3D Technology Breakthroughs in Dentistry: A Detailed Review

Introduction:

Dentistry has advanced over the years with recent advances in 3D technology digitization, and 3D printing technologies. Now, with the breakthrough in virtual surgical planning which is beneficial in the maxillofacial surgery field, the future of surgical dentistry seems to be bright. This instills hope for dental patients, both in terms of oral functionality and aesthetics. This article takes a walkthrough through various breakthroughs in dentistry in detail.

What Are the Recent Breakthroughs in the Prosthodontic Field of Dentistry?

The recent breakthroughs in the prosthodontic field are:

• Traditionally, 2D cephalograms and dental cast models were preferred in dental laboratory work to be mounted on fully adjustable articulators. Subsequently, the work of face-bow registration was used as an interface for surgical planning.

• This has been the traditional method of articulation and face bow transfer in the fabrication of dental bridges, crowns, or dentures for hundreds of years in the field of dentistry, specifically in prosthodontics (a branch of dentistry that involves making replacements for damaged or missing teeth).

• However, with the recent evolution of revolutionary 3D techniques and the digitization of the pre-surgical process, the dental arches of the patient can be easily digitized along with the skeletal anatomy of the patient.

• The impression work in modern-day dentistry can be easily digitized, but taking it further, it can now also be carefully aligned in order to yield a composite 3D model of the patient even prior to the planning of a dental prosthesis.

• Over the years, the 3D digitization technology had multiple drawbacks to overcome, which have now been successfully overcome especially over the last two decades. Some of the drawbacks that had to be considered in the transition from 2D to 3D dental work were eliminating low-resolution dental images and also the high rate of artifacts or errors that were obtained with 2D imaging modalities.

• The accuracy of the occlusal arches of the patient that can be obtained at present, as a result of the current breakthrough in 3D technology is due to the high-resolution CT (computed tomography) or CBCT (cone-beam computed tomography) scanning. This is one of the fundamental breakthroughs in modern-day prosthodontics.

• Currently, a major breakthrough in this field has been achieved by using a combination of scanned plaster models, CT scans, or CBCT scans of the patient's skeletal anatomy. Further, the oral surgeon or the dentist can make use of a reference splint with fiducial markers that can best create the same or a near-accuracy composite representation of the whole dental-skeletal system or the facial system of the patient.

• CT-based scanning, whether it is used for the fabrication of dental splints or models, is usually termed a ‘double CBCT procedure’. This has been one of the widely used present-day procedures prior to dental model or dental/jaw-based splint fabrication. The advent of the triple CBCT method, which is also described by many oral surgeons or general dentists as an ‘all-in-one’ procedure, can also intend to minimize soft tissue errors during the fabrication of dental devices or crowns, brushes, and dentures and ensure detailed acquisition.

What Are the 3D Technology Breakthroughs in Temporomandibular Joint Surgery or Reconstruction?

The clinical features, treatment planning by the dentist or the maxillofacial surgeon, and recent breakthroughs in TMJ (temporomandibular joint) reconstruction and surgeries are discussed below:

• TMJ disorders in patients can commonly result from either the origin of intra or extra-articular pathologies. The clinical features of this disorder could manifest commonly as jaw pain, ear pain, or radiating pain to the ear which the patient may frequently complain of accompanied by limited mouth opening or trismus (restricted range of motion of the jaw). Some patients may also report increasing issues during chewing food either as a result of worsening malocclusion or because of aggravating functional issues arising from jaw deformities.

• Irrespective of the etiology of TMJ issues in dental patients, the maxillofacial surgeon usually prefers conservative treatment or approaches as the first line of therapy or modality. In the case of severe or end-stage TMJ disorders, wherein the outcome of the patient's severe joint disease may not be responsive to such physician-initiated conservative therapies, there may be a necessity for surgical intervention.

• In these cases, CAD/CAM (computer-aided design and computer-aided manufacturing) techniques and 3D technology are highly beneficial prior to surgical intervention in such patients with TMJ issues, or before the reconstruction of the TMJ (that is performed by the oral surgeon to restore both function and jaw aesthetics). Virtual surgical planning is another breakthrough technology in the pre-operative assessment of the joint and also aids in surgical planning.

• Because TMJ reconstruction surgeries have become increasingly more common, be it for implant design, materials used, or surgical techniques to rehabilitate the joint, CAD/CAM can be implemented specifically for the fabrication of stock or custom TMJ replacement.

How Does 3D Technology Aid in the Digitization and Planning of Maxillofacial Tumor Resection or Jaw Reconstruction Surgeries?

Oral malignancies have been known to account for almost three percent of all cancer cases worldwide that are diagnosed annually. More than half of the oral cavity cancers are usually detected at an advanced stage, often leading to complications in the treatment or resection of tumors which impacts the survival rates of patients because of reduced post-operative success rate in high-grade oral cancers. The application of 3D technology maxillofacial tumor resection and jaw reconstruction surgeries are as follows:

• With the breakthrough in 3-D design, 3D technologies, and virtual surgical planning, the shift is now clearly seen from only surgeon-dependent resection procedures to modern procedures that involve accurate and 3D-based evaluation of tumors by exacting the surgical margins.

• These accurate measurements in tumor resection surgery that are planned by the maxillofacial surgeon or the oncologist prior to the surgical procedure have made a marked impact in the fields of tumor ablation as well as in achieving near-perfect control of the surgical margins which was previously not possible. The high-resolution CT of CBCT scan segmentation of the patients' arches now gives scope for deriving accurate or relevant anatomy that is translated to the DICOM (Digital Imaging and Communications) format, allowing the maxillofacial surgeon to create virtual 3D models of the target regions, where the tumor resection has been done.

• This can also help in planning the simulation of the surgical beds and donor sites easily through virtual surgical planning (VSP). Surgical templates can be easily designed through VSP technologies that allow optimal resection design, surgical cutting guides, and acceptable tumor/cancer resection margins.

• Pre-operative assessment by the oral and maxillofacial surgeon through the study and analysis of 3D models is also useful for assessing the post-operative risk of fractures as well.

Conclusion:

Virtual surgical planning along with surgical template fabrication has been a major breakthrough in the dental field that can contribute to the success rates of maxillofacial surgical procedures.

Also, with the recent evolution of radiographic modalities which include high-resolution CT of CBCT, the acquisition of a high-resolution scan is the most appropriate modality deemed by maxillofacial surgeons, orthognathic surgeons, orthodontists, general dentists, and even implant surgeons thereby being beneficial in all the branches of dentistry.