Digital Dentistry: A Step-by-Step Guide and Case Atlas

List of Contributors xi

Foreword xv

Preface xvi

Part 1 Basic Knowledge of Digital Dentistry 1

1 Introduction to Digital Dentistry 3
Renan L.B. da Silva, Jun Ho Kim, Roberto A. Markarian, Rui Falacho, Djalma N. Cortes, Alan J.M. Costa, and Arthur R.G. Cortes

1.1 Definitions 3

1.1.1 Three- Dimensional Imaging 3

1.1.2 Coordinates and Planes 4

1.1.3 Computer- Aided Design and Computer- Aided Manufacturing (CAD- CAM) 4

1.1.4 Mesh 5

1.1.5 Image- Guided Treatment 5

1.1.6 Image Superimposition/Alignment 5

1.1.7 Resolution 5

1.2 History of Digital Dentistry 5

1.3 In- House and Outsourced Digital Workflow 7

1.3.1 The Digital Dental Clinic 7

1.3.2 Impact of Digital Technologies in Dental Clinics 7

1.3.3 The Education of the Digital Dentist 8

1.3.4 Levels of Digitalization for the Dental Clinic 8

1.3.5 Types of Dental Clinics and Business Models 9

1.3.6 Financial Aspects of Digital Dental Clinics 11

1.3.7 How to Calculate the Return on Investment (ROI) 11

1.3.8 Advantages of Digital Dentistry for Clinics 11

1.3.9 Workflow in a Digitalized Dental Clinic 12

1.4 Current Knowledge and Perspectives in Artificial Intelligence in Dentistry 12

References 15

2 Computer- Aided Design (CAD) 18

Jun Ho Kim, Alan J.M. Costa, José Lincoln de Queirós Jr, Juliana No-Cortes, Danielle A. Nishimura, Shumei Murakami, Reinaldo Abdala- Junior, Daniel Machado, Claudio Costa, Otavio H. Pinhata- Baptista, Shaban M. Burgoa, Andrea Son, Lucas R. Pinheiro, Danilo M. Bianchi, Allan R. Alcantara, and Arthur R.G. Cortes

2.1 Digital Imaging Methods 18

2.1.1 Cone Beam Computed Tomography 18

2.1.1.1 Basic Knowledge 18

2.1.1.2 Step- by- Step Procedure 19

2.1.2 Intraoral Scanner 20

2.1.2.1 Basic Knowledge 20

2.1.2.2 Step- by- Step Procedures 22

2.1.3 Desktop Scanner 27

2.1.3.1 Basic Knowledge 27

2.1.3.2 Step- by- Step Procedures 28

2.1.4 Facial Scanner 30

2.1.4.1 Basic Knowledge 30

2.1.4.2 Step- by- Step Procedures 31

2.1.5 Clinical Photographs 33

2.1.6 Magnetic Resonance Imaging 38

2.1.6.1 Factors Affecting MRI Quality 38

2.1.6.2 MRI Assessment of Soft Tissue Anatomy 39

2.1.6.3 Diagnosis of Soft Tissue Lesions with MRI 40

2.1.6.4 Temporomandibular Joint Assessment 41

2.1.6.5 Analyzing Bone Structure with MRI 41

2.1.6.6 Three- Dimensional Reconstructions from MRI 41

2.1.6.7 Studies Using MRI in Digital Workflow 42

2.2 Software Manipulation 42

2.2.1 Types of Software Used in CAD 42

2.2.1.1 Nondental Open- Source Software Programs 42

2.2.1.2 Dental Commercial Software Programs 44

2.2.2 Types of Files Used 45

2.2.2.1 Digital Communication in Medicine (DICOM) 45

2.2.2.2 Standard Tessellation Language (STL) 46

2.2.2.3 Polygon File Format (PLY) 47

2.2.2.4 Object Files (OBJ) 47

2.2.2.5 Files from Clinical Photographs 48

2.2.2.6 Video Files 50

2.2.3 Combining Data:: The Virtual Patient 50

References 52

3 Computer- Aided Manufacturing (CAM) 55

Mayra T. Vasques, Gabriel S. Urbano, Ivan O. Gialain, Jacqueline F. Lima, Fábio Andretti, Ricardo N. Kimura, Danilo M. Bianchi, Dionir Ventura, Fabricio L. Gebrin, Adriano R. Campos, and Arthur R.G. Cortes

3.1 Fused Deposition Modeling (FDM) 57

3.1.1 Basic Knowledge 57

3.1.2 Step- by- Step Procedure 58

3.1.2.1 Calibration 58

3.1.2.2 Printing and Postprocessing 60

3.2 Liquid Crystal Display (LCD) 60

3.2.1 Basic Knowledge 60

3.2.2 Step- by- Step Procedure 60

3.2.2.1 Acquisition 61

3.2.2.2 CAM Software Settings 61

3.2.2.3 Slicing 61

3.2.2.4 Object Printing 62

3.2.2.5 Washing/Postcure 62

3.2.2.6 Conclusion 63

3.3 Stereolithography (SLA) 63

3.3.1 Basic Knowledge 63

3.3.2 Step- by- Step Procedure 64

3.3.2.1 Printer Installation 64

3.3.2.2 Equipment Leveling 64

3.3.2.3 Personal Protective Equipment (PPE) 64

3.3.2.4 Resin Reservoir Preparation (Vat) and Build Plate Installation 64

3.3.2.5 Resin Types 64

3.3.2.6 Resin Preparation 64

3.3.2.7 Resin Supply 64

3.3.2.8 Printing Parameters 64

3.3.2.9 Job Upload 64

3.3.2.10 Print 65

3.3.2.11 Removal of the Build Plate 65

3.3.2.12 Removal of Uncured Resin 65

3.3.2.13 Postcure 66

3.3.2.14 Resin Filtration 66

3.3.2.15 Resin and Solvent Disposal 66

3.3.2.16 Preventive Maintenance 66

3.4 Digital Light Processing (DLP) 66

3.4.1 Basic Knowledge 66

3.4.2 Step- by- Step Procedure 67

3.5 Milling 68

3.5.1 Basic Knowledge 68

3.5.2 Step- by- Step Procedure 69

3.5.2.1 Laboratory Milling 69

3.5.2.2 Calibrating and Testing the Milling Device 70

3.5.2.3 Chairside Milling Procedures 75

References 78

Part 2 Clinical Applications of Digital Dentistry 79

4 Digital Workflow in Prosthodontics/Restorative Dentistry 81

José Lincoln de Queirós Jr, Thiago Ottoboni, Gabriel S. Urbano, Danilo M. Bianchi, Renato Sartori, Juliana No- Cortes, Jacqueline F. Lima, Roberto A. Markarian, Alan J.M. Costa, Shaban M. Burgoa, Charles Melo, Newton Sesma, Florin Cofar, Eric Kukucka, Alexandre D. Teixeira- Neto, Guilherme Saavedra, Diogo Viegas, Andrea Son, Maria L. Gainza- Cirauqui, and Arthur R.G. Cortes

4.1 Clinical Procedures for Intraoral Scanning 81

4.1.1 Teeth Preparations 81

4.1.2 Implant Scanbodies 82

4.1.2.1 Step- by- Step Procedures:: Dental Implant Impressions 83

4.1.2.2 Stereophotogrammetry:: An Accurate and Fast Alternative 84

4.2 Setting Up the Virtual Patient 85

4.2.1 Importing Intraoral Scans to the CAD Software 85

4.2.2 The Virtual Articulator 85

4.2.2.1 Step- by- Step Procedure for Using a Virtual Articulator in a Digital Workflow 85

4.2.3 Esthetic Analyses and Digital Smile Design 88

4.2.3.1 Esthetic Analyses 89

4.2.3.2 Two- Dimensional Digital Design of the Smile 89

4.2.3.3 3D Image- Obtaining Methods for Esthetic Analysis 89

4.2.3.4 Step- by- Step Procedure for 3D Dentofacial Esthetic Analyses 90

4.2.4 Dynamic Smile Analysis 91

4.2.4.1 Step- by- Step Procedure for Dynamic Smile Analysis 92

4.3 Digital Workflow for Restorations/Prostheses 92

4.3.1 Single Crowns 95

4.3.1.1 Tooth- Supported Single Crowns 95

4.3.1.2 Working with Dies 116

4.3.1.3 Implant- Supported Crowns 116

4.3.1.4 CAD- CAM Copings 120

4.3.1.5 Customized Abutments 120

4.3.2 Splinted Crowns and Fixed Bridges 123

4.3.2.1 Step- by- Step Procedure to Design and Mill a Fixed Bridge 123

4.3.3 Laminate Veneers 133

4.3.4 Inlay and Onlay Restorations 144

4.3.5 Digitally Guided Direct Resin Composite Restorations 149

4.3.5.1 Step- by- Step Guide 149

4.3.6 Digital Complete Dentures 152

4.3.6.1 Removable Prosthodontic Rehabilitation Workflow:: The BPS- SEMCD Method Summarized 152

4.3.7 Complete- Arch Implant- Supported Prostheses 168

4.3.7.1 Utilizing CAD- CAM for Full- Arch Prosthetics 168

4.4 Three- Dimensional Printing in Prosthodontics 172

4.4.1 3D- Printed Resin Restorations 172

4.4.2 3D- Printed Dental Casts 176

4.4.2.1 Importing the File 176

4.4.2.2 Handling the File 177

4.4.2.3 Cleaning the Mesh 177

4.4.2.4 Smoothing the Mesh Edge 178

4.4.2.5 Creating the Base 179

4.4.2.6 Making It Solid 179

4.4.2.7 Making It Hollow 180

4.4.2.8 Cutting the Plane 181

4.4.2.9 Exporting 181

References 183

5 Digital Workflow in Periodontology 185

Ana P. Ayres, Alexandre D. Teixeira- Neto, and Arthur R.G. Cortes

5.1 Periodontal Surgical Planning 185

5.2 CAD- CAM Surgical Guides for Clinical Crown Lengthening 186

5.2.1 Planning for Periodontal Surgical Guide Manufacturing 188

5.3 Image- Guided Periodontal Surgery 190

5.4 Surgical Guide for Soft Tissue Graft 192

5.5 Research Evidence 194

References 195

6 Digital Workflow in Implant Dentistry 197

Otavio H. Pinhata- Baptista, Roberto A. Markarian, Shaban M. Burgoa, Alan J.M. Costa, Jesus T. Garcia- Denche, Baoluo Xing, Oscar I. Velazquez, and Arthur R.G. Cortes

6.1 The Concept of Prosthetically Driven Surgical Planning 197

6.2 Static Image- Guided Implant Surgery 197

6.2.1 Dual CBCT Scanning Technique 198

6.2.1.1 Tomographic Guide 198

6.2.2 Using Combined CBCT and Intraoral Scans 199

6.2.2.1 Virtual Waxing 199

6.2.2.2 Virtual Implant Surgery Planning Software 199

6.2.3 Full- Arch Implant Rehabilitations 205

6.2.3.1 The Concept of Digital Image- Guided Implant Surgery for Full- Arch Rehabilitations 205

6.2.3.2 Advantages of Guided Surgery 205

6.2.3.3 Dental Teamwork and Technical Requirements for Planning Guided Surgeries 205

6.2.3.4 General – Performing Surgery 206

6.2.3.5 Step- by- Step Procedure for Full- Arch Image- Guided Surgery, from Planning to Surgery 207

6.2.3.6 Additional Remarks 213

6.2.4 Zygomatic Implants 213

6.3 Dynamic Guided Implant Surgery 218

6.3.1 Surgical Technique 218

6.4 Bone Graft Volumetric Planning 219

6.4.1 Socket Preservation 219

6.4.2 Sinus Lifting 223

6.4.3 Onlay Bone Grafts 225

References 226

7 Digital Workflow in Oral and Maxillofacial Surgery 227

Daniel Negrelle, Alexandre M. Borba, Isabella Romao Candido, Shaban M. Burgoa, Luiz F. Palma, and Arthur R.G. Cortes

7.1 Image- Guided Surgical Removal of Impacted Teeth 227

7.2 Surgical Planning of Orthognathic Surgeries 227

7.2.1 Virtual Skull Construction 227

7.2.1.1 Coronal Panoramic Image 235

7.2.1.2 Three- Dimensional Reconstruction and Segmentation of the Bones 235

7.2.1.3 Importing Dental Scanning 235

7.2.1.4 Mesh Clean- Up 237

7.2.1.5 Osteotomy Design 237

7.2.1.6 Virtual Skull Orientation According to the Natural Head Position 240

7.2.1.7 Cephalometric Points:: Locating and Defining 241

7.2.2 Virtual Planning:: Bone Movements 242

7.2.3 Surgical Splint Creation 246

7.2.4 Comparison of Results from Virtual Planning 248

7.3 Surgical Guides:: Types and Classification 248

7.4 Virtual Planning of Trauma Surgeries 253

References 256

8 Digital Workflow in Endodontics 257

Daniel M. Kier, Lucas R. Pinheiro, Maria Clara R. Pinheiro, and Arthur R.G. Cortes

8.1 Digital Imaging in Endodontics 257

8.1.1 Recommendations for Endodontic Imaging 257

8.2 Electronic Apex Location 258

8.2.1 Step- by- Step Procedure for Using an EAL 258

8.3 Use of the Dental Operating Microscope in Endodontics 258

8.4 CAD- CAM Guided Endodontics 259

8.4.1 Indications and Advantages 259

8.4.2 Step- by- Step Procedure to Perform CAD- CAM Guided Endodontics 260

8.4.2.1 Take a CBCT of the Involved Tooth 260

8.4.2.2 Surface Scan 260

8.4.2.3 Import Both CBCT and Surface Scans 260

8.4.2.4 CBCT Preparation 260

8.4.2.5 Merging of CBCT and Surface Scan Images 260

8.4.2.6 Guided Access Planning 260

8.4.2.7 Surgical Guide Design 262

8.4.2.8 Approval of Planning and Printing of the Guide 262

8.4.2.9 Guided Surgery Access 262

Acknowledgments 262

References 263

9 Digital Workflow in Orthodontics 264

Guilherme S. Nakagawa, Juliana No- Cortes, Adriano G.B. de Castro, Fernando Barriviera, Maurício Barriviera, and Arthur R.G. Cortes

9.1 CAD- CAM Guides for Orthodontic Brackets 264

9.2 CAD- CAM Guides for Orthodontic Miniscrews 264

9.2.1 Technique 267

9.2.2 Discussion 276

9.3 Orthodontic Aligners 276

References 286

10 Digital Workflow in Dental Public Health, Preventive Dentistry, and Dental Education 287

Anne- Marie Agius, Nikolai J. Attard, Gabriella Gatt, and Arthur R.G. Cortes

10.1 Digital Dentistry in Public Health 287

10.1.1 The Role of Teledentistry 288

10.1.2 The Expected Role of CAD- CAM in Public Health 288

10.2 Digital Workflow in Preventive Dentistry 289

10.3 Digital Dentistry in Dental Education 289

References 291

Part 3 Case Atlas 293

11 Multidisciplinary Clinical Cases 295

Alan J.M. Costa, Alexandre D. Teixeira- Neto, Jun Ho Kim, Allan R. Alcantara, Daniel Machado, Gustavo Giordani, Marcelo Giordani, Florin Cofar, José Lincoln de Queirós Jr, Luis E. Calicchio, Djalma N. Cortes, Arthur R.G. Cortes, Guilherme Barrella, Fábio Cabral, Guilherme S. Nakagawa, Richard Leesungbok, Hossam Dawa, and Daniel No

References 371

Index 372