Hardware, Software, Brainware
Morton L. Perel · Implant Dentistry · 2007
Three-dimensional imaging that includes computer-aided design/computer-aided manufacturing, computerized tomography scan, computer-based guided surgery, and stereolithography abounds in our quest to improve the diagnostics and execution of dental implant procedures. Software and computer formulated templates can serve as surgical guides with uncanny precision for the modification of edentulous ridges and for implant insertions. Not only are scans’ pixels of millimeter-measuring value in assessing maxillary and mandibular bone quantity and topography, but bone trabeculation can be seen, and bone density can be determined in Hounsfield units. These computerizations are valuable aids. They are intended to help us in assembling data for diagnostic purposes. They help the implant clinician in decision making, treatment planning, treatment coordination, and treatment execution. They can be valuable helpers. However, they should not transform the implant practitioner into a drill-press operator. Sophisticated technologies do not take the place of sound overall diagnostic skills and that sometimes elusive clinical judgment. After all the education that we hare received in anatomy, physiology, microbiology, occlusion, surgery, prosthetics and biomechanics, we must not succumb to a simplistic view that these technologies will replace our multilayered dental education, and its parallel and subsequent accumulation of knowledge. Implant dentistry draws upon the highest common denominator of our knowledge, skills, and experience. Today’s technology is intended to facilitate the practice of implant dentistry and not to usurp the clinician’s professionalism for which he/she was granted a university based degree. In a flier mailed and postmarked October 19, 2006, the US Department of Navy solicited “an immediate need for dentists…for civilian dental officer positions.” The cover of this solicitation had the pictures of several dental instruments. However, it is the wording that was central to the message. It stated that “These tools don’t work alone…. They need you.” These meaningful few words extend a universal message to all dental clinicians. It is not too much of a reach to extend this message to dental implant practitioners. Regardless of the computerized software, it is our gray matter that matters in the end. That “end” is our approach to the diagnostics. The what-to-do and what-not-to-do. The anticipation of potential problems, let alone the manner in which to avoid problems. The choices. Having a plan B in mind. And, all of this is interrelated with clinical judgment…a clinical judgment that becomes honed over the years. In essence, it all boils down to the following: Hardware (computers, digital cameras, articulators) = $10,000+. Software (production of imagery and casts) = $3,600+. Brainware (accumulated knowledge, diagnostic skills, clinical judgment) = priceless. FigureMorton L. Perel, DDS, MScD Editor-in-Chief, IMPLANT DENTISTRY