The development of digital is entering the core area of ​​the oral cavity. Early digital technology was applied to the oral cavity, mainly for the production of simple restorations and implant guides by the chair. In recent years, digital techniques have been applied in a large number of oral restorations, orthodontics and implants.
When using all-digital jaw reconstruction, all-digital implant technology, and digital orthodontic technology, software is used to complete various complex traditional operation processes, making complex and time-consuming procedures simple and precise, without starting clinical operations. I have already seen the result of the operation, which is the essence of digital technology.
From the history of oral technology development in the past few decades, we can find that many of the world's most advanced technology are first used in the oral field, such as laser, 3D printing, CAD / CAM, planting technology, 3D design and Biological materials, etc. Digital technology is integrated into the craftsmanship of dentistry, turning the craftsmanship process into digital technology, then the oral technology will become a new digital high technology.
The digitization of the dental industry, in the medical sense, generally refers to the use of CAD / CAM technology, oral swab (intraoral scanner) and CBCT (cone beam CT) to provide patients with a more comprehensive treatment plan and a more optimized diagnosis process. Ultimately, it will bring better results to patients, especially in orthodontic and implant applications. The Arterial Network attempts to sort out and introduce the two basic oral scans of oral digitalization, CBCT and typical businesses, and their convenience for clinics, doctors, patients, etc.
Application of mouth sweep in digitization
The intraoral scanner subverts the traditional operation process of clinically preparing impressions and replicating plaster models, eliminating a lot of cumbersome traditional steps such as waiting for impression material solidification, impression sterilization, and perfusion models, while reducing material and labor consumption. The digital dental model can be directly obtained by the clinician, which simplifies the clinical operation process.
Mainstream air purging equipment on the market
1. Doctor's side
The data swept out by the mouth, after computer processing, yields all the intraoral data needed for the clinical and technical end. These data are equivalent to the model to be taken during the traditional restoration. After the "model" is digitized, the digital impression file can be directly uploaded to the cloud, which is convenient to store, traceable, and shorten the length of correction.
Since a complete data is obtained from the patient's mouth, a set of digitized data sets can be connected to other data sets, such as face scans or three-dimensional X-ray images. The results of the big data analysis simulation allow multiple magnifications of the intraoral situation, which enables more comprehensive and intuitive diagnosis and planning possibilities.
These data can be used to repair and develop treatment plans with computer-assisted diagnosis and treatment. Compared with the results of previous doctors' experience, the results are more stable and better. This is the core value of oral scanning in clinical applications, such as using software such as OraCheck and Cyfex. The 3D digital model visualizes a wide range of intraoral changes, such as tooth movement, tooth tilt, tooth rotation, retraction and attrition, to create a fully digital orthodontic system.
2, the patient side
Not long ago, in a study published by BMC Oral Health, the 3Shape TRIOS intraoral scanner was considered the best scanner in seven intraoral scanner tests, terminating the abutment edge of traditional and digital impressions. The clarity and accuracy of the lines were compared.
For patients, they will enjoy efficient, comfortable and intuitive precision treatment, which is comfortable, intuitive, safe and precise compared to traditional modulo, which greatly reduces the opening time and improves comfort. But correspondingly, it will pay a higher price. Therefore, to some extent, digital products are more oriented to the middle and high-end customer base.
3, the technical office end
In the links of patients, doctors, clinics and laboratories, the laboratories are also facing the impact of digitalization. After the doctor obtains the digital impression using the intraoral scanner, the cloud is transmitted to the technician for design. After the technician has completed the design, the design content is immediately transmitted back to the clinic for processing and cutting. In the case where the patient is still in the clinic, the technician is responsible for the “design serviceâ€.
With the emergence of new repair materials, doctors will be more willing to choose the design services provided by the mechanics. Dentists don't want to be technical experts themselves, but they need chairside solutions to give patients a better experience. For the mechanics, such a workflow also depends on an important factor: becoming digital.
The technicians at Glidewell Dental Lab, the largest denture processing plant in the United States, use digital technology to produce more than 1 million dental restorations each year. The company released Glidewell in November 2017. The io? digital solution is to shorten the delivery time of the restoration. This solution includes iTeroElement? port cleaning, fastdesign. Io? software and finalstage. Io? Dental ceramic oven.
In February 2018, Glidewell also partnered with Structo, a dental 3D printing solution provider, to integrate the Structo Velox desktop 3D printer into glidewell. The io? In-Office solution, when integrated, provides dentists with integrated solutions including intraoral scanning, chairside grinding and chairside 3D printing.
At present, the intraoral scanning system is still expensive, and it costs hundreds of thousands of dollars. It also increases the cost of clinics and hospitals, but it is the general trend in marketing and increasing profits. According to the data, 50% of doctors in the United States are considering purchasing an intraoral scanner. Regardless of whether a chair-side system is purchased or not, more and more doctors will use intraoral scanning and transmission of digital impression files. Intraoral scanners used by domestic oral medical institutions are mainly imported.
Foreign companies selling in-mouth scanners in China need to obtain a registration certificate and have the relevant qualifications to sell products through public channels. There are also domestic enterprises in the layout, such as Langcheng, Fussen, Frequency Thai, Meiya Optoelectronics, general hospitals and dental specialist hospitals and other users to purchase intraoral scanners usually take the tender channel.
With the gradual improvement of the medical device registration management system, it is expected that in the near future, more and more mouth sweep manufacturers will join the Chinese market, and the price of scanners will fall.
4. Typical enterprises
3Shape
Founded 15 years ago by Tais Clausen and Nikolaj Deichmann in Copenhagen, Denmark, 3Shape has played an important role in driving the company's rapid growth and becoming a global leader.
3shape Trios mouthwash products are used in clinics and laboratories in more than 100 countries. In 2005, the company introduced the D200 scanner, which made its mark in the dental field. In 2011, the 3Shape Trios intraoral scanner was officially released.
Currently, Trios is available in three models, from the top-of-the-line Trios 3 Wireless to the more affordable Trios3 Mono, a digital impression solution that is widely used in the industry to capture digital images in real time, spray-free, powder-free scanning, and upgrade color models.
3Shape has introduced a digital patient monitoring tool that allows doctors to compare intraoral scans over time. This software allows doctors to track and quantify iliac crest, molars and tooth movement. Digital software such as patient monitoring, orthodontic simulators, patient dynamics, and digital shading measurements have opened up a new world for dentists and patients.
Another important aspect of digital technology is seamless docking. Regardless of whether the clinic has a chairside system, multiple types of treatment options are still available. 3Shape has hundreds of orthodontic solutions, stent databases, implant databases such as Straumann's plantation bridges and planting rods, and even ProSomnus's sleep therapy.
The benefit of having an open chairside solution is that the dentist can do just "single treatment." If the dentist has a chairside solution, they don't want to perform any steps in the internal workflow. They simply click and immediately share the file with the mechanic or solution provider to get the rest of the work done. Dentists have digital thinking, which means they will look at soft tissue and the treatment options available from another perspective, which will be a whole new world.
In addition, the US edentulous digital implant technology has applied the 3Shape Trios mouth scan to clinical scans. The European all-digital planting technology and Korea's all-digital planting technology use 3Shape Trios.
The key to the all-digital technology of edentulous implants is the application of oral swabs. The various digital techniques of edentulous implants are different, but the common point is that they use the mouth sweep. Before the edentulous implant, you can scan with Trios mouth scan. The upper and lower edentulous jaws, the guide software is aligned with the CBCT data, which eliminates errors in the impression and plaster models.
American edentulous implant full digital technology, now can design bone cutting guide, surgical implant guide, immediate denture guide, and finally repair denture guide. The American technology is a mature strategy, and the final restoration denture is high intensity. Resin for cutting. The characteristic is that the guide plates are designed before surgery and used directly after the operation, the patient does not have to wait.
Europe's edentulous maxillary all-digital technology can now design surgical implant guides before surgery. Immediate dentures and final restoration dentures are placed after surgery, the scanning rod is placed in the oral cavity, scanned directly with a mouth scan, and then the immediate denture or final design is designed. Dentures, through the cutting technology to complete the immediate denture, the final restoration of the denture can be done by traditional digital technology. South Korea's edentulous implants are fully digital, similar to European technology.
China's self-developed edentulous jaw-planted digital technology, using a edentulous jaw brush, and then a three-dimensional DSD design of the edentulous jaw, try on DSD dentures, radio dentures, bone-bending guides, surgical implant guides, immediate denture guides, transition The denture guides and the final prosthetic guides are all designed in software and are completed by 3D printing or CAD/CAM cutting. It can be completely model-free. This technology is currently leading.
In the Chinese market, the 3Shape Trios third-generation products have not yet entered. It is worth noting that on May 18th, 3Shape signed a strategic cooperation agreement with the Times Angel. Accurate intraoral data collection is an important prerequisite for personalization of invisible appliances. The second-generation angels teamed up with 3Shape to enable users to quickly and seamlessly interface with the digital angel orthodontic platform of the era, which will strongly promote the innovation of digital oral cavity.
Dentsply Sirona, Dentsply Sirona
Sirona, Germany, introduced the CEREC system in 1987, and the investment time is very early. Sinod, formerly Siemens Dental, develops and supplies the world's leading digital dental solutions, including CAD/CAM all-ceramic restoration systems for chairside (CEREC) and laboratories (inLab), oral integrated treatment stations, digitization Oral X-ray diagnostic system as well as dental treatment equipment and sterilization equipment.
In March 2016, Sinod merged with Dentsply, the US leader in dental consumables, to become one of the world's largest and most diverse manufacturers of specialized dental products and technologies.
In August 2012, Sirona's first intraoral scanner, CEREC Omnicam, was reviewed by a panel of 32 high-level international experts for ergonomic design and won the 2013 iF Product Design Award. It supports video streaming, captures moving images and restores the structure of the jaw in natural colors, and the camera also has anti-shake.
The CEREC Omnicam intraoral scanner helps dentists obtain digital impressions of the teeth in the mouth without the need for powder or spray to process the scanned area. The image of the patient's mouth is displayed on the screen in natural color during the scan. With these highly accurate digital data, the dentist can design a high-precision all-ceramic restoration.
Straumann
Strausmann's CARES integrated digital solution represents a complete dental solution, from digital intra-oral scanning to the use of state-of-the-art CAD/CAM processing for computerized production and processing of repair products, each step with The next step is a seamless link designed for high quality digital workflows.
The digital solution matches the mouth sweep for digital data collection. If the clinic wants to cut the restoration, it can cut the temporary crown, inlay, onlay, etc. by Schroder equipment; if the clinic decides to cooperate with the technology factory Straumann provides the lab's process to work with the scanner to create a restoration. In addition, Straumann also has some CAD/CAM-based technologies. If the clinic can't scan the chair, the model or data will be transferred to the denture processing factory we work with.
The CARES® Integrated Digital Solution is a process solution for exchanging data between dentists, laboratories, and cutting service centers. It is a complete solution for integrating all aspects. The biggest difference between Straumann is that the process is open, optional, and not closed.
iTero (爱é½ç§‘技)
In 2011, Align completed the acquisition of Cadent, which became the only product in the market that was compatible with Invisalign appliance appliances and solved many problems of traditional silicone rubber impressions.
The traditional PVS takes a long time for mold taking, has poor comfort, and has a strong foreign body sensation. It is about 30 minutes. Some patients may also have nausea and vomiting. It takes about half a month for the postal model to be sent to the US Align company. In the end, it usually takes about one month to see the 3D treatment plan, and because the model is sent for too long, there is a risk of changes in the middle and errors in the accuracy.
The first step of the invisible beauty correction program is to take the model. The iTero intraoral scanning instrument can complete the full oral digital scanning in a few minutes, and the tooth data can be accurately obtained. Not only the time is fast, but also the ClinCheck solution can be obtained after scanning, and the correction is initially seen. The effect, the invisible beauty 3D visualization program can be seen within 48 hours, greatly shortening the waiting time of the patient, and the whole process is comfortable.
After scanning, you can preview the correction effect initially, and the excellent visualization effect makes it easier to communicate with the doctor. Because the traditional model is not required to send the data directly to the network, the dental model is more accurate.
The iTero digital impression system has been released since 2006. After 12 years of development, it has performed more than 2.7 million orthodontic scans and officially entered the Chinese market in April 2018.
Application of CBCT in Digitization
Oral imaging is currently fully digital, and one of the key driving technologies is cone beam CT. In the 1990s, the first oral special CBCT machine NewTom 9000 came out, accurate and clear facial 3D images, so that doctors can obtain three-dimensional images of the patient's intuitive facial surface. The device entered the European market in 1996 and entered the US market in 2001.
Mainstream CBCT manufacturers and products on the market
Based on traditional spiral CT, cone beam CT (CBCT) has been upgraded in scanning and data acquisition methods. The biggest difference between the two is that CBCT uses three-dimensional cone beam X-ray scanning to obtain nearly 600 different images. After reconstruction, the three-dimensional image is directly obtained, and the image metal artifact is lighter, while the traditional CT is scanned by two-dimensional fan beam, which is formed after reconstruction. Two-dimensional image data, artifacts are heavier. The most widely used areas of CBCT are maxillofacial surgery, dental pulp, orthodontic treatment, and dental implants.
The emergence of CBCT represents the evolution of medical imaging from two-dimensional to three-dimensional. CBCT increases the resolution of scanning to a height that cannot be achieved by spiral CT, and even appears to be MicroCT. At the same time, the radiation dose of CBCT has also dropped to a new level.
1. Doctor's side
Without the use of CBCT in stomatology, oral digital orthodontics and implants cannot be applied as quickly as they are now. CBCT increased the resolution of the scan to a height that was not possible with spiral CT, and even MicroCT appeared. At the same time, the radiation dose of CBCT has also dropped to a new level.
For the physician, the matching software operation is relatively simple, the 3D reconstruction is fast and rich, and after training, the ordinary technicians can operate. For patients, the cost of examination is relatively low and easy for patients to accept. For example, with orthodontic software such as 3shape and ExoCad, CBCT enables doctors to pay more attention to the thickness, height and functional reconstruction of the lingual bone in the orthodontic process. To complete high-quality orthodontic cases and long-term stability after treatment, periodontal health is very important. In addition, orthodontics are paying special attention to the temporomandibular joint. CBCT also plays an important role in observing the shape of the condyle and joint space.
The earliest application of digital technology in oral implants began with implanted surgical guides. The earliest software design guides developed from Simplant and Nobel. After more than ten years of clinical application and development, more and more companies have developed new guide design software. Such as 3shape, GuideMia, color cube and other software.
The principle of the surgical implant guide software design guide is to position the implant by software simulation after aligning the CBCT data with the dental model, determine the position and orientation of the implant on the dental model, and then generate a guide and guide. It can be cut out by 3D printing or CAM. The basic guide design software on the market is designed in this way. For the edentulous jaw, most of the edentulous teeth are combined with CBCT data for the guide plate design.
Surgical implant guides are used for minimally invasive whole or half-planting, and can also be used to determine the location and direction of the implant before the flap. They are used to determine and prepare the position and orientation of the implant. It has been used in clinical practice for more than a decade.
The all-digital planting technology has been started in the United States in recent years. The all-digital planting technology is different from the full-length guide plate technology. Some people mistakenly believe that the all-digital planting technology is the whole process of guide plate technology. The all-digital planting technology is the comprehensive application of the bone-cutting guide, the surgical implant guide, the immediate denture guide, the transitional denture guide, and the final restoration of the denture guide. The whole guide is only a surgical implant guide. The all-digital planting technique is a comprehensive guide technology. System strategy.
In dental implants, the bone and bone mass of the patient's jaw bone should be evaluated before the operation, and the position of important tissues such as the mandibular canal and sinus should be grasped. Then the feasibility of the implant surgery and the type and size of the implant can be determined accordingly. Parameters such as implantation location, implantation path, and implantation depth.
With the help of some planting software such as Simplant, Nobel clinician and 3shape, CBCT equipment can assist in the design of implant surgery, make planting guides, precisely control the position, direction, length and diameter of the implant to ensure the success of surgery and post-repair. Minimally invasive planting technology has also become a hot topic recently.
In addition, sensitivity, speed and accuracy were verified in the analysis of impacted teeth, the diagnosis of periodontal disease and the diagnosis of temporomandibular joint disease. After the intraoral scan is taken immediately, the dentist combines CBCT to design the digital implant guide, which is efficient and convenient for preoperative planning. CBCT is a supporting planting business and must be equipped with CBCT as long as it is planted.
2, the clinic side
At present, a slightly better public hospital must be equipped with CBCT, and it is a centralized procurement, rarely using spiral CT. Doctors, clinics, and hospitals have universally and fully accepted CBCT and supporting software. The three-dimensional perspective and tissue density analysis provided by CBCT make it easier and more confident for doctors to obtain diagnostic results.
However, the CBCT market accounts for a small proportion. The public and private companies are less than 5%. The first problem to be solved is the purchase of funds. The second is the training of software operation and imaging diagnosis and treatment technology. In the future, whether it is teaching, diagnosis or treatment, it is unlikely to use spiral CT. Because spiral CT is a large CT, it requires professional operation, and the resolution of the soft tissue of the main components in the mouth is very low. The dental diagnostic software is also provided. Need to improve.
In terms of price, the large-field CBCT is between 1.5 million and 3.5 million, the mid-field price is between 600,000 and 1.5 million, and the small field of view is between 400,000 and 600,000. A small dental clinic will take into account the cost of the previous investment. If the cost is not recovered within 1-3 years, the willingness to purchase is very low. Dentists who have already purchased the panoramic machine have eliminated the panoramic machine and have little intention to switch to oral CBCT.
CBCT is a supporting planting business. As long as it is planted, it must be equipped with CBCT. New business will increase the profitability of clinics and hospitals. The clinic is definitely acceptable, but it depends on brand, quality, cost performance and after-sales. In addition, the supporting software is also needed by the market, and now it is not perfect, or it is very expensive. The software system is finally going to be open, and there will definitely be a powerful platform.
The update cycle of CBCT depends on the technical breakthrough of X-ray detectors for key components. The average is about 5 years, and the supporting software is faster. It will be updated in about 2 years. Cost is one of the main reasons that hinder small clinics from purchasing digital devices and software. However, digital equipment and technology are the demonstration and proof of the marketing and technical level of clinics and hospitals, and everyone is willing to invest in this area.
3. Typical enterprises
Carestream
Carestream provides medical and dental imaging systems and IT solutions worldwide, as well as advanced materials for the precision film and electronics markets. With branches in more than 150 countries and more than 600 patented medical and dental imaging and information technologies, it has always been at the forefront of various technological advances in medical imaging and medical IT.
The predecessor of Carestream Health is Eastman Kodak Medical Group, which has a history of innovation in Kodak and has accumulated years of experience in medical imaging. The company has more than 1,000 patents in medical and dental imaging and information technology.
The Core CS solution is a complete system of integrated systems and a range of open system solutions that allow physicians to flexibly choose from a wide range of solutions based on their workflow and clinic layout. Depending on the complexity of the case, the doctor can choose to scan, design and manufacture in the clinic, or scan only in the clinic, and send the digital impression to the lab for processing, which is very convenient and fast, and greatly shortens the patient waiting time. .
The latest product CS 9300C Select leads the CBCT with four unique advantages such as 3D CBCT shooting, CBCT digital film shooting, panoramic shooting, and head positioning.
Danaher
Danaher (NYSE: DHR) was founded in 1969, formerly Diversified Mortgage Investors, Inc. , changed to its current name in 1984, headquartered in Washington, USA, is a leading global designer and manufacturer of scientific and technological innovation products and services, with four platforms for life sciences, diagnostics, dentistry, environment and solutions. composition.
In the development of Danaher, a key node is the acquisition of Kawa. Founded in 1909, Kava is a German-based leader in the manufacture of dental instruments. Its core CBCT products include i-CAT/KaVo 3D eXam.
In 2004, Kava was acquired by the Danaher Group as a company under the Danaher Dental Products Business Platform. In 2006, Surbana was acquired by the Danaher Group, and Cava Simpang became the world's leading manufacturer of dental equipment and consumables, accounting for the largest share of Danaher's dental business.
In 2017, Danaher's dental business earned 2.819 billion US dollars, of which Kawasang State's revenue accounted for the majority, ranking second in the global dental field, second only to the combined Deng Shibo Xiu Nuode.
In July of this year, Danaher split the dental business into DentalCo. DentalCo integration development can be more effective, promote continued profit margin expansion, pay more attention to new investment opportunities, and support future earnings growth through investment mergers and acquisitions.
Meiya Optoelectronics
After more than six years of development, Meiya Optoelectronics has developed a full range of oral CBCT, including 12x8 medium field of view, 15x9 medium field of view and 23x18 large field of view, fully meeting the needs of dental clinics at all levels, as well as supporting intraoral scanners, CAD, CAM equipment, etc., to solve the user's oral problems in an all-round way, has formed a series of oral X-ray CT diagnostic machine products in the medium vision, medium-sized field of view, super large field of vision, etc., to meet the diversified needs of customers.
Among them, the CBCT with a large field of view has an effective field of view of 23*18cm, which meets the needs of clinical diagnosis and treatment of oral and maxillofacial. CBCT currently has more than 2,000 domestic customers and a market share of over 40%. It is the domestic CBCT head brand.
Although digitalization is a trend, the promotion is not as rapid as envisaged. There are many reasons, such as dental habits, clinic procurement costs, long time to obtain foreign equipment registration certificates, etc., like the hidden beauty iTero mouth sweep, this year 4 Officially entered the Chinese market in the month, 3Shape is still the second generation of products entering the Chinese market.
Another big trend is that domestically produced equipment is getting closer and closer in performance, and the price is more advantageous. The trend of domestic substitution is approaching. At present, there are about 80,000 private dental clinics in China, which is the main growth point of CBCT.
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