The Shift to Digital in Clinical Dentistry
Over the past decade, digital technologies have fundamentally changed how restorations are planned, designed, and fabricated. Intraoral scanners (IOS), computer-aided design and computer-aided manufacturing (CAD/CAM) systems, and digital communication with dental laboratories are no longer exclusive to large specialist practices — they are increasingly accessible and expected in general dental settings.
Understanding how these technologies work, their limitations, and how to integrate them into daily clinical workflows is now an essential part of professional development for practicing dentists.
Intraoral Scanning: How It Works
Intraoral scanners capture three-dimensional digital impressions of the teeth and soft tissues using structured light or laser triangulation. The scanner projects light onto tooth surfaces and uses the reflected data to build a point cloud that software stitches into a full-arch 3D model in real time.
Advantages Over Conventional Impressions
- Eliminates impression material discomfort — particularly beneficial for patients with a strong gag reflex
- Reduces material and lab tray costs over time
- Digital files can be stored, retrieved, and transmitted instantly
- Immediate visual feedback allows the clinician to identify scan gaps before the patient leaves the chair
- Can be integrated into a complete digital smile design workflow
Scanning Technique Tips
Scan quality depends on operator skill. Keep these principles in mind:
- Ensure the field is dry — saliva and blood significantly degrade scan accuracy
- Use consistent, overlapping strokes starting from the posterior occlusal surfaces
- Scan the gingival margin carefully — this area is most often the source of inaccuracies
- Review the digital model immediately and rescan areas showing voids or artefacts
CAD/CAM Restorations: In-Office vs. Lab-Based
Once a digital scan is acquired, the restoration can be designed in two ways:
| Pathway | Workflow | Best For |
|---|---|---|
| In-office (chairside) CAD/CAM | Scan → design → mill/print in-office → deliver same visit | Single crowns, inlays, onlays — patients valuing single-visit care |
| Lab-based digital workflow | Scan → transmit to lab → lab designs and fabricates → delivery at second visit | Complex cases, full-arch, zirconia, high-aesthetic cases |
| Hybrid workflow | Scan in office → design collaboratively → fabricate at lab or in-office | Practices transitioning to digital with existing lab relationships |
Material Considerations in CAD/CAM Restorations
The most common CAD/CAM materials include:
- Lithium disilicate (e.g., IPS e.max CAD): Excellent aesthetics and strength for anterior and posterior crowns, veneers, and inlays. Requires crystallization firing post-milling.
- Zirconia: Highest strength — ideal for posterior crowns, implant superstructures, and full-arch cases. Available in monolithic and multilayer aesthetic grades.
- Composite resin blocks: Faster milling, less wear on milling instruments, and easy to repair intraorally. Suitable for interim restorations and lower-stress applications.
Getting Started: Practical Steps for Integration
- Start with scanning only: Introduce an intraoral scanner and continue using your existing laboratory relationship. This builds scanning skills without a major workflow disruption.
- Pursue hands-on training: Most scanner manufacturers offer structured onboarding. Additionally, seek CE courses specifically focused on digital impression techniques.
- Communicate digitally with your lab: Ensure your lab can accept and work with your scanner's file format (STL/PLY). Most modern labs now have this capability.
- Evaluate the business case: Track time saved, remakes avoided, and patient feedback over 6–12 months before deciding on further investment in chairside milling.
Digital dentistry rewards those who invest in training and take a methodical approach to integration. The technology continues to advance rapidly — staying informed through structured education is the best way to keep your skills and your practice competitive.