The CAD/CAM Chorus: A logical progression

January 2011 | Dental Lab Products

The CAD/CAM Chorus

A logical progression

Roddy MacLeod – Vice President of CAD/CAM, Sirona

by Noah Levine, Senior Editor

If you ask Roddy MacLeod, Vice President of CAD/CAM for Sirona, the industry’s transition to digital dentistry didn’t begin with the invention of the first CEREC chairside CAD/CAM system 25 years ago. That technological breakthrough would lead to many more critical developments, but change in the industry really started in the administrative areas of dental practices and laboratories.

MacLeod said the introduction of computers for record keeping and submitting insurance claims kicked off the digitization of dentistry, and since that time things have followed a natural progression that’s moved one part of the industry from analogue to digital formats and workflows with information going digital first, diagnostics heading down the digital path next, and finally, treatment entering the digital realm.

“Nowadays it’s pretty rare to go into an operatory and not see a computer and a monitor,” MacLeod said. “Once you’ve got a computer chairside, it makes sense to look at the radiograph right there on the monitor.”

From there the next logical step has been to digitize the impression process that is the jumping off point for many dental treatments. While the technology is there and working to capture digital impressions both intraorally and via benchtop scanners in the lab, MacLeod said the industry is just now turning the corner from moving from digital diagnostics to digital treatment.

While the previous two phases took off in the practices, the digitization of treatments is something being more driven by dental labs. MacLeod said labs stand to gain the most from digital impressions and CAD/CAM production because the technologies lend themselves to cleaner, faster and more cost effective production processes that also happen to produce highly esthetic and better fitting restorations.

“What the labs are starting to see now is a lot of the full-contour materials out there-for example (Ivoclar Vivadent’s) e.max, and BruxZir by Glidewell-really support the digital process,” he said. “Because of the growth in high strength ceramics, dentists in increasing numbers are ordering these things. The esthetics are good, and people want to get away from metal. This is a driver and an enabler of the digital impression.”

And while MacLeod’s company manufactures the leading chairside CAD/CAM system, he thinks dental labs have nothing to fear from dentists moving to both digital impressions and even chairside milling. This is because most dentists with chairside mills not only continue to send cases to their labs, but actually tend to work more often and more closely with their labs.

“The story with the CEREC is that after about a year of use people’s lab bills tend to increase,” MacLeod said. “They see more and they do more. And, their patients see more and they accept more treatment. When patients can see their tooth on the screen as big as their fist, they get a much better idea and the dentist is better able to communicate the value of their treatment.”

Labs working with dentists using digital impression technology can gain all sorts of advantages by simply being available to the dentists. Digital impressions not only lower overhead in terms of shipping impressions, but the time savings they provide can be a huge benefit to the labs. As an example, MacLeod said a skilled lab can go from receiving a digital impression of a simple single-unit posterior case to staining and glazing a milled restoration in as little as 15 minutes.

“That’s totally changed the workflow of the laboratory and the cost basis of the restorations,” he said. “These are the things the labs can use to ward off the problems of offshoring and cheap labor because you can’t compete with that type of speed. It allows labs to be price competitive with the added benefit of having a faster turnaround.”

So while digital impressions offer chairside benefits to clinicians, MacLeod believes dental labs have the most to gain from wider use of the technology and should be finding ways to help their dentists make the transition. Whether it’s through an arrangement where the labs provide digital impression systems to their dentists in exchange for a set number of cases coming back to the lab each month or by the lab owning a digital impression system that is available for local dental clients to use, MacLeod said there are numerous ways for labs to spur interest among dentists.

Those sorts of value adds don’t have to stop with just getting the systems into the hands of dentists. Labs working with dentists who take digital impressions can be set up to receive impression files as soon as they are taken, so the lab can see the impression while the patient is still in the operatory and any issues with the scan or the prep can be addressed immediately.

“If you’re able to quality control the impressions before they arrive, the number of remakes would go down, the customer satisfaction would go up and your overall efficiency in working would be much much higher,” he said. “My expectation is the lab will be the enabler of digital impressioning because of their strong economic incentive to do so. I think the digitization of the impression will take place very rapidly indeed.”

Of course today the scenario MacLeod describes only can work if the lab’s digital system is compatible with the system being used chairside in the way Sirona’s CEREC chairside unit can link up with an inLab system via the CEREC Connect network. While many labs would like to be able to invest in a digital system that will work well with any other digital impression or computerized milling system, MacLeod said it might be a while before the industry gets to a point where truly open systems like that are the norm.

When discussing the open system model MacLeod said it’s really a matter of the technology still being too new for such a system to work. For data to move between systems, each component needs to not only know how to read the same file formats, but it needs to calibrate and standardize how those files are put together.

It’s really not so different than the way lab technicians can approach using different stones, different investment materials and different porcelains in traditional fabrication techniques. Those materials work together as an “open system” because they have all been fabricated to work within industry accepted variables and parameters. A similar set of universal tolerances and standards has not come about just yet in the digital realm, so labs moving into the digital landscape need to be confident in the longevity of the companies they choose to work with and take advantage of the partnerships those companies form.

“There’s an evolution here, and eventually I think it will be such that all these files will follow some standards and will be passed from system to system in a reasonable way, but none of the players at the moment have developed that standard,” MacLeod said.

That doesn’t mean labs should be sitting on the digital sidelines waiting for the file formats and standards to shake out. Such a wait might be a long one, and besides MacLeod said there are numerous benefits available to labs that make the digital treatment transition now and then help their dentists move along the same path.

“The future is about increasingly automating processes within the lab and the dental office so that the owners of those businesses can do more and do it better,” MacLeod said. “It’s an exciting time, and of course at Sirona we are excited by that because we helped create that industry and we feel like we’re in a pretty good position to capitalize on that not only in our CAD/CAM space but in our other diagnostic spaces as well.”