How to invest in the right technology for your practice

July 10, 2019

 A look at how digital scans can be used whether you send them to the lab or use your own mill or printer in-house.

Before investing in a scanner, it’s important for dentists to understand what they can actually produce with the technology and how. Some clinicians might opt to send the digital impressions to a lab so that a technician can create the restorations like before, just with more accurate information that yields better results. Others might prefer to keep the work in-house, which requires investing in more technology, such as a mill or a 3D printer, depending on what they want to fabricate.

“Some dentists invest in scanners to make impression taking easier on their patients and to improve the quality of the restorations. If you don’t want to go beyond that, you don’t have to,” says Dr. John Flucke, chief development officer for Cellerant Consulting and chief dental editor and technology editor for Dental Products Report. “But, if you’re a gadget lover, you might want to get into the same-day aspect of this. You can be a same-day single-unit crown office and send the more complicated cases to the lab. The nice thing about it is the flexibility. Once the impressions are digital, they’re just electrons. How you choose to use them is totally up to you.”

Before investing in other digital technologies, Dr. Flucke suggests taking the time to become comfortable using the scanner and the new workflow it requires. It’s important to remember you don’t have to purchase everything at the same time; that will just overwhelm both you and your team members, not to mention strain your budget. He suggests continuing to send all your cases to your trusted lab technician-who should be able to produce just about any restoration with the files-until you get really good at using the scanner. Then, you can focus on adding other technologies to your practice.

Once you decide it’s time to expand your digital workflow, how do you know if a mill or 3D printer is best for your practice (or both)? It comes down to understanding what you can produce with each machine.

Mills

Because they’re all open source now, any mill can read the STL files from a scanner, Dr. Flucke says. You just need to select a machine that best meets your needs. There are two types: wet mills and dry mills. Dry mills cut materials with dry tools, while wet mills use water. There are also machines that offer both wet and dry milling capabilities. If you want to offer same-day crown and bridges, the wet mill is the best option, Dr. Flucke says.

When selecting a mill, it’s important to think about the type of materials you plan to use. Wet mills can mill just about any material, says Dr. Chad Duplantis of Fossil Creek Dental Partners, including lithium disilicate, glass ceramic and composite resin. Dry mills can fabricate dry materials like zirconia, making them well-suited for larger cases such as full-mouth restorations. Regardless of the mill you choose, you’ll also need to invest in an oven for crystallization and staining and glazing materials for after the milling cycle.

If you add a mill to your practice, it’s important to keep up with the necessary ongoing maintenance, says Lee Culp, CDT, of Sculpture Studios. This is especially important for wet units, as the liquid can get gummy inside the mill and lead to problems. Look for systems that are easy to clean and then follow the directions for maintenance.

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3D printers

3D printers continue to become more advanced and can now print a variety of materials from PMMA to zirconia, but their capabilities are different than mills when it comes to what they can produce, Dr. Duplantis says. If you want to fabricate multiple-unit indirect permanent restorations ,you need a mill (printers can produce temporaries but not permanent restorations yet). If you’re interested in producing clear aligners, custom trays, models, surgical guides, or occlusal guards, then a printer is what you’re looking for.

There are three main types of 3D printers: Stereolithography (SLA), Digital Light Processing (DLP) and Fused Deposition Modeling (FDM). The biggest difference in these printers is the resolution they provide, with FDMs having the lowest and DLP the highest. Cost “is all over the board” for these printers, Dr. Duplantis says. When making your selection, it ultimately comes down to selecting a printer with the resolution you’re happy with from a reputable manufacturer you know you can trust.

Before you purchase a printer, it’s important to understand how to use it, Culp says.

“Doctors investing in printers often don’t know what they’re getting into,” Culp says. “They want to use the technology because it’s cool, but they don’t realize there’s a lot of work to do.”

For example, you need to know what light source is required to properly cure the printed material, Culp says. Otherwise, you won’t be happy with the results and might start to regret your decision to purchase a printer. You’ll also need to know how to clean the printer and properly mix the resins as well as the type of ovens you’ll need for the material you’re planning to use. It’s also important to purchase the appropriate stains and glazes to finish the restorations.

Because there are manufacturers that offer affordable options, more dental offices and labs are starting to invest in printers, Culp says. This increase in popularity has led to higher quality solutions that are fairly easy to incorporate and use. So, if you choose not to invest in a printer right away or ever, you’ll be able to find a dental lab that can do the printing for you.

“Printing is big now in dentistry and everything is getting better. Things have changed dramatically just in the last year,” Culp says. “Everybody is really nailing down their systems so that they come with their own lights and cleaners. If you’re a lab getting into printing now, you’re getting a pretty good system. In the beginning, it was ‘here’s a printer, have fun.’”

New possibilities

When you move your practice to a digital workflow, you have the ability to improve the patient experience and provide even better care. It starts with investing in a scanner, then, once you’re ready, adding other technologies based on your practice vision. That might mean investing in a mill to offer patients same-day crowns or a 3D printer to fabricate clear aligners in-house.

Whatever direction you choose, it’s important to understand what the technology can bring to the practice and how to best use it to meet your goals.

“I know dentists who have a mill and like nothing better than to block off a morning or a day to complete six restorations for a patient, put the restorations in the oven ,and stain and glaze them and make them look phenomenal,” Dr. Flucke says. “They get satisfaction from knowing that patient will look incredible for the next 20 years. Some dentists don’t want to have to put color on porcelain and fire it in the oven. Those dentists do the cases outside the cosmetic zone and send the esthetic cases out to the lab. Once it’s digital, it becomes your choice on how you want to handle it.”