Throughout the past 10 years, we’ve experienced a major influx of 3D data in the dental profession. In that time dentistry has seen a huge jump in the use of devices that acquire 3D information and generate interactive 3D models of a patient’s anatomy.
For me, the concept of digital impressions began with the original iTero unit in 2006. For those not familiar with it, we used a pedal to capture multiple images of the teeth which the software then stitched together into a virtual 3D model. Compared to today, it was an incredibly arduous process, but well worth it at the time. We then jumped into the world of cone beam with our first CBCT unit in 2008.
Seeing things in 3D was brand new back then. We learned so much more by seeing things as they really are. Treatment planning and the subsequent treatments were easier and more predictable. The other huge benefit from these technologies was in patient education. When patients saw a completed digital scan, or we opened the CBCT for them, they were fascinated. It spurred lots of questions and gave us an opportunity to better educate them about what we were doing and how we could help them.
Since that time, one of the biggest growth areas in the profession has been in the world of intraoral scanners. The devices have progressed to the point of capturing huge amounts of data per second and almost instantaneously rendering it live on the screen. In the hands of an experienced user, full mouth scans can be captured in less than 5 minutes, often considerably less. They have become so fast and easy to use, that many offices are capturing full mouth scans in the hygiene operatory as part of the new patient intake process.
CBCT units have evolved as well. They are faster, use significantly less radiation, and some are using AI to automate nerve tracings and segmentation of the anatomy. What some doctors once considered a luxury has now become a necessity. Once you begin working in 3D, it’s very difficult to go back.
Since I’ve been at this technology thing for a while, one thing I’ve noticed is cycles of innovation followed by cycles of integration. In the early days of dental technology—before operatory computers—things started with cart based systems for intraoral cameras and digital radiography. They were originally standalone systems that had to be wheeled into an operatory to be used. I call this era “Innovation 1.0”.
Things radically changed in the later 1990s and early 2000s when computer processing power grew exponentially and the price of computers fell. That was the point when computers made their debut in operatories. Soon cameras and x-ray sensors were connecting to the operatory computer, and everything became streamlined. The computer became the hub of the wheel and all the ancillary technologies connected to that hub. That’s what I refer to as “Integration 1.0”.
I think we started to progress into “Innovation 2.0” sometime shortly after 2010. That is the point where we started to see serious market adoption of CBCT and intraoral scanners. Both technologies have gone mainstream and are widely adopted today. Of course, it hasn’t been incredibly easy to use the devices together…yet. However, that is about to change, and I think it will lead us into “Integration 2.0”. Brace yourselves.
There are devices coming to market that allow you to merge 3D data into a single cohesive virtual patient. Think about that for a moment. You can take a CBCT, an intraoral scan, and a scan of the patient's face and combine them to put the data on a screen to show your patient. A cone beam scan, an intraoral scan, and a 3D face scan all appearing together in one digital model.
One of the things I love about intraoral scans is that you can do virtual smile makeovers on the scan and before even starting treatment, show patients what they will look like afterward. Dentistry has been doing wax-ups for decades to show patients a new smile, but digital design allows the patients to see how it appears in their own mouths. Now by merging all this 3D data, you can show them what they will see when they look in the mirror. The communication value of this, for me, is beyond comprehension. Being able to combine a CBCT, an intraoral scan, and a facial scan into a single file might be the greatest communication tool we currently have available.
One of the devices designed to combine these three digital imaging technologies into a single model is the MetiSmile from Shining 3D. First the team takes an intraoral scan. Then the MetiSmile is used to scan the face. It has 3 data acquisition cameras, an HD texture camera, and an IR VCSE projector that work together to acquire a scan of the patient's face.
Once that facial scan is complete, the intraoral scan is imported into the MetiSmile software where it is automatically aligned to the proper position. This drops the intraoral scan into the facial scan so the 2 are merged into a single view. The CBCT data can be merged similarly. This file is in 3D and can be rotated and the transparency of all three intra- and extraoral pieces can be changed to provide one definitive view.
Those functions are impressive enough, but the system will also provide mandibular trajectory tracking. This means the doctor can acquire dynamic occlusal data. That data includes centric, open bite, as well as left and right lateral excursions. This data means you can not only show the patient a new smile, but also that the doctor will know the planned restoration will function as anticipated.
Digital tools like this are going to greatly simplify communication. However, they’re also going to simplify the entire process from start to finish. The design can be done in the office, or it can be sent to a digital lab and shown to the patient at a treatment plan presentation appointment. The design data can also be used to fabricate the restoration, which helps improve efficiency and confidence for everyone involved.
We’re going to be seeing more and more tools like this coming to market, and I’m excited about the future as 3D progresses from standalone systems into ones coordinated to provide combined data. In the early days of dental technology we had a program for images, a program for x-rays, and a program for charting. That seems archaic when compared to today’s practice management software. That same technology connection is happening now in 3D. “Integration 2.0” is going to make some incredible changes for the better.
