Dental Asia Jul/Aug 2020

46 DENTAL ASIA JULY / AUGUST 2020 Behind the Scenes W hen Waldo Zarco Nosti first started making teeth two decades ago, the dental technology scene was still using analogue. Under the tutelage of August Bruguera, a specialist in dental prostheses in Barcelona, Spain, Nosti fell in love with teeth – their shapes, colours, the materials used to make them, and even the documentation through photography. “I fell in love with this profession of working with my hands, my eyes, and my heart,” said Nosti. Twelve years ago, he started using Fraunhofer’s Dental CAD technology, which later became known as exocad. Today, although he is competent in using CAD software, he still takes pride in being able to fabricate prostheses using only his hands. According to Nosti, the word ‘digital’ circles back to the Latin word “digitus” which means “finger or toe” in the numerical sense as they can be counted under 10. It was only a little less than a century ago that the word took on the meaning of numerical data in computing sense. Given his background in analogue and his early adoption of CADCAM, Nosti is in a unique position to help fellow technicians overcome their fears of transitioning to digital. Hence, he is often on the road, giving workshops on digital workflows to technicians in São Paulo, Brazil one day, or Darmstadt, Germany, on another. When he is back home in Algeciras, a port city in the south of Spain, he can be found at Estudio Dental CADCAM, where he designs and fabricates bespoke prostheses with four colleagues. “I don’t believe in mass production. We want to be able to give each case the attention it needs, and fabricate prostheses of the highest quality possible. Also, I try to document all the cases, because being able to share my knowledge with others in lectures or through publications is important to me,” Nosti explained. PLAN RIGHT, SAVE TIME The diagnostic and planning part of a treatment is where Nosti devotes the most time to. If this is done correctly, little adjustment is often needed. Therefore at Estudio Dental CADCAM, the workflow usually starts with obtaining information from an intraoral scanner. The 3D data is then aligned with the patient’s photo in exocad’s Smile Creator. Tooth shapes are edited in 2D using exocad’s library of tooth For the past 12 years, Waldo Zarco Nosti has been using DentalCAD for about eight to 10 hours a day, designing more than 60,000 cases for dental patients. To him, the exocad software become a way of thinking, working, and living. With Smile Creator and exoplan, it has given him greater control and has helped him to improve communication between him and the patients. HOW ONE BECOMES A DIGITAL TEAM PLAYER designs as reference in tandem with the patient’s individual anatomy. The proposed treatment plan can be viewed in 3D, and sent to the doctor and the patient as a preview of the new smile. “In addition to helping us decide quickly and easily the correct positions of the teeth aligned to the patient’s face, Smile Creator can also be used as a communication tool. To me, it is the best way to start a case,” said Nosti. To ensure that the desired occlusal function and aesthetic changes are achieved, a diagnostic wax-up can be made using exocad’s Model Creator, and tested in the patient’s mouth. When both doctor and patient are happy with the proposed outcome, Nosti’s team exports the 3D tooth setup to exocad’s exoplan. “We decide the correct position of the implant, taking into account the position of the future tooth. Using the treatment plan we designed, the final restoration is fabricated. This will be used in immediate loading if no complications arise from the implant surgery,” said Nosti. A LITTLE GUMPTION Apart from creating surgical guides for