An interview with the Agnini brothers, specialists in fixed prosthetics, periodontology, and implantology
The brothers Drs. Andrea Mastrorosa Agnini and Alessandro Agnini presented a series of lectures on digital dentistry and mastering the fully digital workflow at IDEM Singapore 2014 in April.
They were two of the star speakers at the Dental Technician Forum introduced for the first time at this year’s IDEM Singapore. Between their packed schedule of lectures and open panel discussions, the brothers took some time out to answer questions on their experiences in Asia, the current state of digital dentistry, CAD/CAM, and 3-D Printing, and how they see these areas developing in the future.
QUESTION:Have you noticed any difference between Asian and European technicians when it comes to their adoption of the latest digital dentistry technology?
Dr. Andrea Agnini (pictured left): We have not really had the opportunity to work closely with any Asian technicians yet so we don’t know which technologies they’re familiar with or which have been widely adopted in Asia. What we have seen is a massive and growing interest in all aspects of digital dentistry, not only among the technicians but among all the elements that make up the modern dental team.
Dr. Alessandro Agnini (pictured right): Yes, this is why you’re seeing more events like the Dental Technician Forum at IDEM Singapore, and similar events around Asia, just like you see in Europe and the U.S. We were here in Singapore last November for the CAD/CAM, conference and we will be back again later this year for another one.
Q:How did you find your Asian audiences at IDEM Singapore? Asians have a reputation for being very shy when it comes to asking questions.
Dr. Alessandro: We received quite a few questions from the floor and also via the SMS system they have been using for the Dental Technician Forum. The audience texted questions and we answered after the presentation during the Q&A session.
Dr. Andrea: The SMS system worked really well because people could ask us anything, and they often asked us about something we did not had time to cover in the presentation or did not include because we weren’t sure if people would be interested.
Q:It has been suggested that Asia might not be as quick to adopt digital technologies as Europe and the U.S. because skilled labor costs are still comparatively low so there are not the same savings to be made by giving some of the technicians’ jobs to machines. Do you think that is true?
Dr. Andrea: You can’t just replace a technician with a machine. In Europe or anywhere else, you still need a dental technician who is well-trained in using all these new digital technologies. It is not easy for anyone approaching these new technologies for the first time. You need a lot of training if you’re going to get a final restoration that is precise, predictable, and gives you the same quality as that delivered via traditional protocols and craftsmen/technicians. So the digital software can help the clinician, the technician, and the patient, but on their own they’re not solving the problem; you still need a skilled person behind the machines to tell them what to do.
Dr. Alessandro: The machine does not know what to do; it can’t look at a restoration and see where there needs to be more support, or whether this molar needs to be done this way or another way. We need a person with the skills, knowledge, and training to decide how to shape this framework if we’re to have long-term predictable restorations.
Q:Now, one well-trained and knowledgeable technician using CAD/CAM can dramatically improve his productivity.
Dr. Alessandro: That’s true. One advantage of CAD/CAM is speeding up production, and another is reducing the variables without reducing the quality. The third advantage is that it can level the playing field between technicians and make standards more homogeneous. Before, especially for big restorations, technicians' skills with their hands were crucial in producing high quality restorations, but with new technologies, perhaps technicians who are less skilled in traditional, manual manufacturing techniques can produce high quality restorations.
Q:While everyone agrees that digital dentistry is the way of the future, there seems to be one area where not everyone agrees. Everyone agrees the first two steps of the process, i.e., the acquisition of data via scanning and CAD design, are essential, but when it comes to the CAM component, there is a divergence of opinions.
One of the other speakers at IDEM Singapore, Mr. Jacobs, seems to think that 3-D printing can already cope with most laboratory manufacturing, and once they have tested and approved the latest biologically compatible materials currently being developed, 3-D printing will be able to do everything, including implants. Do you see that happening, or do you think precision milling will be with us for many years to come?
Dr. Alessandro: We do not have much experience with 3-D printing machines. For sure, they will one day revolutionize the future of dentistry, but right now I don’t think they can match the precision achieved by the milling machines. For the time being, I think milling machines are a gold standard which will be difficult to surpass.
Q:As scanning and CAD/CAM technologies, and especially the software that links the three stages, improve, do you think more dentists will start to do more manufacturing in-house rather than using external labs? If that is the case, what can labs and technicians do to retain their customers?
Dr. Andrea: The in-house milling process is a hot topic in dentistry. But everything must begin and end with the quality of the final restoration in mind, and that will always be the deciding factor. Today the clinician has the option of organizing himself as he prefers, but doing everything by himself is, in our opinion, something that is not convenient or practical.
It’s a different matter if the clinician has a well-trained dental team that can manage all the digital workflow from beginning to end. That team would have to include an expert dental technician who could devote himself or herself to studying and mastering all the new digital possibilities. Only this way can this quality be achieved and the clinician be satisfied from a business and economic standpoint.
Another solution is to team up with an external expert lab that can design, customize, and produce the prosthetic elements. This way, one doesn't have to invest in the initial start-up costs of setting up a dental lab. In summary, the craftsmanship of the dental technician cannot be replaced by digital dentistry; it will still be necessary to work with someone in-house or externally who is up-to-date with the technology.
On the other hand, if dental labs want to stay in business, they have to incorporate the new digital solutions into their practice, understand and invest in them, and figure out how to make the most out of them. It’s the only way dental labs will survive this digital dentistry era.
Q:The buzz words at this year’s IDEM Singapore were definitely CAD/CAM and 3-D printing. What do you predict will be the buzz words by 2018?
Dr. Alessandro: I think the buzz words in 2018 will be "full digital workflows," meaning a completely predictable digital process in the full arch rehabilitation. It is still too early to manage complex cases with the intraoral scanner. The average error is still too big.
John Battersby is a Senior PR Consultant specializing in medical, health and wellness, dentistry, and esthetic medicine. He is currently with Bridges M&C in Singapore, where he handles public relations for IDEM Singapore 2014.
