Closed Vs. Open CAD/CAM – Selecting a Winner

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Dentalcompare
Clinical Director
 Dentalcompare Blog: Closed Vs. Open CAD/CAM – Selecting a Winner

CAD/CAM dentistry has overtaken the lab market, and the latest digital impression systems have finally clued in clinicians that this stuff actually works. It is great to see some competition, and with more systems in the marketplace the innovation is moving along faster than ever.

While people often quibble over how fast a camera can scan, another huge point of comparison between digital dental technologies is whether or not the system is open or closed. In other words, if I buy this scanner, and I eventually want to do in-office milling, do I have to go with a milling machine made by the same company (closed) or can I choose a mill from any manufacturer (open).

Recently Dr. John Flucke wrote a blog post about a new milling machine he will be testing from iOS technologies. If you haven’t met Dr. Flucke, seek him out at the next dental meeting. He is one of the best speakers I have heard, and has a progressive understanding of how technology fits in with dentistry. In this blog post he talked about open vs. closed systems, and he mentioned his dislike for a system that would “force a doctor to only purchase equipment that talks or works with other equipment in that closed system.” The plan for their office will be to test the TS150 mill with the iTero scanner they have been using for years.

I agree with Dr. Flucke, that it’s not necessarily ideal to be “forced” into using technology from one manufacturer. The follow-up question to that, however, is “What will the dental industry actually want to use?” While open systems generally work with the same file formats, they are not set up for plug-and-play connections. There are very few dentists with Dr. Flucke’s knack for technology who want to go through the growing pains of figuring out how to get one system to talk to another.

It might be almost 30 years old, but there’s no doubt Chairside CAD/CAM has had a hard time getting off the ground. My feeling is most clinicians think it’s much easier to drop in an impression tray and walk out of the room than it is to figure out how to get the “camera” to talk to the “printer.” It’s true that it usually is not too difficult to get these systems communicating initially, but there is nothing more frustrating than when one manufacturer updates one part of their software and this creates an incompatibility with the other systems. I have gone down that road with open imaging softwarepractice management software, and digital intraoral x-ray systems, and this showed me the biggest challenge of truly open technology platforms.

So what are we actually being “forced” into when we opt for a closed CAD/CAM system? I happen to have one of these closed systems and plain and simple, it just works. All the time. When there are updates to the scanner or the design software, I know they won’t break the connection to my mill. When new materials are available for my mill, I know the software will be able to work with their specific production parameters.

Sure an open system offers a theoretical limitless set of indications, but those indications are not always easily accessible. The closed systems might only offer a specific set of clinical applications, but these days that set is expansive. For example, let’s look at the fabrication of a surgical guide. There is nothing more amazing than taking a digital intraoral scan, designing a digital tooth in the space where one is missing, syncing that up with a cone beam CT scan, and then fabricating a guide to help place that implant in the perfect position to support that digital tooth (Click here for a case study). Four months later, the same system is used to design and mill an anatomic custom abutment and a crown (Case Study). It matters less to me which brand of mill I am using, and more that it works when I need it.

So what about the argument that closed systems are more expensive? In some cases this is true, but when properly integrated into a practice, the ROI on any of these machines is so overwhelmingly positive that it hardly makes a difference.

Plus, what happens when something does go down (…and regardless of which machine you invest in, it will go down). Who is going to come take a look at your setup and fix it for you? A closed system should include coverage for the entire system, whereas with an open system you might need to know if you should call your scanner support, your software support or your printer support. As a clinician, your hourly rate as a dentist is much higher than you acting as tech support. The ROI plummets when the system is down.

So, which system is right for you? Obviously it depends on the scope of dentistry you are performing. Some practices will only need digital impressions, while others will find benefits in chairside production. Either option can be found in open and closed systems, and in most cases, a mill can be added to a scanner at a later date.

However, if you feel strongly about the future possibilities of an open system, the best choice is to go with a system that is selectively open. These systems provide some of the freedom of choice of an open system with some of the assurances found in a closed system.

Selectively open CAD/CAM systems fall into two categories. The first is open systems where the manufacturer validates connections with other technologies and builds those connections into its system’s software. 3M ESPE has been very active with this model when it comes to the 3M True Definition Scanner. The second selectively open option is purchasing your system from a single company with support for all components included in the sale. As I mentioned in an article earlier this year, companies such as CADBlu Dental will outfit your office with an “open” system, but will also provide support for you to know that all the pieces are working together properly. The idea is that the open elements have been pre-selected to give you a system that works, and their support specialists are experts on not just the individual system components, but also in the ways the components work together. This is a way to adopt open technologies that lets you worry about performing dentistry.

While there are pros and cons to both open and closed systems, it is more important to align you and your practice with what works for you. That is what the majority of dentists are going to want to see, and selectively open systems allow you to straddle both sides of the debate.

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