Chairside Milling Opens New Possibilities for Dental Practices

The technology that powers dental chairside mills—or any CNC mill—is truly an amazing achievement. These solutions basically replicate the skills of a master sculptor and make them accessible to anyone. And just like a master artisan’s skills increase over time, so, too, have the capabilities and efficiencies of chairside milling options.

While the majority of dental practices are not yet producing milled restorations chairside, the technology has reached the point where a mill could be a great fit in any dental operation. Things have progressed a long way from the first mills designed for chairside. The earliest mills on the first CEREC system were integrated into a single device with major limitations on both the materials and geometries that could be milled. But that was decades ago, and today’s chairside mills are versatile, specialized machines designed to help practices treat patients as efficiently and effectively as possible.

For clinicians who haven’t taken a look at chairside CAD/CAM options in a few years, the landscape will look significantly different. In the past just a handful of digital impression scanners were available, and not all of them could connect to a chairside mill, and for the ones that were designed for chairside production there was often just 1 milling option. Today there are numerous scanner options and almost all of them can connect to any number of different mills, as well as many 3D printers. In addition, the days of limited material choices and complex workflows look to be in the past, as numerous chairside milling materials are available for a wide range of applications and many of them are faster and easier to work with than the materials of the past.

Maturing Technology

Eric Mayuga, DDS, has followed the development of chairside milling technology throughout his career. He has worked with several chairside CAD/CAM systems starting with a CEREC system that he began to use in 2004. Dr Mayuga says he enjoyed that system and used it for years before deciding to go back to working with his lab because it allowed him to provide more treatment options to his patients.

“Chairside restorative material options were limited at the time, and I wanted to ensure my patients were receiving the very best restorations with optimal strength, esthetics, and quality,” he says.

He waited almost a decade before investing in a new system for chairside fabrication, but now he’s excited by his options and is thrilled with his choices when it comes to the mills and their capabilities, as well as the materials he can offer to patients at Imagine Dental, his growing practice in Gardner, Kansas. Today he uses 2 different chairside mills to offer a range of restorations. He first invested in a Glidewell TS150e for producing zirconia restorations, but he’s been even more impressed with his DGSHAPE DWX-42W from Roland DGA, which is now a key part of the way his practice operates.

Eric Mayuga, DDS, setting up a case for milling with his DWX-42W.

“We utilize our DGSHAPE DWX-42W chairside milling solution on 98% of cases because of its short mill time and ability to produce an esthetic, long-lasting restoration that is ideal for almost all indications,” he says.

When considering adding another mill to his practice, Dr Mayuga spent time researching his options, and the DGSHAPE DWX-42W stood out for several reasons including Roland DGA’s reputation for making reliable and accurate mills that are widely used in dental labs. His other considerations when evaluating mills included the types of materials and milling tools compatible with the mill, the software used to operate the mill, and special features such as remote monitoring. He now uses chairside milling for crowns, inlays, and onlays, while continuing to work with a trusted dental lab for anterior and multiunit cases that require a technician’s expertise.

Open Advantages

One key feature Dr Mayuga looked for in a mill was a system that would be easy to integrate with the digital technology he was already using in his practice. He says the chairside CAD/CAM systems sold as all-in-one solutions work well on their own but do not always allow for the flexibility and customization he wanted to make sure the mill fits the way he practices.

With more practices employing digital impression solutions, the appeal of open-architecture dental technologies has been growing, says Lisa Aguirre, product manager of dental solutions for Roland DGA, DGSHAPE Americas. This is something dental labs have seen for some time, and as more practices go digital, more open-architecture options will follow as companies with roots in dental lab technology such as Roland DGA bring their technologies to dental operatories.

“Open-architecture systems like Roland DGA’s DGSHAPE DWX-42W provide clinicians an affordable, reliable, and lab-quality chairside milling solution that allows clinicians not only to utilize and integrate their existing digital workflows, but also the ability to add on and integrate additional digital solutions as their practice grows and continually provide their patients with the latest and greatest in dental restorative materials without compromise,” Aguirre says.

Dr Mayuga enjoys being able to set up a workflow that makes digital dentistry a convenient option for more of his patients. For his practice, having 2 mills expands his production capabilities and adds versatility to the way he manages both his and his technology’s time.

“I like having digital dental solutions that are independent of one another, allowing me to easily integrate and interchange them as needed into my digital workflows,” he says. “I can schedule staggered appointments and treat multiple patients throughout the day, optimizing my productivity while continuing to provide my patients with the very best dental restorative care.”

Scheduling for the Mill

Having a custom chairside milling solution has enabled Dr Mayuga to fine-tune his workflows for same-day restorations. He currently schedules a 2-hour block for a same-day chairside restoration and completes every step of the process from prepping the tooth to cementing the crown in that appointment. A big part of his efficiency in chairside production is newer materials that mill in less time and require fewer finishing steps.

Straumann® n!ce® blocks offer fast processing times, and desirable physical properties for chairside restorations.

Having an open-architecture solution affords him access to the widest range of material options, allowing him to select a material to fit the needs of any case. Dr Mayuga says he is currently using n!ce blocks from Straumann. This fully crystallized glass ceramic material offers both strength and esthetics and mills in just 28 minutes in high-quality mode on the DWX-42W. The material does not require extra finishing steps beyond a regular polishing. Dr Mayuga says it mills with great accuracy and restorations require only minor adjustments, if any, at seating.

With the TS150e, Dr Mayuga schedules 3-hour-long appointments. The harder zirconia he produces on that system takes longer to mill and he often needs to spend more time polishing and adjusting those crowns.

Benefits to Patients and Practices

Adding chairside milling capabilities has been a positive at Dr Mayuga’s practice. His patients appreciate same-day crowns, and he’s been able to provide them by building a workflow to fit his needs. He’s very pleased with the ways helping his patients via chairside milling have also been a positive for his practice’s bottom line.

A crown immediately after milling is completed.

“From a patient experience and productivity standpoint, it is nice to be able to deliver a restoration in an all-in-one, easy appointment,” he says. “Patients appreciate the convenience of having only 1 appointment and I do not have to worry about temporaries coming off prematurely. My patients also report less postoperative discomfort and sensitivity with same-day crowns. In addition, since insurance claims are typically sent on the day a crown is seated, we are able to decrease the insurance reimbursement cycle time.”

This impact on the business side really comes from optimizing the efficiencies of his practice around the proficiencies of his technology. For Dr Mayuga, the ability to scale his CAD/CAM capabilities to fit his desired workflow was critical. His success with milling comes from understanding and embracing the technology when it’s ready to meets his needs.

Aguirre says clinicians with scanners who have written off chairside milling in the past should take a look at some of the options available today. When used effectively they free up appointment times and expand what a practice can offer to its patients.

“With inflation and operational costs at an all-time high, clinicians are utilizing chairside milling to assist in reducing overhead costs by reducing patient chair time and number of visits, ultimately increasing a clinician’s production dollars per hour while providing their patients a better overall chairside experience,” she says.