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Chairside CAD/CAM Dentistry: Cents and Sensibility

Issue: Fall 2009

With the introduction of the new E4D Dentist® System (Figure 1) through Henry Schein Dental, providing Same Day Dentistry™ solutions for single-unit indirect restorations is a more viable alternative to conventional two-appointment “prep and seat” procedures than ever before. Although the opportunity is not new, the E4D Dentist System makes Same Day Dentistry™ more practical by offering multiple options for capturing data; more efficient, with DentaLogic Software that guides the user through an easy to use and easy to understand design process (Figure 2); and more exciting with Autogenesis™, SOS™ remote access, and Henry Schein Dental Sales and Support. Let’s take a look at some of the factors that you can consider to determine if Same Day Dentistry with a chairside CAD/CAM system is something you, your practice and your patients can benefit from. In other words…Is E4D 4U?

Healthier Dentistry

Consider a daily practice situation where after prepping, impressions, and placement of the temporary, the patient turns to a clinician when told about coming back for the final restoration in a couple weeks, and asks “why?” Why do I have to come back again, just to get the final restoration? Unless we are dramatically changing the occlusal scheme, or the life of the tooth is questionable, the only answer we as clinicians can provide the patient is really “That’s how long it takes to make the final restoration.” In other words, the dental profession is one of the few healthcare professions that makes an incision into the body and then rather than seal, suture, or stabilize the situation, we basically allow the patient to leave our office and bathe the preparation/provisional in bacteria for a few weeks, allow tooth movement to occur, including hyper-eruption and leave the tooth in a more susceptible, structurally weakened situation than ever before—all because we didn’t think we could offer a Same Day Solution for single unit indirect restorations without a compromise in form, function, or esthetics. That was before the E4D Dentist System. Being able to provide a permanent solution within minutes of prepping the tooth minimizes or eliminates the deleterious effects possible with provisionalization of these singleunit restorations and provides the office with economic benefits and the patient with extraordinary convenience.

Better Economics

Determining if this type of high technology is right for your practice requires careful analysis of the return on investment (ROI). A practice must not only consider hard costs and the potential financial return, but also the positive marketing impact to patients—current and future. In the case of chairside CAD/CAM dentistry there is also a shifting of some financial and human resources from an outside fabrication service to in-office design and fabrication (i.e., milling) processes.

Practice overhead (typically 60%–70%) makes up the majority of “costs” of any dental procedure and being able to complete a procedure in one appointment that previously took two appointments, with about the same amount of chairtime, automatically saves the practice time and money. With no second appointment, there is no expense for greeting, seating, patient preparation, operatory turnover or the possibility of second-visit cancellations.

Every ROI is unique to the individual practice but in most scenarios, if examined closely, the time-tested practice of delivering one restoration over two appointments—separated by up to three to four weeks—is a suspect income generator. Consider a situation where a dentist resists raising his/her fees for the next six years—for fear of losing patients. He/she charges $1000 for an all-ceramic indirectly fabricated restoration. If the practice is prepping and delivering a single-unit restoration over two appointments (based upon a 60%–70% overhead and a $150 fabrication fee) the procedure becomes at most a break-even situation after a certain period of time. With the introduction of Chairside CAD/CAM dentistry, the same doctor completing 20 restorations a month in single appointments versus two appointments and with no fabrication fee, lowers overhead and increases the profit/restoration for the practice dramatically—even without raising fees. This assumes material costs remain similar, five years of payment on the equipment, but does not take into account the potential upgrade of some direct restorations to indirect restorations because of a greater confidence in proximal contacts, contours, and occlusal form and function. Chairside CAD/CAM dentistry—the ability to scan, design, mill, and deliver a restoration in one appointment—may make economic sense for a practice such as this (Figure 3).

During economic slowdowns, it is more important than ever to be in control of major expense categories and analyzing areas where monthly outlays can be conserved and in-house services expanded. Unfortunately, determining if Chairside CAD/CAM dentistry is right for a practice isn’t just a matter of plugging in the number of restorations/month x laboratory fee to determine investment potential. A practice has to take into account the potential “upgrade” of large direct restorations, the impact and awareness to a potential patient base, and the general perception of the practice on being on the cutting (aka milling) edge of new technology. Your local Henry Schein CAD/CAM Specialist can assist you and your practice to determine if this type of technology is right for you economically.

More Convenient

Modern Dentistry for Modern Lifestyles™— that’s what successful dental healthcare professionals today must offer. Patients’ lives are busier than ever before—with carpools, business meetings and travel and just an overall more hectic schedule. Maximizing the efficiency of a dental visit, with the potential of reducing the number of visits to the office by half is an extremely attractive option for most patients.

Chairside CAD/CAM Dentistry is also a convenience for the office and team members. The office is now in complete control—of its schedule…no second appointment scheduling conflicts, of the restoration…knowing exactly where the restoration is and its status…as well as complete control of the treatment options and material selections. With this type of dentistry, digital images of the preoperative condition, the preparation, and the final design can be saved for patient records, future restorative options, or team member education and training. In addition dental assistants can take advantage of the CDD (Chairside Dental Designer) Program (Figure 4), exclusively through E4D University, where they can elevate their creativity, design, and chairside participation through additional CAD/CAM instruction, intraoral photography (Figure 5), and staining and glazing skills.

The E4D Dentist System provides dental offices with an all-in-one solution for Same Day Dentistry.

Laser-based Scanning: Scanning of the preparation and neighboring dentition can be done without the use of a contrasting agent (aka “powder”). Impressions (even alginates) and stone models can also be scanned providing several options for case completion.

 Intuitive Design: DentaLogic software and proprietary automation (Autogenesis™) guide the designer through the process from detailing margins through final restorative design.

Mill: Precise milling of metal-free composite and ceramic restorations is accomplished in minutes with the robust E4D Milling Center. Wireless communication, automatic tool changer, and touch-screen display facilitate utilization in the office.

Contact your local Henry Schein CAD/CAM Specialist to see if E4D is 4U.