When you go to a dentist many treatments are carried out on that day (fillings for example), however some treatments involve actually making something customised for you; we call these’ restorative options’, they are crowns (caps), veneers, implants and dentures. They are used to replace defective teeth (a defect could be decay or cosmetic) and to enhance smiles. It is to the ‘restorative treatment options’ that this article is dedicated.
When you have a crown (cap), veneer or denture made it is made by a dental technician on prescription from a dentist… the writer of this article is a dental technician.
Egyptian technology
I have been working in this field for over 20 years; many of the techniques we use have been around since Egyptian times! I refer specifically to casting gold through what we call a ‘lost wax technique’, just as the Egyptians did, we use gold often to replace a decayed section of a tooth
If we make a veneer (a thin covering over your existing tooth) the whole veneer is typically made by hand… these veneers are often less than 0.5mm! This is incredibly delicate work requiring a great deal of skill.
So what has technology done to help this process, and what difference has this technology made to you as a patient?
Predictability – you get the smile you want
Smile makeovers are in vogue with many TV programs dedicated to this genre of dentistry, CADCAM (Computer Assisted Design Computer Assisted Manufacture) has helped enormously here. I remember going to the barbers as a young boy and selecting my hairstyle from a magazine, with CADCAM technology this is now possible for a new smile.
We are now able to have a selection of ‘study models’ or designs for you to chose from (fig 1), you then chose the one that you like best; it is then possible to digitise your preferred design and overlay it on to your natural teeth that the dentist has prepared for us. Combining this with prototypes that you wear while we make your veneers to see what your friends think, means you get exactly the result you require every time.
This digital smile has now been made a reality and has improved the lives of many patients.
Accuracy
We need a finished restoration (like a veneer) to be highly accurate, typically we work to tolerances of about 50-100 microns, a micron is 1000th of a millimetre…you need good eyes and a microscope to be a dental technician! This has always been possible to do but was only available on only the highest quality work and the highest prices.
The materials we use in CADCAM restorations is also of a higher quality, typically we use a ‘block’ of ceramic which is made in an industrial process from our suppliers, we then take this block and get the machine to mill your veneer from it. Normally the technician would build the porcelain by hand, even the best technician may build in faults that are undetectable, CADCAM therefore allows higher predictability of materials.
What this technology has allowed us to do is to produce this kind of accuracy on a daily basis, every day, every time. But what the machines can’t do is use artistic skill to match exactly what you want, CADCAM can’t help with aesthetics.
Aesthetics
CADCAM can’t help with aesthetic per se, but what technology allows us to do is to dedicate more of our time as a technician to producing the absolute very best result for you. No longer are we worried that our veneer won’t fit, no longer are we worried that we may have built in a fault no-one can see until it’s too late…now we can spend all our time being creative and taking the highly accurate precision made ‘core’ veneer made using CADCAM and characterise it to look like natural, fresh teeth that mimic nature exactly.
Summary
CADCAM has revolutionised dentistry allowing us to produce a higher quality restoration for you, in a more predictable fashion.
Here is a case made entirely using modern CADCAM technology – these veneers are made in the UK under the name i-esthetic
Fig 2. the patient before, her teeth didn’t even touch! Fig 3. After designing by the technician the dentist was able to make her prototypes to test the appearance whilst we made her i-esthetic veneers Fig 4. The dentist took moulds, which we digitised with our scanner Fig 5. Her mouth was then onscreen Fig 6. We use our CADCAM software to design the smiles on the computer Fig 7. This digital design information is sent to our scanning machine Fig 8. We chose the correct ceramic blank Fig 9. The milling machine then mills the block using high speed precision diamond instruments Fig 10. The veneer is then hand finished to mimic nature by the skilled technician Fig 11. The final result, what a difference. This patient is now able to smile with confidence
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