Every so often I write an update of what has happened in our practice in our little minor digital revolution in the backwater of Nottingham. I realised I haven’t done one for a little while yet things have moved on dramatically for us.
The last time we spoke I was talking about the benefits of the production of CEREC Guide 2 and how utilising in house capability of milling allowed us to produce our own surgical guides to any design. We have now been able to explore these much more fully and also reflect on over a year of CEREC Guide 2 and over 150 guides milled.
I think it’s fair to say (although I don’t have exact figures to hand) that at least 33% of the CEREC Guides we have milled haven’t fitted. We have had some contact with the guys at Sirona in Germany to discuss this and it’s clear that we didn’t particularly understand the true pathways that were in place for utilisation of CEREC Guide 2 along with the proprietary Sirona guides that you design and send to Germany.
For single upper anterior sites for guided surgery CEREC Guide 2 is an extremely useful tool but there are significant restrictions on where it can be used, particularly where there is considerable metalwork on a CBCT scan leading to scatter and distortion. Under these circumstances a classic guide must be used which is more time consuming and more expensive.
To get around this we’ve investigated a third party software for the production of surgical guides and the platform we’re utilising at the moment is Co-Diagnostix, one which is favoured by my friend Nick Fahey and also Craig Parker. Our problem with Co-Diagnostix when we first installed the digital milling software in the lab in the practice was that we were unsure if we could mill the Co-Diagnostix files. For £40 per guide we can access the full STL file and mill it on our Sirona MX5 machine. This makes the overall cost of the surgical guide ludicrously inexpensive (excluding the cost of the milling machine itself) approximately £20 per guide not including design cost. The inserts provided by Straumann for the guided surgery guides are very inexpensive and reusable so almost a negligible cost. The other benefit is that Co-Diagnostix guides can be multiple site and when you add sites in the cost of the guide effectively reduces again.
While it’s possible to mill CEREC Guide 2 guides with multiple sites, the key system used by CEREC Guide with the long handles makes using them in posterior sites is almost impossible and the width of the keys means that using them in narrow anterior sites is also very difficult.
We continue to explore the possibilities of in-practice milling for all of our conventional and implant restorations and we’ve had considerable success with this. I suppose one of the most innovative success we had is the milling of PEEK Maryland bridgework for temporary restorations. This material is a fantastic utility material in the milling machine and we can mill large span Maryland bridges that we use routinely in implant dentistry for temporaries in-house now very inexpensively but more importantly very quickly.
We’re now milling full arch restorations of our own for implant restorations in the practice and are making use of the new Atlantis CAD CAM abutment system which works seamlessly with the CEREC scanner.
I have been asked to speak again at the digital symposium in London this year on May 5th and 6th and this will likely be the last time I speak here for a while as i’ve done it a few times in a row now and I’m sure everyone’s getting bored! Some of theses updates I’ll be able to do here, particularly in the realms of guided surgery.
It’s very important for me as we share our thoughts on this stuff with everybody that we investigate as many different avenues as we can, utilising CEREC Guide 2 to its maximum potential but understanding its disadvantages together with utilising third party software systems to allow us to bypass some of the blockages that exist in the software systems.
Blog Post Number - 1211