Tihomir Krastev,Michael Payer,Zhivko Krastev,Juan Francisco Pena Cardelles,Adam Vegh,Dorottya Banyai,Zoltan Geczi,Daniel Vegh
The Utilisation of CAD/CAM Technology Amongst Austrian Dentists: A Pilot Study
Social media,Digital dentistry,CAD-CAM,Survey,Intraoral scanner
Objective Computer-aided design (CAD) and computer-aided manufacturing (CAM) technology in dentistry has become noticeably more significant in recent years. The further development of CAD/CAM systems has led to a broader range of applications, more user-friendly operation, and improved accessibility. The present online survey aimed to investigate CAD/CAM technology utilisation amongst Austrian dentists as the first social media pilot study from Europe on this specific topic. Materials and methods For this purpose, an online survey consisting of 27 questions was created using Google Forms. The questions were divided into 3 sections: general inquiries, questions for CAD/CAM users, and questions for nonusers. The questionnaire was randomly distributed to Austrian dentists via email and social media. A total of 115 responses were submitted. Results The vast majority of respondents, 52.6% (n = 60), practised as general dentists. Furthermore, a significant proportion of participants specialised in oral surgery, 17.5% (n = 20), and orthodontics, 12.3% (n = 14). Approximately half of the respondents, 51.8% (n = 59), reported having a CAD/CAM device at their current workplace. Amongst the CAD/CAM users, 70.7% (n = 58) believed that CAD/CAM is important in increasing the number of patients visiting the dental practice. In total, 54.2% (n = 26) of nonusers indicated the high initial cost of purchasing a CAD/CAM device as the main reason for not utilising this technology. Conclusions CAD/CAM technology appears to have infiltrated the workflow of Austrian dentists with predictions of growing implementation amongst dental practices in the future.
The Utilisation of CAD/CAM Technology Amongst Austrian Dentists: A Pilot Study

Computer-aided design (CAD) and computer-aided manufacturing (CAM) technology in dentistry has become noticeably more significant in recent years. The further development of CAD/CAM systems has led to a broader range of applications, more user-friendly operation, and improved accessibility. The present online survey aimed to investigate CAD/CAM technology utilisation amongst Austrian dentists as the first social media pilot study from Europe on this specific topic.

For this purpose, an online survey consisting of 27 questions was created using Google Forms. The questions were divided into 3 sections: general inquiries, questions for CAD/CAM users, and questions for nonusers. The questionnaire was randomly distributed to Austrian dentists via email and social media. A total of 115 responses were submitted.

The vast majority of respondents, 52.6% (n = 60), practised as general dentists. Furthermore, a significant proportion of participants specialised in oral surgery, 17.5% (n = 20), and orthodontics, 12.3% (n = 14). Approximately half of the respondents, 51.8% (n = 59), reported having a CAD/CAM device at their current workplace. Amongst the CAD/CAM users, 70.7% (n = 58) believed that CAD/CAM is important in increasing the number of patients visiting the dental practice. In total, 54.2% (n = 26) of nonusers indicated the high initial cost of purchasing a CAD/CAM device as the main reason for not utilising this technology.

CAD/CAM technology appears to have infiltrated the workflow of Austrian dentists with predictions of growing implementation amongst dental practices in the future.

Computer-aided design (CAD) and computer-aided manufacturing (CAM) are digital processes which provide the opportunity to create prosthodontics and other dental products in a fully digital way compared with the old conventional method. The virtual data can be manipulated as required before being converted into a physical form using the dimensions and materials defined during the digital design phase. This sequence of steps is referred to as a “digital workflow”. The initial stage in a digital workflow is data capture. Data capture varies greatly amongst commercially available dental CAD/CAM systems. For example, the CEREC system includes an intraoral digital 3-dimensional (3D) scanning device which converts tooth geometry into digital data that a computer can process. In most situations, the scanner used to capture data is an inherent element of the CAD/CAM system and can only be utilised in conjunction with customised software. The second stage of the digital workflow is data processing/planning. Processing/planning software is mainly used for analysis and diagnostics, treatment planning, or CAD. Before proceeding to the final stage of the digital workflow, the software is used to design the intended object (eg, crown, bridge, surgical guide). This process, referred to as CAD, is regarded as the last component of this stage. The last stage of the digital workflow is the fabrication of the desired restoration, referred to as CAM. There are 2 types of manufacturing technologies: subtractive and additive. Furthermore, the subtractive technologies are divided into 2 categories: milling and grinding. A “subtractive procedure” means removing material from a prefabricated block to obtain the required end product. The basic process of additive manufacturing is the layer-by-layer merging of materials based on 3D data models. Currently, CAD/CAM technology is increasingly being utilised in all health care fields, including dentistry. CAD/CAM is changing how products are designed, created, and serviced. Based on the manufacturing technique, CAD/CAM systems are classified into 3 types as chairside, laboratory, and centralised production. With the chairside system, all 3 phases needed in the automated fabrication of restorations may be completed in a dentist's office. The dentist can prepare a tooth, create the restoration, and seat it using appropriate materials within a single session. The dental laboratory model is comparable to the one used to create conventional restorations. The dental office transmits to the laboratory a virtual impression or model of the prepared teeth, and the laboratory fabricates the restoration. In the centralised production model, the practitioner captures data using a scanning device and then sends it to the laboratory via the internet. The dental laboratory is equipped with data collecting and design software. The completed restoration design is sent from the laboratory to a production centre, where it is transformed into suitable commands to operate the CAM component of a CAD/CAM system. CAD/CAM is used in every field of dentistry, including prosthodontics, orthodontics, implantology, and maxillofacial surgery.13, 14, 15, 16, 17, 18, 19, 20, 21, 22 The rapid development of CAD/CAM technology in recent years has resulted in easier handling, lower acquisition costs, and increased quality of the requisite end porducts. In the absence of any data, we evaluated, in the current on-line, pilot questionnaire survey, the extent to which the new CAD/CAM technology is used in Austrian dental practices. In addition we assessed the dentists’ attitudes towards the costs, advantages, and disadvantages of CAD/CAM and the quality of the produced restorations.

The target group of this online survey included all dentists currently practising in Austria, regardless of their speciality area. A survey consisting of 27 questions was prepared and sent to Austrian dentists via email and social media. The survey was in German and was available from February 9, 2022, to March 19, 2022. A total of 115 responses were received. The questionnaire was divided into the following 3 sections: general questions, questions for CAD/CAM users, and questions for nonusers. The first part of the survey was designed to collect demographic data and information regarding the country and year of graduation, and speciality of the participating dentists. The second section presented questions about dentists’ practice and experience with CAD/CAM systems. The last section of the study included 2 questions designed to assess why CAD/CAM technology may not have been adopted in their daily dental practices.

The survey was created using Google Forms and distributed as an electronic link on social media and email. The obtained information's confidentiality and anonymity were maintained. The collected data were stored using Google Forms and Microsoft Excel.

Data analysis was performed using SPSS, and data are reported as means ± standard deviations (SDs) and range or absolute numbers with percentages. Fisher exact test and chi-square test were used for statistical analysis. Differences below the 5% limit (P < .05) were significant. For visualisation, we used Microsoft Excel.

The online survey had a total of 115 participants: 72.6% (n = 82) of the respondents received their dental degree in Austria, 8% (n = 9) of the participants completed their studies in Germany, and another 7.1% (n = 8) studied in Hungary. The duration of the clinical experience of the dentists surveyed varied from 1 to 46 years. The mean value of the clinical experience was 18.8 (±11.5). General dentists represented the most significant proportion of participants at 52.6% (n = 60). The rest of the respondents specialised in various fields of dentistry, with a substantial proportion practising in the area of oral surgery (17.5%) and orthodontics (12.3%). The results are presented in Figure 1. The majority of respondents (71.3%) reported that they had already operated a CAD/CAM system, whereas 51.8% (n = 59) were using a CAD/CAM device at their current workplace. Interestingly, most dentists who did not currently have a CAD/CAM device had no intention of acquiring any. More than half (52.6%) of the CAD/CAM users became aware of CAD/CAM technology online. The vast majority (84.4%) of the participating users have integrated CAD/CAM into their workflow within the last 10 years. The most frequently cited reason for purchasing CAD/CAM devices was the desire to be technologically up to date (58.8%), followed by the demand for increased productivity (38.8%) and improved quality (36.3%). About half of the users surveyed stated that they had undergone CAD/CAM training (54.3%). Intraoral scanners (78,8%) were the most-used aspect of the digital workflow. Slightly less than half of the CAD/CAM users (42.5%) stated that they had a full chairside device at their current workplace. The implementation percentage of each aspect is presented in Figure 2. Sixty-one percent of respondents believed that the availability of a CAD/CAM device impacted their clinical decisions. The most commonly used materials were zirconia, lithium disilicate, and plastics, followed by hybrid ceramics, resins, and zirconia-reinforced glass-ceramics. In terms of clinical application, a large percentage of the dentists surveyed used CAD/CAM to fabricate dental crowns (86.3%). Furthermore, many respondents used CAD/CAM to fabricate dental bridges and inlays (67.5% and 65%, respectively). To assess the overall satisfaction with the CAD/CAM restorations, the participating dentists were asked to rate them on a scale from 1 (very satisfied) to 10 (not at all satisfied). The evaluation was based on 4 questions that considered quality, marginal fit, and patient satisfaction. The results are shown in Figure 3. It was noted that 96.2% of users would recommend CAD/CAM to a friend or colleague. Furthermore, 72.7% of respondents believed that CAD/CAM could lead to an increased volume of patients in the dental practice. The majority of users (73%) prefer CAD/CAM technology instead of conventional manufacturing methods for fabricating prosthetic restorations. Amongst nonusers, the high cost of purchasing a device (54.3%) and the perceived lack of benefits compared to conventional manufacturing methods (31.4%) were the most cited reasons for nonuse. A considerably higher proportion of oral surgeons than general dental practitioners used at least one component of the digital workflow (P = .030). A statistically significant correlation between graduation year and use of CAD/CAM was not observed (P = .288). Nevertheless, the CAD/CAM users were slightly younger than the nonusers. In addition, a correlation between the country of graduation and CAD/CAM utilisation was noted. Overall, Hungarian dentists were more likely to use CAD/CAM than their Austrian counterparts (P = .033). No significant correlation was found between completed CAD/CAM training and a dentist's clinical experience (P = .981; Table 1).

The present survey aimed to provide an overview of CAD/CAM use in Austrian dental practices. To date, there are no similar studies dealing with this subject. Questionnaires are undoubtedly one of the most important data sources in any research project., It is considered that adopting multiple sorts of processes for collecting data and receiving that information from diverse sources can improve the validity and reliability of the data and their interpretation. In this regard, the survey was sent by email and posted on social platforms such as Facebook and Instagram to reach a broader range of participants. The majority of the dentists involved have completed their dental studies in Austria and have worked in general dentistry. The participants’ clinical experience averaged 18.8 (±11.5) years. Consequently, we can assume that the majority of the clinicians who completed the questionnaire were, to some extent, already experienced individuals. In total, 71.3% (n = 82) of the respondents reported having operated a CAD/CAM system before. Approximately half of the respondents (51.8%) had a CAD/CAM device at their current workplace. The majority of the respondents (58.7%) who did not own a CAD/CAM device were not interested in acquiring one. Various reasons were offered for this decision by the latter group and included lack of conviction regarding the quality of the CAD/CAM restorations over conventional fabrication methods, and the high acquisition costs of CAD/CAM equipment. Most users (84.4%) have integrated CAD/CAM technology into their workflow within the last 10 years, possibly due to the rapid development of digital dentistry in recent years. The progress in CAD/CAM technology has resulted in easier handling, lower acquisition costs, as well as improved quality of restorations in terms of features such as occlusal contacts and proximal fit of restorations. Another reason for the increased digitisation of Austrian dental practices is probably the increased affinity for technology amongst the new generation of dentists. Although no apparent significance between the year of graduation and CAD/CAM use could be determined the users were slightly younger than the nonusers. The most widely used aspect of the digital workflow was the intraoral scanner (78.8%), and 42.2% of clinicians reported having a complete chairside device. In a 2016 UK survey, a correlation was found between the level of specialisation of the participating dentists and the use of CAD/CAM technology. General dentists were more likely to use a complete chairside device. In our survey, a similar correlation was not observed. A possible reason for this is the lower number of participants. The survey revealed a positive perception of CAD/CAM technology amongst the respondents, comparable to other surveys conducted in the UK and Saudi Arabia., Future studies can be influenced by learning curve studies as well. One drawback of our study is the relatively small number of respondents. In addition, it is likely that the majority of the respondents were users with perhaps past experience with CAD/CAM technology, and most of the non-users may not have responded. This inherent bias may have impacted the final outcome of the survey. Hence further comprehensive studies are needed to follow up the results of the current pilot study.

The findings of this pilot study show a high level of satisfaction and a favourable attitude amongst the questioned Austrian dentists on the use of CAD/CAM technology in clinical dental practice. CAD/CAM technology appears to have infiltrated the workflow of Austrian dental offices, while further increase in application could be anticipated going forwards. The number of dentists contacted was about 1100 and therefore comprised one-fifth of the Austrian dentists. As a total of 115 responses were received, the response rate was approximately 10%. This survey demonstrated the challenge of collecting an acceptable respondent sample size for an online survey. The disadvantages of such data-gathering approaches were identified. Finally, multicentric studies are needed from neighbouring countries to obtain comprative data form other European countries, as well as from jurisdictions such as Japan where digital workflow in dentistry are far advanced.

None disclosed.