Inside Dental Technology
Incorporating recent innovations into the laboratory
Since the advent of dental laboratory scanning and CAD in the 1990s, digital technology has now evolved to provide users with more efficient multi-indication solutions. It is no longer a question as to whether scanning and CAD will be standard manufacturing protocol in dental laboratories with the rate of adoption of CAD/CAM technology accelerating rapidly. Scan and design technology has progressed to outperform analog processes in most every application, and the bigger question relates more to sorting through the many choices of leading scan and CAD technologies.
On the hardware side, we are seeing a dramatic increase in the number of scanners on the market. This has largely been driven by Exocad’s business model, which focuses on the software integration with scanner hardware. By contrast, 3Shape engineers build scanners and develop the CAD software as an integrated package. These two approaches have some parallels to the Google Android and Apple iPhone approaches, respectively. Google provides a customizable operating system, which manufacturers can then customize and use with their own hardware. Exocad’s approach is similar. Exocad sells its software through distributors that build their own solutions by coupling the software with their hardware, and customizing it. Exocad resellers can execute cosmetic customization of the software on their own, or engage a custom development project with Exocad to have them build unique features for the solutions they desire. Therefore, there are many different flavors of Exocad solutions on the market with different capabilities. Dental Wings has taken a hybrid approach to the market by doing OEM deals with major manufacturers such as Straumann to power its CARES® 7.0 CAD solution, while also providing a Detnal Wings branded solution to the market in a single scanner.
At this year’s IDS meeting in Cologne, Germany, Exocad exhibited 17 different scanners that work with their software. These scanners have varying levels of integration with the Exocad. At the basic level, scanning is performed by the hardware manufacturer’s own scanning software and then imported into Exocad. There is a deeper level of integration in which Exocad’s own scanning software, Exoscan, can drive the scanner to provide a more integrated workflow experience. Currently, ExoScan supports seven scanners.
While 3Shape continues to offer its D500, D700, and D800 scanners, the company has also added the D900 to its line. This scanner makes advancements in both speed and accuracy. It achieves this by using four cameras simultaneously, rather than the two cameras offered by the other three scanners in the product line. By incorporating more cameras, the D900 can scan approximately 40% faster and provides more angles to see inside cavities for impression scanning. The D900 scanner also scans in color, which can have many benefits, particularly when it comes to partial denture design. An experienced technician can mark up a design on the physical model with colored pencils, scan the model, and the scanner captures the physical design to guide the final CAD virtual design. This scanner also uses blue LEDs instead of a laser light and custom designed optics to further enhance the accuracy of scans.
Other manufacturers introduced new iterations of their scanner product line. Amann Girrbach introduced its new scanner, the Ceramill Map400. Said to offer faster data acquisition, the scanner supports sensitive 3D sensors for less than 20-micron data capture. Medit, makers of the Identica high precision scanner, had their newest scanner on display, and we should be hearing more about it in the coming months. Nobel Biocare unveiled the next generation of the NobelProcera™, the 2G, with advanced automation features. Sirona also had a next generation release with their InEos® X5, a fully automated 5-axis unit that can capture an entire jaw in about 10 seconds.
Zfx has brought an interesting and unique feature to the desktop scanner market. The wide variety of implant interfaces on the market can often create challenges in the scanning workflow, and may require that the CAD technician setting up the order inputs the correct implant information. Most scanners use an implant scan body to accurately identify the position and orientation of an implant in a given case. The Zfx Scan Evolution takes this a step further by automatically identifying the implant interface by reading a “circular barcode” marking on the scan body. This is a clever feature that can help to reduce data-entry issues when setting up a case in the software.
Dental Wings has filled a need in the industry by offering bridging technology for the digital connection between the dentist and the laboratory until intraoral scanning becomes more mainstream. Their solution is the iSeries Dental Office Impression Scanner, which the company has nick-named the “3D fax machine.” The scanner holds a traditional impression tray and allows the dental assistant to easily set up a case to be scanned. The scan is then sent to the dental laboratory electronically for design and fabrication. This allows dental offices not ready to adopt a digital impressioning system to take an incremental step toward a digital dentistry workflow.
The general trend in CAD software development and maturity is enabling users to take on complex cases in dentistry with ease. Zirkonzahn blazed the trail for their full-arch screw-retained full-contour zirconia bridge restorations called the Prettau Bridge using their Exocad-based design software. With the rapid growth of implants, and the need for more robust and cost effective solutions for edentulous patients, these cases are a very attractive option for both dentists and patients. Rather than using a costly noble metal substructure and applying porcelain, which is high in labor and subject to chipping, Zirkonzahn’s Prettau Bridge restorations cut material costs dramatically while yielding a high strength and esthetic result. 3Shape’s new 2013 CAD software now makes it much simpler to obtain a final digital design for these full-arch, full-contour, screw-retained bridges with specific tissue design features. Additional CAD features such as the ability to “mirror” a wax up or pre-operative scan also adds to accuracy and dramatically reduces the labor required to obtain a final design.
Another application for edentulous patients is the denture, which until recently, has not been addressed by CAD/CAM technology. Both 3Shape and Exocad are in the process of developing digital denture CAD packages. 3Shape launched their first denture module this year, and Exocad’s is coming soon. One of the challenges with developing new modules is that the CAD, materials, and fabrication processes all need to evolve together. We are now starting to see these components evolving to a point where it is a viable option to fabricate removables digitally, but it is still in its infancy relative to CAD crown-and-bridge workflows.
Another need being met by CAD software developers is that of model design and production from digital scans in the practice. There was a number of new intraoral scanners on display at the IDS this year, some already on the market, and some coming soon. As laboratories prepare to accept digital scan files from their dentists, they need a way of receiving the scans and producing physical models for these cases. Some intraoral scanner manufacturers have created production facilities to fabricate proprietary models. However, there is a now trend in software enabling the laboratory to take more control over this process. Exocad, 3Shape, and Dental Wings have model designer modules that allow users to take imported intraoral scans (or impression scans) and design a model for fabrication. As model fabrication systems are becoming more affordable and practical to use, dental laboratories will be doing more and more of their model work digitally. By having the model design capability integrated in to the CAD software, it helps to streamline the overall workflow for the production of the restoration.
CAD software brings a unique dynamic to the laboratory industry compared to other major purchases because the CAD system that a laboratory purchases today will improve as the supplier releases software upgrades. For the most part, CAD systems purchased three years ago from manufacturers continue to develop CAD software improvements that have delivered advances in ease of use and performance, as well as new indications and capabilities to enhance the overall experience well after the purchase of the product and ROI has been achieved. There are costs involved with getting access to the upgrades, but since the upgrades typically streamline the workflow, open up new indications, and reduce labor costs, the laboratory often experiences a quick return on investment.
There are many viable choices for CAD software and many more for scanning technology hardware. For the best value, laboratories should evaluate systems based on the indications they currently need and potential new applications that could be profitably integrated into the laboratory. Furthermore, the laboratory should consider potential future indications and select products that are anticipated to grow ahead of, or a least in line with, the market. In addition, selecting system components that will include the least labor required to obtain best-in-class designs will help one compete in the market. Most importantly, buyers should talk with their peers who have purchased the systems. This helps them to know how these technologies truly perform in a laboratory environment, as well as how well the users were supported by the manufacturer or reseller. Selecting a reseller based on a strong track record of training and support is equally as critical in the buying decision as the technology decision itself. Making a well-informed technology decision that suits the laboratory’s needs and partnering with a strong reseller or manufacturer will result in a very high success rate for laboratories adopting the technology and experiencing the benefits of CAD for years to come.
Rob Nazzal is the chief executive officer of Custom Automated Prosthetics (CAP) in Stoneham, Massachusetts.
See the progression of CAD technology since Rob’s overview last summer at dentalaegis.com/go/idt380