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A team of doctors provided much needed dental care to indigenous people in the Amazonian region of Brazil. (Photograph: Dentsply Sirona)

Safe and Robust CAD/CAM Technology used successfully in Amazonia

By Dentsply Sirona
November 23, 2018

BRAZIL: In June, a team of Doctors Without Borders (DSF), a Brazilian NGO that provides dental assistance to the indigenous peoples of the Amazon region, went through Amazonia for the fifth time. Purpose: To provide dental assistance to the native residents who normally do not have access to dentists. For the second time, Dentsply Sirona provided support, materials and equipment to the team of dentists, doctors and dental students. During this trip, CEREC technology proved to be vital to delivering fast and efficient treatment to more than a thousand patients.

What should be done when you do not have regular access to a dentist, but require very urgent care for your teeth? In these cases, the ability to provide quick and safe treatment options can be a difference-maker in the provision of dental care. For this reason, Dentsply Sirona equipped the expedition with the AC Omnicam, CEREC MCXL milling machine, CEREC Speedfire sintering furnace and CEREC ceramic blocks units with great success.

The beginning
In 2014, dentist Dr. Caio Machado began the initiative to expand dental care services to Amazonia in a reservation of the Cuniã Lake. In 2017, Dentsply Sirona supported this expedition with CEREC's equipment for the first time. CEREC was used to treat patients directly on-site.

"I was excited to see that this equipment enabled us to offer a top-notch service to the indigenous peoples and the riverside communities," said Machado. "We gave them the chance to be treated with the latest technology of the highest quality. In this case, CEREC also means more than dental care, it changes the lives of many people."

Seeing positive results firsthand from the technology in difficult conditions, Machado understood the value of bringing CEREC back to his São Paulo clinic.

"CEREC achieved very positive results when we used it in Amazonia," he explained. "The high humidity and all logistical displacement between the villages did not cause any problems for the equipment, everything worked with the maximum level of reliability and robustness. Of course, that also encouraged us to continue to use this technology at our clinics."

The dentists
Like Machado's CEREC experience other dentists who accompanied the expedition took the equipment back to their offices.

"I was fascinated by the working speed of the system," praised Dr. Carolina de Carvalho. "In the middle of Amazonia, I finished a dental restoration faster than in my office, where I still work in analog. CEREC really offers many advantages."

Based on her experience using CEREC, Dr. Luciana Sargologos was especially impressed with the workflow at the office. For the past five years, she has done moldings at her office digitally using Sirona Connect and sends the scans to a laboratory.

"That certainly was different during the expedition, and for me it was an entirely new experience," she said. "We perform the entire process, we mill the restoration, we sinter it in the oven and after it is finished, we fit it on the patient at the same time. That was essential, because we only stayed one day in each village."

While the treatments were done in an unusual environment, all the dentists agreed the contrast between the minimalistic conditions in Amazonia and the usability of the CAD/CAM technology made the expedition even more interesting.

The treatment
Without a complete CEREC treatment, most people could not even be assisted with a restoration during the expedition, as Jorge Aquiles' case proves in an impressive way.

The 11-year-old underwent treatment of a partial fracture of the 21st dental element. The crown of the tooth showed a grayish dark area that was probably a pulp necrosis as a result of the lesion. In addition to the chromatic alteration of the tooth, the peculiarities in this case were a loss of the mesiodistal prosthetic space and a protrusion.

The first step was the tooth root treatment. The cavity was then prepared and digitally molded with CEREC AC Omnicam. Afterwards, the design of the restoration was accomplished in a simple and fast manner owing to the high level of automation of the new 4.6 software. The software’s new feature—the analysis of the complete image of the dental arches to automatically generate the restoration design—allowed us to immediately produce it, straight from the first design, practically without adjustments.

For the restoration, an A2 CEREC block was first milled, then machined, and finally cemented. The material offers a great combination of aesthetics and high strength, even in this case where the tooth color was not 100 percent accurate owing to limited material availability. Regardless of this, it was possible to reconstruct the aesthetics and function of the very durable crown, made with a very strong material that offers a young patient a very resilient and satisfactory result.

Conclusion: Without CEREC, the patient would not have received the complete treatment in a single session. Instead, a temporary solution made of photopolymerized composite resin would have been provided but it would have to be serviced again, and that would depend on when the maintenance could take place. Owing to the difficult access to dental treatment, that possibility would still be pending.

The patients
Dentists using CEREC technology treated more than a thousand people during the Amazonia expedition. The news that dentists could make new teeth and give a beautiful smile spread quickly. Patient Valdisa Edinilson was overjoyed after doctors gave her two individual crowns for the anterior teeth.

"These teeth are different, just perfect," Edinilson said. "Now I can finally laugh again as much as I want. I have wanted to get treatment for a long time, but I did not have the money. And so, I was very pleased that I was able to get a crown for my tooth."

The supporters
The success of the treatment spread from the patients to the expedition supporters. "We were able to give a new smile to many people here,” said Dentsply Sirona Global Marketing Manager Fabiana Schleder Ruiz. “It makes me very happy and to me it was a confirmation that I was able to provide help in the right place."

As an active company in the international arena, accepting social responsibility is incredibly important.

"There is no better place to do that than right in the middle of Amazonia," said Schleder Ruiz. She recalls CEREC's first zirconia restoration as extremely touching.

"It was the first completely zirconia treatment to be manufactured and applied on the Guaporé River,” she said. “1,200 degrees Celsius in CEREC's SpeedFire sintering furnace right in the middle of the jungle. Owing to the generator and the power stabilizer, that was no problem at all, and it really impressed everyone.”

Simple operability, robust quality and compact system mobility have converted CEREC into an indispensable part of the expedition.

"To me, CEREC is now a constant part of our project in Amazonia," said Machado.

"As a market and technology leader in the dental market, we are aware of our social responsibility," said Rodrigo Canelhas, Vice President & General Manager, Latin America at Dentsply Sirona. "We will continue to support important projects like this—both by means of our products and our on-site monitoring. The positive feedback from patients confirms this and motivates us to continue working with CAD/CAM solutions that enable us practice high quality dentistry even in remote places like Amazonia."

Dentsply Sirona has already confirmed their support for next year's trip.

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