Striking a Balance with CAD/CAM

How can a team balance non-digital and digital portions of the workflow to capitalize on the advantages of CAD/CAM while maintaining the human touch element?

Chad Perry, DDS

Josh and I have worked together for approximately 3 years, and I am somewhat “old school” with no CAD/CAM capabilities in my office, so when Josh added a milling unit to his laboratory, I was definitely apprehensive. My restorative dental practice consisted of mostly pressed lithium disilicate restorations, because I trust the marginal integrity generated by this process. I am aware of the research indicating the integrity was the same with milled restorations, but personally I am more comfortable with waxing and pressing than I am with utilizing a milling mechanism with a round bur or a diamond to mill the intricacies of the margins.

That said, Josh is the one fabricating the restorations, so I need to trust his knowledge and expertise regarding what processes work best for each case. The key was that we communicated with each other so that we both can be comfortable with the type of work the CAD/CAM technology was being used for in his laboratory. I also knew that because he operates a small laboratory, Josh has complete control over everything and he is involved in each step of the process, from the design to the finished product. Whether a restoration is pressed or milled, if it comes from Josh’s laboratory then it meets with his stamp of approval.

One major benefit I have found with Josh’s utilization of CAD/CAM is that when we have a bridge fracture, he has the STL file and can very easily mill another substructure and then layer it. This has cut our remake time in half because the design process does not need to be repeated.

Another way we utilize CAD/CAM frequently is for shell temporaries. It is extremely beneficial to have a monolithic structure being milled with consistency throughout the structure so I only need to reline it. This allows the laboratory to reduce the turnaround time significantly, which subsequently helps the dentist.

Joshua Polansky, MDC

I resisted CAD/CAM for a long time because I thought a true dental technician needed to use his or her hands for everything. As a small laboratory, I was outsourcing a significant portion of my work, which not only was expensive but also took a lot of time. Once I invested in a CAD/CAM system, I began realizing that there were more benefits than I had expected. It helped save time, which in the end is money, and it also allows me more control. We have implemented a 60% digital workflow. We still handle parts of the process, primarily the finishing steps, by hand, but the machines handle most of the labor. I built my reputation by working with a microscope, but I know now that it is impossible to compete with a machine on the precision aspects. Technicians have the skills and knowledge to attain the best esthetic while maintaining precision, lending the workflow to the best restorative outcomes.

Many of the cases that I work on with Chad are hand-finished at the end—either cut back and layered or fully layered—but the machine handles the majority of the tedious and laborious work. We wax a case for Chad, he mocks it up in the mouth and confirms it, and we scan the wax-up. The machine does everything from that point until when we layer the restoration at the end, which not only helps with efficiency but also ensures that we are exactly matching the wax-up that the dentist and patient confirmed.

Technicians should not rely on exactly what the machine produces, however. When something comes out of my machine, often it looks far from perfect, but I do not worry because it will look good after I get my hands on it.

The bottom line is you need to strike a fine balance of using new technology while implementing the old know-how and knowledge to that new technology. This leads to patients, dentists, and laboratories enjoying the benefits of both worlds.