Mr Fehmer, what are the cornerstones for ensuring smooth collaboration between the practice and laboratory?
Communication is key, regardless of whether the work is analogue or digital. If dental technicians and dentists neither know each other nor exchange information, the collaboration will not be successful. Both parties should establish a clear cooperation plan to set mutual expectations. Once these expectations have been set, there is no need to review every individual case in daily practice.

Being involved in complex cases from the early stages, particularly when diagnostics or implant planning is required, is crucial to success. In these cases, the dentist and dental technician must work together in the early treatment phase to prepare the diagnostics. Only once this is complete and the dentist, patient and technician are satisfied can they switch to autopilot, so to speak, and routinely work through the case, because at this point everyone involved knows what needs to be done.

The third component of the treatment triangle is the patient. What role does the patient play within this framework?
The patient is the top priority. Patients will be the ones wearing the restorations, so they must feel comfortable with and connected to them. Implementing our own vision of aesthetics, even if it aligns with international standards, is not enough. Especially in complex cases, where aesthetic parameters are modified, we need to collaborate with the patient to shape the final look together.

What advantages does a digital smile design offer for patient communication?
Patients come to us with their wishes but are often unable to articulate them properly. This is where smile design is particularly helpful. We can quickly and efficiently create a visualisation for the patient and then translate it into a 3D model. This approach allows patients to understand the direction of the treatment early on and will enable them to approve the plan with confidence.

What digital tools best support and improve workflow efficiency?
Digital diagnostic tools are the most powerful because they allow us to simultaneously evaluate key measurements, such as the exact thickness of specific areas and the amount of space needed for the restoration. These measurements correspond directly to actual dimensions.

“Communication is key, regardless of whether the work is analogue or digital.”

Whether using optical impressions or digital mock-ups, we can efficiently create and merge data. The planned treatment outcome should therefore be visualised at an early stage, for example with a virtual mock-up, so that the patient gets a realistic idea of the planned treatment. The patient’s wishes can be easily adapted digitally. In the second and decisive phase, the patient must be given the opportunity to wear the mock-up as a prototype to verify the restoration because there is no way around intra-oral adaptation. When it comes to transferring the work practically into the final result, we are now able to implement the planning one-to-one with the new high-performance ceramics and composites.

At the University of Geneva, you work with facial scans to create digital avatars of your patients. What capabilities does digital technology offer today, and how much of this can be effectively implemented in clinical practice?
Yes, a lot is already feasible, but these technologies are still very costly and must first become more affordable to reach the market more widely. We are currently equipped with CBCT and intra-oral scanners in our everyday practice and laboratory work so that we can plan and implement the majority of restorations precisely using design software, scanners, 3D printers and milling machines.

In my day-to-day laboratory work, I am already happy when I have 2D portrait photos—one in which the patient is smiling so that I can see his or her teeth and a second with a lip retractor. These photos are easy to import into the DentalCAD software. It allows users to integrate a smile design into the 2D photo and align the models accordingly. This is a great help.

When it comes to ceramic materials, there is an increasing demand for a single material that can meet all indications. Is this achievable?
For tooth-supported restorations, lithium disilicate remains the material of choice for both anterior and posterior regions. However, it is almost impossible to achieve bridges and implant-supported multi-unit restorations in this material. A broad group of zirconias is available for these indications. Combinations of materials in different thicknesses in one blank are available on the market so that wonderful aesthetics can be achieved.

If all restorations were made from one material, zirconia would be that material. The zirconia group of materials can theoretically be used to fabricate veneers, bridges, crowns and arch-spanning—possibly implant-supported—restorations. We are now closer than ever to achieving this goal because adhesive bonding of these materials also works. In addition, productionis cheaper and easier than with glass-ceramics. From our European perspective, aesthetics may still be a little lacking, and this is certainly the reason why we still rely heavily on glass-ceramics. However, if we look at the US, where aesthetics are viewed very differently, we see that zirconia is already being used more.

What development potential do you see for ceramic materials, and is milling an intermediate technology that will be replaced by 3D printing?
Over the past five years, multicoloured zirconias and tetragonal and cubic–tetragonal zirconias have been developed, and we are still far from the end of the line—but of course, the efficiency of subtraction methods is reduced. How useful is it to produce a large disc only to mill it apart again and be limited by the milling geometry? Nevertheless, I am glad that we can currently mill everything.

While we can already print in lithium disilicate and zirconia, costs remain high, and we need to prioritise predictability, aesthetics and durability. The dental industry will surely come up with many more innovations in this area. Who knows what will be possible in the next few years?

Do you have any tips for achieving aesthetic restorations that align with patients’ desires and for fostering successful collaboration with laboratory partners?
Tip 1: Take enough time to communicate with the patient.

Tip 2: For portrait photographs, ensure that the patient is well lit against a neutral background for optimal results. Creating aesthetics begins with high-quality patient photographs.

Tip 3: In choosing the right laboratory partner, the practitioner must consider that the laboratory should be able to provide the services necessary for the practitioner to implement his or her treatment approach. Ideally, both partners should be able to leverage each other’s strengths.

Tip 4: When the practitioner introduces his or her trusted laboratory partner to the patient, it adds value to the experience. It is therefore beneficial for the laboratory partner to be prepared to meet with patients directly.

Tip 5: Good communication with the laboratory partner is the basis for success. Just like in any partnership, it is important to discuss areas that need improvement openly and constructively, as well as share positive feedback. Meeting at least once a year to establish and refine decision-making processes is valuable—and doing so over a good dinner in a relaxed setting can foster an even stronger working relationship.

Tip 6: Dentists should be experienced in adhesive dentistry.

Tip 7: As we are all over-committed to our jobs, it is important to take a break from time to time and to consciously relax to clear our heads and recharge.

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