“You don’t realize how important your back teeth are until they’re gone.” said fourth-year dental student Ming-Tom Wang (DDS ’23), reflecting on a recent case. His patient had pain in his back molars and was unable to chew and eat properly for eight months. Although this is an unusual situation, Wang was inspired by the lecturer to present an exceptional idea for treatment.
Students at the University of Colorado School of Dental Medicine (CU SDM) learn to take impressions, create crowns and restore implants using two processes: digital and analog. Vahn thought why not learn both at once?
“This is an exciting case because it’s a way to take a step forward in dentistry,” said CU SDM Clinical Associate Professor Brian Breda, DDS. “Students can learn how to take a traditional analog print on one side and digital on the other. This is the first time we’ve done anything like this here at CU Dental.”
Wang’s class was the first cohort of students to take a new course called Advanced and Digital Prosthodontics, where they learned how to use a 3D scanner to take digital impressions. Wetting his toes from the introduction, Vahn was only too eager to put it into practice. He worked with one of his mentors, clinical assistant professor David Gozala, DDS, MS, to develop a treatment plan.
“This was not a traditional esthetic case where the goal is to create a smile that looks beautiful,” Wang said. “It was more about restoring the function of the patient’s teeth and mouth. It was difficult for him to eat well. You don’t realize how important your back teeth are until they’re not there.’
A lifelong learner embraces students’ innovative ideas
Patient Dennis Thomas, a Vietnam War veteran and University of Colorado graduate, needed six implants: three on one side of his mouth and three on the other. He has always been an advocate for continuing education, so when Wang gave him the opportunity to be a part of something new and improve student learning, he was more than happy to help.
“I was in the US Army Medical Command, so I understand what it’s like to be a student. This is one of the reasons I chose to do my dental work here at school; I am happy to be a part of their education and the early stages of their careers.”
– Dental Patient Dennis Thomas
Thomas He traveled the world with the military for 23 years Colorado to Missouri, Hawaii, Germany and back. He even spent time in the military medicine radiology program at the historic Fitzsimmons Army Hospital, which is now the cornerstone of the CU Anschutz Medical Campus.
Dennis Thomas in front of the historic Fitzsimmons building
As a lifelong learner, Thomas likes to stay busy – to say the least. Now he is a pilot, pilot, martial arts instructor, skier and snowboarder, photographer, jazz musician, scuba instructor.
“Education does not stop. I’m in my seventies, and I want to learn something new every day.”
This impressive set of interests caused his dental care to be of particular concern: he had to be absolutely sure that there were no air pockets in his mouth. If he soared too high or dived too deep with an air pocket, the build-up of atmospheric pressure drops could cause extreme discomfort or, worse, could crack and tear the tooth.
“My dental team is very good at meeting my needs,” Thomas said. “Like a bartender who remembers your drink, they remember I’m a scuba instructor and a pilot, and they always ask how it’s going. I can tell that they are not just asking to see how my mouth feels, but also because they care about me personally. It’s good to see how medical professionals are paying such attention.”
Thomas and Vann are especially drawn by their Colorado upbringings, both born and raised here in the Centennial State and attending the University of Colorado at Denver for their graduate degrees.
Student Min-Tom Wang and patient Dennis Thomas at the CU School of Dental Medicine Student Clinic
Digital vs. analog, from the student’s and patient’s perspective
“I expect the long-term results between analog and digital implants to be very similar,” Wang said. “It’s like two different paths to the same goal.”
In the traditional analog process, a student removes an adhesive impression from the patient’s mouth and sends the physical impression to a lab to create implant crowns.
In the digital process, the student creates a 3D image of the patient’s mouth using the TRIOS 3Shape digital scanner. The implants are then designed in a computer program and milled on an Ivoclar milling machine, which creates an identical physical copy of the digital design, ready to be delivered to the patient in minutes.
“[Thomas] loved the whole digital process,” Wang said. “It’s much faster for the patient. Although it’s more work for me as a student and as a practicing consultant, I think it’s worth it to provide quality treatment in a more efficient way.”
3D rendering of the patient’s mouth (left side) with digitally designed implant crowns shown in situ
Analog impressions of the patient’s mouth (right side) with physical crowns on the implants
Students learn the digital impression process as part of their curriculum, but historically they have sent digital files to labs to create implants. In this case, however, Wang ordered all of the implant parts, digitally designed the crown with his faculty supervisors, and milled the implant crown to become the abutment.
This is the first time a student has completed the full milling process, from impression to handover, all at the student clinic.
The final step is to make sure the implants fit correctly, feel good, and work as closely as possible to natural teeth. “That’s the goal,” Wang said.
At his first follow-up appointment, Thomas told Van, “I feel great. My bite feels natural, the alignment gives me a beautiful smile, and all the implants feel like my real teeth. I am proud of the work that [Van] did I really appreciate him and the whole team.”
When asked what he would eat first — now that he has full functionality of his back teeth — Thomas said, “I’m going to smoke brisket and ribs for my family this weekend. I can’t wait to dig in.”