From time to time I like to provide these updates on how the digital things are going in the practice as it generates a lot of discussion. I know that some people are quite interested to see whether it's going to work or not and I like to be quite open about how the process is going.
Previously it centred around the CEREC situation in the practice and how we were using that, both for conventional restorative work and implant work. You can read about some of our previous experiences here, here and here.
The CEREC story for our practice has been a huge success despite the fact that we are not a big restorative practice and we continue onwards to push and develop the system to work to our strengths in the practice. It's now used the majority of time for conventional restorations and single tooth implant restorations in e-max which make it really cost effective in terms of lab and really quick. This allows us to do things like provisional healing abutments (milling provisional abutments of the day of implant surgery to create ideal emergence profiles) and same day implant crowns at the time of implant exposure. This reduces clinical time down massively for patients and increases profitability in implant services due to the investment in technology.
It allows us to provide all the diagnostics for single implant cases entirely digitally - no models, no impression material and digital design and go guided for the vast majority of our cases.
The return on investment of this is incredible and it paid for itself in the first 18 months, we are now 2 years in and that led us to the next step; 2 weeks ago we took delivery of the following equipment: MC X5, inEos X5 and the infire HTC speed together with the full Sirona inLab 15 package.
In the end we decided to run with the Sirona package for several reasons:
1. We were already fully CEREC and running with the Sirona CBCT.
2. After looking extensively at other systems the supply chain is so well established with Sirona and their knowledge of the product is so great that, despite some reservations in other areas it seemed like the best fit for us.
We got this fitted into the practice by Henry Schein and the installation was seamless; it went in in one morning and was running and milling by the afternoon. Thanks to Henry Schein for an amazing service on this.
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This now gives us the in practice capability to mill full arch surgical guides for multiple implant cases, to mill Zirconia of pretty much any size - full arch to single unit, to sinter the Zirconia in our own furnace. We can mill anything out of e-max, anything out of PEEK, anything out of PMMa and anything out of composite.
To give you an idea of the economies of scale here - one single composite disk is around £150 and can mill 20 crowns. There is clearly a digital planning process as part of that but you can see where the advantage runs with this.
We saw a case in the practice this week of extensive wear of 8 lower front teeth against an upper implant restoration and the plan is to mill all 8 units in composite to provide a long term, retrievable and repairable restoration. This will be done in-house; 3 hours or design time (£135) and 8 crowns in composite (approximately £100). Clearly there is equipment to pay for here, maintenance and training etc but we have done all the analytics price wise on the lab set up and we understand what the break even point of the lab is and it looks really favourable so far (i'll report on that later when I have more things to talk about)
We've also started to show the set up to some of our patients and it blows their mind, it's extraordinary!
I will discuss some of the hiccups in other blog posts, for example no system is apparently open despite the fact that they sell you it as open!!
The other problem we've had is that we're so far ahead on this that it seems even when we speak to Sirona in Germany some of the things they're saying we can do with the machine they've never done themselves, not practically in any event.
That's ok because we hoped and expected to be at this kind of stage but it can be a bit frustrating for Mark in the lab when he realises a pathway that exists and runs all the way down it only to find out from Sirona in Germany that they're not absolutely sure how it works. I guess this is the price to pay for being at the cutting edge.
The problems that have occurred at the moment are:
1. Sirona don't want us to be able to mill Straumann guided surgery guides. They want us to design the guide, send it back to them, allow them to unlock the guide to send it back to us to allow us to mill it (presumably for a charge). Absolutely ridiculous and that will need to be sorted.
2. Problems with the pathway to Createch with what is supposed to be an open lab system but which caused us huge issue in file transfer and compatibility. Not sure whether this is at the Sirona end or the Createch end, nobody really wants to take any responsibility.
3. Problems with the temperature of the furnace for some of the Zirconia disks. They are losing translucency when they are fired in the furnace which means you have to start the case again and run it overnight. Not a surprise for guys who are running their own lab but a big surprise for people who are just setting up the lab capability.
Anyhow, for those interested in the digital stuff - keep reading and keep chatting to us. We'll continue talking about this and continue to develop some ways of teaching some of the concepts we have developed in the practice for the benefit of patients everywhere and the enjoyment of dentists in the new digital world.
Blog Post Number: 1111
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