Latest Blog Post

Perhaps worth an update for the guys that are asking lots of questions to us about the digital pathway we have been trying to develop over the past 18 months – 2 years.

It is a very interesting road that we have travelled; there has been a lot of pain and a lot of pleasure and some enormous highs. We are more and more invigorated by the journey into digital than we ever were at the start.

Where we are at the moment is that we had five targets in the first two years of the digital integration into the practice, which for us started with Sirona and the XG 3D CBCT machine, the Omnicam and in-practice milling. These were to:

1. Provide implant diagnostic wax ups using CAD CAM and milling in house
2. Provide guided surgery and mill guided surgery stent in house.
3. Provide provisional implant restorations milled in house.
4. Provide final implant crowns milled in house.
5. Effectively be able to take straightforward implant cases all the way through from start to finish with guided surgery and no analogue impressions.

I am delighted to say that using this system we have been able to entirely nail this and have hit all five of these targets and are now integrating them into the practice on a day by day basis. But it’s not really the full story and in the true spirit of sharing and honesty it is important to know that this pathway is not for everybody and there is a lot of difficulty and development involved. If you’re looking for an in-practice milling system where you can do inlays, onlays, crowns and all of the above then the CEREC system from Sirona is probably the one for you. At the moment, as the system is locked and not open to other users, it probably needs to tie in with the CBCT. That itself is a little bit of a nuisance as there are perhaps better CBCT products out there which will work better than Sirona’s and certainly give better resolution that you can’t use in the system at the moment as it is locked. This may change as a result of Sirona’s acquisition by Dentsply but at the moment the system is locked and it is a huge disadvantage to the CEREC system, the fact that is closed. If I could ask one thing of Sirona it would be to open the system tomorrow but they won’t listen to me I’m sure.

For us the journey now enters into other avenues because we have licked the system here and we can continue to use it and are delighted with the results we get from the Sirona system but perhaps that’s because we have an in-house CDT and technician who is familiar with CEREC.

For others the answer may be an open system and the one that everybody seems to be talking about at the moment is 3-shape. We were privileged to have a demonstration from 3-shapes country manager in the practice before Christmas and the product is staggering. Also in conversation with colleagues, particularly Jameel Gardee who has become a DSD master and is a long-term friend of mine from student days, the possibility for 3-shape are enormous. Scanning is extremely straightforward and simple and the scans are magnificent and easy with multiple functionalities including HD photography and shade taking. The company is based in Denmark and is a wonderful, developmental company with innovation at it’s heart and I hope to be able to spend two days there meeting developers and training using the 3-shape system before taking it on loan as the next stage of development of the digital pathway in our practice continues.

With an open scanning system such as 3-shape it is then possible to choose your third party software or your CBCT machine or your milling unit or just scan and send to your lab, that way you can be into digital much less expensively with an enormous innovative product.

I have talked a lot about Sirona and what we have done with it and we have had great success but for us the next stage of our development is to pull in a different digital platform and to run both side by side. There is credibility in only ever talking about one system with no experience of another. This will allow us to use co-diagnostix from Dental Wings which is linked to Straumann for some digital planning and guided surgery production and be able to compare these directly with the Si-cat guides we get from Sirona; not only in the quality of provision but also in the customer service and price. 3-shape will take us onto 3D printing for our surgical guides and initially we will do this through Queens Medical Centre in Nottingham and also through some 3^rd part 3D printing providers, again to look at customer service and cost and quality of guide. It’s fair to say we are on the brink of purchasing a 3D printer for the practice but we will do our research properly over the next year and further to that we will probably be looking at a laser milling unit within the next two – three years to start milling metal and everything else that will afford us. It’s moving extremely fast and it’s hard to know exactly which way to turn. For that reason, all I would like to do with these pages as far as digital is concerned is honestly and openly discuss our experiences of this as we move forward.

This month we will mill our first CEREC guide 2 which is our in-practice surgical guide milling for single units. I have already seen a demo of this, my only concern is that the in-practice milling units are 4-axis and will not mill into undercuts therefore the guided surgery guides will not ‘clip’ into position. I will report back on that though more clearly in the next few weeks and months with positives and negatives and hopefully present some photographs and some digital stuff as we go forwards.

Any comments, suggestions for improvement or experiences are greatly appreciated so let’s continue to keep the discussion going and I hope to see as many of you guys as possible to chat about this.

Finally, it’s fair to say that digital dentistry has invigorated my implant practice. I have not been so excited about anything in dentistry since the first CBCT machine (and I am more excited than that) I think the last time I was this excited about dentistry was when I started out my implant career seventeen years ago.

Blog Post Number: 823