When they presented their clinical case in 2016, they caused a stir: Prof. Dr Petra Gierthmühlen and Udo Plaster, DT, both from Germany, were among the winners of the international IPS e.max Smile Award. They provided an exemplary rehabilitation of a severely eroded dentition by combining digital methods with an accurately planned and consistently implemented treatment plan.
In this interview, Prof. Dr Gierthmühlen talks about the advantages of digital methods in dentistry and spotlights areas where conventional manual tasks are likely to remain indispensable in the future.
How does the digitization of dental procedures affect your day-to-day work?
Prof. Dr Petra Gierthmühlen: Especially when I am working on a complex case, I appreciate the benefits of computerized planning methods that I can use together with face scans. Digitization has become an integral part in the fabrication of restorations.
When do you use digital methods and when do you prefer analog, i.e. conventional manual procedures?
Prof. Dr. Petra Gierthmühlen: In complex cases, I carry out all the planning digitally. When it comes to small all-ceramic restorations, such as inlays, onlays, occlusal veneers, crowns and bridges, I choose to have them fabricated either with a CAD/CAM method or with an analog method such as the press technique. I opt increasingly more often to use digital methods for implant-supported single crowns and bridges in the posterior region in particular and, of course, for temporaries. In the case of large removable restorations, such as telescopes, conventional fabrication methods continue to be central.
In your Smile Award case, you combined digital and manual steps with each other. What were the advantages of this approach?
Prof. Dr. Petra Gierthmühlen: This approach provided Udo Plaster and me with several advantages to produce the restoration that won us the award, such as:
- simplified treatment planning due to being able to e.g. contrast the esthetic analysis of the preoperative situation with the goal to be achieved
- no need for time-consuming steps, such as waxing up
- cost-effective, time-saving, predictable esthetic treatment outcome
- reproducible results from initial planning through to the temporization and the final restoration
- preview of the restoration in the oral cavity, allowing the patient to visualize the final outcome
- digital access to the recorded data sets
- high-precision, mechanically stable, esthetic restorations
Why did you use the press technique, rather than a digital method, for the fabrication of the final restoration?
Prof. Dr. Petra Gierthmühlen: The esthetic implementation usually requires manual expertise, for instance when the restoration is veneered. Of course, we could have completed the restoration entirely digitally. However, we decided to mill it from CAD wax and then press it using a conventional method because the thin margins cannot be realized with every CAD/CAM unit. In this context, I am already very excited about the PrograMill milling units from Ivoclar Vivadent, which are specifically designed for IPS e.max.
Which steps, do you think, will be implemented digitally and which will remain manual in the future?
Prof. Dr. Petra Gierthmühlen: In my opinion, single-tooth restorations will be increasingly fabricated chairside in a completely computerized procedure. In complex cases, the gain in predictability is impressive if a digital method is used.
However, I think that the need for manual completion by a highly skilled dental technician will always remain in the case of high-end esthetic restorations - even more so in complex rehabilitation such as full-arch restorations, no matter whether they are placed on implants or natural teeth. Such cases will always require the expertise of a dental technician. At the same time, digital methods can make the fabrication of temporaries, abutments, monolithic restorations and complete dentures a great deal more cost and time effective.
In the field of removable prosthetics (telescopes, hybrid prostheses), there has been a certain level of stagnation in the development of digital dentistry solutions. Nonetheless, innovations have also begun to emerge in this area, as was seen at IDS 2017.
You can find a detailed description of the award-winning work in the specialist publication Reflect.
Prof. Dr Petra Gierthmühlen will be a speaker at Ivoclar Vivadent's "Competence in Esthetics" Symposium in Vienna (from 10 to 11 November 2017), where she will focus on "All-ceramic materials and minimal invasive dentistry: Facts and visions”.
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