Chairside CAD/CAM Dentistry: Benefits and Drawbacks
Despite the length of time since digital dentistry’s inception in 1985, there’s still an ongoing, healthy debate about its value and place in general dentistry practices.
When evaluating new technology, experts recommend considering three questions:
- Does it improve the ease of care?
- Does it make the patient more comfortable?
- Does it improve quality?
If you’re considering investing in chairside CAD/CAM, we hope you find this overview of its advantages and drawbacks, which addresses the points above, helpful.
WHAT PROPONENTS LOVE
Time Savings. The principal and best-known advantage of chairside CAD/CAM is that it saves both doctor and patient time by delivering the final restoration in a single day. No second appointments, no provisional to make or to re-cement. In fact, the technology allows clinicians to work on and deliver multiple single-tooth restorations in one visit.
In addition, by training assistants to scan the arches and bite, and to handle other tasks, the doctor can be available to see other patients and perform other procedures, thereby maximizing his or her time.
Staining is an art form. Some doctors use the lab for anterior restorations initially until they build their comfort level. But once they’re accustomed to staining, they find that having an in-office unit gives them the ability to modify the restoration shade without having to send the product back to the lab, saving both time and expense.
No Physical Impressions. CAD/CAM technology doesn’t require physical impressions, which creates several advantages. For one, it removes the risk of impression shrinkage, leading to fewer adjustments and less chair time.
In addition, it eliminates the need for repeat impressions. If there’s a void in the image, you can rescan the selected area or the whole tooth depending on what’s needed.
Creating only digital impressions enables you to archive patients’ impressions for as long as desired without the need for a physical space to store casts. Digital impressions also eliminate the need for purchasing impression trays and materials, as well as the cost of shipping impressions to the lab. A related benefit: reduced environmental footprint.
Better Patient Comfort. Many patients are uncomfortable with the impression process, which can cause discomfort, gagging and stress. Removing this step can mean higher office and doctor ratings online. Over the years, the intraoral scanner has become smaller and faster, eliminating the need for patients to keep their mouths open for long periods—something that originally was an issue.
For patients with cognitive impairment or physical challenges, many dentists find it very helpful to have the ability to deliver the prosthesis on the same day.
With regard to treatment acceptance, scans allow doctors to show patients the final product, which improves satisfaction.
Multiple Use. Chairside CAD/CAM enables doctors to fabricate crowns, bridges, veneers, inlays and onlays, and implant surgical guides. Some scanners, such as iTero, provide the ability to make night guards and clear aligners in-house. Alternatively, digital impressions can be remitted to a lab for those products.
Fun Factor. Many doctors who do digital dentistry truly enjoy the process. They find that learning to use this technology and integrating it into their practices increases their professional satisfaction.
Improved Quality. Those who use a CAD/CAM system also argue that it improves care. Because the camera magnifies the prepped tooth, dentists can adjust and improve the form and margins immediately.
Competitive Advantage. In some communities, providing digital dentistry services might give you a strategic advantage. When deciding whether to invest in this technology, consider what your competitors are doing and whether patients have been asking you about “same day dentistry” or “teeth in a day.”
WHAT CRITICS POINT OUT
High-Cost Solution. Chairside digital dentistry is a significant financial investment involving multiple pieces of technology, including the CAD/CAM system itself, a Cone Beam CT for 3-D imaging, and an optical scanner for digital impressions and accurate color analysis for staining. There’s also the cost of software updates, as well as restorative materials.
While solo practitioners can, of course, be successful in making their investment pay for itself after a few years, it might be easier to dive in if you’re in a group practice.
Keep in mind that practices no longer need to take an all-or-nothing approach to digital dentistry. Whereas CAD/CAM once required the purchase of a complete system, today’s intraoral scanners save images via stereolithography files that can be read by the lab. This makes it possible to get started with digital imagery and add in-house milling equipment later, once your staff is more comfortable with the technology.
When deciding whether to invest in digital dentistry, consider the savings as well as the expense. For example, fabricating prostheses in-house means saving on lab fees, and improved efficiency will help to defray the cost of your investment.
Learning Curve. Doctors and staff will need to receive training on how to use the software that runs CAD/CAM technology. Newer software carries out a number of steps in the background, enabling the dentist to arrive at the restoration with fewer clicks of a mouse. Adopting digital dentistry also means adjusting to a new workflow.
Quality Concerns. While the quality of early CAD/CAM restorations has been a concern, as digital dentistry advances, so does the quality of the restorations. For example, restorations that use a 5-axial milling unit handle undercut better and are more exact than those milled with a 4-axial unit.
Research suggests that today’s CAD/CAM restorations are stronger and less likely to fracture than those milled from earlier materials, and that they fit better as well.
Many factors play into the decision to invest in CAD/CAM technology. Success depends on several variables, including your own enthusiasm, your staff’s willingness to learn new technology and change long-standing processes, and your practice’s competitive environment.
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