Wednesday, February 28, 2018
There is no question online entities such as Zappos and Amazon are altering the way we shop. It’s often less expensive, more convenient, and comes with reviews to help you determine if you will like the product.
Obviously, the part of all this that works for you as a consumer will also work for you as a dental professional. Some say this change in consumer habits is so relevant that maybe the dental convention itself will become a thing of the past. That certainly may be true for some smaller regional meetings no matter how good the keynote speaker may be.
However, walking into the 2018 Chicago Dental Society Midwinter Meeting, you could almost start to think the internet didn’t exist at all. With dozens of fantastic speakers, hundreds of vendors, and tens of thousands of attendees, this convention is more relevant than ever. And with a bevy of new and forthcoming innovations on display, the meeting still seems to set the tone of what is happening in the industry.
Digital Dentistry – Here to stay
At one point intraoral digital x-rays were this exciting new thing. We talked about all their benefits, including efficiency gains and less radiation for your patients. While adoption of this technology was slow, it has picked up over the years. Now, if you don’t have digital x-rays, you may as well hang a sign on your practice that says “We don’t want new patients.” As dentistry changes, patients are updating their expectations about the type of office they want to be in.
Digital impression technology enjoyed the same exciting debut to our field as digital x-rays. However, we still see the same reluctance to jump on board. The impressions are accurate, the systems affordable, and the workflow offers unprecedented efficiency. Plus, the competition only continues to heat up. As new and more advanced digital impression options continue to arrive, impression material will only continue to decline in use.
Existing intraoral scanner systems continue to grow, and often a simple software update can add new indications and improved scanning. However, the bigger leaps forward come when the hardware gets an update, which is the case with the latest from 3Shape, the TRIOS MOVE. This system is still built with a cart, but this time, the cart is almost skeletal and puts the focus on the 13 inch HD touchscreen monitor which is mounted to an articulating arm. This allows for more agile positioning and makes it even easier to show your patients whats happening during and after scanning. The MOVE also makes scanning more flexible as the handpiece is wireless. These design features add up to a scanner designed to foster communication, patient education and to spur increased case acceptance.
Take the newest digital impression from KaVo, the X Pro. It is one of the lightest wand style cameras on the market, and a plyable thin cable connects it to the computer. It performs streaming capture (not stitching), and the resulting image is in full color. The camera itself has accelerometers, so you can manipulate or turn the model on the screen without putting the wand down.
The software, called DTX Design, allows you to design a restoration for chairside milling, or export a .ply (polygon file format) or .stl (stereolithography) file to transfer to your lab. With open architecture built into its design, you can take advantage of many different milling machines out there.
Speaking of…
3D Milling and Grinding – Next Gen Architecture
While Ivoclar Vivadent is best known for their materials, they introduced a brand new milling machine for use in your office. It is called the PrograMill One, and they took a unique approach to the way it actually mills.
Rather than holding the block still and moving diamond burs around it, the mill holds the bur steady and moves the block around the cutting. This allows the bur to be more precise and stationary to increase accuracy and avoid chipping. You also have the option of loading eight different burs (rather than the average of two) so you can do faster grinding of the larger structure and have more detailed burs to carve in the anatomy in the crown.
The machine can load up to five different blocks of different materials and sizes so you can also batch the jobs for fabrication. Just in case someone is using your scanner, you also have a tablet program that connects to the PrograMill One to view all current and future jobs.
If all that were not impressive enough, there is also the overall footprint. Less than half the size of larger mills, you can place it almost anywhere in your office. Think about the space a Keurig coffee maker would take, and drop it there. The machine only does wet milling, but the good news for those with a Sirona SpeedFire sintering furnace is you can also mill out zirconia.
Speaking of zirconia…
Zirconia – Goodbye PFM
The technology and chemistry behind zirconia continue to improve to give us better shading and translucency than ever before. What this means is we can now place monolithic restorations that have better esthetics than PFM, avoid the possibility of chipping veneering porcelain, and have improved strength over even lithium disilicate (e.Max). Plus, you can easily fabricate these using digital design, taking a fraction of the time and cost to make it.
Ivoclar Vivadent introduced a new zirconia block called eMax ZirCad. With a good range of VITA shades, the blocks can be milled with CEREC and E4D systems, as well as the new PrograMill One. Final sintered blocks can be customized with stain and glaze, and Ivoclar will soon be releasing dyes to dip color into the pre-sintered crown as well. While you might not put these on a central incisor, a final strength of more than 1,000 Mpa make these a perfect choice for molars.
Kuraray, best known for their bonding materials such as Clearfil and Panavia, are also experts in the field of porcelain and zirconia. They have had a line of lab zirconia (in larger pucks instead of blocks) called Katana. The best part of the system is that they built vertical shading change into the block itself. Think Empress MultiCAD blocks from Ivoclar. They show more depth of color and better translucency than the average milled zirconia block.
Dr. Greg Campbell, one of the best clinicians out there (as well as a good friend and mentor!), also introduced a new way to finish the Katana material. By going through a series of polishing steps prior to sintering, the crown comes out of the sintering oven looking glossy as if it had been glazed already. You can either deliver it right then or customize it with more stains if desired. Either way, using this technique avoids the post-sintered polish that can create a pearl effect on the finished surface.
3D Printing – Building a New Future
For the most part, the best application of all this CAD/CAM technology has been the ability to fabricate restorations by either milling chairside or sending the case to the lab as a digital file. The beautiful part about capturing the mouth in a 3D model is that this file can be utilized for 3D printing as well. We have seen the widespread commercial use for 3D printing, and I know a few people who have small inexpensive machines in their house for printing knick-knack toys. However, the applications in dentistry are already beginning to revolutionize the industry.
For example, rather than waiting for several weeks for a surgical guide, why not print one right in your office? A patient misplaces their retainer or Aligner? Just print another one. You can even print an entire denture base in one resin type, and print the teeth in another. As with other CAD/CAM technology, it gives us the ability to improve accuracy and efficiency when fabricating these things, and dental labs have pushed to adopt these technologies at a faster pace than dental practices. Labs are using these systems to print models, wax-ups, and to add efficiencies and quality improvements to numerous other steps in their production workflows. A number of new printing innovations unveiled at Midwinter and the concurrent Lab Day event print faster, are compatible with more materials and automate the finishing of these 3D printed parts.
Systems such as the EvoDent DLP 3D Printing System are compatible with dozens of materials and can be used for more than 10 indications including models, custom trays, indirect bonding trays for ortho, retainers and more. This versatility and the fact that additive manufacturing can be more cost effective than milling point to this technology continuing to grow within dentistry. In fact, chairside 3D printing is already viable for tasks such as surgical guides, and fixed restorations could be coming out of a printer before long. DWS Systems demonstrated their DFAB printer in Chicago. The machine is designed for the production of long-term temporary crowns and bridges of up to five units, and it can print them in less than 20 minutes. It can even apply shading changes throughout the crown or bridge. Just as with CAD/CAM milling, as the materials for these systems get better, the clinical possibilities will continue to expand.
Cloud Software – Not Just a Lofty Ambition
One standout category this year in Chicago was cloud-based practice management software. I have heard arguments of how a big server is best and most reliable. When it comes to imaging and storing large files from cone beam systems, I would agree that having a good server and a fast local network is best, but anyone who has done an upgrade from one behemoth version of PM software to another knows the pain involved.
Our own office has typically waited a year or more before upgrading to different versions of the software because we knew it would be days before things would be working well again. Need to roll a new workstation out? Plan on paying your IT guy for four hours of time at a minimum. Plus, there is the constant worry that our backups are working and staying current.
Because everything is run from a web browser such as Chrome, cloud software eliminates every one of those headaches. New workstation? Turn on the computer (PC or Mac) and open a browser and log in. Connecting from home? Open a browser and log in. Need to install the latest updates? Close and reopen your browser and log in. Hurricanes or wildfires destroyed your practice computers? You can manage the entire practice from your iPad.
Top on the list of these cutting-edge platforms are Dentrix Ascend, Carestream Cloud, and Patterson Dental’s Fuse. They all work wonderfully from a simple internet browser, and the user interface is clean and tidy.
Up to this year, the main shortcoming of these systems has been the amount of features that were available. But rather than simply roll out a direct online version of the local PM software, these developers are thinking more about workflow and how the modern dental practice is run.
It’s a great example of “Intelligent Design.” They have gone into the workflow of each staff member, and even created quick-view reports to keep your finger on the pulse of the practice. For example, rather than having 14 steps to print out a list of patients overdue for recall, you can find the information with a single click. That means you can access relevant information quickly, without getting bogged down with yet another tech support call. That means this software becomes an asset to your practice, rather than a headache.
Whatever software you are currently using, all have upgrade paths with database conversion that are available to you whenever you are ready to take things to the cloud.
While online shopping may continue to grow, it’s nice to be able to get a hands-on preview of all these products. And if you are missing the details that go with the products, look no further than Dentalcompare to fill you in on the latest. We will continue to help you make the best decisions for your practice to bring your clinical care to the next level.
Are there other exciting new products you have seen? Anything you would like to see covered further by Dentalcompare? Drop a comment below!