Add-On Value with Add-On Modules
Innovative business tactics are helping to expand the use of CAD/CAM
This past year has been exciting for developments in dental CAD/CAM systems. Although we still have not achieved the elusive "one-click crown," the key players have enhanced the ease of use and speed of design for their core crown-and-bridge systems to get us closer. In addition, CAD companies have extended the breadth of their capabilities by developing more add-on modules for their respective platforms. For the past 3 years, the number of these modules for both open-software CAD platforms, such as 3Shape, exocad, and Dental Wings, and more proprietary platforms, such as Sirona, Straumann, and Nobel, has increased—and many more are on the way.
Using add-on modules is a smart method for laboratories to add new products to the line of offerings and expand the capabilities of their CAD/CAM systems. These modules enable the purchase of additional capabilities that can be integrated into the current workflow as the laboratory masters the basic CAD platform. For example, a laboratory that purchased a CAD system for crown and bridge design may later decide to tackle designing custom abutments. The laboratory can simply purchase the add-on module, and the new capabilities will be available in the CAD system. Some companies have aided the process by allowing "as needed" use of an add-on module so that laboratories can grow their volumes before investing in purchasing a CAD module. 3Shape, for example, introduced the CAD Points business concept. A laboratory can purchase a pack of CAD Points and use them as needed to design units in certain add-on modules without actually buying the module itself, helping to defer the investment until the laboratory is confident that it has the volume to justify the expense.
Custom implant abutments and bars, partial removable frameworks, and model design modules are all available from most of the major CAD companies today. These modules are not new, but each company continues to enhance the functionality to provide faster design and more control.
Surgical Planning and Guided Surgery
One recent addition to the open and proprietary CAD players is surgical planning and guided surgery, which opens a new realm of capabilities for laboratories. This is a major area of focus for all CAD players and has spurred the creation of independent software and Internet-based modules such as 360imaging, Blue Sky Bio, and iDent. In 2012, Sirona implemented integration between its CEREC CAD software and its GALILEOS imaging system, and now the open-architecture players are making it available as well. Dental Wings and 3Shape have released their modules already, with Exocad’s expected soon. The concept here is to utilize a cone-beam computed tomography (CBCT) scan, merge it with a surface scan of the model scan or the teeth directly (using an intraoral impression scanner), and optimize implant placement in the bone. This optimal placement is informed by the CBCT scan showing bone mass, bone quality, and nerve location.
Integrating this with the restorative design software enables the user to interactively adjust the implant placement to properly support the restoration. The ability to collaborate with the surgeon and general dentist helps the laboratories become involved in treatment planning from the onset of the case. Often, the positions of the restorations are not taken into account during implant placement, which creates significant complexity for the dental laboratory to fabricate a functional and esthetic result for the patient. By having the CBCT data, surface scan data, and restorative design all integrated, the implant placement can be easily optimized for the best outcome.
3Shape has just released the Implant Studio module in November 2014 in North America after acquiring regulatory clearance (Figure 1). The user interface is built using the same design theme as 3Shape’s other CAD software, so the look and feel will be familiar for 3Shape users. The step-by-step workflow bar at the top of the screen walks the user through the process to generate the plan and guide. 3Shape supports two workflows for planning and guide design. In the first workflow, the laboratory can generate a proposed plan and guide design and send it to the surgeon for approval prior to fabrication. The second workflow enables the surgeon to set up the plan and guide design and then send the design to the laboratory for fabrication.
In 2013, Dental Wings purchased coDiagnostix, a surgical planning and guide software company, and integrated it with its own prosthetic CAD software offerings. The most recent software release unifies the prosthetic design software with the surgical planning module to work more seamlessly together. To take this a step further, the Dental Wings Synergy system is a unique collaborative platform that enables the surgeon to modify the implant position, which is reflected in the laboratory’s CAD software in real time via an Internet connection between the surgeon and laboratory (Figure 2). The laboratory can then adjust the crown design, which will be reflected instantly in the surgeon’s software. This allows live interaction between the two parties to rapidly determine the ideal plan. The Straumann CARES System can also provide this capability as it has fully integrated Dental Wings functionality.
Once the plan is determined and approved by the surgeon, both systems will generate a surgical guide design, which can be fabricated typically by additive manufacturing.
Exocad has rolled out a new version of the exocam module, available in two formats. The first can perform the complete CAM function, including everything from nesting to tool-path generation. The second is a "nesting only" variant for integration with tool-path calculation algorithms purchased from third parties. For example, if a laboratory already has CAM software such as Sum3D or Delcam, exocam can serve as an integrated front end for the nesting function and then send the nested project to Sum3D silently in the background to calculate the tool paths.
3Shape has also opened up to be able to work with third-party CAM software (Figure 3). Both 3Shape and exocad recognized that many laboratories have CAM software with milling strategies and optimizations that work well with their existing equipment. By integrating with the existing CAM software, they can provide a more integrated user experience without running the risk of changing their tool-path calculation engine in production.
Streamlining the CAD/CAM Workflow
As laboratories implement CAD/CAM processes and begin to scale up their infrastructures, all of the systems connected to the workflow generate data that can be used to provide visibility and optimization to the digital workflow in the laboratory. An add-on software module, developed by Custom Automated Prosthetics, called CAPZilla plugs into the CAD/CAM components and the case-management system to unify this data, streamline the workflow, and provide high-level visibility into productivity, system utilization, and remakes. This information is gathered from the systems already used in the process without burdening technicians with the task of performing additional data entry.
This information can be used to help understand how the laboratory personnel may be contributing to the amount of internal remakes and can provide real-time feedback to improve on faster cycle times. High-level reporting provides laboratory owners with trend information about the performance of the overall production. These reports can also provide insight into equipment utilization to determine whether a new piece of equipment is necessary or if there is hidden capacity. By providing deeper visibility, this add-on to a CAD/CAM system enables the laboratory to make data-driven decisions to continually improve processes, eliminate waste, and ultimately increase profitability.
Unlike most hardware investments, these actively developed software modules grow in value. The CAD/CAM software of today is significantly better than the versions most laboratories purchased a few years ago, or even just earlier this year for that matter. Laboratory owners who are keeping up with the upgrades and add-ons are benefiting significantly from this phenomenon and will continue to do so for years to come.
Rob Nazzal is the CEO of Custom Automated Prosthetics (CAP) in Stoneham, MA.