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数字化技术在牙种植学中的运用
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來自 The University of Hong Kong 的課程
口腔种植学 （Implant Dentistry）
27 個評分
從本節課中
种植牙的术后、未来的发展
种植体毫无疑问是“高维护”设备！在这个模块中，我们将讨论如何设计个性化，循证的策略，以保持种植体的长期健康和功能。我们还将回顾最常见的技术和生物学并发症，并讨论预防策略，早期诊断和管理技术。同时，我们将探讨一些尖端的技术和新趋势，包括在组织工程和再生中使用数字技术，在植入程序中使用动态导航和数字化工作流程等，这些趋势可能改变种植牙的未来。
與講師見面
Nikos MattheosClinical Associate Professor in Implant Dentistry
The University of Hong Kong
Dental technology is advancing rapidly in dentistry.
Computers are making what were previously manual tasks easier,
faster and more predictable.
However, dentists who want to use the technology
often do not have the time or knowledge to understand it.
A basic knowledge of the digital workflow
for dental restorations and implant dentistry
can help dentists to manipulate the technology,
and purchase a CAD/CAM system
that meets the needs of their clinic.
In this presentation, we will discuss the relation
of dental technologies, digital workflow,
and the final customized digital treatment protocols.
Some clinicians may think they fully understand
the digital workflow when they only purchase
one kind of digital technology,
such as intra-oral scanner.
However, the complete digital workflow
composed of various digital technologies,
with both hardware and software,
material science and dental technology.
Fully digital workflow is based around four elements,
namely, data acquisition,
data processing with Computer-Aided Design (CAD),
Computer-Aid Manufacturer (CAM),
and the final laboratory surface veneering processes.
There is various data capture equipment in dental clinic,
the most common are the Cone-beam CT.
The output DICOM file can easily be processed
by most software.
The 3D facial profile can also be captured with 3D camera.
The output STL file can be used for surgical
or cosmetic planning, together with the Cone-beam CT data.
For dental tissue 3D data,
we can capture directly by intra-oral scanner,
or indirectly by scanning physical dental model
by model scanner.
Digital impression will be detailed discussed
in other presentations.
Various CAD software are available for orthognathic surgery,
such as Materialise SurgiCase.
Implant planning software, for example, SimPlant,
NobelClinician, 3Shape Implant Studio,
are available for surgical templates
in implant guided surgery.
Now many software packages available
for the design of dental restorations,
such as veneers, crowns, bridges and implant prostheses.
A further development in the CAD/CAM technology
used in dentistry, is the transition
from closed to open access systems.
The most common closed systems are
the NobelProcera, Sirona CEREC.
Open systems such as ExoCAD, 3Shape,
Dental Wings, Sirona inLab, open up access
to a much wider range of manufacturing techniques,
and associated materials can be selected.
Moreover, there is a third-party software
for the data transformation amongst open or closed system.
This may be useful for commercial lab
or larger group clinics with digital dentistry.
Computer Aided Manufacturing in digital workflow
divided into two chains: Additive Manufacturing
and Subtractive Manufacturing.
That is, 3D printing and Milling.
There are several kinds of 3D printers
available in the market,
namely, conventional stereolithography,
more common PolyJet and,
the Fused Deposition Modeling (FDM),
and Direct Metal Laser Sintering
for metal printing.
One of the largest 3D printer companies,
Stratasys, produces two kinds of 3D printers,
the FDM and PolyJet.
The precision of FDM is up to 50µm,
whereas the PolyJet within 10µm accuracy.
And thus, PolyJet 3D printer is commonly
used in dentistry.
So, what we will print for the digital workflow?
We will print surgery planning models
for treatment planning or illustrations for the patients.
Some surgical models are printed for
surgical hands-on training.
Medical tools and device prototypes
was printed to assess the surgical use feasibility
before the final milling production.
In this case, a zygoma implant
extended drill guide was made.
This implant surgical guide was printed
with biocompatible materials.
If the data acquisition is captured by digital impression,
the physical models have to be produced by 3D printing.
Conventional crown and bridges models, implant models with
special use implant analogue are printed.
In orthodontic cases, the quality of the 3D printed models
are far superior to the stone models.
For Subtractive Manufacturing,
the simple crown, abutment can be milled by
simple in-house milling machine.
If the clinic with in-house dental lab,
more comprehensive dental prostheses can be produced
by the in-house 5-axis milling machine.
Hard metals or fully sintered zirconia
can be milled by industrial-level milling machine.
After CAM production, the final veneering
will be done by dental technicians.
Materials involved usually are acrylic or porcelain work
or surface stain only,
depends on the prostheses designs.
After understanding different kinds of dental technologies,
let's see how those things formulate
our daily digital workflow.
Many digital workflow can be customized
and formulated for crown and bridge work,
implant guided surgery,
implants prostheses, orthodontics treatment,
and maxillofacial surgery.
This is the simplest digital workflow
for single crown or implant abutment in
daily practice by CEREC.
Data acquisition by digital impression,
crown or abutment was designed by build-in software.
Ceramics milled by in-house milling machine,
and then final veneering process by dental technicians.
For implant-guided surgery digital workflow,
even the same treatment,
different CAD/CAM systems have different digital workflow.
For example, the closed system NobelGuide workflow
the surgical guide was produced by NobelBiocare.
The open system features 3Shape Implant Studio workflow,
the surgical guide can be fabricated by 3D printing.
Moreover, the Sirona CEREC Guide workflow,
the surgical guide was fabricated by milling PMMA.
Different systems have their own advantages
and disadvantages,
so we can consolidate those systems
and customize our own clinic workflow
for guided implant surgery.
The most common use is
the Implant Prostheses Digital Workflow.
Implant models are scanned by the model scanners
and CAD by different software,
in-house milling or outsource to milling centers afterward.
And again final veneering process
by dental technicians.
Some dental technologies and equipment
can also formulate the digital workflow
for orthodontic and maxillofacial
surgery treatments.
Each workflow is governed by
detailed treatment protocols.
Patient treatment may involve several digital workflows
for example implant guided surgery workflow
and implant prostheses workflow
for immediate loading,
Then customized treatment protocols
can be formulated.
Here is an example for part of the treatment protocol
for full implant prostheses workflow.
There are several bottlenecks in
full digital workflow.
1. Initial investment for the equipment for
various digital technologies.
2. Manpower and the learning curve
to manipulate the technology.
3. The workflow itself has limitations,
especially in closed systems.
4. The choice of materials.
Full understanding of material science is important
in digital dentistry.
For the take-home message,
Determine the scope of digital work in dental practice.
Digital technologies formulate the
customized digital workflow.
Experts with knowhow for CAD, data processing and
manufacturing (AM & SM) to link up the digital chains.
Formulate strict treatment protocols
to maintain the accuracy of all digital technologies
within the digital workflow.
Keep update and review the latest digital technologies
to optimize your own
digital workflow.
We hope these overviews have helped you
in understanding digital workflow
in relation to implant dentistry.
Thanks for watching.
Goodbye.
