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Another digital update from The Campbell Clinic

Colin Campbell
by Colin Campbell on 23/04/17 18:00

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So where are we now?

Over the past three years or so I have periodically done some little updates in the hope of helping people navigate their way through this extraordinary but complicated and ever growing digital world that we’re in.

As I look and think back to what I’ve written previously it seems it was ridiculously simple only three years ago.

From our point of view, at the end of last year we invested in a full Sirona laboratory set up to run in the practice with our two technicians, Mark and Marta. That included a 5-axis milling machine, a Sirona lab scanner and a furnace for ceramic. Without a doubt this was the biggest digital jump forward since we invested in CEREC and the Sirona CBCT three years ago.

In general terms, this is proving to be very successful although it is a very steep learning curve. The Sirona 5-axis milling machine is an extraordinary device to use and to watch and although we have had a couple of mechanical difficulties with this machine in the first six months, some of the work we’re able to produce with this is extraordinary from a practice point of view. This includes such things as milling our implant surgical guides (not printing) milling any form of restoration in ceramic, acrylic or composite from a single unit to a full arch, milling full arch temporary PMMA bridges and milling PEEK, in particular Maryland bridges which has been a great addition to the practice and something we can do very quickly in the event of difficulties or problems.

The five-axis milling machine though is much slower than the CEREC mill because it has a single motor and the CEREC mill has two motors. This means that individual crowns can be milled much quicker in a CEREC chair side motor.

Small CEREC Guide 2 surgical guide units can still be milled in the desktop milling machine whereas the larger surgical guides are milled in the 5-axis milling machine.

Moving into this world though has led to further opportunities for development and mind-boggling visions of what is to come along with difficult decisions on where to go next. My technician Mark Melbourne was as IDS on behalf of us to look at all the things that are available and the amount of information and ideas he brought back was extraordinary. We are also a regular stop off now for people in the industry who are interested in digital who want to either talk to us to try to sell us something (I try to limit this as much as possible) but it’s clear there is a huge battle going on and it also seems obvious that not everybody knows exactly what or why they’re doing things with this and haven’t yet figured out how it will make money or benefit patients.

We have integrated into the practice the use of Co-Diagnostix which is Straumann’s preferred platform for guided surgery planning. This allows us to design and mill Straumann surgical guides quite inexpensively but to extremely high quality and the milling of guides provides an excellent option that can be taken on by labs anywhere or by anyone with a larger milling machine in practice.

As yet we haven’t stepped into the 3D printing arena because I want more functionality from a 3D printer than just milling surgical guides and I don’t feel in my practice that the milling of surgical guides would add up to the value of investing in a 3D printer (particularly not when we can mill our guides in a machine that will also mill full arch bridges). We do though think that it’s likely we will soon be able to invest in a 3D printer which will allow us to print mandibles and maxillae which will allow us full visual analysis of larger cases before we start, for example immediate full arch cases.
Finally though, the use of prototypes digitally in advance of treatment being carried out are so straightforward and simple for the digital programme that they can then be transferred into provisional restorations at the second stage of implant treatment and, if all is well, can be copied exactly for the final restorations in ceramic. This is something that is now happening routinely in full arch cases but a patient will undergo immediate full arch reconstruction on a single day, followed by provisional PMMA (acrylic) restoration at three months for approximately three months wear. This can then be re-scanned and copied almost exactly (any wear or chipped areas can be remodeled by the technician prior to milling) then the restoration can be milled in ceramic.

I hope this is understandable – as I write it it does seem to be something that I would never have been able to pick up even three years ago. The journey is not straightforward and not without it’s ‘speed bumps’ along the way but it is definitely providing advantages for our patients and it is definitely providing advantages for us. So it’s a win win situation which we are now really committed to moving forwards.

Note – I am speaking at the digital symposium in May presenting video of a very difficult upper anterior surgically guided case. If this is something you’re interested in it might be a good place to start.

 

Blog Post Number - 1260

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Colin Campbell
Written by Colin Campbell
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