CAD/CAM dentistry has been around quite awhile. In fact, we had this technology in our office in the early 1990s. At that time these machines were in their primordial state. CAD/CAM stands for Computer Aided Design and Computer Aided Manufacture. The two titans in this arena that are battling it out in the dental marketplace are the D4D CAD/CAM made by the company E4D and the Cerec CAD/CAM made by Sirona. Each has its advantages and disadvantages. The entire package for each one runs above $120,000. Let me spell that out, one hundred and twenty thousand dollars. What do these machines do? They allow the dentist to take a tooth that needs repair and prepare that tooth to accept a restoration. Then the machine takes an optical impression of that prep and sends that to the manufacturing side of the unit and fabricates the restoration.
The main advantage to the CAD/CAM are like many new technologies that they can increase efficiency. Instead of approximately two appointments for that new crown, it might take one appointment. And multiple teeth can be completed in one, albeit longer, appointment.
Two days ago I found myself sitting on a flight next to another dentist and he saw I was reading the Cerec magazine and asked, “Are you a Cerec dentist?” Neither of us, as it turns out, uses this new technology. Why? His first words why he has not embraced CAD/CAM mimics how I feel at this point. “My lab man does far more for me than just make a restoration,” he told me. WOW. It comes down to the dentist’s time and what the lab does for us. These have been my thoughts exactly.
This past week I had two very difficult restorations to complete. In one, a 54 year old man fractured a lower right second molar that we placed a temporary on two weeks ago. Because of the way his bite exists, the amount of tooth that needed to be adjusted for the crown was limited. So Mr. Jeff Austin at Utah Valley Dental Lab who is a wonderfully talented guy, one of the most talented laboratory technicians in the country, made this crown. But he made this crown the thinnest he could bringing the specifications to the minimum thickness that the material allows. Yes, I could of made this crown with a CAD/CAM machine, but it would not of been the same. Jeff spends far more time perfecting this crown than any dentist would have done with a CAD/CAM. He sees things that may not be readily apparent and he will call me and discuss the different options to get what is best for the patient. Jeff is a true professional striving for excellence. This crown that was seated on this man was a symphony to me: materials, bite, fit, color and shape all worked together. A difficult tooth that we made look easy.
The other difficult case that we seated this past week was on a 62 year old patient that I’ve known for 25 years. This tooth had some gum issues where the margin of the crown was below the gum, hidden in a way. The first time we did this restoration nothing was right. The bite was off, the fit was off, even the color was off!!! Bad dentistry? Bad labwork? Not at all. It would have been bad if we altered it to fit when it really just needed to be redone completely. Excellence in dentistry is not getting it right the first time, it comes from just getting it right. This week we cemented the remake. It really was another symphony.
At this point in time I like the Computer Aided Design part of the CAD/CAM duo. I can see a time in the near future when I purchase half of the machine (yes, you can do that) so that I can send the optical impression directly to the lab and have them fabricate the restoration. I am waiting for the right moment to get into this area. These machines and my lab have to sync up before I leap. As I’ve said before with technology, you don’t want to be the first to get in and you don’t want to be the last.
The point is that with an excellent laboratory behind the dentist, as a partner, the value of the CAD/CAM machine becomes greatly diminished.
So whether it is CAD/CAM, Invisalign, Erbium/Yag Lasers, Diode Lasers, Velscope, Digital X-rays and all our other high technology equipment, it is important to put these new technologies in perspective and not believe that the technology is the end in and of itself. It is not the hammer; it’s the house you build with it.
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