Same Day Dentistry: In house CADCAM Crowns, Are we there yet?
About 10 months ago, I was recruited to come to VCU School of Dentistry as the school's first Director of Digital Dentistry Technologies. One of the main reasons I took the job was that I would have an opportunity to shape the VCU dental curriculum in CADCAM as well as other digital technologies. It is one of my very first missions to incorporate intraoral scanning or digital impressions and in house CADCAM crown fabrication into DDS curriculum. My vision is that in the next decade, digital impressions will replace most conventional alginate impressions as well as polyvinyl siloxane impressions in the dental school education. While it is universally recognized that intraoral scanning and one day CADCAM crown insertion are important experiences that a dental student need to learn as part of his/her education, there are several challenges presented in most contemporary form of DDS curriculum.
First, time allocation and teaching implementation, over the past 2 decades the DDS curriculum has significantly evolved. In almost all US dental school, there is an emphasis on early patient interaction and clinical skill development. At the same time, there is a trend of reducing pre-clinical prosthodontic/restorative laboratory. There is also a trend of reducing time in student's laboratory work. Adding CADCAM dentistry into the curriculum presents a challenge of which parts of the current curriculum need to be removed or at least modified. Before I came to VCU, it has wisely been decided that it would be better to integrate CADCAM dentistry into the exist pre-clinical and clinical courses, rather than to set up an independent CADCAM course. This idea while presents some challenges in modifying multiple courses and relying on good communication among involved course directors, it allows CADCAM dentistry teaching to be designed as a part of overall integrated DDS curriculum.
Second, financial resources and infrastructure, most dental schools are struggling of keeping up with the increasing cost to produce a competent DDS graduate while maintaining reasonable tuition and fee as well as other school's missions. The cost of equipments, laboratory/clinical space as well as qualified staff personnel and faculty can be a major obstacle in establishing a CADCAM program. I am lucky to have space and some resource allocations for the VCU CADCAM program. I hope that our CADCAM program will also be part clinical teaching and reducing outsourced laboratory expenses.
Finally, the strategic execution, teaching CADCAM dentistry in the laboratory setting presents more of the challenge in the set up, however, teaching it in the clinical setting presents more challenges in the execution. Teaching environment does not happen simply by putting an intraoral scanner and a milling unit in the pre-clinical lab or clinic. We have to train our core faculty who would foster and engage the teaching-learning environment for dental students. More importantly the core faculty should empower other clinical faculty to step in, help, and participate in our CADCAM teaching.
About two weeks ago, I hosted a CADCAM training session for our senior dental students. This group of highly motivated dental students had previous Planmeca CADCAM online training. I spent about 1 hour to go over CADCAM materials, scanning process, restorative design as well as milling and cementation. Then, I gave a 2-hour hand on session when students worked on their scanning skill using dental casts to fabricate an in silico restoration. I also did a few one-on-one CADCAM sessions for several students afterword. A few students now requested me to teach them in lived patients. While there has been some glitches in the matrix, we are moving forward on the CADCAM teaching. I expect that it will get easier as we do more and as we become more experienced. It has been a great learning experience for me in the past 3 months of being here at VCU. I am happy to be a part of the VCU digital dentistry endeavor and to “Make it Real!” here in Richmond.
