Dental Asia January/February 2019

Clinical Feature
chemical structure and mechanical
properties, suggesting differences
in their clinical behavior outcomes
and performances. 9
Digital workflow
A scanned STL impression file
(stereolithography) and completion
of a prescription form can formulate
a free online treatment plan in two
to three days. Digital impression
techniques are considered a clinical
alternative to conventional impressions for
orthodontic and fixed dental restorations. 13
Dentists with no experience can undergo
a one-day hands-on training course that
will enable them to become a Nuvola user.
As a registered user on the Nuvola Web,
the patient’s details can then be uploaded,
allowing for ongoing communication with
the lab in Italy and monitoring of each
case’s production progress. NuvolaView is
a 3D video that displays the entire process
of the treatment from the beginning to the
end in an interactive format. From there,
the single or double arch 3D models can be
manipulated to ensure that movements are
in line with the desired result. There is also
a video guide to interproximal reduction
(IPR) and techniques required to apply
the attachments.
Flugge evaluated the precision of
iTero scanning and found out that
the iTero intraoral scanner is less
accurate than model scanning. He
suggested that the intraoral conditions
(saliva and limited space) contribute to the
inaccuracy of a scan, with recorded median
deviations of 37μm. 12
Finally, Akyclcin studied 60 dry skulls and
scanned the maxillary and mandibular
arches using the iTero scanner. Direct
digital acquisition of the dental arches
with a chairside scanner provided almost
1-to-1 diagnostic information of the
investigated anatomy, which was superior
to the conebeam CT measurements. 11
Conclusion
Reports on the Nuvola system provide
The NuvolaView
information that allows dentists an
alternative tool to treat their patients.
Nevertheless, the scientific papers
available are not sufficient enough to
draw a more evidence-based conclusion.
It is recommended that more research be
conducted on new products. The concept
“Disruptive Innovation” applies to any
new medical services, technology and
products. Initially, the disruptive product
is usually not on par with existing products,
but may be satisfactory for many users
provided it is more economical, and is likely
to improve over time.
From the user’s point of view, the product
should be:
1. Technologically simplified,
standardised and provide solutions.
2. Based on business models that are
affordable, accessible and profitable.
3. Backed by research that reinforce each
other and form the infrastructure. 14
From the clinician’s point of view, the
treatment outcome should be predictable
and safe to use with no complications. DA
References:
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2. Ercoli F, Tepedino M, Parziale VandLuzi
C 2014, A comparative study of two
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11. Akyclcin S et al 2013, Diagnostic
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models, American Journal of Orthodontics
and Dentofacial Orthopedics, Volume
144, Issue 6, December, Pp 916-922
12. Flugge T et al 2013, Precision of intraoral
digital dental impressions with iTero
and extraoral digitization with the iTero
and a model scan American Journal of
Orthodontics and Dentofacial Orthopedics
Volume 144, Issue 3, September 2013,
p. 471
13. Seelbach P, Brueckel C, Wöstmann B
2013, Accuracy of digital and conventional
impression techniques and workflow
Clinical Oral Investigations September,
Volume 17, Issue 7, pp 1759–1764
14. Christensen C M, Grossman J & Hwang
J 2009, A Disruptive Solution for Health
Care, In the Innovator’s Prescription
McGraw-Hill p.441
About the Author
Dr. Kevin NG,
BDS(Adelaide), MDS,
DDPH(Sydney),
MSc.Imp.(Leeds),
FRACDS, FHKAM(DS),
FHKCDS(Comm. Dent)
DipImpDent(RCS,England)
Dr. Ng, is the Hon. a/Clinical Professor at
the Faculty of Dentistry, University of Hong
Kong in 2017 and also in Private Practice.
JANUARY / FEBRUARY 2019 DENTAL ASIA 39