Paul Feuerstein, DMD
For more on this topic, go to www.dentaleconomics.com and search using the following key words: preps, restorations.
The recent IDS show in Cologne, Germany, showed several new products, as well as enhancements on existing ones. In the next few months, I will try to cover them. But for now, there were a few that really caught my eye.
One giant area is CAD design and building of dental restorations. Whether taking traditional impressions or digital impressions, if you send these to a lab, chances are the workflow will dramatically change. There were several impression scanners, notably from 3Shape and Dental Wings, that allow the lab or dental office (with a smaller model) to merely lock in the impression(s) or Triple Tray, close the door on the unit, and push a button.
In minutes, the virtual models appear on the screen. I brought a Triple Tray impression from my mouth and handed it to the representative. He initially would not accept my case since this was outside of protocol. But I assured him that it was strictly for a demo of something I was familiar with so I could assess the outcome. (His boss later came in and was quite disturbed until I proved that this was strictly a journalism study and not a clinical one.)
I watched my preps, then the opposing, and finally the articulation appears on the screen. It was much faster than if we had to pour them up and wait for plaster and mounting. He then proceeded to design my crowns in a fashion similar to those of CEREC or E4D.
With the 3Shape system, the models were carefully articulated — and in fact — showed up in an animated version of a fully adjustable articulator. The models can be moved around if you have a facebow relationship that can be transferred to this screen. Upper and lower models are moved in all excursions, the pins are set, and the condyle settings are adjusted — all on the screen. The file is sent electronically to the lab, so there are no more UPS or FedEx charges, no lost or damaged models, and a quicker turnaround.
There are margin markers, die ditching, and virtual waxing tools — all that use either a mouse or other input device. One company from my home state of Massachusetts, Sensable, had a joystick that not only waxed crowns but also partial frameworks, bars, implant substructures, and more.
Even more amazing with this system is the fact it uses “haptic” technology. This is similar to what you have on a video game where you can “feel” the terrain — or in this case — the hard tooth structure, margins, and even rugae on the palate. The images can then be sent to the CAD machine to mill out or “print” the castings or even make castable plastic wax-ups for copings, crowns, frameworks, etc.
These are all lab tools but the impact to the dentist can be a game changer. No longer will you be returned a stone model from the lab, just the restoration. The labs who embrace this technology will cut their staffs and eliminate the plaster and wax-up departments. There will not be a model charge so the cost to both sides will, in theory, be lower.
Shipping is only one way unless you send the impressions for the lab to scan. There is a method to print or mill a model if one is requested, of course, at a fee. Those dentists who have already embraced CEREC or E4D never have a model for the cases designed and built in the office.
Speaking of those in-office complete systems, there were some interesting advancements in materials. Ivoclar, VITA, and DENTSPLY each introduced new materials and processes. Many of these were designed for the lab CAD systems, such as CEREC inLab, but will ultimately be applied to the in-office milling stations. Bridges can now be milled with a solid ceramic frame, and more beautiful and occlusion-friendly materials are available for the outer layers.
These are milled like a jigsaw puzzle so the “enamel” fits over the frame, and they are fused together. Ivoclar’s CAD-on system fuses these parts in an oven, while VITA’s Rapid Layer Technology uses a resin cement. DENTSPLY showed a millable metal for copings and full crowns called Crypton. After milling, it has to be sintered in the oven for about 90 minutes. At this time it is for the inLab, but should be available for chairside in the future.
This is just a glimpse of more than 80 CAD companies that exhibited at IDS. Even robots performed some of these tasks. In fact, there was a GPS system that — in essence — controlled your hand position when placing implants. The new dentists coming into the profession have grown up with this sort of technology, and are not in as much awe as some of us older dentists. But then I guess they will not experience the thrill of hot wax on the hand or touching the casting right out of the centrifuge.
Dr. Paul Feuerstein installed one of dentistry’s first computers in 1978. For more than 20 years, he has taught technology courses. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a website (www.computersindentistry.com) and can be reached at [email protected].
