Цифровий протокол
Стоматологія стрімко рухається у бік тотального «оцифрування». Вже набила оскому фраза “повний цифровий протокол”. Нам подають, що “digital” – концентрація технологій та нівелювання “людського фактора”. Само собою, це передбачає недосяжну раніше точність, естетику та швидкість. Здавалося б, ось воно, світле цифрове майбутнє…
А ще ми живемо в суспільстві споживання. Неухильно зростає попит на ідентичність. Люди швидко звикають до хорошого і легко піднімають планку. І ось вже плановану посмішку пацієнт хоче оцінити на своєму обличчі, майбутню реставрацію спочатку приміряти, чи готові зуби отримати ще сьогодні, а новою посмішкою відразу поділитися з усім світом …
Чи варто уточнювати при такому тренді, наскільки сильно для стоматолога зростає ціна лікарської помилки?
Digital Dentistry
Термін став повсюдним буквально за пару років. Майбутнє почалося ще вчора і медицина опинилася на піку технологічного прогресу. На сьогодні багато клінік впровадили цифрові етапи в повсякденну практику. Комп’ютерна томографія, 3D планування імплантації, сканування ротової порожнини, віртуальний дизайн посмішки, фрезерування майбутніх зубів із негайною фіксацією — давно стали звичайним явищем.
Ще раніше комп’ютерні технології з’явилися в зуботехнічних лабораторіях, кардинально змінивши правила гри. Зараз уже мало хто може уявити ортопедичну стоматологію без CAD/CAM.
Але, як завжди, є нюанс. Все правильно, цифрова обробка дає недосяжну раніше точність. Так, суттєво зросла швидкість, багатьох тривалих етапів просто немає. Але що не так у “цифровому королівстві”
1. Залежний ланцюжок
Тут варто відзначити, що майже все стоматологічне виробництво – технологічний ланцюжок послідовних етапів Як приклад: сканування > зшивання сканів > зіставлення маркерів > моделювання абатментів > дизайн відновлення > фрезерування конструкцій > поклейка платформ > забарвлення реставрації.У реальності така послідовність істотно довша або перетинається з іншими. До того ж, більшість етапів є «залежними», тобто такими, що випливають один з одного. Це означає, що “максимальне відхилення попередньої операції стає початковим значенням наступної. У такому у разі, помилки не усереднюються, а накопичуються” / Е.Голдратт
2. Повний цифровий протокол
Іншими словами, вся технологія виробництва потрапляє у визначення “CAD/CAM”. Як уже зазначали, у цій лінійці відсутні багато аналогових етапів. На жаль, але до числа “випалих” часто потрапляють контроль і запас. Крім того, отримання фізичної реставрації тільки на фінальному етапі сильно збільшує невизначеність, а також вартість можливих помилок.Тому, саме в наш вік і при “цифровому протоколі” наріжним каменем стає планування.
Цифровий пацієнт
І тут варто віддати належне “Digital” – основні переваги “цифри” виявляються у всій красі ще на етапі планування стоматологічного лікування.
Перш за все, комп’ютерні технології дозволяють нам з’єднати дані пацієнта з різних джерел. Цифрові відбитки, скани обличчя, результати томографії та аксіографії точно поєднуються в єдиний тривимірний проект. Додавши ще фотографії, ми хіба що створюємо “віртуального пацієнта” – Digital Patient.
При цьому у нас є вся необхідна інформація, яка допомагає спланувати функціональну та естетичну реставрацію.
Два вектори
“Якщо ви не знаєтеті, куди йдете, будь-яка дорога зможе привести вас туди.” /Л. Керрол
Концептуально, є два напрями планування: прямий та зворотний.
1) Пряме планування – визначення цілей і завдань, виходячи з відправної точки, де зараз. У нашому випадку прикладом планування клінічної ситуації буде цифровий вакс-ап. Можна виділити:
- діагностичний – планування відновлення зубного ряду;
- естетичний – дизайн реставрації, що відштовхується від форми та конфігурації обличчя пацієнта ( facially-driven-design );
- функціональний — прогноз реабілітації з урахуванням центрального співвідношення та індивідуальних рухів нижньої щелепи.
Діагностичне моделювання дозволяє побачити кінцевий результат стоматологічного лікування, приміряти його на пацієнта або підтвердити обраний шлях реабілітації.
2) Зворотне (реверсивне) планування – від мети до шляху її досягнення. Іншими словами, варіантне складання програми процесів. Цей метод набагато точніший і наочніший. Він дозволяє вибрати оптимальну послідовність етапів, сконцентруватися на конкретних кроках, розставити контрольні точки, спрогнозувати терміни.
Тут ми працюємо від наміченого результату до поточної клінічної ситуації. У у нашому випадку прикладом реверсивного планування будуть:
- вибір ортопедичної конструкції від цифрового вакс-апу;
- планування імплантації від запланованої реставрації;
- доопераційна протетика від навігаційної імплантації;
- постійне протезування як етапи на шляху до мети.
Зворотне планування сильно зменшує невизначеність і допомагає розрахувати необхідні ресурси. Тобто дозволяє лікареві зберегти нервові клітини, а пацієнтові здоров’я та гроші.
Об’єднавши обидва методи планування, ми допомагаємо вам ясно уявити цілі, розсунути горизонти та досягти нових висот. Цифрове планування – єдиний спосіб уникнути грубих помилок і досягти потрібного результату комплексного стоматологічного лікування.
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