Streamlining the workflow with CAD/CAM dentistry

Dr. Azita Vakili, DMD, a prosthodontist practicing in Solana Beach, Calif., was not an early adopter of CAD/CAM technology. Describing herself as picky, she didn’t think it could produce the results she wanted for her patients. The margins, she thought, were not tight enough. The esthetics, she deemed, were not good enough. And forget about doing anterior restorations with it.

However, after a lot of research, she took the plunge into CAD/CAM dentistry, selecting an open CAD/CAM system from ETI Digital Technology in Anaheim, California. After practicing dentistry for nearly 27 years, Dr. Vakili was surprised by the results. She even did an anterior restoration-on a family member, no less-using her Dental Wings Intraoral Scanner and Roland DWX-4W Wet Milling Machine.

Her lab technician, Clarence Cezar, is the owner of CERAM-TEK Dental Laboratory in Carmel Mountain Ranch in San Diego, and he has more than 21 years of experience in the dental lab. As a busy lab owner who frequently finds himself “on the bench” all day, Clarence appreciates how her investment has improved their overall working process.

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We spoke with Dr. Vakili and Cezar to see what both of them like about their system from ETI Digital Technology and what advice they might have for other clinicians considering a similar investment.

Dr. Vakili, you had your reservations about CAD/CAM dentistry. What changed your mind and why did you want to update your workflow?

Dr. Vakili: It is a service that a lot of patients are looking for, to get the one-day appointment crown. I feel with the newer material, we can provide a great product that fits, lasts and looks beautiful. It is very competitive to a high-quality lab.

With upgrades to your technology, what are some improvements to your workflow and efficiency that you both have noticed?

Dr. Vakili: With the Dental Wings Intraoral Scanner, we don’t have to use as much impression material. Also, with some of the patients who have a gag reflex, that is where this machine is so helpful. We eliminate their gag reflex. We can make the impression and it is very accurate because it is not impression material that could change dimensions. It is a digital scan of the preparation, the implant abutment or tooth. I also use it for our orthodontic treatments that we do with aligners. We can scan a full mouth without impressions.

Cezar:There’s a huge amount of time saved since Dr. Vakili sends digital files, which can be received in minutes. Many of the typical steps of fabrication of restorations are no longer necessary.

What have the patients’ responses been to the intraoral scanner?

Dr. Vakili: They love it. They say, ‘Oh, is this a new technology?’ And I say, ‘Yeah, this is the latest and the best!’ They like it a lot. It is very clean. Sometimes it takes a bit longer, but because of the accuracy, I think most of them like it. They like to see the picture of their whole tooth on the screen.

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Once the impression is scanned in, how has it changed your workflow from that point?

Cezar: The process is definitely streamlined.

Dr. Vakili: It is much faster. Before, when we sent our impressions out, we would take a lot of in-between time from when we prepared the tooth or make the impressions for the orthodontic aligners to the time that we could get the product back, whether it be a crown, the Invisalign, or the clear-correct trays and whatnot. So that is one thing because everything is just emailed now.

In our office workflow, however, the impression is sent to the back office, where we have the design software. Within five minutes, we design the crown or the veneer or whatever we’re doing, and we send it off to the Roland mill. In about 45 minutes, we have the final product. So, it has made our workflow a lot more efficient.

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Cezar: From picking up the case to emailing the case, model work is eliminated and design of the restoration can be done immediately.

Dr. Vakili, do you find that the new system allows for your dental lab technician to collaborate early in the process?

Dr. Vakili: Yes, because you can email it right away to them and then you can talk about it on the phone and say, ‘Hey, how are we doing with this? What should I do different?’ Or, ‘Can you read everything correctly?’ The patient could still be in your care, so you can make the modifications then and that is very helpful.

Dr. Vakili, you mentioned earlier with the new materials that you can make a product competitive with a high-quality lab. Can you expand on what you mean by that?

Dr. Vakili: Well, the material is very lifelike now. They look real. Sometimes we insert them and patients can’t tell which one is the crown next to their natural teeth. The esthetic is gorgeous. It looks like it is growing out of the gum line.

So, there’s a lot to be said about how you can design your fit and how you have the material now to help you out with the esthetics. A lot of dentists are hesitant when they go to a digital type of a workflow to do front teeth. I delivered a crown for a family member on the front teeth and it is beautiful. My family member loved it.
So, if you have the courage to spend a little time and design it and all that, you can do a lot with it.

Do you two have any advice for someone who’s considering making the switch to CAD/CAM who maybe feels hesitant about undertaking a new workflow like this one?

Dr. Vakili: Well, I personally had a lot of hesitation for many years and part of the hesitation was really the expense that goes with these machines and the support and all that. I took a couple of years to study these systems. I like this particular system because it was so reasonable compared to others. The value was so great compared to the other ones that I was studying.

A lot of the other companies have a monthly fee for your data and support. This one does not have that, but we have the support. And it is an open system, so it is not locked to one particular company where you have to use their machinery or their product. You can have STL files that work with any other digital workflow. For instance, I can use my Dental Wings Intraoral Scanner with multiple other mills; it does not have to be just Roland. Many other systems won’t allow you to do that.

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As far as the value part, there was a very low risk financially than some of the other ones that were in the hundreds of thousands of dollars.

Cezar: Success of the delivery of restoration starts with the doctor. Just like a traditional impression, a clear scan of the margin is absolutely key. Knowing how to read a scan to check of any discrepancies around the margins is important.

Is there anything else you want to mention about the product, the workflow, or advice you’d like to add?

Dr. Vakili: The first three months, I had a definite learning curve. I was frustrated at times, but I had support from ETI and I worked through it. Then, we have had our assistants train and they can take care of a lot of the notes from me. So, initially there was a big learning curve, but now we are very comfortable with it. We want to learn more on it now because they have a lot of different options. For example, you can design your implant’s surgical guide. You can design your abutment and crowns on abutment. So, we are on to bigger and better things now. l