Prophylactic Intraoral Scanning

Novelty

In order to get better and more efficient we must constantly rethink our processes. It is the same in every field be it a plastic injection moulding factory or a dental laboratory. Staying competitive demands perpetually offering more for less. This “more for less” doesn’t have to mean more amount of teeth for less money. First of all we can improve just on one aspect to improve the general quality. Secondly there are many different parameters beyond just quantity and price. We can improve on material selection, time of design, complexity of design, quantity of assembly parts, biomimicry, tissue integration.

There are two ways of how we can better our existing workflow. The most common and easier to do is optimisation.

Process optimisation

Herein lies everything that makes our workflow faster, less costly, more reliable while still retaining very similar process structure. The amount of steps can be minimally reduced i.e. some steps merged, but the general thing looks pretty similar from one version to the next one.

Process innovation

Compared to optimising, innovating is much more revolutionary. Here a whole new workflow can be thought out and a completely new approach to solving our problems can be invented. With innovating there are much more drastic changes and much better results, that can usually get even better with optimisation down the road. All until the point of new innovation.

Such is the way of making our work amount to more for the cost of less.

The idea

Like the title says I would like to present an idea of prophylactic intraoral scanning. It is meant to be carried out on every patient before he/she becomes a patient. What I mean to say is that we would want to capture the state of his teeth before it ever gets compromised. Be it by lack of hygiene or an accident. By capturing the data of intact teeth we would have a lifetime reference for that patient of what nature has created.

State of morphological knowledge

When it comes to creating artificial teeth, one should always follow the nature. Why? Simply put, nature has been developing every living organism with heaps of time and an unimaginable amount of variants. With this iterative process it has created a nearly perfect tool for chewing. By realising this, our only option is to try and copy the nature as closely as possible.

And this is exactly where we encounter our problem!

I love tooth morphology, modelling teeth, copying nature, learning through active observation, contemplating and searching why the form is such and how does it all work together. Teeth have been thought out by nature from the smallest of building blocks, up to all 32 of them working together in absolute unimaginable complexion. The attention to detail, the micro adaptations, the tight tolerances and unprecedented dimensional accuracy, of this organ is simply stunning to me. I am definitely not alone with this enthusiasm, but the fact is we are a minority. A very minor minority.

The morphology I see from posts on social media, the works I see in patient’s mouth, are nicely put extremely lacking in morphological aspect in most cases. Which materials we will use to crate our teeth from and what way of fabricating is very relevant in our field right now. But the fact is that material selection has as much influence on longevity of our prosthetic work as does it’s shape. Incorrect shape can result in loads of problems sometimes ending up creating even more harm than it was set to resolve at the beginning.

There is no problem so bad that you cannot make it worse - Chris Hadfield

Our teeth develop almost completely identical on the left and right side. But with different positions and different habits that we as humans have we abrade the left and right side differently. These discrepancies are visible but they are usually pretty minimal. When a technician is restoring a tooth and has the colateral equivalent intact, he should of course copy it. Copying has never been easier and required less skill, than it does with CAD software. Usually an exact copy will not work, just because of those micro adjustments I mentioned. Here comes the knowledge of gnathology. How teeth abrade, which jaw movements are possible and how the affect our teeth. Still the process is very fast and the results are great.

Copying works when we have a natural reference to copy, but what happens if the reference has already been improperly restored with poor morphology? Or in complete arch cases? With the adoption of digital design software there has been an inflow of digital libraries. Most of them terrible, some kind of adequate but none optimal. My idea aims to solve exactly this problem. The best library is what nature made for that patient. Many high quality dentists are starting to notice that the teeth shapes are getting ever so similar; especially anteriors. A technician finds one or two libraries he/she like and forces them on every patient. There is minimal adjustment and the lack of morphological knowledge shows a lot.

Solution?

Scanning natural shapes of that patient for that patient is now possible. The only catch is, one has to do it many years in advance.

Every critical and objectively thinking dental technician will be aware that he/she will never be able to better nature. Realising this, the very next best thing one can do is copy it as close as possible.

Right now we have a very limited amount of patients where we can copy the intact tooth and use it on the adjacent side. But at one point in time of 99% of patients we had the opportunity to copy every and any tooth. The point at which all teeth were fully erupted, they had minimal abrasions and the teeth were still unrestored. Somewhere around the age of 18 most of the teeth (with the exception of wisdom teeth) are fully erupted and positioned. That would be the best time to visit a dentist and have a reference scan taken that would be stored for the patients lifetime. That scan would be patients property and he/she could transfer it to any restorative dentist or dental technician. That scan would serve as an immense aid in correct restorations.

Why it couldn’t be done before?

Intraoral scanning

Now connecting the topic with dentistry, with the arrival of intraoral scanners practices have started optimising the way they capture data.

The cost of acquiring data had lowered drastically once one passes the ROI point. There has never been a way in dentistry to capture data better and cheaper. It’s not faster but has a lot of additional benefits.

Positive volume

It’s an innovation because the dentist can for the first time, see the positive volume of what he/she has captured. Before any data captured was a negative; some kind of impression. That had an inherent time cost of creating a model. Be it in practice or in dental lab it was never immediate. Only with a positive model is one able to visually critique his/her work. From the assessment of prepared dies, to tooth positions, occlusion and many more.

Long term storage

Something we take for granted is that scanned data is dimensionally stable. Of course it is, since it’s digital, but that is a great advantage compared to impressions. Models are dimensionally stable but they can be damaged with improper handling.

Physical things are also always susceptible to chemical damaging.

Scanned data can be quickly searched and retrieved. There is no cost of physical space (if you exclude the space of the server) being taken up, at least not in your practice. The data can be easily moved around when changing locations and can be backed up to ensure an even greater reliability.

All of the characteristics mentioned above are simply amazing for data archival.

Final thoughts

My proposal doesn’t help the current situation of lacking morphological knowledge among dental technicians, nor does it have an immediate effect if it starts being practiced. But as the saying goes the sooner you start, the sooner you will ripe benefits from it. Also this scan could help dentists with their fillings since the dentist could print the model of the original state in advance before the patient would come to get a direct restoration. The dentist could then use that model in combination with the impression technique to restore the tooth correctly.

The best time to plant a tree is 20 years ago. The next best time is now. - Chinese proverb

Proudly written by my own thoughts without GPT-3.