3DIC: Plenty of learning going on

26 06 2010

For the more than 150 attendees at this weekend’s event, there were plenty of opportunities to learn. Some were on hand to learn how to get more out of their current CBCT systems, or how to market their current technology, while some were seeking knowledge on how/why to integrate the technology.

We spoke with a variety of attendees including i-CAT owners, Gendex owners and even a dentist whose main goal this weekend was to learn more about CBCT even if though he’s not quite ready to add a sysytem to his own practice just yet. Drs. Christopher Phelps and Martin Van Vliet shared their experiences with using the technology in their offices and also what they hoped to take away from the 3-D Dental Imaging Congress. Dr. Phil Estes, meanwhile, told us he’s not ready yet to bring cone beam into his Texas practice, but that learning more about it this weekend will help him make a decision in the future, as well as help him immediately understand better what some of his referring doctors are doing with the technology.

Look for videos to come soon from these three attendees at dentalproductsreport.com.

Other opportunities to learn more about the technology available today came from those who visited the exhibitors and from viewing a live i-CAT scan presentation in which the attendees were able to ask questions while scans were being presented.

NBGC2010: Nobel Biocare Global Symposium Day Three

26 06 2010

While speakers in the main hall focused on minimally invasive procedures, it was standing room only in the parallel session as attention turned to the laboratory side of the dental world on the third day of the Nobel Biocare Global Symposium 2010. With everything from the accuracy of digital systems, to materials science, to in-depth porcelain layering techniques and even CAD/CAM-based business models up fro discussion, it made for a wide ranging session packed with information, opinions and tips.

Dr. Stefan Holst who presented on a similar topic the day before, gave the laboratory side of the systems attention as continued to speak about the myths and realities of CAD/CAM systems and digital aspects of dental laboratory work. While he again cautioned that scanner accuracy is not quite to the level he would like it to be, Dr. Holst asserted that industrial scale mill technology is capable of producing parts with more than enough accuracy for the needs of the dental and dental lab industries. With CAD/CAM production on the front end of the lab process, technicians can have more time available for the detailed veneering work that makes a finished zirconia crown amazing to behold. He also said that extra time in the process might allow lab technicians to communicate more and more effectively when working with clinicians on treatment planning.

Dr. Holst said he believes much more study is needed to determine and refine scanner accuracy, but the digital design process offers lab technicians a more accurate overall work environment and process. This is especially true with software systems are intelligent when it comes to the materials being used for a specific case and provide a warning if the design will not be functional when it is taken from digital concept to physical reality. Other advantages he sees to moving to digital design and computer-driven production is the lower cost of producing implant bars for retaining “fixed-removables” and the ability to produce custom implant abutments, which he said are as accurate as stock abutments.

Tasked with showing how zirconia crowns can be effectively used in the esthetic zone, Naoki Aiba, CDT offered up not only gorgeous images of crowns he has created, but a number of innovative and creative technical tips that can help with crown design and fabrication. Aiba began by saying he always does a bit of customization on the Procera zirconia copings he receives prior to layering his porcelain. He typically reduces the thickness by .2 mm to create greater translucency before using In-Nova powders to add character. After adding his first porcelain layer and designing the cutback, Aiba said he likes to use a coffee cup warmer to pre-dry the crowns before the first firing. After that first bake, he corrects his margins prior to adding a second build up. Aiba said he likes to polish his ceramics prior to glazing because this allows him to bake them at a slightly lower temperature.

Moving on to explain his process for communication with clinicians, Aiba said he like to work with digital images that he can manipulate in Adobe Photoshop. This part of his process comes in especially handy for shade matching because by cutting and pasting the shade tab images on top of the the temporaries in the image, he can determine the exact shade to match. To further assess the color, he uses the software’s color analysis to compare values between the shade tabs and the restorations.

Belgian brother Luc and Patrick Rutten were up next with a presentation on how they use CAD/CAM production to obtain esthetic results. Both expressed a strong belief that CAD/CAM production allows more cost effective production that, more importantly, is more precise than traditional casting techniques. The pair shared their techniques for firing porcelains on top of zirconia copings, saying they have learned over time that the material needs to be treated differently than metal substructures. They work hard to make sure they build in translucencies and florescences to make their restorations as close as possible to the natural dentition. When completing their cases, the brother Rutten said they deliver the final restoration seated on gypsum models so the contacts are perfect and the clinician can seat without adjustments.

“It’s better if we do it in the lab than if the clinician has to do it chairside,” Luc Rutten said.

Of course for that to work out, communication between lab and clinician must be solid and preparations and impressions or scans used to create models must be highly accurate. Understanding the issues clinicians deal with is a key component to making the communication and case planning process a smooth one, Luc Rutten added.

The final laboratory presenter was Australian lab owner Robert Hill who exhorted the audience to embrace the change hitting the industry and adapt CAD/CAM processes into their business models. Stating, “It’s time to move on,” he said waxing should not be needed any longer and digital production processes are a way to bring in new efficiencies to a lab. While he said he was not 100 percent pleased with every aspect of the Nobel Biocare system he uses, he selected it for his lab because he believes it will grow to add the features he wants to see and is ready to address all of the types of restorations he produces. The biggest advantage of CAD/CAM he’s seen is the ability to design milled implant bars that are more accurate, stronger and far faster to produce through a digital process.

“If you’re not doing implant bars—screw-retained fixed or removable—you’re wasting part of the market,” he said.

Hill continued on to outline his vision of a future lab with a completely digital workflow that cuts down on the mess and waste while increasing productivity. With outsourcing for fabrication on industrial mills, Hill said a lab could work with just a furnace, a scanner and a computer. In fact, he finished by showing his boat and calling it his second lab because he is already to take his laptop with him and remotely complete some case designs while out on the water.

For the weekend’s final session, a panel of speakers who presented throughout the weekend were brought back to review two cases, discuss the diagnosis and plan the treatment. The complex cases presented both clinical and financial challenges for the panel, and both the members of the panel and the clinicians remaining in the audience participated in the exercise.

The session provided a lively conclussion to the three day event and provided an opportunity to see the topics covered in the educational sessions put to use in actual clinical cases. After the panel put forward their proposed treatment, the actual clinical outcomes were revealed.

The weekend wrapped up with many good byes and trips to the airport as the international crowd of attendees and speakers left with new information on technolgies, techniques and treatments, and a solid overview of the implant and digital dentistry systems Nobel Biocare has available.

3DIC: Are you happy?

26 06 2010

Dr. Mark Tholen

Are you happy seems like a big question to ask (or try to answer) in a weekend. More importantly, what does it have to do with cone beam technology?

Dr. Mark Tholen, in his lecture, looked at the reasons why some practices with CBCT are successful and others are not, revealing the common denominators among dentists who see the benefits. In his post-podium interview, he gets into the bigger picture of general happiness and success, how we define these things (more money, or more time for family, or more time for hobbies), and then how the built environment of the practice and operatory help facilitate that success and bring the values of the dentist in line with the way he or she is presented through the practice’s design.

He ended our conversation by stressing the importance of dental professionals being good stewards of their most valuable instrument—their bodies—and how technology helps lighten the load and lessen the repetition for both dentists and their teams.

The complete video interview will be available later this weekend.

3DIC: Uniting two technologies

26 06 2010

We spoke with both a user and a product director about a partnership involving D4D Technologies and Imaging Sciences International involving cone beam pairing software solutions.

Dr. Sharnell Muir, owner of Kelowna Dentistry By Design in Canada, shared some of her experiences with using E4D Compass software to pair cone baem data with E4D scanned data. Mark Hillebrant, Director of Product Management , Gendex and i-CAT, discussed some of the benefits of this product designed to provide an all-in-one solution through the integration of intraoral models or impression scans (E4D Systems) and cone beam data (i-CAT and GXCB-500) for surgival and restorative planning.

For more informationon E4D Compass, see the August issue of Dental Products Report. Look below for the interviwes with Dr. Muir and Hillebrant from the 3-D Dental Imaging Congress in La Jolla, Calif., June 25-26.

3DIC: It’s not the Scan, it’s the Plan

26 06 2010

Dr. Scott Ganz

Cone beam pioneer Dr. Scott Ganz has used the technology for decades now, but spoke about the recent developments that have gotten him excited about CBCT’s impact on the dental industry.

At his post-podium interview, Dr. Ganz described the “remarkable evolution” that has allowed the technology to expand from radiologists in hospital settings to dental practices. He mentioned that the recent advances with i-CAT and Gendex sytems are helping provide numerous benefits to both the patient and the doctor. One myth he wanted to bust, was a belief by some that CBCT is really geared most toward practices heavy into implants.

“It’s way beyond just dental implants,” Dr. Ganz said. “It’s really a cross platform, cross speciality technology.”

He also stressed that there’s a lot more to just taking the scan, thus he shared his slogan: “It’s not the scan. It’s the plan,”

Now that CBCT is providing dentists with a slew of great information, what’s next? With many users having been taught 2D in dental school, it’s critical that they now know how to take this new 3D data and diagnose and treatment plan in ways in which the patient comes away with the best possible care.

Events such as the 3-D Dental Imaging Congress are a great source of developing these skills, he said.

3DIC: CBCT and Your Network

26 06 2010

Steven McEvoy

It’s easy to forget that when incorporating new technology such as cone beam, that planning for the back end and networking your practice correctly is essential to overall success. Steven McEvoy, President of MME Consulting, was here this weekend to remind attendees that they need to work closely with their IT partners to ensure things come together well.

In our post-podium interview, McEvoy focused on the fact that 3D data requires some additional considerations, including these three key things:

1. An up-to-date back-up system to make sure you don’t risk losing all this new data

2. Server space — bigger than traditional 2D files, there needs to be able storage room for your 3D data

3. The ability to transfer data quickly — part of the fun and benefit of these types of scans is the ability to share them easily with referring or referred doctors, so make sure your equipment is up to speed

As far as the financial investment to get the back-end up to speed, McEvoy says that practices with a more modern network are probably in good shape. In general, the cost of getting IT involved is around a couple hundred dollars and well worth the expense. McEvoy also recommends that dentists reach out to the IT side at the same time they are firming the commitment of the purchase, allowing ample time to bring the practice’s network in line with the new requirements.

3DIC: 3-D Ortho: Integrating Tomorrow’s Technologies Today

26 06 2010

Dr. Aaron Molen says we’re currently witnessing a paradigm shift in how we diagnose and treatment plan orthodontic patients.

At his post-podium interview with DPR he talked about an exciting future where CBCT will do more than just treatment plan patients, but will be used to actually treat orthodontic patients. The internationally recognized expert on the subject of 3D x-rays talked about how practices can expand the scope of their practice for orthodontics, and he discussed how technology advances have made indirect bonding a better choice today than in the past.

In addition to his regular speaking engagements, Dr. Molen maintains a popular website on the subject, www.3DOrthodontist.com, and travels back to Los Angeles monthly to lecture to the UCLA orthodontic residents.