Wading or plunging into the digital workflow

Bruce McDonald, DDS, says, "Many dentists view CAD/CAM technology as just another overhead cost. What they fail to realize is that CAD/CAM is a very efficient and inexpensive dental technology that is replacing a very inefficient and expensive technology."

Among the countless reasons to "go digital" are enhanced collaboration, communication, and patient care

Bruce McDonald, DDS

While most dentists have experienced the benefits of "the digital workflow" in terms of practice management, relatively few of my colleagues have made the leap to digital impressioning, much less chairside dentistry using a CAD/CAM system.

Yet I can say from my experience, there is much to gain by investing in some or all of the technology. This includes greater efficiency, faster turnaround, expanded patient services, and improved communication with patients, specialists, and especially our laboratory technician partners.

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My technician and I collaborate successfully using the Planmeca FIT open-architecture CAD/CAM system, which allows communication and collaboration with third parties, including specialists, and incorporation into practice management software. Although the components of the system, including the scanner, can be purchased individually to enable doctors to start with digital impressioning only, it made sense to my partners and me to purchase the full system. We had been to several events where we saw demonstrations of the system, so we were ready to make the leap to CAD and the advantages of chairside milling.

Because the PlanScan scanner and design software work within Planmeca's Romexis modular platform, we can merge restoration designs with CBCT images in the 3-D module to plan dental implant surgeries and generate implant surgical guides. We can then share these images with our surgical and laboratory teams so that all team members can participate in the planning process to provide the best care for our patients.

From a workflow standpoint, this system has greatly simplified communications within our team, especially with our laboratory technician, Sam Payne. We can capture preoperative diagnostic scans and send them via STL file to Sam's lab. Sam uses PlanCAD Premium design software, which is another module in the Romexis suite for large cases, especially for anterior cases where he can quickly provide digital diagnostic wax-ups. These work-ups may be shared among many open digital platforms. Sam describes them as "the blueprint for the final design," which "gives the collaborative team a preoperative view of the challenges that will need to be met for each patient."

The digital wax-up Sam provides can also be viewed by patients next to their own photographs enhanced in the Smile Design module, so that they can see their expected results. We then use these digital wax-ups to print 3-D models and generate provisional restorations based on the CAD designs.

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The value proposition we offer to our patients has improved significantly with CAD. Besides the faster turnaround times, today's CAD restorative materials, such as eMax and zirconia, offer significant improvements in strength and esthetics over traditional PFM crowns and bridges. Further, the precision implant planning means improperly placed implants are a thing of the past.

The ability to provide same-day chairside milled restorations has significantly increased efficiency and dramatically impacted production in our practice. A single-unit crown restoration that normally takes two hours and two appointments now takes less than an hour, doubling production per hour and saving the laboratory cost and turnaround time.

Many dentists view CAD/CAM technology as just another overhead cost. What they fail to realize is that CAD/CAM is a very efficient and inexpensive technology that is replacing a very inefficient and expensive technology.

As chairside milling becomes more popular, the scope of the dental laboratory is changing. Instead of stamping out single-unit PFM crowns, today's digital laboratory produces extraordinary restorations using high-tech precision equipment. With our ability to communicate via these software technologies, the digital laboratory technician plays an ever-increasing role in treatment planning and overall patient care.

Editor's note: Samuel Payne, a dental technician and ceramist, is the owner of MyRapidCAM, an independent dental laboratory in Vero Beach, Florida.


Bruce McDonald, DDS, has a private practice called Ocean Oaks Dental Group in Vero Beach, Florida.

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