Prosthodontics In A Realm Of Eco-Friendly & Digital Workflow
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What is ‘Green Dentistry’?

Can we make messy and tedious Prostho work fast and precise?

Is everything in dental office possible at your fingertips?

How to be an environment friendly dentist?

For all these queries…. Read further….

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Introduction:

There is no question that Earth has been a giving planet and it is what we all have in common. Being eco-friendly helps us to reduce the detrimental impact of practices that we follow, promotes environmental awareness and sustainability of all living beings on this earth. We dentists routinely use a variety of materials and equipment in our practice that creates hazardous effects on the environment. It is necessary to understand our responsibility of being eco‑friendly in every aspect of life. Secondly, dentistry is a profession that continuously demonstrates innovation and improvements that involves the adoption of digital technologies in all forms to improve the quality of care, and patient experiences. Digitization has become part and parcel of contemporary dentistry with the likeliness of most of the procedures being based on the digital techniques in near future. This article reviews such factors that can be incorporated to help make remarkable changes in the practice of Prosthodontics.

The concepts of the ‘Green dental practice’ include conservation of water and energy, reduction of waste and elimination of hazardous toxins for patients and the environment and use of non-toxic products that promote green products.

Eco-friendly dentistry can be achieved in two directions.

  1. By development of appropriate policies and its implementation.
  2. By dentists alone taking responsibility/ownership in the absence of policies and regulations.

How To Go Green?

  • Planning of a ‘Green’ Building
  • Minimum use of electronics in the office
  • Appropriate lighting for a clinic
  • Digital X-rays
  • Paperless office
  • Use of waterless vacuum system
  • Measures in infection control
  • CAD/CAM Systems (In-office Laboratory Restorations)

The 4 R’s Of Eco – Friendly Dentistry

The best way to protect and heal our planet is by waste management in dental clinics by implementing the 4 R’s- Re think, Reduce, Reuse and Recycle which has been discussed by Pockrass et al.

I. Rethink –

Change in the process of thinking is a mind set, which is important and essential to rethink our contribution to the planet. The first step of which is to think how the dental offices are run. Apart from routine dentistry, outreach programs with mobile dental van should be considered to change the modern practice along with some water and energy savings.

During establishment of dental offices –

  • Use stratica or linoleum flooring
  • Use LED for illumination
  • Save electrical energy by using one main switch
  • Use tinted glasses for windows to avoid heating up of the office

II. Reduce –

Before thinking of waste segregation, a thought should be given to reduce the amount of waste that is generated by intelligently consuming them. The four possible waste sources in dental offices include,

  1. Mercury‑containing dental material
  2. X‑ray developer and fixer solutions, lead foil of X‑ray film
  3. Infection control barriers including disinfectants and disposable barriers and
  4. Conventional vacuum saliva ejector systems.

One should purchase products with minimum packaging and by use of ‘Tele dentistry’ which reduces the cost and waste of resources and connects dental health care providers in rural or remote communities with specialists in centers of excellence. Switch to latest technologies to save time, material, and increase efficiency like –

  • Digital patient records
  • Digital X‑rays and
  • Digital impressions.

III. Reuse –

By extending the use of an item, one can reduce the waste contribution thus reducing its demand. Also, the amount of energy needed to produce new products is reduced. Switch to reusables over disposables. For example, use of –

  • reusable stainless steel impression trays
  • sterilizable impression trays
  • sterilizable implant/surgical tips
  • biodegradable disposable cups etc.

IV.Recycle –

The waste that gets generated in dental offices can be reprocessed and recycled into a fresh product. This will in turn reduce the waste of raw materials, thus decreasing water and air pollution. Recycling of dental materials like

  • Dental waxes,
  • Casting alloys (in case of in-office labs)
  • Dental instruments and
  • Gypsum products

can be done in small quantity at dental offices only. [A detailed description of each will be updated in next series of articles]

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Prosthodontics As A Digital Technology

There are multiple benefits of digital dental technologies which can be framed under four broad categories.

The first is improved communication. Electronic patient records that offer platforms for clear exchange between dentists, patients, dental laboratory technicians, and third party stakeholders, thus enhancing clarity in communication. The digital record can accelerate, elevate the accuracy of and enable digital commerce (billing, drug prescriptions, laboratory prescriptions).

The second is improved quality. Beyond the digitized, pixel/voxel quality of data, the digitization of data supports quality control measures. This multilevel quality improvement enhances workflow and efficiency, record keeping, data fidelity, and therapeutics.1 The intra-oral scanning of tooth preparations that are viewed in high contrast, magnified fields on a computer screen and often in direct sight of the patient permit real-time modification for interative clinical improvement. Regarding the productivity, efficiency, and accuracy of digital impression systems and related milled crowns, Fasbinder (2013) reported that the digital impression technique is faster according to some reports, and that a crown fabricated using a digital impression possesses equal or greater marginal accuracy than conventional crowns.2 A recent systematic review and meta-analysis, Chochlidakis (2016), concluded that digital impression techniques provided better marginal and internal fit of fixed restorations than conventional techniques did.

Additional tools in diagnosis include the effective digitization of photographs and diagnostic casts. Regarding intraoral scanning for the purposes of diagnosis and planning, a recent study demonstrated that there was no difference between plaster cast dimensions and those from intraoral scans, except for the mandibular intermolar width.

The third benefit is archiving individual patient data. Storing of virtual diagnostic casts is possible due to the high fidelity of the scanned image. Advantages of archived diagnostic casts in 3-D include

  • producing durable images without loss or damage of original casts
  • interfacing with other images for analysis by innovative analytic and design software
  • eliminating human error and
  • reducing the cost of storage.

Together, these three general advantages of digital dentistry lead to practical and economic advantages for the entire therapeutic team and patient.

A fourth and critically important benefit of digital technology in Prosthodontics is its positive impact on the patient experience. The improvement in diagnostic data serves to inform enhanced treatment plans. The digital platform elevates the discussion of planning and informed consent to three dimensions where clarity is provided. The reality of a single visit indirect restoration is not easily attained without digital technology and is now widely available.

Apart from these four important benefits, Digital Prosthodontics technology has an impact even in dental education. At the clinical level, the three most widely adopted digital technologies were

  • digital radiography (91%) and cone beam CT (85%),
  • CAD/CAM indirect restorations (58%), and
  • virtual surgical guides and implant placement (30%). [A detailed description of each will be updated in next series of articles]
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Future & Limitations of Digital Prosthodontics

Prosthodontics has much to offer and plenty to gain from the current emergence of digital technology into all facets of dentistry. In the coming few years, complete integration of data from all sources into an integrated electronic patient record will place digital technologies centrally within diagnostic and planning activities. But there are some barriers to going digital in a prosthodontic clinic like

  • reluctance of dental practitioners to workflow disruption
  • absence of basic computer skills and unfamiliarity with digital technology
  • lack of access to new information
  • need of better office systems
  • need of training of staff and dentist to manage the equipment
  • initial costs and IT costs of managing large datasets
  • concern about security and privacy
  • technical and expert support
  • potential financial risks and
  • poor evidence regarding the integrity of the digital solution.

Keeping these barriers in mind, we can incorporate many ideas of being eco-friendly in routine dental practices. Digital and eco friendly dentistry is quite challenging and possible in prosthodontics with few aspects to be followed meticulously.

Dr. Chandrakala. V
Reader (Associate Professor) at K.L.E Society's Institute of Dental Sciences, Bangalore. and Consultant Prosthodontist at leading hospitals and clinics of Bangalore.

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