Nearly 300 attendees, including laboratory owners and managers, outsourcing centers and manufacturers, were on hand at the International CAD/CAM Technology Symposium and Expo held in November. This valuable learning opportunity included manufacturer presentations and an action-packed exhibit hall, and LMT was your eyes and ears at this year's event.
"Thank you for stepping out of your labs to hear where the future of our industry is going." With these words, Glenn Thom, CDT, executive director of the Dental Laboratory Owners Association of California (DLOAC), kicked off the group's third annual International CAD/CAM Technology Symposium and Expo, held in November at the Ritz Carlton in Pasadena, California.
One thing is crystal clear: the world of digital technology is moving full speed ahead and it's quickly changing the way laboratories operate and the services they offer, and the manufacturers are responding to the needs of the marketplace.
For instance, the price of a complete CAD/CAM system can be cost prohibitive to many laboratory owners--some come with a $199,000 price tag—but more and more manufacturers are now offering stand-alone scanners, a less expensive alternative that allows the laboratory to buy only the scanner to scan and design its own restorations and then send the data off-site for fabrication. Twelve of the 13 CAD/CAM systems on hand now offer a stand-alone scanner option; most are in the $30,000 price range.
Another example is the growing availability of CAD-generated implant abutments. An alternative to stock or laboratory-fabricated cast custom abutments, manufacturers tout this service as more economical, less labor intensive and more precise than traditional methods. Three manufacturers at the symposium—Atlantis Components, Nobel Biocare and U-Best Dental Technology—currently offer CAD-generated implant abutments and two more—3M and Kavo—plan to launch the service this year. Although each manufacturer's service works a bit differently, in general, the laboratory sends either a traditional or scanned model to the company, which mills the abutment out of zirconia or titanium then returns it to the laboratory.
The concept of "open" systems—meaning digital data can be read by any manufacturer's milling or rapid prototyping unit—was a recurring topic of the meeting. Laboratory owners are intrigued by this concept because it gives them more versatility. "If you have a scanner, the open system idea is really appealing because you could send the data to any system you want—but right now that's not possible. That would make me want to get a scanner, because I wouldn't be locked into just one system," said Evan Penrod, owner of four-person Crown Laboratories, Inc., Sandy, Utah, who currently outsources his CAD/CAM restorations. At the show, there were two open systems on hand; see details of the InVision® DP 3-D printer from 3D Systems and the imagen™ system below.
Another hot topic was digital impressions. This area of digital technology continues to generate excitement in the laboratory community. "Digital impressions are coming to the forefront and initially there will be a hybrid of both traditional and digital impressions. How fast is it going to happen? There's high interest from dentists, so probably faster than we think, and it can have a very positive effect on the C&B process in the laboratory," said 3M ESPE's Jim Buchanan. In 2006, 3M purchased Brontes Technologies, a developer of proprietary 3-D intraoral imaging technology.
During his keynote presentation, industry leader Jim Glidewell—who owns Glidewell Laboratories, Newport Beach, California, and five other labs in the U.S., Costa Rica and Mexico—announced that his laboratory recently purchased the Cadent iTero™ for its in-house operatory (for more information on iTero, click here http://www.lmtcommunications.com/articles/digital_weaklink.asp). Here's how the system works: Once the digital impression is captured, it is reviewed on screen for accuracy and the margin is identified. Then it is emailed to Cadent's manufacturing facility for milling into the physical model. That model is then sent to the laboratory for restoration fabrication. "I can see my margins, contact areas, embrasure scanning, and any areas that need more reduction. If there are, the dentist simply repreps and rescans," he said. "The slowest part is impression capture and margin identification, but that will improve. In the future, you won't need a model at all, you'll go right from the digital impression to making the crown."
The latest systems
At the show, there were 14 manufacturers on hand to detail their systems—five more than at last year's event—and four of them are new players in the laboratory marketplace (note: LMT is reporting only on the systems that were present at the DLOAC symposium):
imagen™. New to the market in 2006 and one of the most talked-about technologies at the show, the imagen system uses the 3D printing process (a type of rapid prototyping) invented at the Massachusetts Institute of Technology in the early 90s. Instead of milling down a block of material, the system creates a precious metal coping by adding powdered metal in layers and bonding them together (the process only uses the material it needs so there's no waste as there is with milling). Once complete, the coping is sintered, then prepared for final porcelain as usual. The system can fabricate 100 single units a day and is an example of an open system—it can accept scanned data from a variety of manufacturers' devices.
With this system, laboratories have two options: they can rent the complete system for $2,500 per month (which decreases on a sliding scale based on productivity); the print fee per unit is $10, the material cost is $30 per gram of finished product and the average price for an anterior unit is $28. Or, a lab can rent the scanner only and send the data to the imagen production center for fabrication; an anterior costs $50 and a posterior costs $65; both fees include metal finishing and one-way shipping.
The company also noted the exciting future potential of this technology: one day it will be used to produce full ceramic restorations, including zirconia, that have variable color and translucency built throughout the material because you will be able to selectively color and harden sections of the buildup during the layering process.
InVision® DP (Dental Professional) 3-D printer. 3D Systems' Ron Synder detailed this rapid prototyping unit that uses scanned data to fabricate individual copings and up to 16-unit bridges in a light-cured resin. The user scans a model, designs a virtual waxup, then sends the data to the Invision DP printer that "prints" the waxup in layers; it is then ready to be cast or pressed with conventional techniques. Scanning and design take about two minutes, and the unit can print 20 units in about three hours and up to 150 in about five hours. In addition to outputting digital data to its own wax printer, the InVision DP scanner is another example of an open system—it can export data to any other open system. A different version of 3D Systems' printer was formerly available through Cynovad as part of the Neo; this new version just completed beta testing and is now ready for sale. The scanner and design software cost $39,000 and the printer costs $80,000. The company is working on a software that creates a full crown waxup that it plans to have on hand at Lab Day Chicago and formally launch at the IDS meeting in Cologne, Germany in March.
Prismatik CZ Clinical Zirconia™. Launched in 2006, Glidewell Laboratories' system consists of a milling unit and software that works with a scanner made by 3Shape. "Our objective was to make a zirconia substructure at a PFM price," said Mervyn Rudgley, an engineer Glidewell hired 18 months ago to spearhead digital manufacturing and Prismatik CZ's development. The unit mills 12-15 units in three-and-a-half hours and the company offers three levels of partnership, including marketing materials: labs that send less than five units per day pay $59 per outsourced coping; at 5 to 25 units per day, a lab can become a remote design partner, meaning it purchases a scanner and software for $30,000, e-mails the data to Glidewell and pays $39 per unit; and at over 25 units per day, labs have the option to purchase the full system for $141,000 with an approximate per-unit cost of $15. The laboratory manufacturers its own zirconia block and, soon, its own pressable ceramic for zirconia.
Ceramill System. Amann Girrbach America's in-house manual zirconia milling system offers an economical alternative to a digital CAD/CAM system. The system is scheduled to hit the U.S. market this month, and has been evaluated at dental laboratories throughout Europe. The Ceramill is based on the pantograph principle, or copy milling which, according to the company, "puts the material back in the hands of the technician." To create a zirconia coping, the user applies a light-cured resin over a traditional die, attaches the resin buildup into a plastic plate and inserts it into the milling unit, side by side with a YTZP zirconia blank. The unit has two conjoined arms that hold the probe tip and the milling handpiece. The user manually traces the resin buildup with the probe tip while the other arm simultaneously mills a duplicate coping out of the zirconia block. The unit mills one coping from start to finish in 25-30 minutes for approximately $34, including labor costs. Three-unit bridges can be milled in 35-40 minutes; medium and large zirconia blocks are also available and can process a full 14-unit span. The complete system retails for $27,212 and includes the milling unit, suction device, sintering furnace, LED lamps, motion-sensored curing light, materials starter kit and two-day training course.
Updates to existing systems
The 10 manufacturer-exhibitors at the show with systems already on the market are offering more affordable hardware options, beefing up software capabilities, and adding new material choices and indications. Here's a peek at what's new and what's next:
CeraSys. Launched at the 2005 DLOAC Symposium, there have been several system developments in the last year. In addition to its three-axis scanner that scans one unit in seven minutes, CeraSys America's new five-axis scanner takes two-and-a-half minutes per unit and is ideal for poor margin preps. The CeraDesign software now offers automatic connector placement and a complete pontic library. The CeraMilling unit, which initially only milled zirconia and wax, now features an all-purpose mill that the company says can "machine everything from A to zirconia" and has different cutting tools depending on which material you're cutting. The CerasysZR material, which is 95% zirconium oxide, comes in two base colors, white and translucent; both can be stained to match any shade.
Cercon. Following the trend of manufacturers offering more affordable hardware options, Dentsply's newest component is the Cercon Eye, a stand-alone scanner that allows laboratories to buy only an in-house scanner, then scan and send data to be milled at one of the company's 220 milling sites. The Cercon Eye costs $13,500 and the Art software that drives the system is $7,100.
Etkon. A new version of the software, etkon visual 3.2 that features pontic and connector bar libraries, was launched in December. Labs can produce single crowns, inlays, onlays, Maryland bridges, and telescoping and fully contoured crowns in a new proprietary YZ material called Zerion. This spring, EtkonUSA will also have a new proprietary etkon milling machine from Germany, and additional software upgrades are in the works, including a full contour crown and bridge library as well as the ability to scan inlays using a waxup and scan function called CopyCad.
KaVo EVEREST®. A double scan feature and simultaneous five-axes technology allow KaVo's EVEREST users to mill implants, bars, slide attachments and more. Launched at Lab Day, the system's implant capabilities will be broadened by an on-screen design function and a cooperation with implant provider NEOSS®, allowing EVEREST users to mill custom titanium or zirconia implant abutments for a broad range of implant brands. At Lab Day, the company also unveils new EVEREST software architecture, based on modules by the software company, geomagic®. Coming soon: a remote scanner solution.
inLab®. Sirona Dental Systems' new 2.9 software offers three additional features: a Manual Correction Mode allows the user to scan two different models and digitally overlap them to create a virtual matrix, a Reduction Mode allows restorations to be designed in full contour mode then reduced to accommodate the desired amount of porcelain, and a Margin Cementation Gap reduces space at the margins and allows you to profile unique fit requirements for each client. Also, various materials can now be milled using a Step Bur that has four cylindrical steps, a design that stabilizes the concentric milling action and eliminates the need to overmill; the infiniDent web-portal allows inEos and inLab users to upload files for fabrication. In the works: CAD-generated titanium and zirconium oxide implant abutments from Straumann, as well as metal frameworks.
Katana. Coming soon is a software upgrade: a dual scan technique where technicians can scan the prep and the waxup—a benefit for implant cases where virtual waxups are not ideal. Katana is manufactured by Noritake, marketed by Zahn, and distributed by Custom Milling Center (CMC).
Lava™. New from 3M ESPE in 2006, laboratories can purchase a stand-alone scanner, the $34,500 Lava Scan ST, and send the digital data to one of the nationwide authorized Lava milling centers. Lava currently fabricates single crowns and up to six-unit bridges; eight-unit bridge capability and an implant abutment service are coming this year.
Procera®. Now available from Nobel Biocare: longer-span Procera zirconia bridges (10 units up to 60mm long), and the first alumina one-piece bridge in up to four units. Procera abutments are also available for other implant systems, including Astra Tech in titanium and Camlog in zircona and titanium, and replacements for the Procera esthetic abutment kit can now be ordered using the scanner. Coming soon: the ability to scan Procera implant bridges in both titanium and zirconia using the Forte scanner.
TDS (Turbo Dent System). In the second half of 2007, the company will launch a new software module, Implant Smart, that uses CT scan technology to create a blueprint for the case in advance of the implants being placed. Implant Smart integrates the CT scan into the software and allows the dentist to select his implant of choice, review the CT scan for bone consistency and health, and then virtually place the implants. The software also allows the technician to provide clients with a complete solution: you can fabricate a surgical guide or stent for easy implant placement, the custom implant abutment in titanium or YZ material, the temporary crown, and/or the YZ /VM9 final restoration. Existing TDS customers will receive the software module first at no charge for beta testing with their doctors.
ZenoTec System. Users of Wieland Dental Systems' machine will soon be able to design copings in full contour by selecting from a full library. The file can then be split so the coping and full contour can be milled out of two different materials. For example, the coping can be milled out of zirconia and the full contour can be milled out of resin and then invested and overpressed. A hardware update will speed up the machine by approximately 20% and, rather than only milling the disc in the horizontal position, the unit will be able to tilt the disc during milling to maximize the unit-to-material ratio. Also to come will be "pre"-shaded zr-discs that no longer require dipping and are ready for any lighter shade of porcelain.