Dr. Kaye discusses key considerations when expanding your digital dentistry capabilities: costs, readiness of the dentist, readiness of the practice, equipment, materials, and time. He then offers tips for making a transition.
I am often asked this question by dentists looking to get into digital restorations, as well as by those who currently use a digital scanner and send scans to a lab. As someone who has offered CAD/CAM services to patients for more than 15 years, I find this easy to answer. While this technology may not be for everyone, many practices can benefit from milling crowns and making one-visit appointments part of their workflows.
I have written at length about the benefits of single-visit dentistry, and so have others. The value proposition for patients in having complete restorations managed in a single visit - rather than multiple visits - is abundantly clear. Consider that a single trip alone requires patients to reschedule activities, take time off work, and find care for their children. For patients who have to travel some distance to see us, eliminating trips saves additional time and money. Single visits assuage patients’ fears and minimize their discomfort, as most patients would prefer a single visit if it meant fewer injections. Foregoing a temporary restoration also eliminates the possible inconvenience of it falling out.
The value proposition for the dentist begins with these outpatient benefits, saying nothing of the additional levels of control afforded by chairside CAD/CAM. With all of these benefits to both practices and patients, what would prevent the adoption of a single-visit workflow? Let’s look at some of the prevailing issues.
In order to do chairside CAD/CAM, you need an intraoral scanner, software that allows you to design restorations, a mill that can accurately manufacture restorations, and sometimes a sintering oven.There are costs associated with acquiring all of these pieces of equipment.
There have been a number of proposals on how to determine the economic viability of adding chairside CAD/CAM. My own proposal is easy. Simply note the number of units your practice produces per month, as well as how much is spent on the lab to produce those units. Manufacturing those restorations in-house will eliminate the lab bill. In addition, there are savings on impression materials and whatever costs are involved in second visits, both of which are quantifiable. As long as the amount being spent on CAD/CAM equipment and supplies is less than what is currently being spent on these other items, and that the steps can be done in a reasonable amount of time, then it makes sense to invest.
Readiness of the dentist
There is a learning curve associated with doing one-visit restorations. As with anything new, it requires effort to become familiar with the ins and outs of the equipment, software, and workflow changes. This requires the dentist to prepare and begin on solid footing. The practices that integrate new technologies with the highest rates of success are those who have dentists who are ready, willing, and able to put forth the effort to make the transition.
Readiness of the practice
Chairside CAD/CAM is a technology that changes a practice’s workflows, inherently affecting the organization of the business as a whole. This is usually for the better. Improving efficiency, providing new services, and allowing for single-visit restorations typically benefits the business overall. However, the dentist must ensure that the staff is well prepared, otherwise the dentist risks a rough transition. Proper training and guidance are imperative. Luckily, the hurdle is only temporary.
Until recently, the only way to get into chairside side CAD/CAM was to purchase an entire system. This included an intraoral scanner, mill, and specific software. But technology has evolved. There has been a proliferation of intraoral scanners that capture digital impressions in the form of stereolithography (STL) files, and these files can be sent to labs for fabrication of restorations. The practices that already have scanners can consider doing chairside CAD/CAM by adding a mill.
Another factor in deciding whether to do chairside CAD/CAM is to look at available materials. Determine what can be processed within the time frame of a single-visit procedure. Nano-ceramic blocks can be polished in a matter of minutes following milling, whereas lithium disilicate usually has to be oven fired. Zirconia blocks with significantly shortened sintering times have recently become available.
Calculate your total time for a single-visit restoration, from the time the patient is seated to the time of dismissal. Here is an example:
- Anesthesia: 5-15 minutes
- Tooth preparation: 10-30 minutes
- Intraoral scanning: 2-15 minutes
- Restoration design: 5-30 minutes
- Milling: 8-20 minutes
- Sintering and polishing: 5-25 minutes
- Cementation: 5-20 minutes
Tips for efficiency
As with any workflow, you will improve efficiency over time. Here are ways that you can speed up the process without sacrificing quality.
- Buffer anesthesia to get immediate onset (using the Anutra local anesthetic delivery system, for example).
- Become more proficient with the scanner.
- Good prep design is key, so refine the prep if needed after first scan.
- Maintain the mill and always use fresh burs.
- Regularly calibrate the sintering oven.
In summary, chairside CAD/CAM continues to become easier to incorporate into a practice’s workflow. With this information in mind, seek out additional resources and decide if now is the time to bring this powerful technology into your practice.
Gary Kaye, DDS, FAGD, is the founder of the New York Center for Digital Dentistry and has practiced in New York City since 1993. He is a graduate of the Columbia University College of Dental Medicine. Dr. Kaye consults with other dentists and dental manufacturers, and lectures on topics including ceramics, occlusion, and digital dentistry. He is on the guest faculty of Planmeca University in Dallas, Texas.