Should you invest in CAD/CAM for your dental practice?

CAD/CAM dentistry has become more popular in recent years. What used to be the exclusive domain of digitally-oriented dental labs has now become a viable investment for tech savvy dentists that wish to have the convenience of a dedicated computer-enabled design and milling machine at their disposal.

This article will discuss the factors to consider investing in the relevant software and hardware to fabricate digitally milled restorations in the comfort of your own practice.

What is CAD/CAM dentistry?

CAD CAM stands for Computer Aided Design and Computer Aided Manufacturing.

CAD CAM technology is used to design and mill a dental restorations for your individual case using a computer-aided design program. The CAD design is sent to a CAM milling machine, which creates your new restoration from a block of biocompatible synthetic material. The cad cam system provides significant benefits over traditional dental restorations such as improved speed, accuracy and aesthetics.

In recent years, cad cam dentistry has become a very popular choice for dental implant restorations. It enables the dentist to create a restoration that is customized for each patient, and it also allows the patient to have more control over the appearance of their final restoration.

The dentist takes a cast of the patient’s mouth and then uses cad cam software to design a restoration that fits perfectly in the patient’s mouth. The dentist can also choose from  different materials to use for their final restoration. CAD/CAM dentistry can be thought of as a modern solution that allows for greater flexibility and more options.

Factors to consider

There are a few factors to consider when deciding if cad cam is the right investment for your practice.

The first factor is the cost. Using cad cam technologies can be expensive, so it is important to weigh the cost against the benefits.

The second factor is how much profit the equipment will get yield, meaning the ROI of your initial outlay. You can estimate the ROI of your cad cam system by dividing the expected increase in profit by the capital investment for acquiring the equipment. For instance, if your dental practice is projected to add $20,000 in additional revenue a year by spending $100,000 on the cad cam set-up. This yields an ROI of $20,000 divided by $100,000, or 20%.

The third factor is how comfortable your staff is with cad cam. If your staff has had previous experience with cad cam then this will require less training and enhance productivity from the outset.

You need to determine a budget for your office. This will help you decide if cad cam is the right choice for your practice. If you decide to purchase an intra-oral scanner, you will also need to consider buying a digital impression system to go along with it.

It’s wise to set a prudent budget instead of jumping in without a full picture of the costs involved. CAD CAM technology is usually the logical next step for dental practices that are already digitally connected and comfortable using the system for their daily work, including digital scanning and 3D imaging.

Benefits of CAD/CAM in dental practices

CAD/CAM technology has revolutionized the dental industry by providing dentists with a way to create dental prosthetics and other dental devices using three-dimensional computer models. This technology allows you to produce high-quality dental devices quickly and efficiently.

Here are some of the main benefits for investing in CAD/CAM for your dental practice:

Increased accuracy and efficiency

CAD/CAM technology allows you to create dental prosthetics with a high level of precision. This means that you can produce restorations that fit well and are less likely to cause complications for your patients.  CAD/CAM dentistry can help you save time and money because single crowns, bridges, and other dental devices can be produced in a fraction of the time that it would take to make them by traditional methods.

It will greatly reduce the problem of miscommunication between the dentist and dental technician. Besides making your work less stressful and minimising outsourcing costs, you can better control over how the final restoration looks.

Decreased overall costs

Patients who have had traditional dental procedures are often required to come back for a second visit to adjust their prosthetics. This is because the dentist cannot perfectly replicate the teeth of the missing teeth. With cad cam dentistry software and milling technology, you will be able to produce restorations that fit your patients’ mouths perfectly in just one appointment.

More predictable results

With conventional dental procedures, the dentist is unable to predict how long the procedure will take. With CAD/CAM, you will be able to predict the time it will take to complete a procedure. This will result in better results and happier patients.

Reduced number of visits

CAD/CAM technology allows for the creation of a model of the existing teeth. This digital model is then used as a guide to create the crown. With conventional dental procedures, there is a need for several visits. With cad cam technology, there is only one visit. This reduces the number of visits and makes it easier for the patient.

Increased patient comfort

The traditional method of making a crown has several limitations, for example, the need to use moulds which can be uncomfortable for the patient. Other drawbacks include the need for the patient to come in more than once for adjustments and the use of dental impressions which can be uncomfortable and sometimes even painful. CAD/CAM technology eliminates these limitations and makes it easier for the patient.

Disadvantages of chairside CAD/CAM

Of course, owning a cad cam machine in your dental practice is not always rosy, with many cost considerations. For example, you would probably need to employ a skilled technician who can run the CAD/CAM system and interpret scans. There are also costs associated with having an in-house cad cam milling machine including the initial investment in both hardware and software as well as maintenance fees.

Let’s take a look at some of the drawbacks:

Increased costs associated with chairside CAD/CAM

As a dental office, you will need someone who is skilled in the use of the cad cam dentistry. The person who runs the machine is referred to as the ‘operator’. The operator must be able to interpret scans and ensure proper fit.

You will also need to purchase the cam system which costs between US$100,000 – $150,000. The system will also require an annual maintenance fee.

Design limitations with in-house CAD/CAM

The design of a CAD/CAM appliance is fairly limited compared to traditional castings.

CAD/CAM appliances are limited in terms of material. You can’t use cam dental systems for all types of appliances. CAD/CAM is ideal for all-ceramic fixed retainers as well as for removable appliances. It can also be used for partial dentures, but not full dentures.

In-house dental milling machines are generally unable to manufacture splints, bleaching trays, athletic mouth guards, castings and diagnostic wax-ups.

Steep learning curve

CAD/CAM is not beginner-friendly. It takes a lot of time and effort to fully master the technology. Not all dentists are CAD/CAM-certified. Although the technology is becoming more popular, there is still a lack of professionals who are familiar with the process. Limited research on this subject is the other reason why CAD/CAM dentists are still rare. If a dentist wants to learn CAD/CAM, he/she will have to attend an in-office training session and also purchase the necessary equipment.

Inability to work offline

CAD/CAM dentists report that they cannot work offline like conventional dentists. For example, when a dentist wants to create a new restoration or make changes to an existing restoration, he/she will have to use the CAD/CAM system to do so. This is because the data and files that are used by CAD/CAM systems are stored in computer files. Therefore, the dentist will have to access his/her computer if he/she needs to make changes to a restoration or create a new one.

It is not possible to use the CAD/CAM system off-site. Off-site refers to situations where a dentist works in an environment other than his/her clinic/office, for example when visiting patients in their homes or nursing homes.

Over reliance on technology can also result in lost work due to the sudden breakdown of computers.

Popular dental CAD/CAM systems

From the plethora of brands and systems, we have whittled the list down to feature arguably the three biggest players in the chairside CAD/CAM market today.

Dentsply-Sirona CEREC

Known as the CAD/CAM system that started it all for chairside and lab-based CAD/CAM dentistry. CEREC technology was invented in 1985 by Prof Dr Werner Mörmann and Dr Ing. Marco Brandestini from the University of Zurich.

The Dentsply-Sirona CEREC system has come a long way since then. The new CEREC features marked improvements from its early days to achieve clinically predictable results, at a faster rate and with greater ease. For example, the CEREC Primescan is a cutting edge intraoral scanner that can achieve a high level of accuracy in digital impressions.

The latest iteration of the CEREC software employs artificial intelligence to support the production of restorations., not to mention a high degree of automation and touch-screen functionality.

At the heart of the system is the milling unit, CEREC Primemill. It can create restorations such as a full zirconia crown in about time it take to brush your teeth. he sintering furnace known as the CEREC SpeedFire is designed for chairside treatment.

3Shape TRIOS Design Studio

The 3Shape Trios Design Studio is the fully integrated chairside CAD/CAM system that combines intraoral scanner, CAD/CAM software and a host of web portal services for enhanced patient interaction.

The 3Shape chairside solution offers quality scan technology, intuitive design software, and best all, smooth integrations between all the critical elements and components. The all-in-one system makes designing and milling same-day crowns and bridges, inlay/onlays, veneers, and implant-retained crowns in your practice an easy endeavour.

The same-day dentistry workflow begins with digital models powered by the 3Shape TRIOS digital impression solution, them porting the digital impressions over to the restorative design software, TRIOS Design Studio, where you get to plan and design each case in a guided workflow.

Next, the 3Shape open ecosystem lets you select the milling machine you want, either through their Trusted Connection milling machines or via open .STL CAD export.

Finally, the CAD/CAM software integrates with the company’s Trusted Connection mills that have been tested and validated to ensure consistently accurate restorations.

Planmeca Fit

Planmeca offers its own version of an end-to-end CAD/CAM system, from intraoral scanning to software design to precision chairside milling. The Planmeca FIT® system is designed for dental clinics, and includes all the necessary components for an open and fully integrated digital workflow.

Planmeca FIT CAD/CAM system promises single-visit, on- hour appointments for patients. It does this by “eliminating non-productive steps”.

The steps begin with the Planmeca intraoral scanner that support several open file formats for fuss-free imports and exports.

Using the Planmeca Romexis software, different users are able to scan, design and manufacture simultaneously, unleashing the power of efficiency, allowing you to treat more patients in lesser time while making the most of your resources.

The open CAD/CAM system features the Planmeca milling units for creating restorations directly at a dental clinic. The milling machine optimises automatic tool changers and smart tool paths to complement material characteristics.

FAQ: Chairside CAD/CAM Dentistry and Materials

What is chairside CAD/CAM technology, and what are its benefits?

Chairside CAD/CAM technology is a digital workflow that involves three steps: impression, digital data processing, and restoration production designed using subtractive manufacturing processes. The benefits of chairside CAD/CAM technology include reduced operating times while having high standards of precision and aesthetics.

What advantages does in-office milling offer for restorative dentists?

Restorative dentists can gain significant advantages from committing to in-office milling, such as reduced chair time, no need for VPS impressions or bite registration, no fabrication and cementation of temporary crowns, no sensitivity, microleakage or pulpal insult from temporaries, no emergency appointments to repair, remake or recement temporaries, no lab delays, no need for second appointment for crown delivery. Additionally, in-office milling can increase productivity, faster collections, and provide greater control over time.

What benefits does single-appointment dentistry offer for patients?

More and more patients are demanding single-appointment dentistry due to its benefits, such as convenience and a shorter time commitment. A dental patient survey conducted in 2015 found that 85% of patients would prefer same-visit dentistry, 50% would pay more to receive a restoration in one appointment, and 67% would travel farther. Two out of three patients would change dentists to book a single-visit appointment. Same-visit crowns are the No. 1 patient-requested dental technology.

What are the classifications of CAD/CAM chairside materials?

CAD/CAM materials for chairside production can be classified according to their composition, which includes glass-ceramics, feldspathic and leucite-reinforced ceramics, lithium disilicate glass-ceramics, and zirconia. Recently, CAD/CAM resin composite and hybrid ceramic materials have also been introduced.

What are the main advantages and disadvantages of CAD/CAM chairside materials?

The main advantages of CAD/CAM chairside materials are accurate, aesthetic restorations delivered rapidly to the patient, with many options for materials available.

The main disadvantages are that the application can be more complicated, and the clinical outcome of the restoration is mainly influenced by the type of material chosen to carry out the restoration and the way in which it is managed.

What are glass-ceramics materials, and how have they evolved over the years?

Glass-ceramics materials were the first to be developed for CAD/CAM systems. They are characterized by a significant amount of glass components, making them among the most translucent and aesthetic materials, providing a “chameleon” effect that allows the restoration to mimic the color of the existing tooth. These materials have had a remarkable increase in bending force resistance from 125 to 375 MPa over the years.

What are feldspathic and leucite-reinforced ceramics, and what are the available options in the market?

Feldspathic ceramics (Vitablocs Mark II, Vita Zahnfabrik; Bad Sackingen, Germany, and CEREC blocks, Dentsply Sirona; Bensheim, Germany) and leucite-reinforced ceramics are two types of ceramics available on the market. Leucite-reinforced ceramics can have greater strength than feldspathic ceramics, but they are more difficult to mill.

What are the other CAD/CAM materials available?

Other CAD/CAM materials available include lithium disilicate glass-ceramics and zirconia. Lithium disilicate glass-ceramics are used in restorations requiring greater strength, and they are easy to mill, while zirconia is used for larger restorations, and it is characterized by its high flexural strength.

Recently, CAD/CAM resin composite and hybrid ceramic materials have been introduced, which provide easy intraoral repair with light-cured restoratives and a faster production rate since firing is not needed.

How can a clinician select the appropriate CAD/CAM chairside material for a restoration?

The clinical outcome of the restoration is mainly influenced by the type of material chosen to carry out the restoration and the way in which it is managed. The clinician should choose the appropriate CAD/CAM chairside material based on the specific clinical indications of the material and its mechanical and physical features.