the DLP Editorial Team

Help your dentists choose a cement that will deliver optimum bonding to the CAD/CAM restorations your lab creates.

The following are key considerations to keep in mind:

Stocking a cement that only works with a limited number of materials is both inefficient and inconvenient. Look for a product that can be used with a wide range of materials including etchable glass ceramics, nonetchable zirconia and alumina ceramics, resin nanoceramics, composite, metal and fiber-reinforced composite posts.

High adhesion, wear resistance and flexural strength: 

Review product claims for adhesion to both dentin and enamel, as well as with both self-etch and total-etch procedures. Additionally, examine results for wear resistance and flexural strength to determine that a product meets your personal standards.

Ease of use, time-savings and simplicity:

 Compare the total number of components involved in an adhesive system and cement, as well as the time required for each step in the process.

For maximum simplicity, look for an optimized system such as 

3M™ ESPE™ RelyX™ Ultimate Adhesive Resin Cement 

. This system, designed with a dark-cure activator for the adhesive integrated into the cement, helps save time and lessens the components needed to complete the procedure.

Articles

How to achieve the ultimate bond with CAD/CAM blocks

Lang Dental was founded in 1929 by Samuel C. Lang. The company was housed in a small bungalow on the north side of Chicago. The first products were a zinc oxide and eugenol cement and silver filings that were used to make silver amalgam fillings. We no longer produce these items.

In 1989, the company built a modern, 20,000-square-foot manufacturing facility in Wheeling, Illinois, about 10 miles north of O’Hare Airport. All of our products are manufactured, tested, packaged, inspected, and shipped from our headquarters at 175 Messner Drive.

3. How many generations of Lang have been involved in the management of Lang Dental?

I am the third generation. I joined the company in 1973. Sam Lang ran the company from 1929 until 1957. My father, Ed Lang, was a chemical engineer. He joined the company in 1945 when he was discharged from the Navy. Ed ran the company until 1979. It was under Ed Lang’s administration we introduced the JET line of auto-polymerizing acrylic resins. Today, there is a fourth generation of the Lang family involved in management. My daughter, Kate Seger, joined the company in 2002 and my other daughter, Jennie Dompke, started in 2009.

Lang Dental sells its products worldwide through a network of authorized distributors; however, the 

end user is the practicing dentist and dental laboratory technician

Virtually every dentist who has graduated from a U.S. dental school in the past 40 years has been taught how to make a provisional crown with JET Acrylic. The results are consistent and the colors are accurate. The end result is durable and color stable, ideal for long-term treatment.

6. What else do you offer besides JET Acrylic?

Over the years we have concentrated on developing and improving all forms of acrylic resin products. Acrylics are very versatile and can be effectively implemented into many procedures and appliances that will benefit the patient. We currently produce denture base resins, denture repair acrylic, orthodontic acrylic, provisional crown and bridge materials, denture reline products, and a number of materials that improve the function and esthetics of each of these products. A complete list of products is available on our updated website, langdental.com.

7. What does Lang Dental Manufacturing have that is new?

We recently started selling two new materials. The first is 

, a truly permanent resilient denture liner. NOVUS is a laboratory-processed resin that permanently bonds to the denture base and maintains its resiliency indefinitely. Additionally, it is easy to trim and finish, and does not promote microbial growth. This is a denture liner that will last the lifetime of the denture. The other new product is JET SET-4 provisional crown and bridge acrylic. This is the next generation of JET Acrylic. It is faster setting without any additional exotherm or distortion.

8. How has Lang Dental lasted so long under the same management?

The principles of unwavering quality and customer service are well ingrained in the company’s culture. That, together with value pricing, will allow any business to survive.

9. What is the most unusual application you have heard of for your products?

In the early days of the NASA Space Shuttle missions, a resin we produce was used as a fabric stiffening agent on the asbestos insulation between the skin of the spacecraft and the heat deflection tiles. This was the result of research done at Rockwell International. It goes to show that acrylics are a very versatile material, and Lang Dental is one of the few companies to have put a product into outer space.

Lang Dental will continue to expand the scope of its products. As technology changes and research expands, we will be keeping our eyes, ears and minds open to new ideas and applications for our current, and soon-to-be-current products.

This article originally appeared in the April 2013 issue of 

. To read more great articles like this every month, 

Q&A: Dave Lang

Adding a design station is probably the lowest-impact way to bring some in-house CAD/CAM to your lab.

These days, it’s almost impossible to picture a business operating without a computer. So, while digital production may not be finding its way into every dental lab in the United States, computerization of some part of the business has probably already occurred.

That standalone computer may be handling records and-via an Internet connection-providing a means of communicating with dentists about prescriptions and case details. It also could provide a relatively low-impact jumping-off point for labs looking to take a step into CAD/CAM production, or an easy way for labs to add capacity to their digital design capabilities.

From full systems with in-house production capabilities to both closed- and open-architecture scanner-based systems that rely on outsourcing the production end of the process, all dental laboratory CAD/CAM systems have one common feature: the computer-fabricated restorations are designed via software in a virtual environment. Adding digital capabilities can really be as simple as installing one of those software applications to a computer already present in the lab.

Well, maybe not the computer being used just for record keeping and communications because dental lab CAD software requires a computer with a bit more power than the average PC. It takes a higher-specification PC to get the best performance from 

, said Sheila Cullers, Delcam’s North American Dental Business Development Manager.

While many of the digital dental design programs are sold as a package with a scanner, DentCAD and 

3Shape’s DentalDesigner™ are available as software alone

, which can be a starting point for labs beginning to transition into a more digital workflow.

Cullers said DentCAD is designed to bring efficiencies to labs with any level of digital design experience.

“It allows you to increase productivity and flexibility, whether you already use a 3D dental CAD program or are looking to migrate from the manual process of creating dental restorations into a 3D CAD design environment,” she said. “The intuitive user interface guides the user through the entire process to create dental restorations. No prior CAD/CAM experience is required.”

These software applications are designed for use in a broad range of indications such as straightforward full-contour crowns to be produced on a mill, anatomical copings designed to provide optimal support for veneering ceramics, and the design of implant bars and customized abutments for the most complex implant-supported restorations. A digital design station is a true multi-disciplinary addition to a lab.

Learning to use this software effectively is critical for the investment in digital technology to provide a return, and Cullers said Delcam prefers to do software training via face-to- face formats for all new users, with remote training via the Internet or over the phone reserved for support questions from experienced users.

Working in a virtual 3D environment still requires attention to the same details technicians handle when waxing up a case traditionally, but the software is designed to automate some steps and keep track of variables that come with individual clinical situations.

Of course, taking a digital design from a computer screen and turning it into something that can be placed in a patient’s mouth requires more than just software, and this is where partnerships are important.

Both DentCAD and DentalDesigner are “open” applications designed to work with standard file formats that can be output for a wide range of production workflows and materials.

Knowing how the final restoration will be produced from the digital design is a critical first step to the design process. Cullers said the material choice will impact the design, and the software can help ensure appropriate thicknesses are being built into the restoration design to provide the desired strength and esthetics.

For labs without in-house production capabilities, the manufacturing step will need to be handled by a trusted outsource partner. Who that is will likely depend on a range of factors, but with open design software applications, dental labs can link up with a wide range of milling and production facilities.

All this talk of production is missing the first part of the digital dental laboratory workflow. Without a digital intraoral capture or a digitized physical impression, there is no data from which to start the designing within the software.

Cullers said this is why today most labs making their way into the CAD/CAM production side of the industry choose to add a scanner along with their software. Still open software applications such as DentCAD and DentalDesigner are designed to accept data from more than just the scanners from Delcam or 3Shape.

This means a lab that already has a scanner can probably add a DentCAD design station while continuing to use that scanner, or could try to take on overflow cases from another lab with a scanner. These connections open a new business model for an all-digital lab, taking in cases from dentists using digital impressions and outsourcing the production after designing the restoration virtually.

But while that may be a low-impact entry into dental lab CAD/CAM, the relatively small number of dentists scanning at chairside means for now it makes much more sense to add a scanner as a part of a lab’s digital transition.

How to manage a soft CAD/CAM launch with a design station

Adding a scanner creates a clear path for a dental lab to transfer existing work from a physical to a digital workflow. But the process doesn’t start by scanning the next impression to arrive.

The real first step to this process is deciding what type of scanner to invest in.

There are a range of available technologies to digitally capture impression geometries, but they can be broken down into two scanner types: open scanners that export designs in a standardized format for output to a range of mills and printers, and closed scanners, such as 

, that send data to the scanner manufacturer for production at the company’s industrial-scale production facility. Of course closed is not the term those companies prefer to use.

“Our system is more of a network system now,” NobelProcera Product Manager for North America Kim Solomon said. “We bring value because we’re responsible through every part of the process. You have an actual partner in us when you purchase the scanner.”

The advantages that come from this partnership are what Solomon believes set systems such as 

 apart from open-architecture scanners. When showing a lab the scanner, Solomon touts the advantages of working in concert with Nobel Biocare.

If business at labs using NobelProcera grows, it means Nobel Biocare’s business grows. Of course, that shared success hinges on the high quality of the final restorations being produced, and Nobel Biocare takes responsibility for making sure its industrial-scale production technology is as precise and efficient as possible.

In turn, labs using the system know their software and scanners are precisely designed to work with those technologies. The partnership also provides assurances for the lab in terms of warranties on equipment and restorations. Solomon said having the system serviced by the company that created it rather than by a distributor is another big advantage.

Purchasing a system that puts a lab into a partnership with the system’s manufacturer actually creates additional connections because companies the size of Nobel Biocare have partnerships and clients from throughout the dental industry, Solomon said. When a lab adds the NobelProcera scanner, it forms secondary partnerships with the materials manufacturers the company partners with-

The companies work together on R&D and product synergies, and thoroughly test new options before bringing them to the network, Solomon said.

“We have certified and matched products,” Solomon said. “If you use our milled titanium coping with their titanium porcelain, we’ve already done the testing to assure the laboratory technician that they will work.”

The partnerships also extend in the other direction. Dentists using Nobel Biocare’s clinical products also fall under the umbrella of the NobelProcera Network. The company’s NobelClinician software has been expanded with a NobelConnect portal capable of linking labs to clinicians for implant treatment planning, and eventually for planning other cases as well.

By creating an inclusive network and carefully choosing partners, Nobel Biocare is looking to make the NobelProcera system adaptable to fit a variety of labs, CAD/CAM business models and experience levels.

Labs looking at adding a scanner need to be sure they have demand for restorations produced via CAD/CAM technology. Solomon said most labs currently outsourcing for the production of e.max, zirconia copings and frameworks are building up enough business to bring some of the digital workflow in-house.

A Network system is a good fit for labs that are not technologically adept because the lab does not have to worry about managing file formats or milling vendors. Nobel Biocare is invested in the laboratory to get the system up and running efficiently and profitably.

“We are 100% accountable,” Solomon said. “We set a business plan in motion. We help the laboratory owner not only adapt to using this system but also empower him to see how it can help him run the lab more efficiently.”

This starts with training- onsite, at Nobel Biocare facilities and online-to teach technicians how to use the scanner and design software. While Solomon said it is user-friendly, it requires the same technical knowledge previously employed in the physical production processes.

Applying existing skills to a digital design workflow is one part of adding a scanner, but growing digital business is just as important. Solomon said Nobel Biocare is set up to help with this. The term closed-architecture scanner may be used widely, but Solomon prefers to think of it as a network scanner that creates a partnership providing benefits to everyone involved.

“We recognize it is a very crowded marketplace out there,” Solomon said. “Our focus is on our network of laboratories and how we can help them grow. Precision and profitability are the cornerstones to our approach. We’re not in it to just sell scanners, we’re really looking to partner with a laboratory and help them grow their business.”

What closed-architecture scanner is right for your lab?

, the DLP editorial team outlines all the different paths for embracing CAD/CAM and becoming a high-tech lab.

Adopting any technology into your lab isn’t intended to be a sprint. The process requires thoughtful planning, financial preparation and total team buy-in to facilitate success.

Here, we lay out different entry points (or growth points) on the way to incorporating CAD/CAM in a serious way:

> What closed-architecture scanner is right for your lab?

Closed-architecture scanners are about linking up with a partner ready to provide both technology and production.

> How to achieve the ultimate bond with CAD/CAM blocks

Help your dentists choose a cement that will deliver optimum bonding to the CAD/CAM restorations your lab creates. Following are key considerations to keep in mind.

> The workflow possibilities with open-architecture scanners

Open-architecture scanners make it easy to connect your lab to an almost limitless range of workflow options.

> Benefits of in-house lab, start-to-finish CAD/CAM systems

Systems with a scanner, software and a mill allow labs of all sizes to bring start-to-finish CAD/CAM capabilities in-house.

> How a stand-alone mill can help your lab take complete control of finalized productions

A large-capacity mill brings versatility and self-sufficient production to labs fully invested in CAD/CAM production.

Adding a 3D printer to your lab can increase precision and accuracy while reducing production and finishing times.

> How to find the right level of CAD/CAM integration for your lab

Even labs that don’t plan to invest in CAD/CAM technology are likely to work with milled restorations at some point.

As part of our Chart Your Technology Course Series, the DLP editorial team outlines all the different paths for embracing CAD/CAM and becoming a high-tech lab.

Chart Your Technology Course Series: How your lab can embrace CAD/CAM

CAD/CAM has become a way of life for some technicians and dental labs, but even labs with little to no CAD/CAM investment have felt the impact from the technology and the material and restoration options it’s made available.

Numerous outsource options and workflows are available, ranging from sending a model to be scanned, designed and milled by an outsource partner, to investing in a scanner for in-house design, to buying into a complete system with on-site milling. It comes down to each lab finding what level of integration fits best.

For some labs outsourcing, coping and framework production will provide great efficiencies, for others it might be custom abutment fabrication, while other labs may offer full-contour CAD/CAM crowns to their dentists without investing in a scanner or a mill. Regardless of a lab’s investment, just about every lab should be prepared to finish CAD/CAM restorations.

 Global Programs Manager Veeraraghavan Sundar said a lab first must answer the business question of where CAD/CAM-whether in house or outsourced- will fit in the lab’s workflow because the technology is certainly a part of the future of the industry. Labs may find they increase their efficiency by outsourcing coping and framework production to focus solely on the critical porcelain work dentist clients have come to count on.

This flexibility is one of the big benefits to CAD/CAM technology, added DENTSPLY Prosthetics Product Manager Rebecca Winemiller. While Sundar said labs that outsource any part of design or production will need to adjust to losing a bit of control over the process, Winemiller noted that once outsourced parts are back from the milling center, finishing a restoration will not require major process adjustments.

In reality, mastering design software and adjusting to in-house milling requires the biggest learning curves and adjustments for a lab, said Beth Collington, Sales Training/Education Manager at 

. Partnering with an outsource center such as Custom Milling Center in Arvada, Colo., is an option that can lessen that curve, but however a lab fits new technology and processes into its operations, Collington said labs that take advantage of CAD/CAM can offer highly esthetic restorations with stable fabrication costs.

Achieving the same esthetics a lab is used to providing requires following the same steps the lab is used to taking. Whether milled or cast, a framework will need to provide the same level of support to the veneering porcelain, Sundar said. When it comes to finishing the restorations, the differences are subtle, and the keys as always are using compatible materials and following manufacturer directions.

A lab moving from alloy to zirconia substructures will need a zirconia compatible porcelain. However, finding an entirely new system does not have to be a part of the equation.

Most porcelain systems now offer layering porcelain for zirconia and the shades will often complement and match shading with the corresponding PFM porcelain from the same manufacturer, Collington said, adding that most zirconia porcelains should work well with any zirconia substructure because the material has a stable CTE.

The ability to stay with a familiar porcelain shade system can help minimize the learning curve. For instance, a lab using DENTSPLY’s Ceramco 3 could migrate to Ceramco PFZ, while a lab using Noritake EX-3 could make a similar move to Noritake CZR when transitioning to zirconia substructures. However, Sundar noted that any transition requires attention to detail.

That advice also goes for labs making a transition to finishing full-contour milled restorations that will only require the lab to add final stain and glaze effects. This step can be a tricky one for some labs because there is less they can do to adjust shade, translucency and other esthetic details, Collington said. Because most full-contour translucent zirconias need to be dipped or painted with a coloring solution prior to sintering, labs outsourcing the milling steps need to trust the milling partner to provide the correct shade. Remakes can be costly and frustrating because once sintered, the core color is difficult to change.

That issue is sidestepped with a material such as 

, which is full-contour zirconia manufactured with pigment blended throughout the material. Collington said Zirlux crowns have shade all the way through to the core and can be finished using the 

With much of a full-contour zirconia crown’s color on the surface, a dentist grinding the crown to adjust occlusion can create a white spot, but Collington said Zirlux crowns avoid that problem because the shade is blended throughout. With research showing full-contour zirconia is very kind to opposing dentition when properly polished, labs need to help dentists understand the importance of retaining or restoring that polish when the crowns are seated.

When it comes to figuring out where and how CAD/CAM might fit within a lab’s operations, it’s also something that does not need to be done alone. Sundar said DENTSPLY’s technical education department is staffed with CDTs experienced at helping labs move through the process. Custom Milling Center also is staffed with experienced CDTs to support customers new to the process of finishing milled restorations.

This can really involve as little as adding accent shades to a full-contour crown to as much as casting from a milled wax coping. Just about any part of a lab’s workflow can be fit to a CAD/CAM model; it’s just a matter of deciding which one makes the most sense for an individual business.

How to find the right level of CAD/CAM integration for your lab

It’s always a showstopper when there’s a demonstration of a 3D printing system taking place in the exhibit hall of a trade show. Watching digitally-designed copings, frameworks, crowns or models rise up and take shape on the print platform can be almost mesmerizing.

But these high-tech printers are more than just attractive novelties.

With the ability to rapidly produce high-precision parts that fit a variety of production workflows quickly and cost effectively, a 3D printer can become a critical part of a dental lab’s CAD/CAM operation.

“Superior accuracy, fine details, high resolution and low cost per case; these should be the key factors for dental labs considering the move to digital dentistry and 3D printing,” said Avi Cohen, former Head of Medical Solutions for 

“With a 3D printing solution doing the detailed work, dental labs can eliminate the bottleneck of manual modeling and allow the business to expand and stay ahead of the competition.”

Consistency and efficiency are big benefits of an investment in a 3D printing system, said Ron Snyder, CDT, former Dental Application Manager for 

 along with a range of other additive production technologies.

Whether the technology is being used to produce in-house models based on digital or scanned impressions, or making digital designs into wax forms for casting, Snyder said 3D printers provide speed and precision.

“It’s faster than using a dip pot and just dipping a die in,” he said. “What you get is more consistency. If the computer says it’s a 3/10 of a mm coping, it’s really going to be a 3/10 of a mm coping.”

Digital design software saves time on the front end by automatically blocking out undercuts, the wax forms don’t need to be fine tuned prior to casting, and once cast the end results require 50% less finishing time, Snyder said, adding that these efficiencies lead to material savings that can reduce a lab’s alloy consumption by 10-30%.

Grant Day, CDT, manager of Technical Support for 

Envision-TEC line of 3D printers available through Zahn

 are adaptable and upgradable systems with sizes ranging from desktop units to industrial scale systems.

A variety of materials are currently available that allow Envision-TEC printers to produce lost wax casting patterns for fixed restorations, and there also is an FDA registered resin for long-term temporaries.

Objet’s printers can be used to produce stone models, orthodontic appliances, implant surgical guides and veneer try-ins, and Cohen said parts produced with the company’s 3D Printing system are classified and approved for use as medical devices.

Materials available for the various 3D Systems printers can produce casting patterns, models, partial frameworks and just about anything that can be digitally designed.

These systems are designed to make existing lab technicians more efficient by automating time consuming tasks, freeing up time for other steps in the production process. Cohen said Objet’s printer can reduce fabrication times by 60%, and if that time is well spent, technician output can increase by an even wider margin. The benefits of 3D printing grow even more evident when the technology is paired with chairside digital impressioning.

“The moment you have an oral scan impression on your computer, the 3D printer gets to work producing exactly what you see on screen, without deviations or faults,” he said.

Digital designs that can be exported in the STL format can be sent for production on any of the companies’ systems, and the ProJet printers also can be set up to print designs from CEREC and Lava users.

Very little needs to be done to print a design, and Snyder said his company’s software stands out by automatically generating the supports and arranging the designs on the print platform for efficient production.

“You’re not sitting around looking at a computer screen and fiddling around with the jobs. You’re just sending the jobs and walking away,” Snyder said.

3D printing systems can be employed in a number of ways to fit in with labs of various sizes and specializations. The only prerequisite for adding any of these systems to a lab is scan and design capabilities.

Finding the printer that fits your lab’s size and business is really the key, Day said. Of course investing in efficient technology is also about growing that business, and Cohen said a 3D printer can help a lab scale up its production capabilities without adding staff to the payroll.

Snyder said ProJet printers are currently in use from labs as small as two-person operations to large scale production centers with 2,000 employees. Regardless of size, every lab investing in the system is set up to fill in unused capacity by taking on outsource work, and 3D Systems promotes the outsource capabilities of labs with its printers online at 

For labs with scan and design systems in place, adding and being trained on a printer is a relatively simple process. Day, Snyder and Cohen all said training is a simple process and depending on the lab’s CAD/CAM acumen, it could be printing in 3D in as little as one day. Day and Cohen said Zahn and Objet both provide onsite installation and training with ongoing customer support available for labs with questions after the training is completed.

3D Systems sells printers through reseller partners such as CadBlu and Sensable Dental. Snyder said ProJet labs contact their printer source for support, but if those companies need further assistance, 3D Systems is there to provide the answers.

Of course setting up and learning to properly use and care for the printer is only one part of the equation.

It is far more important for a lab to know how the 3D printing system will fit into the lab’s processes if it expects to achieve the best business returns possible, Snyder said. That needs to happen prior to purchase so the lab has a plan in place when the printer arrives.

“It’s one thing to learn how to use a piece of equipment. It’s something else entirely to learn how to integrate it into your business,” Snyder said. “Some of it is ancillary management that has nothing to do with operating the equipment. It’s operating the business.”

Could a 3D printer easily become a critical part of your dental lab’s success?

Someday, chairside digital impressioning may be standard operating procedure and cases will go directly from the operatory to a lab’s computer, but until then, lab scanners will be the main gateway to digital workflows.

In this segment, we focus on shifts to open-architecture scanners designed to give a lab options in both digital design and physical production.

scanners such as systems produced by 3Shape

 allow labs to send digital restoration design production on any number of mills, 3D printers and other CAM systems. This means open scanners can bring digital efficiencies to just about any workflow for any type of restoration a lab produces, and users have their choice of production partners, materials and just about every other detail.

Adding digital processes to a lab is really about leveraging technology to increase efficiency. Working from scanned data for digital case design can allow the lab to automate some of the more labor intensive steps in the fabrication process, and an open system lets the lab choose which parts of the process are to be done digitally and which will still be hand crafted.

3Shape International Product Manager Sven Nonboe said 3Shape’s system is designed around that type of flexibility with a full-range of indications available through the 

, which can be used for everything from basic coping design, to full-contour crowns, implant bars and removable partials. The “user-friendly yet flexible” system guides the user through the scan and design steps allowing people to get to work quickly and at a quick pace.

Those efficiencies are of great benefit to a busy lab, but the scanners also should let lab technicians make use of the skills, knowledge and techniques they already possess within the digital environment.

One way 3Shape is trying to accomplish this is through the high-quality scans captured by the 5 megapixel cameras of the company’s 

D800 scanner, which is capable of detecting hand-drawn markings on models being scanned

, whether they’re removable design sketches or margin lines.

The software then picks up on these lines and automatically incorporates them into the digital design. Nonboe said synergies between the scan and the design technologies are designed to be efficient so labs can achieve optimal outcomes via digital production steps. And these synergies go both ways between the scanner and the software.

Getting into scanning via an open-architecture scanner does leave the lab with many decisions to make. What products will be produced based on digital designs? Will all or just part of the case be done digitally? Will production be done via a mill or printer in-house? If outsourcing the production, who will the cases be sent to?

With open systems, labs face these choices, but they’re also not locked into that decision once the choice has been made. If an outsource production partner isn’t delivering the expected quality, the lab can look for another place to send cases, or even another material or fabrication technique to test out.

Open scanner systems allow the flexibility to change and expand how labs work. If digital business grows, a second workstation can be added to the system. If a lab starts off sending designs out for production they are not locked into using the same system or materials when deciding to bring some of that business back in-house.

While milled restorations seem to be the first thing people think of doing with digital workflows, labs can go digital for some processes without becoming strictly CAD/CAM operations.

That freedom is the biggest advantage. Labs going this route set themselves up with options. The lab can make a digital transition at its own pace and if that plan isn’t working, it can be changed.

The workflow possibilities with open-architecture scanners

The digital technology currently available to dental laboratories opens numerous new opportunities for collaboration and outsourcing, but there are plenty of options for labs looking to incorporate CAD/CAM production without relinquishing control of any part of the workflow.

Complete CAD/CAM systems- comprised of a scanner, software/ workstation and a mill, often designed and manufactured by one company- can provide an entry into CAD/CAM or a solid expansion choice for labs already scanning or designing digital restorations.

These stand-alone CAD/CAM systems such as 

, among others, provide labs with a digital workflow that takes a case from a physical or digital impression to completed prosthetic quickly and accurately without any part of the process being completed outside of the lab.

Working with a complete CAD/CAM system where every component comes from the same company offers labs a number of advantages, not the least of which is efficiency.

Because the scanner, software and mill were all designed together, the workflow between parts of the system is seamless and training on the technology is simplified because technicians only need to learn one interface, rather than having to understand how to transfer data from one company’s software to hardware from another company.

Having one source for the technology is advantageous whenever a lab using the system is looking to improve their work. When there are any questions about how some part of the process is supposed to be completed, a lab with a complete CAD/CAM system knows exactly where to turn for troubleshooting assistance.

DENTSPLY Prosthetics Product Manager Erica Henny said labs using Cercon will notice this cohesiveness and support from the moment they adopt the system. While these systems might be designed and supported by one company, they are not always designed to work in isolation. A big advantage to the Ceramill system, for example, is that it is a complete system, but with open architecture software capable of working with data from scanners and software made by other companies.

This means the system can be a good expansion choice for labs already into CAD/CAM production in one way or another.

It is not difficult to show labs how adding such a system can provide solid return on investment because in-house CAD/CAM production is both efficient and cost effective, especially because most of these systems do not charge a per-unit clock or dongle fee.

With complete control of the production process, labs with a system such as Ceramill can complete cases more rapidly while maximizing the use of milled materials. This can add up to large savings for labs currently sending a large amount of work to a milling center.

Having the ability to complete every step of the process in-house can speed up a lab’s production, and Henny said a big advantage of Cercon is that it is among the least expensive complete systems on the market, but still offers labs a range of options. Those options include not only in-lab milling of zirconia and base cast resin, but also the ability to outsource to the company’s Compartis® manufacturing facility for greater material options and implant bar fabrication.

And like all technology, the improvement process is never ending. Purchasing a complete system makes it easier for a company to update the software in ways that enhance the capabilities of the related hardware. Henny said forthcoming updates to the Cercon art software will provide for the design of custom implant abutments as well as full-contour zirconia crowns.

With the ability to mill zirconia and acrylic materials, the Ceramill Motion provides a launching point for in-house production, and the Ceramill Mind software features a virtual articulator and the ability to import data directly from intraoral scanners, which means labs looking to work completely digital can skip model fabrication when they choose to.

Determining if a complete CAD/CAM system is a good fit for an individual lab requires some inward analysis.

It’s not just about the size of a lab taking advantage of the scalability of digital workflows. The common factor linking those labs is the desire to increase their efficiency in certain areas of production by controlling the pace of the work and reducing per unit manufacturing costs.

Henny said many mid-sized dental labs benefit greatly from adding the in-lab CAD/CAM capabilities of the Cercon system, and those benefits can be realized quickly because of the system’s ease of use. Still, the system fits with any lab looking to invest in its business by reducing the time it takes to complete a case and return it to the dentist.

Benefits of in-house lab, start-to-finish CAD/CAM systems

CAD/CAM production in a dental lab needs to be a round-trip operation. The patient-specific information required to produce a restoration can be easily digitized, but the designs based on that information need to be exported from the computer in a physical form, and for labs fully committed to a digital production model, investing in a stand-alone mill can be a great way to take complete control of the finalized physical production.

Whether your lab is experienced in the scan and design sides of CAD/CAM and looking to bring the production in-house or completely new to the digital side of the industry but looking to remain self-sufficient, there are a wide range of mills currently available for milling different dental products. From tabletop-sized units to stand-alone systems, these open-architecture mills have a range of capabilities and can mill an array of materials, but the one thing they all bring to a lab is control.

“If they bring their own milling system in, then they have full control of the products being released,” said Chuck Warren, CDT, who runs Tempus Dental Laboratory in Springville, Utah, is an advisor for 

 and produces restorations on the company’s 

Adding a mill allows a lab to reduce the time it takes to create a CAD/CAM restoration because nothing is being sent to an outsource partner, and in-house production can significantly reduce the cost per unit for the lab, said Steve Campbell, General Manager of 

 range from a new tabletop-sized unit to the large scale Origin Pro Duo and are designed to provide a modular approach in terms of their capabilities.

This approach allows a lab to invest in a mill that will handle the materials they currently work with and then add new material options when there’s demand from customers or the lab is ready to drive the demand through additional capabilities. This means a lab can start milling in wax, zirconia, lithium disilicate, and expand into in-house custom abutment milling, and soon implant bars.

Campbell said a big advantage a lab gains by adopting an open mill such as the Origin line is the optimized use of material gained from milling discs rather than single-use blocks.

“When considering a significant investment in a CAD/CAM system, astute lab owners calculate the production costs as well as the initial outlay,” he said. “In stark contrast to the blocks used in most of the existing desktop milling systems, the efficient disk utilization common to each of the 

 provides for some of the lowest expenses in the industry.”

Similarly, Warren said the way the T1 works with discs of material is one of the features that sets that mill apart from the many other milling systems he’s used during his more than a decade milling dental restorations. He likes the way the T1 can have a range of discs loaded in a stack so it can be programmed to produce a range of restorations from different materials and then set to run all night or over the course of a weekend.

The system is designed for easy loading of the materials, and Warren said this simple time savings adds up for his lab. While the T1 is strictly a dry mill so it won’t tackle titanium or lithium disilicate, which are both milled wet, he and his dentist clients are consistently impressed by what the 7-axis milling system can create from zirconia, PMMA, wax and a range of other materials. He keeps his mill loaded with an array of materials so it’s ready to go right away when his workflow calls for a new material to be milled.

“The T1 is exceptionally more efficient than all of the other milling systems that I’ve had and been exposed to in the sense that you can stack discs in and do multiple millings at the same time,” Warren said. “There’s enough blanks in this thing, you can mill all weekend.”

Both the Origin mills and Wieland’s milling solutions are open-architecture technologies, which means any CAD file that can be exported in STL format can be sent to the mill for production. Warren said the CAM software that controls his T1 is designed for both new and experienced users.

It features presets for milling a range of restoration types from a range of materials. However, advanced users are able to customize those presets to maximize how material is used, speed up the milling process or do just about anything. The total control of the system even extends to when Warren isn’t in the lab, as the T1 can be controlled remotely so overnight or weekend milling runs can be monitored, and priorities can be changed via the Internet.

As his lab grew more and more focused on CAD/CAM production, Warren said the workflow shifted to take advantage of the efficiencies available. Rather than wax up designs by hand, every case at his lab is computer designed, with the wax up milled on the T1. Even though he’s been using milling systems for years, Warren said he is constantly amazed at how the capabilities of both the software and the hardware continue to get easier to use while producing more accurate and better looking restorations.

“It’s just a huge, huge time saver, and it doesn’t get tired,” he said. “It mills what I don’t think is capable of being milled.”

Training on these systems is provided at the time of purchase and both Warren and Campbell said technicians familiar with CAD/CAM production can be confidently running their mill after just a few days of training. Campbell said it might be a few weeks for labs completely new to digital production, but the modular nature of the Origin systems allows a lab to take on one production change at a time, adding new features and options whenever ready for that next step.

Knowing when a lab is ready to invest in a mill is important because while these systems bring major efficiencies and automate parts of the production process, they can represent a major investment for a lab.

Campbell said labs with existing CAD/CAM business and large outsource expenses for production are good candidates for investing in a mill. However, this does not mean mills such as the Origin systems or Wieland’s Zenotec T1 are just designed for large labs. Warren’s lab isn’t a huge operation, but he firmly believes his lab’s digital production capabilities are what keep them successful and allow them to compete in an ever more global dental laboratory industry.

Investing in a mill also is an investment in the lab as a business, Warren added. While technicians are valuable because of their knowledge and skills, those attributes aren’t easily passed on to new people, and this means the lab’s resale value is limited. However, a digital lab is something that can be sold and passed along to a new digital technician.