CADapalooza 2009

A mixed crowd representing both the dental and the lab sides of the industry turned up in Miami Beach Friday, Aug. 7 for Henry Schein and D4D Technologies’ CADapalooza event. Before things formally got underway the crowd of CAD/CAM owners and those just curious about the technology mingled and discussed what brought them to the event.

When the lights went down for the start of the program, Justin Chi, CDT walked on stage in formal wear with tails, sat down on a piano bench before a computer and began to design a restoration from within D4D’s E4D system. When the lights came up MC for the day Dr. Curtis Jansen took the mic and the full day session championing dental CAD/CAM technology got underway.

“It’s changed the way I do dentistry,” Jansen said, sounding a bit like he was leading a revivalist meeting while describing the E4D system he’s had for close to a year.

The rest of the day’s sessions carried a bit of this same tone as the speakers lauded the advantages they find in performing CAD/CAM dentistry to crowd that was mostly enthusiastic about the technology, but sometimes showed skepticism and reservations. While Jansen and others praised their chairside system, the meeting put plenty of focus on the role lab technicians can play in the world of digital dentistry, and the event served as a platform for previewing D4D’s forthcoming E4D Labworks and E4D Sky, an online network of labs and dentists working together through the company’s systems.

First up among the guest speakers, Dr. Gordon Christensen gave his thoughts on where dentistry is headed, and in his mind the future will involve digital technologies and new materials. Showing data to support his arguments, Dr. Christensen explained that metal restorations are losing their appeal, and among the newer materials, lithium discilicate is showing the most promise for long-term success.

The biggest changes on the horizon are being driven by technology, he explained, and while he admits CAD/CAM will not be a fit for every dentist, he thinks it is an important development and one that will lead to a greater number of minimally invasive restorations. The key to the technology’s success will be incorporating it into a practice, and he believes well-trained staff members can help a dentist maximize use of the system, adding that developments in chairside digital design and milling materials will make the overall quality of restorations much better.

“From a clinical standpoint, there’s never been a better time in dentistry for both dentists and patients,” he said to open the presentation that he concluded with the statement, “If I were a young dentist right now, there is no question I would have a CAD/CAM in the office.”

Up next Dr. Jansen was joined by D4D Vice President of Dental Technologies Lee Culp, CDT for a discussion on their experiences working together to pilot the E4D sky system that allows dentists and lab technicians to collaborate on cases. Culp was quick to tout the system’s ability to function as a communications hub that allows professionals in distant locations to simultaneously work from the same three-dimensional model. He explained how the system still allows him to do many traditional laboratory functions, only now he is able to do much of his work off a digital model rather than taking the time to build a physical one.

“I have literally not waxed anything for over 11 months,” he said. “I can in seconds make changes that in wax would have taken hours or days.”

Culp was quick to point out that he wouldn’t be using the system if he didn’t think it would allow him to do everything he could do before going digital, and noted that he’s now able to accomplish his tasks faster and more easily, but can still charge the same fees.

Next to the microphone was Dr. Marvin Berlin, whose mcinneydentist.com practice has found adding and marketing around CAD/CAM services to be a boon to his bottom line. By advertising his ability to provide “same day crowns” Dr. Berlin has seen a steady flow of new patients and transformed the time previously spent fabricating temporaries into the time it takes to design and mill the permanent restoration.

However, like many dentists, Dr. Berlin said he prefers to just prep the tooth and seat the restoration, so he explained how his practice has had the assistants trained as Chairside Dental Designers. The extra training and expertise empowers the assistants, allows them to handle the scans and restoration design. Meanwhile he pays extra attention to his prep work and finds the milled restorations fit well.

“It’s just amazing what our assistants are now able to do,” he said.

During a live demonstration of the process of scanning and creating a restoration narrated by D4D Vice President of Marketing and Clinical Affairs Gary Severance, the crowd had a chance to see the E4D system’s capabilities to scan both intraorally and from an impression. Severance said the ability to scan impressions makes it possible to use the system even when patients cannot easily be scanned.

After screening Ceramic Wars a short video spoof of Star Wars that told of lab technicians fighting to secure their place in the digital chairside world, Dr. Ed McLaren, DDS, MDC lectured on the science of current restorative materials and adhesives while expressing his belief in dental CAD/CAM and the potential available from digitally connected practices and labs.

“I honestly believe that 80-90% of all restorations with be made by CAD/CAM in the next 5-10 years,” he said, adding that labs will play a key role in this by delivering same day, lab designed and milled restorations while displaying a financial break down of how this can work out lucratively for the labs.

While discussing the materials studies he does at his lab at UCLA, Dr. McLaren said lithium discilicate is among the most promising materials he’s seen and explained why “there is no correlation between flexural strength and clinical success.” More than the material used, the technique used to create a restoration will have the biggest influence on the strength of the finished product. Dr. McLaren explained this is due to the fact that milling from a solid block of a substance allows fewer opportunities for imperfections to be introduced when compared with techniques that form the restoration in different ways.

“You can weaken a material up to 90% during processing,” he said.

Next he covered bonding strengths of adhesives, and said his research shows the full-etch technique still provides the strongest bond between the prepared tooth and the restoration. However, he said the current batch of all-in-one cement products do achieve a similar bond strength if used with a separate primer.

Toward the end of the afternoon Culp returned to the microphone to provide a preview of where D4D sees dental technology heading in the near future. The company is working on developing a range of scanning technologies that will aid in preventive dentistry and when restorations are needed, they will be designed digitally and milled full contour.

“Dentistry should be about more than fixing things, it should be about preventing things,” he said.

To accomplish this, D4D is working on developing Optical Coherence Tomography that will allow dentists to scan subgingivally through tissues up to 5 mm thick. These scans would allow perio without probing and restoration preparation with packing cord. Additionally the E4D Sky network should be operational by this fall, and D4D is building an 8,000-square-foot milling center to add capacity to participating labs and dentists.

Other future plans include the ability to do digital denture design and a system that will combine cone beam scans with intraoral digital scans to create a completely workable 3D digital model of a patient from which to plan treatments. Culp said this will allow dentists and labs to collaborate on implant cases with design and fabrication of the surgical guide, implant, temporary restoration and permanent restoration possible before the surgical implant procedure begins.

“We’re beyond all these things that we’ve done in the past,” he said, summing up the day’s message nicely. “Dentistry will be performed digitally in the near future.”