21 Feb 2015
February 21, 2015

Back to the future

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(Edited 1/3/15)  It is 30 years since the CEREC concept was introduced to dentistry.  It is a CAD/CAM (which stands for Computer Aided Design/Computer Assisted Manufacture) device.  It is a machine that can capture a digital 3D image of teeth, the operator manipulates the data and then instructs a milling machine to make the final restoration.  In the early days it was limited mainly to ceramic inlays, which is a type of filling.  A much wider range of restorations can be made in 2015

The early devices were primitive, which is the nature of new technologies when viewed retrospectively.  For example what sort of computer games were available 30 years ago and what is available today?

I have been watching and waiting for CAD/CAM technologies to reach a point that they could produce restorations that are the equivalent or better than traditional methods.  Initially the question I asked myself was in 2015 is the “all-in-one” CEREC concept my CAD/CAM preferred choice? I believe the answer is no.  One reason is because the world of CAD/CAM is progressing with frightening speed.  All-in-one systems tend to fall behind ‘best practice’ for a very simple reason:  It is hard to imagine how one company can produce the best data capturing device, the best CAD and CAM software and then the best milling machines. With dozens of companies competing to have the latest and greatest device plus massive software giants it is inconceivable one could do it all and lead the world in every category.

An analogy is try and imagine a single company that could design and make the best processors in a computer plus all of the rest of the computer hardware, all of the software you use and provide you with all encompassing support.  Apple is the biggest company in the world however even they have Intel make their computer chips.

Some background will help you understand why I have invested in a very different solution to manufacture dental restorations (things like crowns, bridges, onlays, inlays and more.  In rare cases it can be done on the same day but more often than not it lakes longer to do some tasks as well as achievable. You see it is like building a house, many problems require you either do it fast or well. Which would you prefer?

The world has moved on from 1985. Back then CAD/CAM was very new to dentistry. There were huge challenges in how to capture the 3D images in an accurate way, writing the software to manipulate the data and how to mill with enough precision. Published independent articles even today indicate this system may not produce a dental restoration that is a precise as one produced with conventional methods. To be fair they are a lot closer than in 1985 but still not there yet. I think that is probably why very few Australian specialist prosthodontists use this system.

In 2015 we have better options with industrial levels of precision and a wider range of materials that can be used.  I recently invested in an iCore 250i 5 axis milling machine (see https://www.youtube.com/watch?v=vJ2wJSFMUI0 for a video of the machine in action). It uses a high speed air driven turbine with a 5 axis milling pathway (the drill and object can move in five different ways to make more complex shapes,).  It can mill either wet or dry allowing a wider range of materials to choose from.  We can mill everything except for metal which we send out to industrial milling centres which have million dollar DMG machines.  The iCore is self calibrating and uses a range of drills which it changes automatically.  That means we can do the bulk drilling faster while finishing the fine detail with very small fine diamonds drills. The CAM software is the brains of the machine and the secret of great CAD/CAM results.

Why does;t all dentists sue a system like this?  Well you need to research what is best in each category, find support persons with specialised IT experience in getting components from different companies to work together and ideally employ a full time ceramic technician to pilot all of this hardware/software.  Not many practices have the skills, the time and dedication and the staff to do this.  i am lucky to have a great team working with me.

I could go on for pages and pages but I guess you get the idea. We can produce restorations with surprising precision, the equivalent or perhaps even better than made by conventional methods. We can use a full range of materials so their is not compromise in strength or biocompatibility. All of this and you get your new teeth faster than before! Next time you come into the practice ask to see our collection of high tech laboratory equipment.

Oh and if I am away from the practice lecturing on my favourite high tech gadgets Marty my very talented ceramic technician will show you around.

Scott

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