Fig. 23). Everything was then unscrewed again and polished and the occlusion checked (Figs. 24 & 25).

Discussion
In this type of situation, multiple parameters need to be
mastered, including bone management, aesthetic evaluation, functional evaluation and psychology. With new digital
tools, the dentist is able to evaluate the patient and collect
all the data, static and dynamic. Additionally, the dentist is
able to delegate a part of the work to the laboratory by fully
virtualising the patient and sharing the digital twin with the
dental technician.
This clinical case highlights how the practitioner can gain
a comprehensive idea of the initial situation both aesthetically and functionally and understand the compensation
mechanism of occlusion and the impact on the mandibular position and movements. Once the initial evaluation has
been done, jaw-motion records allow the conservation of
the functional initial situation in the prosthetic project.

After the surgery, mandibular movement will only be driven by
muscular exteroception recorded on the initial situation. Thus,
when the designed prostheses including the initial functional
movement are placed, the entire stomatognathic system will
not encounter any obstacle and integration will be smoother.

Conclusion
The new tools in digital dentistry redefine traditional protocols.
They keep improving the predictability and quality of treatment
while simplifying the processes. Managing the dynamic occlusion of implant restorations in a completely digital workflow is
a reality with MODJAW Tech in Motion. The practitioner is able
to evaluate the mandibular position and the dynamic motion of
the patient and to integrate a new set of data in the prosthetic
project to create a static and dynamic occlusion.
Editorial note: Please scan this QR code for the list of references.

about
Dr Maxime Jaisson holds
a master’s degree in biomechanics
from the University of Reims
Champagne-Ardenne in France,
a university diploma in applied facial
prosthetics and a doctorate in
odontological sciences. He is a dental
surgeon and a co-founder of MODJAW.
Dr Marion Paris is a dental
surgeon specialised in oral surgery.
She is a clinical director at Ardentis
dental and orthodontic clinics and
was formerly a university lecturer
and hospital practitioner at the
then Paris Diderot University
(now Université Paris Cité) in France.
Dr Ouassim Salmi holds a m
aster’s
degree in digital dentistry from
Université Paris Cité in France.
He is a dental surgeon and
a clinical manager at MODJAW.

Motion data is very valuable in a situation of immediate loading,
as jaw motion is partially driven by proprioception that programmes muscular contraction and is in the muscle memory.

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| industry report

Transforming dentistry with
groundbreaking technologies
Lifelike restorations with a micro-layer of porcelain
By Kuraray Noritake Dental Inc.

Some companies mainly make use of basic technologies developed by others to improve their products and introduce new ones, while other companies
conduct fundamental research and basic technology
development in-house. Is this difference relevant for
someone who uses the resulting products in the dental
practice or laboratory on a daily basis? It is. Companies
that develop everything from scratch usually have a
deeper understanding of the products and their production procedures, making it easier for them to modify
specific features, solve existing problems and respond
to market needs. This article describes the impact of
two basic technologies developed by Kuraray Noritake
Dental Inc. for the production of zirconia-based indirect
restorations.

1 2023

All-ceramic evolution
A milled monolithic or only minimally reduced core made of
high-strength ceramics plus a micro-layer of porcelain—that
is today’s formula for success in the production of highly aesthetic indirect restorations. The approach is far less complex
and time-consuming than traditional production and layering
procedures are, and its outcomes can be quite impressive.
Concerning aesthetics and function however, it is essential
that the right types of material are selected and combined.

The core: Multilayered zirconia technology
When the first opaque zirconia framework materials conquered the dental market, leading manufacturers cautioned

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industry report

that not all zirconia is alike. Significant quality differences
exist that depend on the raw materials selected as well
as the processing techniques and equipment used for
blank production. This is particularly relevant considering the increasing aesthetic potential of the core
materials and decreasing thickness of the veneering
porcelain.
When Kuraray Noritake Dental Inc. identified the need for
zirconia core materials that offer greater aesthetics with
a higher translucency and a tooth-like colour structure,
it decided to develop a completely new type of dental
zirconia. It began establishing a sophisticated raw material production, blank pressing and pre-sintering process in-house. This was the basis for the development
of the dental industry’s first polychromatic blank with a
seamless colour structure and precise shade matching
with the VITA classical shade guide. In order to identify
the best ingredients and procedures, the research and
development team experimented with different raw
materials, formulations and grain sizes, developed ways
to optimise the purity of the ingredients and focused
on perfectioning the homogeneity and density of the
blanks and—of course—the integrity of the different
layers. Currently, three products based on this original
multilayered zirconia technology are available for dental
laboratories: KATANA Zirconia UTML, KATANA Zirconia
STML and KATANA Zirconia HTML PLUS. They offer
different levels of translucency and flexural strength
(Fig. 1).
In June 2021, Kuraray Noritake Dental Inc. introduced a new,
next-level multilayered zirconia disc: KATANA Zirconia
YML. The company developed this blank in response

1
Fig. 1: Four-layer colour structure of a KATANA Zirconia Multi-Layered disc.

to the marked need for a universal zirconia with high
aesthetic potential. The blank offers colour, translucency
and flexural strength gradation, the highest translucency
being in the enamel and the highest flexural strength
being in the lowest body layer (Fig. 2).
All multilayered zirconia discs and the technology incorporated in them support the production of lifelike
restorations with reduced handwork. No matter whether
the user prefers to work with materials offering a
uniform strength and selects them depending on the
indication or with the universal solution, the effort in

2
Fig. 2: KATANA Zirconia YML: multilayered zirconia disc with colour, translucency and flexural strength gradation.

1 2023

[50] =>

| industry report
The micro-layer: Synthetic feldspathic
porcelain technology

3
Fig. 3: Extremely regular margins of a KATANA Zirconia crown after milling
thanks to the favourable material structure.

finishing is reduced considerably owing to the optimised translucency and natural colour gradation of the
core materials. Furthermore, the quality of the restorations produced is high thanks to regular margins,
smooth surfaces and a precise fit as a result of the
homogeneous, high-density structure with low porosity
and a high level of purity (Fig. 3).

Differences are found not only in zirconia but also in
the performance of veneering porcelains. They typically
consist of feldspathic porcelain, and most of them are
based on natural feldspar. Depending on where this
feldspar is mined, it may have slightly different properties. That is why manufacturers of such natural feldsparbased veneering porcelains need to adjust their
formulations from time to time, and handling and aesthetic properties might be somewhat different with
every new system purchased. In the 1980s, these variations in the composition of natural feldspar led to
unpredictable material properties, causing difficulties in
reproducing the natural tooth colour and even porcelain
fractures and cracks appearing after firing of porcelainfused-to-metal restorations. Limited colour stability was
also an issue.
For Noritake Inc., one of the parent companies of Kuraray
Noritake Dental, these issues were reason enough to
start developing a different kind of porcelain. After
analysing the issues and weighing the possibilities,
a completely new synthetic feldspathic porcelain technology was developed (Fig. 4). It provides for stable
coefficients of thermal expansion, particle distribution

Fig. 4: Synthetic feldspathic porcelain technology with a structure resembling that of natural enamel.
4

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[51] =>

industry report

Fig. 5: Different micro-layering approaches with CERABIEN ZR FC Paste Stain. Fig. 6: Different micro-layering approaches with CERABIEN ZR Internal Stain
and CERABIEN ZR Luster porcelain, leading to highly aesthetic outcomes.

and colour, as it is no longer dependent on natural
sources of feldspar.
Originally, this technology was used in Noritake Super
Porcelain AAA (now Noritake Super Porcelain EX-3),
introduced in 1987, a veneering porcelain for metal frameworks. The technology also formed the basis for the development of CERABIEN ZR porcelain and CERABIEN
ZR FC Paste Stain for porcelain layering on zirconia. This
line-up of internal stains and porcelains was specifically
developed for micro-layering on zirconia. All products
have one thing in common: as they are based on synthetic feldspathic porcelain, they offer consistent mechanical and handling properties and predictable shade
effects. The material structure and particle distribution
resemble those of natural teeth, supporting lifelike outcomes (Figs. 5 & 6). Using the CERABIEN ZR FC Paste
Stain liquid ceramic system on a monolithic restoration
or on one with minimal cutback (0.1 mm) offers reduced
effort.

Connecting components: Touch
polymerisation and monomer technology
When needing to cement the finished prosthetic restorations on to implant abutments or frameworks, it is essential to select a cementation system that is able to fulfil
high aesthetic and functional demands. The PANAVIA
family of resin cements from Kuraray Noritake Dental Inc.
employs many different technologies that provide for a high
bond strength to various substrates and a tight marginal
seal. The key technology incorporated in any Kuraray
Noritake Dental Inc. cement is the original MDP monomer
invented by KURARAY CO., LTD. in 1981. It is capable of
establishing a particularly strong and long-lasting bond to
enamel, dentine, metal and zirconia. The self-adhesive resin
cement PANAVIA SA Cement Universal also contains the
LCSi monomer, a long carbon chain silane coupling agent.

This monomer forms a strong chemical bond with resin
composite, porcelain and silica-type ceramics (like lithium disilicate), removing the need for a separate silane
component (a primer or adhesive) when bonding these
types of prosthetic restorations. PANAVIA V5, the strongest cement in the PANAVIA line, employs touch polymerisation technology. It seals the interface between the

“The key technology
incorporated in any
Kuraray Noritake Dental
cement is the original
MDP monomer invented by
KURARAY CO., LTD. in 1981.”
tooth and the restoration to prevent microleakage and
provides for a high polymerisation ratio even when
dark-polymerising and hence delivers a strong bond in
virtually every situation.

Conclusion
KATANA and CERABIEN are excellent partners for a
simplified approach to lifelike restorations. The high level
of quality and reliable performance offered by these solutions are due to proprietary technologies and streamlined
in-house production procedures that really make a difference. PANAVIA resin cement systems based on proprietary monomer and polymerisation technology are the
perfect choice for cementing prosthetic restorations on
to implant abutments or frameworks.

1 2023

[52] =>

| manufacturer news

3Shape innovative software

Do more digitally as a dental laboratory with 3Shape solutions
3Shape enables a laboratory to do more digitally. The company
delivers versatile solutions that optimise the laboratory’s daily
tasks and communication. It streamlines digital workflows to help
build strong relationships and repeat business with dentist
customers. Whether dental professionals take analogue or digital
impressions, 3Shape’s award-winning solutions will help to
manage their caseload more productively.
3Shape software for laboratories
3Shape offers innovative software solutions to optimise the everyday workflow efficiency for laboratories. 3Shape Dental System
is a dental CAD software program that provides a wide range of
in-demand indications, enabling dental technicians to design with
ease. 3Shape laboratory management software provides workflow management for all types of cases, enabling better customer
communication and improved tracking of orders, cases and
invoices.
3Shape dental laboratory scanners
Fast and accurate, 3Shape’s award-winning scanners enable
laboratories to efficiently connect analogue cases to digital workflows.* With four models in its portfolio, 3Shape offers laboratory
scanners for every budget.

1 2023

The dual-model F8 scanner is the newest addition to the scanner
portfolio and enables laboratories to do more in less time and
with fewer steps. The efficient dual-model scanning workflows
allow technicians to fast-forward to the design steps.
3Shape Design Service for laboratories
3Shape Design Service brings laboratories both the speed of
artificial intelligence and the design expertise of dental professionals to support all design needs. With turnaround times as fast
as 5 minutes, 3Shape Design Service is easy to use and is perfect
for when the laboratory is very busy.
3Shape LabCare
3Shape LabCare is a support package that enables laboratories
to keep up to date. Through customer support, regular updates
and training, LabCare provides peace of mind for a dental laboratory
business.

* Accuracy assessed according to the ISO 5725-1 standard.

www.3shape.com

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manufacturer news

Innovation and freedom

3Shape TRIOS intra-oral scanner portfolio
3Shape TRIOS intra-oral scanners have received the prestigious
Cellerant Best of Class Technology Award for an unprecedented
ten years in a row!
The TRIOS intra-oral scanner portfolio features TRIOS 5 Wireless,
which was designed for improved hygiene, next-level ergonomics
and effortless scanning; TRIOS 4 Wireless, which features advanced wireless scan-ready technology and diagnostic treatment
options; and TRIOS 3 Wired, which offers proven scanning technology for a smooth introduction to digital dentistry.
All three models include free 3Shape patient engagement apps,
TRIOS Smile Design, TRIOS Patient Monitoring, TRIOS Treatment
Simulator and Model Maker. In addition, all models can freely
connect to the 3Shape Unite platform—an ever-expanding ecosystem of over 8,000 integrated laboratories, clear aligner makers,
implant solutions, 3D printers and milling machines, practice management software solutions and more. The 3Shape Unite platform
makes it seamless for dentists to find and send cases to treatment
partners as well as work with their own digital dentistry solutions.
Dental professionals can support their scanning with TRIOS Care—
a complete peace-of-mind service agreement that includes
software updates, unlimited support coverage, a five-year full
warranty, accidental drop coverage, express replacement and
training programme. Alternatively, dental professionals can select
TRIOS Only—a free service that includes software updates and
pay per case coverage.

3Shape Academy offers online educational opportunities and
live events so that dental professionals can learn best workflow
practices and earn continuing education credits.
TRIOS offers ease of use, speed and accuracy
3Shape TRIOS intra-oral scanners are recognised for their ease
of use, scanning speed and accuracy. In clinical and case studies,
dental professionals document TRIOS use for all indications.
This includes single crowns, clear aligners, implant treatment and
dentures, even scanning fully edentulous patients.
In studies, TRIOS has performed better than or as well as competitor scanners in terms of accuracy, precision and speed.
Additionally, comparison studies have shown that patients overwhelmingly prefer digital impressions being taken with TRIOS
compared with conventional analogue impressions.
True wireless freedom
In October, 3Shape introduced TRIOS Share—the world’s first
solution that enables dental professionals to scan and plan on
every PC in their practice with a single TRIOS wireless intra-oral
scanner. TRIOS Share connects TRIOS wireless scanners to the
practice’s Wi-Fi network. This allows dental professionals to walk
from room to room with TRIOS in hand and use whatever PC is in
the respective surgery, including practice management system
PCs, to both scan with and manage cases on.
Extra 3Shape licences are not needed, nor are Wi-Fi hubs or clear
paths to the Wi-Fi network. TRIOS Share runs on standard Wi-Fi,
not on point-to-point, 60 GHz connections like other brands.

www.3shape.com

1 2023

[54] =>

| manufacturer news
Groundbreaking dental technologies

Kuraray Noritake Dental: Born in Japan
the inspiring leadership of Kiyoko Ban, a woman who, by the
1980s, was already at the forefront of enhanced dental aesthetics
and who is regarded as a true innovator in the field of dental
ceramics.

Kuraray Noritake Dental is quintessentially Japanese and has a
long-established history that has shaped its entire existence.
Today, the company’s craftsmanship, underpinned by groundbreaking dental technologies and outstanding product quality,
is recognised across the globe.

In the years to come, both Kuraray Medical and Noritake Dental
Supply focused on advancing their core competencies. Then, in
2012, they joined forces to form Kuraray Noritake Dental. This
combination of long-standing expertise in polymer-based organic
chemistry with ceramic-based inorganic chemistry has enabled
Kuraray Noritake Dental to develop a whole range of groundbreaking
dental products. These include gold-standard self-etching adhesives and innovative universal adhesives, an array of cutting-edge
resin cements for streamlined workflows, easy-to-use composites
for direct restorations, highly aesthetic zirconia blanks for indirect
restorations, and pioneering liquids and porcelains for virtually
every finishing and staining technique in use today.

Kuraray, which is the parent company of Kuraray Medical, was
founded in 1926 in Kurashiki in Japan by Magosaburo Ohara, who
was a true innovator. He later would state: “I can see ten years into
the future.” Over the years, this forward-thinking outlook has
proved to be at the very core of the company’s pioneering drive.
Kuraray initially began to develop dental products in the 1970s
and later introduced its first key adhesive technology—the MDP
monomer—in 1981.
Noritake, which is the parent company of Noritake Dental Supply,
was founded in 1904 in Nagoya in Japan. Its ceramic tableware
and industrial abrasion wheels are well known globally.
In 1987, Noritake launched its first dental products and established
an entirely new class of veneering ceramics. This was done under

Brands like CLEARFIL, PANAVIA, KATANA and CERABIEN stand for
groundbreaking technologies integrated into products that make
an enormous difference. They now sit at the forefront of the latest
trends in minimally invasive dentistry, helping users to attain the
ultimate goal of maintaining natural teeth across the entire lifetime
of a patient.
Kuraray, which is the parent company of Kuraray Noritake Dental,
boasted net sales of ¥541.8 billion (€3.8 billion) in 2020 and
had a workforce of over 11,000 employees in December 2020.
Thanks to its pioneering advances in engineering resulting in
an exciting, innovative and universally utilised dental portfolio,
Kuraray Noritake Dental is considered the jewel in the crown of
this organisation. For every single one of its employees, wherever
they operate in the world, a healthy smile means more than
anything else.

www.kuraraynoritake.com

1 2023

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manufacturer news

|

New dental 3D-printing workflows

SprintRay’s world leading dental 3D-printing solution
for complete digital integration
SprintRay announces new dental 3D-printing workflows to provide
an even smarter end-to-end integration that enables dental
practices and laboratories to use dental 3D-printing solutions for
completely digital dentistry.
As a digital dentistry company, SprintRay is presenting improved
end-to-end workflows at IDS. Highlighting crowns and nightguards,
SprintRay offers chairside dental 3D-printing solutions.
“With our new ‘Crown Kit’, it is now possible to print crowns in less
than 15 minutes. With AI Cloud Design and a polishing kit to individualise the crowns, the complete workflow from data capturing to
delivering to the patient can be done within an hour, making this
the first truly chairside 3D-printing solution,” says Dr Amir
Mansouri, CEO of SprintRay. “We also are proud to present
our latest material SprintRay Crown, a ceramic filled hybrid
crown material for definitive restorations with more than
50% ceramics, making 3D-printed crowns eligible for reimbursement
through the US healthcare system,” he continued.
Bruxism is a common condition worldwide, and therefore nightguards are other dental appliances that SprintRay offers on its
Cloud Design Services. Using artificial intelligence design and the
proven resins SprintRay Nightguard Flex and Nightguard Firm,
SprintRay aims to help dental professionals protect their patients’
smiles. “We are happy to be able to offer our latest Nightguard
materials to our European customers. We present a material that is
durable yet flexible, making it a patient favourite around the world,”
states Patrick Thurm, general manager of SprintRay Europe.
Nightguards and crowns are only two examples of the broad workflow range that SprintRay offers. Besides high-class materials for
dentures, surgical guides and try-ins, SprintRay offers a design
service for many applications to make implementation in the
dental clinic as easy as possible.
Having a full product portfolio of 3D printers, an automated washing
and drying system and a post-curing
system, SprintRay offers intuitive
and reliable 3D-printing solutions
exclusively for dental professionals.
The integration and expansion of
digital dental workflows is frictionless. The smart slicing software RayWare, an extensive

range of SprintRay resins, validated material partner resins and
Cloud Design Services make SprintRay the partner of choice for
dental practices and laboratories around the world.
In order to even further simplify the fully digital workflows,
SprintRay is proud to present SprintRay CloudDrive, an integration
tool that will store and organise all intra-oral scans in one place,
making it easy to access them and further use them in design
software or to send to Cloud Design Services.
Having smart digital integration, further workflow innovation and
a world-class 3D printing portfolio, SprintRay is set to be the
partner of choice for dental practices and laboratories in dental
3D printing and digital dentistry. “Dental is our passion and supporting our customers with advanced technology and software for
a comprehensive workflow is the goal that we sprint to everyday,
at ‘Bolt speed’,” concludes Dr Mansouri.
Meet SprintRay at IDS 2023! Visit Hall 3.1, Booth H010/J029 to
learn more about SprintRay’s 3D-printing workflows.
Note: Some solutions are not yet available in all countries owing to
regulatory requirements. Please consult your SprintRay partner about
local availability.
www.sprintray.com

3D printing
1 2023

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supplement

Artificial intelligence: A gift to dentists
Dr Kyle Stanley, USA
The May 2019 edition of The Atlantic magazine
contained an article titled “The truth about dentistry”.
In it, the author visualised dentists—not a particular
dentist but dentists in the abstract—as sinister authority figures looming over the helpless patient’s recumbent form, drill in hand. Mistrust permeated the scene
like swamp fog. “When he points at spectral smudges
on an X-ray,” the author pleads, “how are we to know
what’s true?”
Then there was the Dustin Hoffman movie Marathon
Man with its Nazi dentist-cum-torturer, and the famous—
or, if you’re a dentist, notorious—1997 Reader’s Digest
article by a writer who visited 50 dentists in 28 states,
picking them at random out of the Yellow Pages,
and was given treatment plans ranging in cost from
under US$500 to nearly US$30,000. That one really hit
a nerve, so to speak.

Dr Kyle Stanley

1 2023

Dentists have had their share of bad rap, but still, the
experience of the Reader’s Digest writer was probably not terribly far from the truth. It was borne out,
with eerie accuracy, by a 2021 Dental AI Council study
intended to quantify the suspected inconsistencies
in dental diagnosis and treatment. The same set of
full-mouth radiographs was presented to 136 dentists,
and they were asked to provide tooth-by-tooth diagnoses and a treatment plan. A person with confidence
in the scientific basis of dentistry might naturally expect
a limited amount of diversity among the responses

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“Once trained, an AI program can pick out a
particular face in a crowd or write an essay or a love
poem as well as or better than you can.”

and would assume that the commonalities would far
outweigh the differences. Not so. Not once did more
than half of the participants agree about the diagnosis
for a given tooth. The variety of estimated costs was
almost comical, ranging from US$300 to US$36,000—
figures strikingly similar to those cited by the Reader’s
Digest author. Worse, the range of cost estimates did
not present as a bell curve, the majority of responses
clustered together and only a few outliers at the
extremes. Instead, the distribution was more or less
flat; the frequency of a cost estimate of US$1,000
was about the same as that of a cost estimate of
US$10,000.
Other studies have found that dentists’ interpretation
of radiographs—the very foundation of diagnosis—was
far from reliable. Estimates of cavity depth and recognition of radiolucencies were wrong as often as they were
right. In another study, three dentists examined several
thousand radiographs; their interpretations were in full
agreement only 4% of the time.

Houston, we have a problem
How should we account for this lack of precision
in a medical field? Is it due to dishonesty? To greed?
To variations in skill? To honest differences of opinion?
Whatever the reason, it gives dentistry a bad name.
But there is a remedy. It comes in the form of a
powerful new technology that is already transforming
many aspects of our lives: artificial intelligence, or
AI for short.
AI is an umbrella term covering a wide range of computing techniques. They range from “general AI”—
intelligence indistinguishable from that of a human

being, in all circumstances—to “narrow AI”, specialised programs whose expertise is limited to a particular class of problem. Most make use of a programming technique called a “neural network” by loose
analogy to the structure of the human brain, and all
have in common the property of trainability. They
learn by taking in vast amounts of data of a certain
type—say, photographs of faces or samples of text—
and extracting commonalities. Once trained, an
AI program can pick out a particular face in a crowd
or write an essay or a love poem as well as or better
than you can.
General AI is the darling of science fiction writers, but
is very far from realisation. No AI system has anything
like the broad knowledge of all aspects of the world that
a human being has, and so, for the time being at least,
we do not have to worry about being taken over by
independent-minded and malevolent robots like the
notorious HAL of 2001: A Space Odyssey. Even the
comparatively limited task of safely operating a car
in an urban environment has not yet been mastered,
despite years of effort and oceans of investment.
Narrow AIs, however, already easily match or surpass
human abilities, and they have become the tools of
choice for performing many exacting tasks. Many of
these involve computer vision, the analysis and recognition of objects or imagery. More than a decade
ago, it was found that a trained AI could recognise and
categorise nodules in radiographs of cancer patients’
lungs as accurately as a panel of oncologists could,
and much faster. Computer vision and AI are now
familiar parts of the oncological toolkit, and they are
being applied to a widening array of medical fields.
One of those is dentistry.
Dentists are in an excellent position to take full advantage
of AI. There exists, to start with, a virtually limitless supply
of dental radiographs for training. The radiographic
image is the coin of the realm in dentistry; patients are
accustomed to having their pathologies explained to
them with reference to the “spectral smudges on an
X-ray” evoked by The Atlantic’s reporter. The range of
pathologies to be detected is relatively narrow, and
the AI program can not only identify them but also
quantify them with greater than human precision.
The dental radiograph is, therefore, an ideal application
for the sharp focus of narrow AI.

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The second opinion—so to speak—provided by an
AI program is directly valuable to the practitioner. The
computer is hypersensitive to subtle greyscale gradations; it may detect something the human reader has
overlooked. More importantly, it is never tired, distracted
or rushed and so is not prone to the types of mistakes
and oversights that people routinely make simply because they are human. The AI program may in many
cases simply duplicate the perceptions of the human,
in which case nothing is gained but confirmation, but
it may add information overlooked by the human or
differ in its interpretation, leading to a re-examination
and re-evaluation of the evidence.

“The computer is
hypersensitive to subtle
greyscale gradations; it may
detect something the human
reader has overlooked.”
Even if these benefits may seem minor to an experienced practitioner confident in his or her abilities,
there is another side of the AI experience to consider:
the patient’s. The results of the AI program’s analysis are presented to the patient in vivid, intuitively
understandable form. The radiograph no longer consists merely of spectral smudges, but has become
graphically compelling, having highlighted areas,
colour-coded outlines and explanatory labels. For a
patient, the enhanced display conveys a heightened
sense of precision, clarity and objectivity. The diagnosis is no longer just the opinion of one person, whom
a cynic might suspect of ulterior motives. It need not
be taken on faith; it is supported by the unbiased
authority of a digital computer.
While the graphic presentation of a computed analysis may impress a patient as something more than human, the practitioner should be aware that the AI program is an assistant, not a supervisor. Even though
the accuracy of AI’s radiographic analyses in various
medical fields has been shown to be indistinguishable
from that of human interpreters, the AI program actually
knows much less about teeth (or lungs or livers) than
the trained and experienced practitioner does. What it
does know, and knows very well, is how a large number of specialists have interpreted a very large number
of radiographs. Its findings are, in effect, those that hundreds or thousands of dentists would make if they were

1 2023

to vote on the content of a given radiograph. Where
there is not unanimous agreement, majority opinion
prevails, or findings are presented in terms of probabilities. The practitioner using the AI program remains
entirely free to form a different opinion or to disregard
the advice the program gives, but has the benefit of
knowing what a large group of peers would have made
of the radiograph in question.
The most significant impact of dental AI, however, is
not that it necessarily brings a superhuman level of certainty to the data upon which diagnoses are based—
although in most cases it may—but that it provides,
for the first time, an objective and universally accessible standard of reference. Objective standards are
precisely the thing that dentistry has lacked in the past,
and their absence has given rise to suspicions about
the candour and consistency of dental diagnoses.
Look at the Reader’s Digest writer: guided only by a
phone book, he collected a bewilderingly large variety
of diagnoses. If he had visited only dental offices
using an AI assistant, he would have been given a
much smaller variety, and the differences would have
been due to small variations among the radiographs
made by different practices rather than to the whims of
individual dentists or the immediate financial needs
besetting them.
Consistency is not the only thing AI brings to dentistry.
It also provides support for insurance claims and facilitates record-keeping, tracking of patients’ dental health
and comparison of performance among multiple practices in an organisation. It trains dentists at the same
time as dentists train it. In the future, it may reveal connections between dental health and general health that
we do not now suspect.
Those are some of the collateral benefits. Above all,
however, AI will give patients the reassurance of
knowing that the condition of their teeth is not merely
a matter of opinion.

about
Dr Kyle Stanley is a specialist in implantology and a
passionate advocate for mental health in the dental profession.
He is founder and chief clinical officer of Pearl, a company
transforming patient care through artificial intelligence.
Dr Stanley maintains a private practice in Beverly Hills in the
US, where he focuses on implant surgery and prosthetics.

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Users

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supplement

AI and its
applications in
advanced dentistry
By Forrest Hall, USA/Germany

Artificial intelligence (AI) is a discipline of computer
science that involves the development of intelligent agents,
which are systems that can perceive their environment
and take actions to achieve a specific goal. AI has a wide
range of applications, including healthcare, and it is increasingly being used in dentistry to assist with diagnosis,
treatment planning and other aspects of patient care.
In this article, we will explore the role of AI in dentistry, including its history, its applications, the different types of AI
used, and a detailed description of how it works.
The history of AI in dentistry dates back to the 1960s,
when the first computer-aided detection and diagnosis
systems were developed. These early systems used
simple algorithms to analyse dental images and provide
diagnosis or treatment recommendations. In the decades
that followed, AI has become increasingly sophisticated
and has been used in a variety of dental applications,
including the detection of oral cancer, the diagnosis of
dental caries and the planning of orthodontic treatment.
AI is becoming more vital to the diagnostics of dental
conditions such as caries, periodontal disease and oral

1 2023

cancer. Through machine learning algorithms trained
on large data sets of dental images, AI programs can
recognise patterns and features that are indicative of
specific conditions.
When used in treatment planning, AI is a powerful tool
for tailoring orthodontic treatment or implant surgery.
This can be achieved using CAD software, which allows
dentists to create detailed 3D models of a patient’s
mouth and plan treatment based on these models. Many
companies offer design programs that can now handle
treatment planning from the initial scan to follow-up.
Patient care is also enhanced by AI. Scheduling appointments, managing patient records and providing educational materials can all be managed using intelligent
assistants or chatbots, which are able to communicate with
patients and provide information or assistance.
But how do AI programs get so smart to begin with? One
way is by learning through images, or computer vision.
There are several different approaches to using computer
vision AI specific to dentistry. The program identifies

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“AI is becoming more vital to the
diagnostics of dental conditions
such as caries, periodontal
disease and oral cancer.”
Another way of training an AI system is through semisupervised learning in which machine learning algorithms
are trained on a data set of dental images that are partially labelled, which means that only some of the images
are accompanied by annotations or labels. The algorithm
is able to learn from both the labelled and unlabelled
images and is able to provide more accurate diagnosis
or treatment recommendations.
AI systems might also analyse images a different way,
through deep learning, which is the use of deep neural
networks. Deep neural networks are machine learning
algorithms that learn and recognise patterns in data by
analysing large data sets of images. They can learn
complex features and patterns in dental images and are
able to provide highly accurate diagnosis or treatment
recommendations.

features indicative of certain conditions through image
analysis. These features may include the size, shape and
intensity of certain structures in the image, as well as the
presence or absence of certain patterns or textures.
Such AI programs can be developed through supervised
learning. This involves the use of machine learning algorithms that are trained on a labelled data set of dental
images, which means that the images are accompanied
by annotations or labels indicating the presence or absence
of specific conditions. The algorithm is able to learn the
patterns and features that are indicative of these conditions and is able to provide diagnosis or treatment
recommendations based on these patterns.
Another method of developing and training AI systems
is through unsupervised learning. This involves the use
of machine learning algorithms that are trained on an unlabelled data set of dental images, which means that the
images are not accompanied by annotations or labels.
The algorithm is able to learn the patterns and features
present in the images and is able to group the images into
clusters or categories based on these patterns.

Natural language processing is yet another way to develop an AI program for helping dentists. By using algorithms that understand and interpret human language,
intelligent assistants and chatbots become more personable and less frustrating, which frees up time and ensures
effective communication with patients with far faster
response times and that is not limited to office hours.
Overall, AI is playing an increasingly important role in
dentistry, and it has the potential to greatly improve the
accuracy and efficiency of dental diagnosis and treatment. It is an active area of research and development,
and it is likely that we will see many new and innovative
applications of its technologies in the future.

about
Forrest Hall is a young entrepreneur
and 3D-printing enthusiast from Texas
in the US whose experience designing
and building custom laser tables
and 3D parts has led to collaboration
with international space programmes
for part production and design
consults with parachute manufacturers
around the world. He currently lives in
Germany, where he is advancing his career in mechatronics,
additive manufacturing and engineering.

1 2023

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supplement

Study highlights how artificial
intelligence can be used
for detection of caries
By Brendan Day,
Dental Tribune International

A study from researchers at Charité—Universitätsmedizin Berlin has sought to measure the impact that artificial intelligence has on the ability of dentists to detect caries.

Though artificial intelligence (AI) is being increasingly
integrated into a variety of dental products and services,
the body of literature evaluating its perceived benefits is
scarce. To help rectify this, researchers from Charité—
Universitätsmedizin Berlin have recently published the
results of a randomised controlled trial they conducted.
These results demonstrate that AI can increase the
diagnostic accuracy of dentists.
Artificial intelligence technologies are steadily being adopted by dental practices aiming to digitise and streamline their workflows. From initial consultations, diagnosis

1 2023

and treatment planning through to surgical procedures
and postoperative care, a range of dental tasks can now
be augmented by the various AI solutions that have been
developed in recent years.
The performance of these AI-powered tools in medical
and dental settings, however, has rarely been tested in
clinical trials. As a result, the real impact of AI on the
decision-making and diagnostics processes of dental
practitioners remains somewhat unknown. This lack of
clarity can carry over into decisions regarding available
courses of treatment and their advantages.

[63] =>

supplement

examined with the assistance of this AI tool, whereas the
other ten were not.
According to the study authors, their hypothesis—that
dentists using AI would be significantly more accurate
than those not using AI—proved to be partially correct.
In their discussion, they noted that “using AI significantly
increased dentists’ sensitivity, especially on enamel caries lesions, but did not greatly alter specificity; on more
advanced lesions AI did not impact on accuracy at all”.
They stated that it was likely the AI was more helpful in
situations where changes between images were miniscule, and that it played a lesser role when carious developments were significant and relatively easy to notice.

“Gathering evidence to better
evaluate the benefits that
AI can deliver dentists is at
the core of what we do.”—
Prof. Falk Schwendicke
“Our results demonstrate that combining the AI model
performance with human expertise can reach accuracies
which are beyond those of the AI itself (...) or the human
experts on their own,” the authors wrote.

MAD_Production/Shutterstock.com

It was also noted, however, that using the AI software led
to an increased likelihood of the dentists deciding to use
invasive restorative therapy to treat the carious lesions.
“In this sense, using an AI support to improve sensitivity
may increase the risk of type I errors and overtreatment,”
the authors remarked, adding that it could be beneficial
for the dental industry to provide evidence-backed treatment recommendations for lesions of various depths.
In their view, this would ideally lead to “better, not necessarily more invasive care”.

The research team thus commenced a trial using
dentalXrai Pro, a software program that allows dental
practitioners to analyse radiographs based on AI. The
dentalXrai Pro project was co-founded at Charité by
Prof. Falk Schwendicke, head of the Department of Oral
Diagnostics, Digital Health and Health Services Research,
and has since been spun off into a start-up simply titled
dentalXrai.

Prof. Schwendicke confirmed that further studies regarding
the dentalXrai Pro software are already being planned.

The AI-utilising software was employed by the 22 participating dentists to support their detection of caries on
20 bitewing images randomly chosen from a pool of 140.
Of the 20 images analysed by each dentist, ten were

Editorial note: The study, titled “Artificial intelligence for
caries detection: Randomized trial”, was published online
on 14 October 2021 in the Journal of Dentistry, ahead of
inclusion in the December 2021 issue.

“We are already planning on examining a different sample cohort using the updated version of this software that
will be available early next year,” he told DTI. “Gathering
evidence to better evaluate the benefits that AI can deliver
dentists is at the core of what we do,” he explained.

1 2023

[64] =>

supplement

Dental imaging market: Product
innovation to stimulate demand
Ali Shakerdargah & Dr Kamran Zamanian, Canada

imaging market. Most companies direct their funds towards research and development in the CBCT market
owing to its leading position.
One of the main trends in the dental imaging market is a
shift towards AI and data insights to improve patient care.
AI-driven technology can provide a personalised dental
solution that fully adjusts to the specific clinical needs of
each individual patient.
Research and development in AI technology has taken
place mostly in dental radiography, and this new technology is establishing its role as a smart assistant that
brings dentists a number of benefits. These include, but
are not limited to, being able to quickly and easily identify
problems, having automated and more precise diagnostics for dental radiographs and receiving suggested
treatment plans.

1
Fig. 1: The total volume of global dental imaging procedures is increasing every
year, and most of that growth is in the CBCT segment. (Image: © iData Research)

Dental imaging is a crucial part of oral care, and the
volume of imaging procedures is predicted to increase as
the global population ages and experiences more dental
problems. According to the latest market insights from
iData, harmful consumer behaviours and artificial intelligence (AI) are also expected to have an influence on the
growth of the dental imaging market.
The global dental imaging market saw less than two
million procedures performed in 2021, and the European
market accounted for less than 400,000 of them. The
total volume of procedures is increasing every year, and
most of that growth is in the CBCT segment. As a result
of the COVID-19 pandemic and the shutdown of dental
offices, the total global market experienced a sharp decline in 2020 but had almost fully recovered by the end
of 2021. Global market growth has been relatively steady
in recent years as a result of product innovation and the
ageing population.

Innovation driving growth
in dental imaging market
The CBCT market is the largest segment in the dental
imaging market, followed by the intra-oral radiographic

1 2023

The use of AI technology in dental imaging is expected
to grow rapidly and become one of the main drivers of
the dental imaging market.

Cosmetic usage boosting CBCT
Increased prevalence of harmful consumer behaviours,
such as regular increases in sugar and fatty food consumption and inactivity, may result in dental caries.
As a result, the overall volume of cosmetic procedures
to restore normal oral and dental health is expected
to rise.
Traditionally, 2D dental imaging machines have been
used as the main tool for capturing an image of the mouth
prior to procedures; however, 2D machines have a huge
limitation in depicting the shape and form of mouth,
as looking at a 3D object in 2D is not very accurate. Therefore, the complication rate of dental procedures was
higher before the availability of 3D dental imaging tools.
The birth of CBCT scanners was a revolution in the
dental industry, as it enabled dentists to capture 3D images
and see the mouth from any angle. CBCT helps dentists
to visualise the structures without the need of superimposition, and this advancement helps dentists to
identify a patient’s issues more clearly and to adopt
a better treatment.

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supplement

The use of CBCT in the dental industry is expected
to increase as a result of the rise in need for cosmetic
surgeries.

An ageing population requires
more dental imaging
Dental problems can occur at any time in life, but the
probability of their occurrence has a strong positive
association with advanced age. In other words, as you get
older, you are more likely to have dental and oral problems.
Age-related dental problems include, but are not limited to,
periodontitis and root and coronal caries.
Globally, there has been a shift in population dynamics.
For example, across Europe, a significant proportion of
the population is now geriatric. People in this age category require more extensive dental care, for example
for the provision of implants and overdentures or for the
treatment of age-related conditions. As the number of
people in this age bracket needing these procedures increases, dental professionals will require more advanced
dental radiographic devices.

COVID-19’s impact
on the dental imaging market
The global and European dental imaging markets experienced a steep decline in 2020; however, the effects of
the COVID-19 pandemic on the dental imaging market
are expected to vary by market segment. During the
pandemic, non-essential visits to dental clinics were not
possible, and this limited the ability of manufacturers to
sell their products.
Crucially, the COVID-19 pandemic reduced the number
of dental procedures in 2020, and this reduction was
directly tied to respective countries’ hospital and clinical
prioritisations. Urgent procedures were performed, but
patient safety necessitated meticulous preparation.

Dental imaging market set
to keep growing
The dental imaging market has met growth expectations,
and the volume of procedures presents an opportunity
for manufacturers to enter the market. The market is
predicted to grow alongside the ageing population
and the increase in number and significance of dental
imaging product innovations.
Overall, the global dental imaging market was valued
at less than US$2.5 billion (€2.2 billion) in 2021, and
the European market was valued at slightly above
US$500 million. The global market is expected to grow
moderately, and the European market is expected to
experience a slight decline.

2
Fig. 2: In terms of value, Western Europe’s dental imaging market trails
behind that of North America. (Image: © iData Research)

“The dental imaging market
has met growth expectations,
and the volume of procedures
presents an opportunity
for manufacturers.”
about
Ali Shakerdargah is a research
analyst at iData Research.
He develops and composes
syndicated research projects
regarding the medical device industry,
publishing the Global Dental Imaging
Market research report.
Dr Kamran Zamanian is CEO and
founding partner of iData Research.
He has spent over 20 years working in the
market research industry with a dedication
to the study of dental implants, dental
bone grafting substitutes, prosthetics,
as well as other dental devices used in
the health of patients all over the globe.

1 2023

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supplement

Artificial intelligence and augmented
reality in implant planning
Dr Francesco Mangano, Italy
CBCT (root) and intra-oral (crown) scans. The segmentation and alignment are automated, being the result of
a learning process (machine learning) which represents
the basis of AI.
It is a real revolution that has opened the door to changes
in all fields of dentistry: from the possibility, for example,
of planning a 3D orthodontic set-up that is truly safe for
the bone to the planning of prosthetic complex cases.
In implantology, AI-assisted software such as Virtual
Patient Creator (Relu) allows us to enhance our diagnostic
and planning skills.

Dr Francesco Mangano.

Technology is now pervasive in dentistry, and implantology is no exception. Intra-oral and face scanners, CBCT
and digital condylographs allow us to acquire 3D images
and videos of our patients, useful not only for diagnosis but
also for treatment planning. The patient becomes virtual.
Until recently, however, this information was difficult
to segment and assemble, and this limited the patient
virtualisation process. Obtaining the virtual patient was
difficult and costly, needing time and effort, since segmentation and alignment were essentially manual, and
operator-dependent.
Today, thanks to artificial intelligence (AI), it is possible
to use cloud-based software capable of returning to the
clinician, in a few minutes and at very low cost, the entire set of 3D files of the patient (derived from intra-oral,
face and CBCT scanning). These files, in STL format, are
perfectly aligned and segmented, eliminating any possible
error by the operator. Each tooth, for example, is the result
of the perfect fusion, segmentation and alignment of

1 2023

In particular, the use of 3D files in STL format processed by
Virtual Patient Creator (Figs. 1 & 2), combined with modern virtual reality and augmented reality (AR) systems,
creates new possibilities. In fact, it is possible to upload
all files derived from AI-assisted software directly into
apps specifically designed for AR, such as HoloDentist
(FifthIngenium). Thanks to these apps, wearing an AR device
such as HoloLens 2 (Microsoft), the dentist can view the
holographic 3D models of the patient and use them to
make a correct diagnosis and for communication with
the dental laboratory, colleagues or patients in order to
illustrate to them the selected treatment plan.
The use of AI and AR technologies transforms the manner
of not only diagnosis and communication but also of implant planning. On the basis of the set of files segmented
and aligned via AI, the surgeon wearing AR glasses such
as HoloLens 2 or Magic Leap 2 (Magic Leap) can plan
the positioning of one or more implants in the correct
3D position, inclination and depth, using holograms.*
Basically, it is no longer necessary to use software dedicated to guided implant surgery: the surgeon drags and
drops the desired fixture from a 3D library provided by the
HoloDentist app and positions it within the holographic
model of the bone. The surgeon can also enlarge the
holographic models to such an extent that they have the
same dimensions as the operator, and the same applies
for the hologram of the implant. Finally, by navigating
inside these models, the surgeon can tilt, rotate and
otherwise move the implant within the bone hologram.
This process is also guided by other masks and holograms,
which can be on or off during 3D planning, for example that of
the teeth and soft tissue or that of the prosthetic wax-up. This
is authentic 3D planning, without the need for any guided

[67] =>

supplement

|

1
Fig. 1: Automatic segmentation from CBCT in Relu’s artificial intelligence-assisted, cloud-based software.

implant surgery software or conventional 2D radiographic sections. This allows planning in a fast, intuitive
and fun way, drastically reducing costs. The spatial position of the implant thus designed is saved
and exported, together with the other files, for
the design of the surgical guide, in open-source
software. The next future development will be

the import of this planning into a dynamic implant navigation system.

*S
 can this QR code to watch a video on 3D implant
planning with holograms using HoloDentist and
HoloLens 2.

2
Fig. 2: Fusion and automatic alignment and superimposition of 3D files from the intra-oral scan over the CBCT data.

1 2023

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[68] =>

supplement

Ethical guidelines missing in field
of dentistry and AI, researchers say
By Luke Gribble, Dental Tribune International
in their practice technology that uses AI but many do not fully
understand what it is they are using,” he continued. Adding
to that, Dr Mörch pointed out that there are currently around
100 sets of ethical guidelines for the use of AI across all
sectors. “They are everywhere. They are mentioned in the
news, and the EU has its guidelines. However, when we
look specifically at dentistry, there is no mention of a code of
ethics related to AI that a dentist can follow,” he explained.

Dr Carl-Maria Mörch

Dr Maxime Ducret

Maintaining high ethical standards within the medical
profession is key to providing the best care possible. The
doctor–patient relationship is sacred, and the information
exchanged between these two parties is based on a high
degree of trust that the practitioner is prescribing the proper
treatment for the right reasons. The integration of artificial
intelligence (AI) in dentistry is now prevalent, and there seems
to be a third party entering this sanctum of trust. In a recent
study investigating ethics and the use of AI in dentistry,
researchers revealed that much work is still needed to
ensure that dentists better understand the technology they
are using and that patients and their data are protected.
During a recent discussion with Dental Tribune International
(DTI), lead researchers Drs Carl-Maria Mörch and Maxime
Ducret spoke about their study, about the still underresearched topic of AI and ethics in dentistry, and about
the challenges that the field is facing. Dr Mörch is the scientific manager at FARI—AI for the Common Good Institute
in Brussels in Belgium and a researcher at the Université
Libre de Bruxelles, and dentist Dr Maxime Ducret is associate professor in prosthetics and digital dentistry at the
Université Claude Bernard Lyon 1 and a hospital practitioner
at the Hospices Civils de Lyon.
“One of the major issues is around transparency and the lack
of explainability regarding the technology dentists are using,”
said Dr Ducret. “We have more and more dentists adopting

1 2023

This limited understanding creates unforeseen risks. However, as stated in the study, those risks have been around
for some time and little has been done. In the study,
Drs Ducret and Mörch noted: “The frequency of publications mentioning ethical issues related to AI has not increased since 2015 and remains low, highlighting a potential
lack of interest in this topic.” They added that some ethical
issues around big data and digital technologies have been
addressed but there has been little examination of AI’s ethical
issues and its introduction into a practice setting.
One explanation for this gap in the research could be a lack
of training and education. “As a patient, we expect a dentist
to know what the limitations of a certain tool or technique
are, and so it should be expected that dentists know the
limitations of the technology they are using too,” explained
Dr Mörch to DTI. “Practitioners receive training in a huge
range of areas but have never had an introduction to, or
classes on, the ethical issues around AI.” When an algorithm
is used, for example, to examine a radiograph and sometimes suggest costly procedures, dentists must know exactly
how the AI reached its conclusion and clearly communicate
this to the patient, explained Dr Mörch. At the moment, the
researchers believe that lack of understanding could mean
that there is also a blind spot regarding the risks AI can pose,
and thus, interest in this issue is limited.
This lack of education has prompted researchers to begin
developing guidelines to help dentists better prepare for
the future. “There is no such thing as a universal tool that
can suit academics, practitioners and researchers. Even in
universities, you can have several fields working within
dentistry, so there is no one-size-fits-all,” said Dr Mörch.
However, the idea behind this work is to see whether dentists can recognise the ethical risks that might arise when put
into theoretical scenarios and glean certain guidelines from
those resonances. When asked how dentists could start
improving their knowledge of ethics right now, Dr Mörch

[69] =>

supplement

Additionally, the researchers noted in the study that sharing
data could help create more transparent and understandable
technology from which everyone from the patient to practitioner and manufacturer could benefit. “It is pretty simple to
say, but sharing data and the benefits is challenging in reality,” admitted Dr Ducret. However, he continued: “There are
many questions around data security and intellectual property (IP), but the point we wanted to make is to try and reduce
the time, expertise and energy currently used to make progress in the field, as it clearly lacks sustainability. We want to
encourage a type of dentistry that does not try and promote
again and again a novel solution by starting from zero, and
there are ways to collaborate without losing IP, not only in the
field of research but also within industrial groups.”
Along with transparency and education, there are other
serious ethical questions around the development of new
technology that need to be considered, the researchers
said. One of these is about the collection of patient data
that could then be used to develop new algorithms and sold

back to patients in the form of a new procedure or piece of
technology. “I think people are not aware the way current
AI solutions are developed, and dentists need to be responsible for telling patients what might be done with data that is
collected,” noted Dr Ducret.
AI has the potential to revolutionise dentistry in far greater
ways than it has done so far. However, according to the
researchers, the question is how this new technological era
should be optimised in order to provide the best oral healthcare
possible. “In our paper, we try to highlight some questions
that those in the field may need to discuss in the coming
years. For now, we do not have a perfect solution, but people need to think about it,” said Dr Ducret. Adding to that
sentiment, Dr Mörch noted, “Right now the technology
requires a high level of knowledge, and if insufficient effort is
put into the training of practitioners and researchers, we will
end up with a field that is illiterate regarding the equipment
they are using. We should know and be responsible for all
the techniques we promote, use and teach in healthcare.”
The researchers believe the question of whether industry,
practitioners and patients can come together to find a way
to integrate AI in a safe and sustainable manner is one of
the most critical challenges facing dentistry today. If it is not
addressed soon, they are concerned that the sacred doctor–
patient relationship could one day be damaged beyond repair.
Editorial note: The study, titled “Artificial intelligence and
ethics in dentistry: A scoping review”, was published on
21 June 2021 in the Journal of Dental Research.

explained that practitioners could begin by asking more
questions about how manufacturers of certain types of
equipment arrived at their conclusions and what the implications might be for their patients. “Be aware regarding what
the technology says it can deliver and what the results are,
and if it is not clearly improving care, then remove it,” added
Dr Ducret. “The chain of responsibility is also critical. In the
case of a malpractice event, the question is, who will be held
responsible? Before implementing these tools, one needs to
know where responsibility lies,” continued Dr Mörch.

“In the case of a malpractice
event, the question is, who
will be held responsible?”
—Dr Carl-Maria Mörch,
researcher

Artificial intelligence is revolutionising dentistry in amazing ways, and researchers believe it is time for a set of ethical guidelines to be developed to help dentists with this transition.

1 2023

[70] =>

| meetings

Implant Solutions World Summit 2023
Cutting-edge implant science and innovation
By Dentsply Sirona
Dental professionals are invited to join world-leading
experts in implant dentistry in an exclusive state-of-theart congress, the Implant Solutions World Summit, in
Athens in Greece from 8 to 10 June. Here, they will discover cutting-edge science and be able to explore the
latest innovations in digital dentistry, bone regeneration
and optimised implant treatment solutions, including the
EV implant family—all while enjoying the company of their
peers and friends from around the world.

“Peer-to-peer education is vitally important for our implant solutions community and we are thrilled to bring
implant professionals together from around the world to
explore the latest innovations and science transforming
implant dentistry,” said Tony Susino, group vice president
of global implant solutions at Dentsply Sirona. “The event
promises to be an inspirational opportunity for learning
and networking as we glimpse into the future of implant
dentistry and optimised patient care,” he continued.

The Implant Solutions World Summit will bring together
professionals who are passionate about elevating the
dental industry and improving the quality of implant treatment and care for patients. The congress will take place
at the InterContinental Athenaeum Athens hotel, close to
Greece’s famous Acropolis.

Innovative implant solutions
and digital workflows

Scientific programme
The Implant Solutions World Summit will feature presentations by more than 40 world-renowned experts in implant dentistry, who will share best practices, expertise and
insights. Dental professionals will learn about managing
implant complications, the connection between systemic and
oral health, maximising aesthetics, controlling risk factors,
maintaining peri-implant health and more.
The programme has been developed with the scientific
chairs, Prof. Tara Aghaloo from the US and Dr Michael
Norton from the UK. The programme chairs are Steve
Campbell from the UK, Dr Malene Hallund from Denmark,
Dr Mark Ludlow from the US, Dr Stijn Vervaeke from
Belgium and Dr Martin Wanendeya from the UK.

70

1 2023

The Implant Solutions World Summit will also feature
an interactive exhibition and exciting master class
workshops that will allow attendees to learn more about
Dentsply Sirona’s products, solutions and workflows,
including the company’s premium implant portfolio—
DS PrimeTaper implant system, DS OmniTaper implant
system and Astra Tech Implant System. They will also
receive information about OSSIX regenerative solutions,
DS Signature Workflows for single-tooth and partial- and
full-arch restorations, and the cloud-based DS Core platform
for building a successful and efficient dental practice.
The innovative and comprehensive implant solutions
portfolio from Dentsply Sirona has been developed to
help practices grow their implant dentistry business and
achieve the best results for their patients.

Editorial note: More information about the event can be
found at dentsplysirona.com/worldsummit.

[71] =>

THE GLOBAL DENTAL CE COMMUNITY

REGISTER FOR FREE
DT Study Club – e-learning community
www.dtstudyclub.com
@DTStudyClub

Tribune Group is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA
CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.This continuing education activity has been planned and implemented in
accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group and Dental Tribune Int. GmbH.

[72] =>

| meetings

International events

IDS—
International Dental Show 2023

Expodental Meeting

14–18 March 2023
Cologne, Germany
www.ids-cologne.de

18–20 May 2023
Rimini, Italy
https://www.expodental.it/en

13–15 April 2023
Sydney, Australia
www.icoi.org/events

18th IDENTEX—
International Oral and
Dental Health Exhibition

72

1 2023

8–10 June 2023
Athens, Greece
www.dentsplysirona.com/
worldsummit

FDI World Dental Congress

4–7 May 2023
Antalya, Turkey
https://cnridentex.com

24–27 September 2023
Sydney, Australia
www.fdiworlddental.org/
world-dental-congress-2023

4th EAS Congress

36th Int’l Dental ConfEx
CAD/CAM Digital
& Oral Facial Aesthetics

11–13 May 2023
Torino, Italy
www.eas-aligners.com

27–28 October 2023
Dubai, UAE
https://cappmea.com

The British Dental Conference
& Dentistry Show

Digital Dentistry Summit

12–13 May 2023
Birmingham, UK
https://birmingham.dentistryshow.co.uk

16–18 November 2023
Prague, Czech Republic
www.digital-dentistry-summit.com

© 06photo/Shutterstock.com

ICOI World Congress

Implant Solutions
World Summit

[73] =>

|
© 32 pixels/Shutterstock.com

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1 2023

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[74] =>

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1 2023

[75] =>

Athens, Greece
June 8–10, 2023
Where history, future
and science meet

Are you passionate about implant dentistry?
Are you committed to science, innovation
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Do you want to provide your patients with
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At Implant Solutions World Summit, you’ll discover
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#ImplantSolutionsWorldSummit

Follow Dentsply Sirona for
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dentsplysirona.com/implants

[76] =>

TRULY CONICAL PRECISION

Fully
guided!

CONELOG®
PROGRESSIVE-LINE
conical performance 1, 2
at bone level

Precise conical connection
long conus for reduced micromovements
superior positional stability in comparison
to other conical systems 1,2
easy positioning with excellent tactile feedback
integrated platform switching supporting the
preservation of crestal bone

[1] Semper-Hogg, W, Kraft, S, Stiller, S et al. Analytical and experimental
position stability of the abutment in different dental implant systems with
a conical implant–abutment connection Clin Oral Invest (2013) 17: 1017
[2] Semper Hogg W, Zulauf K, Mehrhof J, Nelson K. The influence of torque
tightening on the position stability of the abutment in conical implant-abutment connections. Int J Prosthodont 2015;28:538-41
CONELOG (R) is a registered trade mark of Camlog Biotechnologies GmbH.
It may however not be registered in all markets.

VISIT OUR
WEBSITE!

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[cover] => digital international No. 1, 2023

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