journal of prosthodontic research 58 (2014) 1–2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/jpor
Editorial
Paradigm shifts in prosthodontics A happy new year and season’s greetings to all our readers. New year gives us the chance of a fresh start for all our endeavors, and we are starting 2014 with a renewed front cover and page layout. Needless to say, the goal of JPR, as the official journal of the Japan Prosthodontic Society, is to promote prosthodontic science, a field which has been consistently and rapidly developing, by publishing articles of the highest quality [1,2]. One of the significant changes in medicine that occurred in the 20th Century is the paradigm shift from a doctor-oriented system to a patient-oriented system. Since 1980s, the term ‘‘health-related quality of life’’ has been increasingly used when the outcomes of health conditions and therapy for such conditions are evaluated. This emerged out of a growing recognition that traditional clinical measures of health need to be supplemented by data obtained from patients that capture their experiences and concerns. It reflects the fact that we are no longer aiming to just prolong life or to render it free of disease, but to make it better [3], and acknowledges that the issues addressed by the term ‘‘health-related quality of life’’ are important determinants of care seeking and adherence to treatment [4]. This is also the case in dentistry, where the impact of oral disorders and dental interventions on an individual’s healthrelated quality of life, which is called the oral health-related quality of life, has also been increasingly recognized as an important component of oral health in 21st century. It is well recognized that the association between objective measures of dental diseases and a patient’s report of oral status is not very strong [5], and objective measures do not accurately reflect patients’ perceptions. This situation clearly indicated the need to introduce a patient-oriented system in dentistry. In fact, a lot of studies made efforts to establish a model that could comprehensively and multidimensionally evaluate the consequence of dental diseases, not only the presence or absence of dental disease but also social and emotional aspects. Consequently, several instruments that measure oral health-related quality of life are currently available and have been utilized in various clinical studies [4]. In prosthodontics, information regarding effects of tooth loss or prosthodontic treatments on oral health has been accumulated over past 3 decades by welldesigned clinical outcome research using such instruments.
These studies generally suggest a significant contribution of prosthodontic treatment to the improvement of impaired oral health because of missing teeth and provide evidence that can be referred to when clinical decisions are made for prosthodontic patients. This field is one of the target topics of JPR [2]. Another important and more recent change that is currently occurring in dentistry is the use of digital technology in dental treatment, so called ‘‘Digital Dentistry’’, which has also been included as one of our journal’s target topics [2]. It first emerged as CAD/CAM dentistry for restorations such as inlays. In this early phase, the technique was not very popular because of the poor accuracy of fabricated restorations, technical complexity, and higher costs when compared with traditional methods. However, great efforts were made to improve CAD/CAM dentistry, which created innovative technologies, allowing CAD/CAM based restorations to be put into practice. They eventually gained popularity and have now become indispensable in clinical dentistry. The most important impact of CAD/CAM on dentistry was the change that it caused in the traditional laboratory workflow, so-called lost-wax technique, which had been the standard procedure for fabrication of metal restorations. Moreover, it should be noted that one of the most important innovations responsible for popularizing CAD/CAM based restorations was the introduction of zirconia, which can only be processed by CAD/CAM. Because of its excellent mechanical properties, which include a high fracture strength and toughness when compared with other ceramics, the application of ceramic restorations can be expanded to the molar region or to fixed partial dentures [6]. In addition, escalating precious metal prices and concerns regarding metal allergies facilitated the rapid increase in popularity of zirconia, which in turn contributed to the promotion of Digital Dentistry. Recently, the digital impression technique has attracted a lot of attention and has rapidly expanded the popularity of this technique in the market. Digital impressions created using intra-oral optical scanners will play a central role in digital
2
journal of prosthodontic research 58 (2014) 1–2
dentistry in the near future, because this method has the potential to change the whole traditional prosthodontic treatment workflow. Impression materials, which were routinely used in clinical practice, are prone to dimensional changes because of on-going chemical reactions and dental stone shows expansion because of secondary reactions while setting. These dimensional changes may result in a misfit of dentures, whereas direct digital scanning of teeth is theoretically not associated with such changes [7]. Furthermore, digital impression data has the potential for use in combination with other types of digital data. For example, they can be combined with CT data of bone images to virtually and morphologically reconstruct the masticatory system. Moreover, jaw-tracking data can be combined, which allows functional reproduction of jaw movement, so-called virtual articulator. These technologies enable morphological and functional simulation of prosthodontic treatment on the computer screen, which patients, dentists, and co-dental staff can share, and clinical treatment would then follow this simulation with the aid of the latest technology, which also depends upon digital technology. We are in the middle of a paradigm shift of dental treatment, from analog to digital. This shift has been primarily driven by advances in prosthodontics and will have a huge impact on the entire field of dentistry, considering its potential to change the traditional, long-established treatment workflow that has been the worldwide standard for more than 100 years. This situation reminds me of the 1980s when analog records were replaced by compact discs. It took a couple of years for CD to gain popularity, but once people understood the merits of the CDs, records disappeared from the market soon after. Of course, the ultimate merit of digital dentistry should be evaluated according to patient-oriented outcomes, as stated before. Theoretically, digital workflow brings a variety of advantages for us and also for patients, which should be proven by high quality studies that use patient-reported outcomes and I expect and eagerly hope that it would not take long before such evidence is established by future studies. On the other hands, digital technology should be regarded as a supplement or
one of the available tools to support prosthodontic treatment. Digitization of the entire process of prosthodontic treatment will not be possible, not because of technical complexity but because a patient’s perception of treatment is not digital.
references
[1] Yatani H. Inaugural address by the new president of the Japan Prosthodontic Society—promoting prosthetic dental practice as a contributor to society. J Prosthodont Res 2013;57:233–5. [2] Baba K. Journal of Prosthodontic Research in great shape and continues to grow. J Prosthodont Res 2013;57:151–2. [3] Guyatt GD, Cook DJ. Health status, quality of life and the individual. JAMA 1994;272:630–1. [4] Locker D, Allen F. What do measures of ‘oral health-related quality of life’ measure? Community Dent Oral Epidemiol 2007;35:401–11. [5] Boretti G, Bickel M, Geering AH. A review of masticatory ability and efficiency. J Prosthet Dent 1995;74(October (4)):400–3. [6] Miyazaki T, Nakamura T, Matsumura H, Ban S, Kobayashi T. Current status of zirconia restoration. J Prosthodont Res 2013;57:236–61. [7] van der Meer WJ, Andriessen FS, Wismeijer D, Ren Y. Application of intra-oral dental scanners in the digital workflow of implantology. PLoS ONE 2012;7(8):e43312.
Editor-in-Chief Kazuyoshi Baba DDS, PhD* Department of Prosthodontics, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ohta-ku, Tokyo 145-8515, Japan *Tel.: +81 3 5498 1963; fax: +81 3 3784 6468 E-mail address: [email protected] Available online 9 January 2014 1883-1958/$ – see front matter # 2013 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved. http://dx.doi.org/10.1016/j.jpor.2013.12.003
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/jpor
Editorial
Paradigm shifts in prosthodontics A happy new year and season’s greetings to all our readers. New year gives us the chance of a fresh start for all our endeavors, and we are starting 2014 with a renewed front cover and page layout. Needless to say, the goal of JPR, as the official journal of the Japan Prosthodontic Society, is to promote prosthodontic science, a field which has been consistently and rapidly developing, by publishing articles of the highest quality [1,2]. One of the significant changes in medicine that occurred in the 20th Century is the paradigm shift from a doctor-oriented system to a patient-oriented system. Since 1980s, the term ‘‘health-related quality of life’’ has been increasingly used when the outcomes of health conditions and therapy for such conditions are evaluated. This emerged out of a growing recognition that traditional clinical measures of health need to be supplemented by data obtained from patients that capture their experiences and concerns. It reflects the fact that we are no longer aiming to just prolong life or to render it free of disease, but to make it better [3], and acknowledges that the issues addressed by the term ‘‘health-related quality of life’’ are important determinants of care seeking and adherence to treatment [4]. This is also the case in dentistry, where the impact of oral disorders and dental interventions on an individual’s healthrelated quality of life, which is called the oral health-related quality of life, has also been increasingly recognized as an important component of oral health in 21st century. It is well recognized that the association between objective measures of dental diseases and a patient’s report of oral status is not very strong [5], and objective measures do not accurately reflect patients’ perceptions. This situation clearly indicated the need to introduce a patient-oriented system in dentistry. In fact, a lot of studies made efforts to establish a model that could comprehensively and multidimensionally evaluate the consequence of dental diseases, not only the presence or absence of dental disease but also social and emotional aspects. Consequently, several instruments that measure oral health-related quality of life are currently available and have been utilized in various clinical studies [4]. In prosthodontics, information regarding effects of tooth loss or prosthodontic treatments on oral health has been accumulated over past 3 decades by welldesigned clinical outcome research using such instruments.
These studies generally suggest a significant contribution of prosthodontic treatment to the improvement of impaired oral health because of missing teeth and provide evidence that can be referred to when clinical decisions are made for prosthodontic patients. This field is one of the target topics of JPR [2]. Another important and more recent change that is currently occurring in dentistry is the use of digital technology in dental treatment, so called ‘‘Digital Dentistry’’, which has also been included as one of our journal’s target topics [2]. It first emerged as CAD/CAM dentistry for restorations such as inlays. In this early phase, the technique was not very popular because of the poor accuracy of fabricated restorations, technical complexity, and higher costs when compared with traditional methods. However, great efforts were made to improve CAD/CAM dentistry, which created innovative technologies, allowing CAD/CAM based restorations to be put into practice. They eventually gained popularity and have now become indispensable in clinical dentistry. The most important impact of CAD/CAM on dentistry was the change that it caused in the traditional laboratory workflow, so-called lost-wax technique, which had been the standard procedure for fabrication of metal restorations. Moreover, it should be noted that one of the most important innovations responsible for popularizing CAD/CAM based restorations was the introduction of zirconia, which can only be processed by CAD/CAM. Because of its excellent mechanical properties, which include a high fracture strength and toughness when compared with other ceramics, the application of ceramic restorations can be expanded to the molar region or to fixed partial dentures [6]. In addition, escalating precious metal prices and concerns regarding metal allergies facilitated the rapid increase in popularity of zirconia, which in turn contributed to the promotion of Digital Dentistry. Recently, the digital impression technique has attracted a lot of attention and has rapidly expanded the popularity of this technique in the market. Digital impressions created using intra-oral optical scanners will play a central role in digital
2
journal of prosthodontic research 58 (2014) 1–2
dentistry in the near future, because this method has the potential to change the whole traditional prosthodontic treatment workflow. Impression materials, which were routinely used in clinical practice, are prone to dimensional changes because of on-going chemical reactions and dental stone shows expansion because of secondary reactions while setting. These dimensional changes may result in a misfit of dentures, whereas direct digital scanning of teeth is theoretically not associated with such changes [7]. Furthermore, digital impression data has the potential for use in combination with other types of digital data. For example, they can be combined with CT data of bone images to virtually and morphologically reconstruct the masticatory system. Moreover, jaw-tracking data can be combined, which allows functional reproduction of jaw movement, so-called virtual articulator. These technologies enable morphological and functional simulation of prosthodontic treatment on the computer screen, which patients, dentists, and co-dental staff can share, and clinical treatment would then follow this simulation with the aid of the latest technology, which also depends upon digital technology. We are in the middle of a paradigm shift of dental treatment, from analog to digital. This shift has been primarily driven by advances in prosthodontics and will have a huge impact on the entire field of dentistry, considering its potential to change the traditional, long-established treatment workflow that has been the worldwide standard for more than 100 years. This situation reminds me of the 1980s when analog records were replaced by compact discs. It took a couple of years for CD to gain popularity, but once people understood the merits of the CDs, records disappeared from the market soon after. Of course, the ultimate merit of digital dentistry should be evaluated according to patient-oriented outcomes, as stated before. Theoretically, digital workflow brings a variety of advantages for us and also for patients, which should be proven by high quality studies that use patient-reported outcomes and I expect and eagerly hope that it would not take long before such evidence is established by future studies. On the other hands, digital technology should be regarded as a supplement or
one of the available tools to support prosthodontic treatment. Digitization of the entire process of prosthodontic treatment will not be possible, not because of technical complexity but because a patient’s perception of treatment is not digital.
references
[1] Yatani H. Inaugural address by the new president of the Japan Prosthodontic Society—promoting prosthetic dental practice as a contributor to society. J Prosthodont Res 2013;57:233–5. [2] Baba K. Journal of Prosthodontic Research in great shape and continues to grow. J Prosthodont Res 2013;57:151–2. [3] Guyatt GD, Cook DJ. Health status, quality of life and the individual. JAMA 1994;272:630–1. [4] Locker D, Allen F. What do measures of ‘oral health-related quality of life’ measure? Community Dent Oral Epidemiol 2007;35:401–11. [5] Boretti G, Bickel M, Geering AH. A review of masticatory ability and efficiency. J Prosthet Dent 1995;74(October (4)):400–3. [6] Miyazaki T, Nakamura T, Matsumura H, Ban S, Kobayashi T. Current status of zirconia restoration. J Prosthodont Res 2013;57:236–61. [7] van der Meer WJ, Andriessen FS, Wismeijer D, Ren Y. Application of intra-oral dental scanners in the digital workflow of implantology. PLoS ONE 2012;7(8):e43312.
Editor-in-Chief Kazuyoshi Baba DDS, PhD* Department of Prosthodontics, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ohta-ku, Tokyo 145-8515, Japan *Tel.: +81 3 5498 1963; fax: +81 3 3784 6468 E-mail address: [email protected] Available online 9 January 2014 1883-1958/$ – see front matter # 2013 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved. http://dx.doi.org/10.1016/j.jpor.2013.12.003
