Shaun Keating, President and CEO, Keating Dental Arts, Irving, Calif.

	What is the dream scenario for the dentist and laboratory’s workflow? The simple answer is that the final result is achieved in an easier manner, more accurately, with less cost and in a shorter time frame. Thanks to the ever-evolving world of dental technology, we are able to experience that scenario today!

	We all know in the business and service industry that costs are higher and errors more frequent when the human element is incorporated into the workflow, versus a machine that is designed to do the same job. This is evident in virtually every industry such as automotive, aerospace, medical and yes, even dentistry. As 

 has become more sophisticated and less costly, areas where it was thought that only humans could fill are now being replaced by machinery. 

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	So, how does this apply to the dental world? From the dentist’s perspective, machines have not replaced the human diagnosing and treating the patient… yet. Nor have machines replaced the design and artistry of the ceramist… yet. However, there is technology now that has improved the laboratory and dentist’s 

 to be more accurate, more efficient and less costly. Where this is most evident is in the area of digital impressions. 

	Conventional dental impression-taking is an aspect of dentistry that by its nature can be riddled with errors that can cause greater expense and inefficiency for both the dentist and laboratory! It is estimated that a dentist pays as much as $60 per impression, not including any redoes that may occur for a bad impression. The dentist also incurs greater costs if his/her impression results in the laboratory notifying the office that they need to take a new impression thus the office incurring the expense of another appointment for the patient; let alone the frustration and inconvenience for the patient and office. From the laboratory in this scenario they also incur the expense of pouring a model they won’t use plus needing to have a new pick up for the new impression.  Conventional impressions also require the lab to pour up a stone model, which costs man-hours plus the potential for human error when stone mixing and trimming the dies. 

	Digital impressions eliminate these errors and reduce cost by getting most of the human factor out of the equation. Capturing digital impressions is easy and is as accurate, or even more accurate, then conventional impressions. There is no distortion and no need to pour a model; though if a model is desired; that model can be imprinted or milled, also eliminating any material or human error. Since the impression is sent via the Internet, there is no cost for delivery and the lab receives it immediately. Once received by the laboratory, the impression can be immediately uploaded into the design software (CAD – computer assisted design) where the technician designs the restoration and then imports that into the milling machinery for manufacturing, followed by finishing. 

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	With today’s highly esthetic strengthened monolithic ceramics, the lab can produce single or multiple unit crowns and onlays efficiently, accurately and inexpensively while getting them back to the dentist within a few days verses the traditional two plus weeks. Another huge advantage for the laboratories is that they can plan and design dozens of restorations to be scheduled for milling overnight when the laboratory is closed. Again, a huge time saver plus an enormous financial savings as there are no human labor costs. Obviously the one area in the digital workflow that can allow for human error is whether the person is using the digital devices correctly or not. So be it for the dentist or laboratory technician, proper training and instruction on the use of these technologies is imperative and once this is done, the potential for errors being created becomes very rare.

	Needless to say there is an initial cost to both the dentist and laboratory to purchase the equipment, i.e. digital scanner, design software and/or milling machinery. However, as with every industry, it is still, in most cases, more profitable and efficient to produce using the newer technology, even while recapturing the cost of the initial purchase. In regards to technology purchases, this author suggests that the dentist and laboratory do extensive research before making any acquisitions. One downside to newer technology is that it changes rapidly, so before purchasing anything, make sure the item one plans on purchasing meets the needs of the practice and laboratory, plus that if the technology improves or changes in the short term that the item can either be upgraded or replaced for a reasonable cost. In some cases the device’s initial cost is so reasonable that even if it is replaced in a few years, it still was smart financial investment.

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	Another area, which has made laboratories and dental practices more profitable, more efficient and more simplified, is the area of milling (CAM – computer assisted manufacturing) restorations. Due to the advancements in CAM technologies, millers have become extremely accurate and less expensive. Along with this has been the development of newer ceramics that have the strength to be used in stress bearing areas, can be milled with extremely high accuracy and though they are monolithic, they have beautiful esthetics combining translucency and strength. 

	The process of milling restorations is far more efficient and less expensive then conventional manufacturing as the impression is virtual, the design is virtual and the restoration itself can be milled without the need of an analog model. This eliminates a lot of human labor and a greater potential for error. Dentists have the option of sending their digital impression to the laboratory for the milling process or can purchase a chair side miller and manufacture the restoration in house. However, the latter requires the dental office to not only purchase the miller, but need to have someone trained to design and import the data into the miller, plus the equipment and skill set to finish the restoration for optimal esthetics.

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	It was not too long ago that the above-discussed technology was thought to be science fiction in the dental world. Now it is reality and who knows what lies ahead! Nevertheless, dentists and laboratories need to stay abreast of the evolution of technology in order for them to stay relevant in today’s marketplace.

Articles

Shaun Keating, CDT and Dr. Jack Ringer explain why staying abreast of technological developments is crucial for lab success.

Exploring today's digital dental workflow

For years now, my dental laboratory has relied on Roland 3D milling technology to produce the highest quality prosthetics for our dentist and laboratory clients around the globe. So I was ready to hear more when Roland told us the new DWX-50 was available.

It’s based on the same proven 3D milling technology we have used here at Keating Dental Arts for years. In fact, both of Roland’s new DWX dental mills, the 4-axis DXW-30 and 5-axis DXW-50, are designed  with features and upgrades specifically for the dental lab industry. We decided to go with the DWX-50 (Fig. A).


	Designed to be a workhorse and streamline the production process, the DWX-50 features 5-axis simultaneous machining capabilities (Fig. B) and a 5-station automatic tool changer with a tool length sensor (Fig. C). A diagnostic notification system allows for unattended production by alerting the operator via email should any system errors occur and when jobs are completed.

The DWX-50 is built on open technology that supports a wide range of software, tools and materials from several manufacturers. As a production machine, the DWX-50 can produce up to 100 units a day or more. The mill allows you to connect up to four machines to one computer, so you can readily add production capacity to your laboratory.  

It also features an integrated air blower system and an advanced dust collection system, particularly important if you are milling zirconia. A built-in dust collection tray connects to any lab vacuum system, keeping the cutting area clean and free of debris (Fig. D).


	It took us less than two hours from the time of delivery to when the DWX-50 was milling test units. The machine itself has a very small footprint in the lab as well.    

Right away, we saw the DWX-50 has a very intuitive user interface, which is especially important if a new operator needs to be trained. Our operators were proficient after the initial training session.
	To drive the machine, we use SUM 3D CAM software (sum3ddental.com). This is a very straight forward easy-to-use program. We especially like that the DWX-50 starts milling as soon as the first elements of the tool path are generated and continues while the remaining tool path is being processed. This saves up to 30 minutes of down time per job…very efficient!  

While SUM 3D CAM software works well for us, the DWX-50 supports virtually any dental CAD/CAM software solution on the market, including Dentmill, Hypermill, EdgeCAM, Work NC and Cambridge. While putting it through its paces, we found the DWX-50 works perfectly with both the 3Shape and Dental Wings scanners we have in our lab.

In evaluating the DWX-50’s simultaneous 5-axis machining, we found the internal adaptation of the cases we milled were excellent. Marginal integrity was also excellent. In fact, we found it to be comparable with that of the much larger mills (Fig. E).

The consistency of the machining, especially at the margins, of all the Roland mills that we’ve used has reduced internal remakes significantly over a competitive mill system that we had used for some years. Throughput is also very efficient and similar to that of larger mills.

We really appreciate the DWX-50’s automatic tool changer (Fig. F) and self calibration feature. This capability can save us up to 30 minutes over machines that require manual calibration…again, very efficient.

With the DWX-50, we have milled wax, zirconia and PMMA (Fig. G). Screw retained provisionals are a very useful application for our lab. We also like the fact that the mill cools the wax and PMMA stock with compressed air instead of coolant. All of these features add up to make a mill that is powerful, efficient and impressively accurate.


	The DWX-50 is backed by a world class manufacturer.  Our service from Roland has been seamless. Any time we’ve contacted them, they’ve handled our needs immediately.

The DWX-50 supports a wide range of tool sizes from your vendor of choice. Roland stocks 0.8 mm, 1 mm and 2 mm tools for the machine (Fig. H). Occlusal anatomy on full contour restorations is very precise with the DWX-50 (Fig. I).

We highly recommend the DWX-50. A large, digital focused lab such as ours found it to be more than up to the tasks we had for it. However, priced at just $29,995, it offers all the speed, precision and versatility of much larger, more expensive mills, and its compact size, ease of use and compatibility with the most widely used dental CAD/CAM software titles make it a great milling option for labs of any size. It’s proven to be a great investment for our lab and can certainly be a nice addition to yours as well. 