This article from THE DENTAL ADVISOR will focus on the ever-changing world of CAD/CAM. We will review all of the chairside systems, provide tips for choosing the right system for your practice, present clinical tips for using the systems, as well as protocols for success in CAD/CAM. In addition, the role of the laboratory and milling center and the concepts of closed and open architecture systems will be discussed. Finally, materials for use in CAD/CAM will be discussed, along with clinical tips and information on training and support.
Clinical CAD/CAM
CAD/CAM is an acronym for computer-aided design/computer-aided manufacturing.
The CAD portion of the process involves the use of a scanner to create a digital model of the preparation. Once the model has been generated on a computer workstation, the restoration can be designed by the doctor, an assistant, or a lab technician.
The CAM portion of the process involves the use of a mill or special printer to fabricate what was designed during the CAD process. This could be a coping, the final restoration, or a working physical model.
Q: Why would you consider changing to CAD/CAM?
A: CAD/CAM is an exciting area of dentistry that is growing in different areas every day. It offers many advantages to the dentist, assistant, and patient. The process is very precise and can reduce adjustment time. Best of all, patients love the digital impression process.
Positive features:
- Increased accuracy and consistency
- Allows dentists to scrutinize their preparations carefully
- No mixing or cleaning up impression material
- Offers instant display and feedback, allowing the dentist to make corrections immediately
- Positive patient experience
- Eliminates these steps: tray selection, mixing/dispensing materials, disinfection, mailing impression to/from laboratory
- Environmentally friendly
Q: What are the different types of in-office CAD/CAM systems?
A: If you are thinking about investing in digital technology, one of the first decisions to make is what type of system will be best for your dental practice. Currently, there are two types of systems on the market:
1. Chairside CAD/CAM systems [CEREC AC (Sirona) and E4D Dentist (D4D Technologies)]. These systems require one dental appointment in which the dentist scans the preparation, designs and mills the restoration, has the option to stain and glaze, and seats the final restoration.
Advantages:
- One visit
- Can cut cost on inlays, onlays, crowns, and veneers by milling in-office
- No temporary, reduced sensitivity, no debonds
Disadvantages:
- Longer chair time for patient during visit
- Additional supplies needed
- Ceramic and composite blocks only
2. Digital impressioning systems [3M ESPE Lava Chairside Oral Scanner C.O.S. (3M ESPE), iTero (Cadent, Inc.), and CEREC via CEREC Connect (Sirona)]. These systems require two dental appointments. At the first appointment, the dentist scans the preparation, views the interactive digital model, and in some cases designs the restoration. The digital model is then sent electronically to the appropriate lab for fabrication of the final restoration.
Advantages:
- Cost is less for scanner only
- Wider variety of case selection and material
- No need to change current laboratory
- Saves time at seat appointment because fewer adjustments are needed
Disadvantages:
- Requires second appointment
- Model fees/scan fees
- Requires temporary
- Difficult to scan subgingivally
CAD/CAM and the laboratory — open architecture vs. closed
Chairside CAD/CAM and digital impressioning systems are further distinguished by the way they communicate. Closed architecture systems communicate only with equipment from one manufacturer, meaning the Company A scanner can only communicate with a Company A milling system. Open architecture equipment can communicate between different manufacturers. A scanner from company A can output an electronic file (STL) that a mill or printer from company B, C, or D can work with. To further complicate matters, some "closed architecture" systems are now being opened to select partners in what is called "selectively open" architecture. In this case, a scanner from Company A can produce a file that a mill or printer from Company C can work with, but equipment from Companies B and D cannot work with the file. Laboratory CAD/CAM systems also fall into closed and open architecture categories, some of which are compatible with the chairside CAD/CAM and digital impressioning systems and some that are not.
Q: How does the laboratory fit in the picture?
A: When deciding which system is right for a dental practice, one needs to assess what level of interaction will remain with the lab. Is the intent to lower lab bills by doing most of the design and milling work in the dental office? Is it to focus on only digital impressioning and let the laboratory design, mill, and finish the restorations? Or is the ideal solution somewhere in between? If lower lab bills is the primary focus, then chairside CAD/CAM is the solution. Open and closed architecture really does not matter. If digital impressioning is the main focus, then open and closed architecture is an important consideration. Consult with your laboratories to find out which systems they currently have, are considering investing in, or have access to through their partners. If the doctor wants to mill his or her own restorations but still wants the option to send cases to the laboratory, both CEREC AC and E4D Dentist offer a laboratory mill option. However, at the moment these systems have closed or selectively open architecture, and may have limitations when it comes to large-span bridges, restoration height, or choice of materials.
Q: What additional costs are involved with a CAD/CAM system?
A: To fabricate chairside restorations, the fees you will have to account for are the cost of the ceramic or resin block, reflective powder (if needed), diamond burs for the milling process, oven for staining/glazing, and the stain and glaze. In addition to customary lab fees, digital impression systems require additional scan and model fees.
Lava C.O.S.
Scan fee -- $16-$20
Model fee* -- $16-$30
Other fees -- Powder ($19/bottle)
iTero
Scan fee -- $25/quarter arch, $35/full arch
Model fee* -- $18-31
Other fees -- Disposable sleeves ($2.50 each)
CEREC Connect
Scan fee -- $25 (fee waived with acquisitions system)
Model fee* -- $22 flat fee
*Model fees may vary based on case size and monthly volume
To read more, including Comparing the Four Systems, Digital Workflow, and THE DENTAL ADVISOR’S CAD/CAM Clinical Success Tips, visit www.dentaladvisor.com.
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