CAD/CAM and Practice Management

David Burt, DDS

During the last 10 years, the accelerating pace of digital dentistry has brought major sectors of dentistry together that don’t seem to have much common ground. At first glance, the digital workflow of CAD/CAM in a dental practice would appear to be a strictly clinical issue with little bearing on the practice management side of the office; however, a closer look at the effect that they have on each other reveals a totally different picture of how we approach dentistry as a profession as well as a business. These synergies of practice elements can be obvious as well as subtle and warrant an examination to define how they work in our day-to-day professional lives.

Practice management software programs that have taken over the ledger, superbill, and appointment book have been steadily improving for the last 25 years and are now found in almost all dental offices in some form or fashion. With a few clicks of a mouse, these programs can create reports and display statistics that can be used to check the business status of a dental practice at any given moment. Dentists can now instantly see where they stand in the health of their office and make corrections to maximize efficiency and return on investment. So where does CAD/CAM fit into this picture? Some of the answers may surprise you.

When we examine the largest outward changes in dental workflow, the first one that is readily apparent is found in appointment scheduling. Chairside CAD/CAM has reduced the time or number of visits needed to perform a given task, whether it be reducing the time required for a single visit crown or reducing the typical five visit series for denture fabrication down to three visits. The influence of CAD/CAM has affected the way we perceive needed chair time, and practice management software highlights these time-saving efficiencies with metrics such as dentist hourly production or daily production quotas. A 4-unit CAD/CAM bridge, which can be fully inserted and adjusted in 15 minutes, requires less than half the time needed for the same bridge fabrication in porcelain fused to metal because of the accuracy of fit and interdigitation with the opposing arch. Digital denture fabrication is a new and growing concept that shortens the traditional five visit process to three visits and delivers that same results as analog fabrication with up to 66% less time spent by the doctor. This efficiency of chair time allows the front desk to better schedule appointments for the doctor and reduce the usual “feast or famine” syndrome that can create stress in the practice as a result of potentially wild fluctuations in collections from day to day.

Another outward change brought about by the influence of CAD/CAM on the modern-day practice is that the workflow of dentistry has become more staff-driven rather than doctor-driven. Digitally scanning both arches, taking the bite registration, selecting the shade, and handling other lab details needed before a crown preparation is actually started can be done by the staff without the doctor present. The doctor then prepares the tooth, erases the original tooth from the scan, and images the preparation himself, which facilitates adherence to many state practice acts that require the dentist to take the “impression” personally. In some states, an “expanded functions assistant” is permitted to fabricate and seat the temporary, allowing the doctor to be chairside for what is basically a “prep and go” situation. To achieve even more efficiency through chairside CAD/CAM fabrication, staff can image, design, mill, and prepare for a crown insertion with the doctor only being needed to create the tooth preparation and perform the final cementation of the unit or units.

While these changes in practice that stem from the synergy of practice management and CAD/CAM stand out as the most obvious ones, there are some other aspects of the union that, while not as readily apparent, are no less important to the overall health and wellbeing of the modern dental practice. Participation in insurance PPOs and HMOs, can create many pressures on a dentist to control office overhead so that profitability is not adversely affected due to the reduced fees required by many insurance companies. Dental laboratory fees for CAD/CAM procedures reflect this efficiency by charging less for certain cases because of a decreased demand for labor in ceramists, impression disinfection, model making, and postage. Fees for certain CAD/CAM prosthetics are at their lowest in history and can help a dentist maintain a stable bottom line in the face of reduced insurance allowances. Furthermore, greatly reduced lab turnaround times for modeless digital restorations, which can be measured in days rather than weeks, allow more dentistry to be performed during the same time period without increasing the demands on a practitioner.

Finally, because of zero distortion, the precision of CAD/CAM restorations has resulted in an extremely low remake rate of crowns and bridges. The cost of a second analog impression combined with additional shipping costs and time needed to deliver the case can have an enormous effect on a practice’s overhead costs. Getting it right the first time is a hallmark of digital dentistry, and the statistics bear this out.

In conclusion, the incorporation of CAD/CAM technology into dental offices has affected practice management in a way that is not only additive, but exponential. Both are tightly integrated into today’s modern dental practice, and they will continue to offer more synergistic benefits as time goes on.

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For a personal perspective on CAD/CAM and digital dentistry, read David Burt’s companion article.

About the Author

David Burt, DDS, maintains a private practice, Mountainville Dental, in Allentown, Pennsylvania.