Clinical Perspectives on CAD/CAM
Sonny Torres Oliva, DDS
Recently, I upgraded my smartphone at substantial cost to one that is lighter and faster with better graphics and resolution. I spent days playing with all its new features and apps, but as weeks went by, I stopped using these special features as frequently. I went back to using the phone only to text, check my emails, and take pictures.
For most of us, technology is a cool toy in the beginning. Then, we tend to go back to what works in our hands rather than utilizing the full potential of our purchase. CAD/CAM technology is a good example of this. Time is a luxury that I don’t have and a steep learning curve costs valuable resources. Having spent my early years as a laboratory technician with my father, I have seen how CAD/CAM technology can help maximize production as well as improve quality in our restorations. The challenge is to apply this methodology in a clinical setting.
Define Your Market Profile
By analyzing what segment of the population we are servicing, we can determine which system to adapt to our practice. PALA® Digital Dentures (Heraeus Kulzer, www.paladigitaldentures.com), AvaDent® (www.avadent.com), DENTCA™ (www.dentca.com), and DWOS Full Dentures (Dental Wings, www.dentalwings.com) are some examples of the systems that can be used in a removables-based practice. Your practice can also cater to same-day restorations using an all-inclusive system like CEREC (Dentsply Sirona, www.cereconline.com) and Benco Dental’s OneVisit (www.benco.com).
Determine Your Digital Workflow
Understanding that there are multiple steps in implementing CAD/CAM technology in your practice is key, including scanning a prepared tooth, designing, milling, and finishing. You scan a prepared tooth using an intraoral scanner like TRIOS® (3Shape, www.3shape.com), 3M™ True Definition Scanner (3M ESPE, www.3mespe.com), or iTero® Element™ (Align Technology, Inc, www.itero.com), and send it to your laboratory for completion. You can also do all the steps using a complete system.
Understand the Language of CAD/CAM
Each system is unique. Learning the difference between file extensions, such as .cdt and .stl, can determine whether your intraoral scan can work with third-party software, which will save the practice a costly initial investment. Also, understanding that each milling center will have its own data medium exchange files is extremely important. These are design and milling parameters set by each dental lab for every product and implant system. The parameters ultimately determine the accuracy of each fabricated restoration.
Set Practice Goals
A CAD/CAM system can be efficient and accurate, but nothing compares to the artistry and craftsmanship of a seasoned laboratory technician. A stained and glazed crown will not have the depth and character of a layered and individualized restoration, though a CAD/CAM-fabricated restoration has other key advantages, such as shorter turnaround times. Practitioners must determine the clinical priorities that are important to their practice.
CAD/CAM systems will forever change the way we perform dentistry. It will make us plan our cases better, fabricate more precise restorations, and eventually be more cost-effective. It is extremely important to understand your chosen system well, incorporate it into your practice thoughtfully, and use it fully to reach its greatest potential.
About the Author
Sonny Torres Oliva, DDS
New York, New York