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Before You Invest in CAD/CAM, Part 1

Before investing in “chairside” CAD/CAM for your dental practice, there are some basics you should be considering. In this post we raise two important considerations for any dentist considering CAD/CAM: 1) Clinical considerations, and 2) Variations of CAD/CAM in the dental practice. Let’s get started…

Clinical Considerations

What CAD/CAM is right for your practice? In truth, CAD/CAM is a tool in the practice to bring doctor benefits, patient benefits, or both. However, like any machine it is rather dispassionate about your clinical skills. If you have great clinical skills, CAD/CAM will be a delight. If you have two left hands, you might struggle. On the other hand, nothing in dentistry has the power to teach like seeing your preps and impressions on the monitor in front of you. Imagine prepping a tooth, scanning it quickly and seeing it magnified 30X? If you can learn from your mistakes, you can master CAD/CAM.

Before we get into the systems themselves, let’s take a quick look at some common clinical considerations…

Fast or Slow?
Are you a fast dentist, or a slow dentist? Why do I ask? Well, if you are slow, you will probably be slow with CAD/CAM. If you are fast, you will probably also be fast with CAD/CAM. In fact, the machines don’t change your dentistry, only you can do that. The machines will not suddenly make you a better (or worse) dentist. It is just a machine, which means garbage-in-garbage-out.

Enjoy isolation?
You don’t realize how good your lab technician is until you start making your own restorations. That is because technicians receive deficient impressions all the time and nearly as often, under-prepared tooth preparations. They then work their magic and fix your mistakes and, 9 times out of 10, deliver something you can seat. If you don’t enjoy isolation, or you’re not particularly good at it, you will struggle taking digital impressions. There is one simple rule with digital impressions: you need to see the margin! All of the margin. If you can’t, whatever you mill won’t seat properly. Ask me how I know.

Too deep for rubber dam? This dentist used Isodry to expose the margins. IOS cameras have no problems here!

Prep God or Prep Newbie?
It doesn’t matter if you use your own CAD/CAM or the Lab, if your preps suck, so will your restorations. Milling/Grinding machines use burs to cut the intaglio of your restorations. The burs used typically vary in diameter from 1,2 mm to 0,6 mm. If the peaks of your preps have smaller circumferences than the milling/grinding burs, your restorations will often ‘hang’ on these peaks and not seat. Think round and flowing preps, think smooth. Do not think like G.V. Black and Co.

Think smooth, think flowing preps for CAD/CAM. Remember, CAD/CAM machines came AFTER dental school.

And this:

Isolation, prep design, reduction. Amen.

Variations of CAD/CAM in the dental practice

Now that we have some of the clinical topics out of the way, let’s look to the different types of CAD/CAM we can find in the dental practice today.

First, “chairside” means different things to different people, so let’s clear this up. There are three variations of Chairside CAD/CAM in the dental practice today: 1) In-Office Production, 2) Same Day Dentistry and 3) Single Visit Dentistry. But beware: they are not created equal!

In-Office Production means you have a CAD/CAM system in the office, but you are providing dentistry much as you did in the past: multiple appointments, placing a temporary, multiple drilling and anaesthetic sessions, etc. The focus of this workflow is on cost reduction per unit produced. And, depending on your production costs (machines costs plus variable material costs), you will likely save on a per-unit basis, but the main advantage of this approach is full control over the clinical outcome. Typically the dentist is doing the “lab work” during slow times, after hours or on off days. Patient benefit: No real change.

Same Day Dentistry means you are typically preparing the tooth and making a digital impression in the morning and having the patient return later in the day for the final placement of the prosthetic. This offers the patient benefit of receiving their restoration within the same day and for the dentist, you can design the case away from the patient and you are likely able to skip the temporization step. Patient benefit: Better-than-before.

Single Visit Dentistry is completing a prosthetic case within 1 to 2 hours and offer the most benefits for both patient and dentist. However, it comes at a price! For one, fully integrated systems are expensive today but also bring extra pressure for the dentist – namely performing the case in front of their patient. Patient benefit: Very high.

From the patient’s perspective, the single-visit treatment method offers the most benefits by far. For example, they only need to plan one one appointment, they receive no temporary and there’s also just one anaesthetic and drilling session. If you doubt this makes a difference, read 5 Hurdles To “Yes, I’ll Have That Crown”.

But as you already know, small things in dentistry make a big difference. According to a study of more than 600 patients*, offering Single Visit Dentistry yields a 250% increase in case acceptance for Crowns, a 36% higher satisfaction with the Crown itself and a 128% higher recommendation rate for the dentist. If you’ve ever wondered why the CEREC® dentist is smiling, this is it.

While the Single Visit approach delivers the most benefits for everyone involved, the one challenge for the dentist is to complete the procedure literally “at the chairside”. For some the thought of using a camera and software in front of their patient creates stress. For others it is an opportunity to bring value to their dentistry while the patient is waiting and maybe even deepen the relationship between the doctor and patient.

Using CAD/CAM inside the dental clinic gives the clinician the ability to control the entire process, which you may find is either very attractive or very frightening. If you find the idea of producing your own work exciting and a measure of professional growth, you are correct, and you are likely to enjoy having CAD/CAM in the office. If you believe chairside CAD/CAM is overwhelming and you would rather not have all that responsibility, you are also correct, and maybe CAD/CAM in the office is not for you.

Today there are as many digital impression cameras used in dental offices as there are complete chairside CAD/CAM systems. In North America, for example, about 40% of general dentists own a digital impression camera or a full chairside system. The adoption is similar in Europe and many dentists doing digital impressions today are looking to add milling in the coming years. As it happened in the dental laboratories over the last ten years, the flood of CAD/CAM systems into the dental practice is upon us.

The question you have to answer is, which is the right system for you: In-Office Production, Same Day Dentistry or Single Visit?

*Eric Mower and Associates, Study On Patient Perception Of Single Visit Dentistry, January 2012, USA, n=600 Patients

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