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work potentiated and productivity increased, but mediocre work will be emphasized by the technology. Hence, dentists and dental technicians should not look for refuge in technology or take it as a means of solving preexisting problems, but rather focus on acquiring knowledge and performing high‐quality dentistry that respects all the basic principles and then potentiate it through a digital approach.

1.3 In‐House and Outsourced Digital Workflow

       1.3.1 The Digital Dental Clinic

      For many years dental professionals have been delivering dental treatments based on analogue workflows and well‐established principles of dental procedures. With the introduction of digital dentistry, many of the conventional steps in dental procedures are being changed for digital procedures, by means of computerized software, apps, hardware, equipment, materials and techniques.

      Current and recent research projects have been addressing the actual benefits of the new digital methodologies arising in the field of dentistry. The need for such projects is also being investigated, considering that there would be no point in changing established workflows and implementing new technological methods without clear benefits for patients and professionals. Among the research findings that are further discussed in this book is the fact that digital workflows can increase quality and predictability, deliver faster results, standardize processes, and enhance communication among the dental team and the patient [8]. These findings mean that the adoption of digital workflows is becoming more popular in several countries. Nevertheless, only a small number of dental clinics and practices are actually adopting in‐house CAD‐CAM systems in their daily clinical routine.

       1.3.2 Impact of Digital Technologies in Dental Clinics

The digital era is completely transforming the ways in which people interact, work, and live. In many areas, the number and types of jobs available are changing. At the same time, entire professions, markets, products, and services rise or disappear. The dental profession is also being impacted by the digital transformation. In a digital dental clinic, treatment workflows use computerized technology that can affect dental teamwork at all levels: administration, support personnel, receptionists, dentists, hygienists, and dental technicians.

      Administration personnel and secretaries can quickly store and analyze large amounts of patient data, using dedicated management software, improving efficiency and diminishing the quantity of paper used. The dental hygienist will need to be able to understand and use high technology equipment such as dental scanners and digital x‐rays, while support personnel should also be able to maintain biosafety measures in highly sensitive machinery. This means that, for instance, the hygienist could perform intraoral scans and be able to analyze and correct mistakes during the procedure if necessary, using specialized software under dentist supervision. Currently, dental hygienists and even dental technicians in most countries do not have digital dentistry training in school, making the selection of specialized personnel in the market more difficult. Therefore, with the adoption of digital trends, members of the dental team will need special education for the use of workflows, equipment, materials, and methodologies.

      Another important aspect is that digital dentistry adds tools to aid in treatments that still follow the same principles of dentistry. The adoption of digital dentistry allows for enhancement of treatments and abilities obtained using conventional analogue techniques. For instance, oral surgeries can be more accurate and faster by using surgical guides to orientate drilling procedures (see Chapters 6 and 7). Digital imaging and new software tools are useful to enhance oral diagnosis. New materials such as zirconia and new ceramics improve esthetic outcomes. Machinery can work continuously with accuracy and speed that no human is able to achieve.

       1.3.3 The Education of the Digital Dentist

      The need for education in digital dentistry is also very clear for dentists, who might have a key position in the dental team. The role of the digital dentist is to plan, execute, and coordinate the dental staff while delivering digital treatments. Ideally, the digital dentist needs to make decisions, and thus has to fully understand both analogue and digital dental procedures. A growing number of studies are increasingly supporting satisfactory clinical outcomes with digital technologies. As a result, the reliability of CAD‐CAM restorations is creating a growing demand from practitioners and students to learn about digitalization.

      To support this trend, dental schools are increasingly improving their schedules with new information on digital technology for dentistry students. The student can be presented with concepts of digital dentistry applied in several areas of dentistry, but they are rarely allowed to conduct clinical cases, nor to receive more in‐depth information.

      Some academic discussions suggest that digital dentistry will advance to be a major field of study. One of the reasons for this is that the dentist needs to master new knowledge, skills, and training to conduct dental treatments [9]. This suggests that digital dentistry should be considered a separate specialty degree in the field of dentistry. On the other hand, others believe that digital concepts are merely a new way to resolve traditional problems, and therefore digital dentistry is to be considered a subfield derived from the main specialties (i.e., digital prosthodontics using the principles of conventional dental prosthodontics). Either way, digital dentistry represents a large field of study for young dental professionals and more experienced practitioners.

      Most practices that decide to purchase their first digital equipment are generally given technical training that could last some days. However, this initial education is likely to be an introduction to the theoretical concepts, technical features, and capabilities of the equipment and/or software. At this initial point, further education on courses, books, and scientific publications helps to fill the gaps in training while the equipment is used in a dental clinical routine.

      Typically, the initial production of digital dental work will focus on basic procedures but over time, as the digital dentist becomes more and more experienced, a mind change is likely to occur and a digital way of thinking emerges, providing new insights into planning and executing current dental procedures in novel ways. The dental clinic may thus be organized by digital dentists with expertise in digital technologies to organize and supervise the creation and outcomes of dental treatments.

       1.3.4 Levels of Digitalization for the Dental Clinic

There is nowadays a paradox in the dental market as the most advanced treatments and materials are found in digital dentistry but only a minority of dental practices are digitalized. Factors which may be impairing a more widespread use of technology in dentistry include investment costs, technical education, and cultural resistance to change. There can be a misconception among dentists that in order to use digital technology, one must first invest large amounts of money and that the return on investment would be hard to obtain.

      The reality is that virtually any dental practice can offer digital treatments, not necessarily initially producing their own work in house but outsourcing to third‐party clinics or laboratories more advanced in digitalization. Other possibilities can start with mobile phones, by using dedicated apps that allow smile planning, for example. The complete digital clinic, in which every single procedure is conducted with digital equipment, delivering automated, standardized, cheaper, and reliable results, is beginning to be suggested as a feasible idea by some research findings [9, 10].

      The actual digital clinic may be situated somewhere between the two extremes of lack of adoption and large investment for hard users. In a more realistic approach, the dental clinic and dental professionals can be digitalized in different levels. For instance, one orthodontic clinic may be digitalized for intraoral scans only, outsourcing the set‐up, planning, and fabrication of aligners. Meanwhile another clinic is able to deliver same‐day restorations produced with in‐house equipment and personnel. The decision on the degree of digitalization for the practice will depend on the specialty of the dental clinic and the focus on their more specific needs.

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