If you're caught in the quagmire of digital technology, LMT offers 10 tips to help you with the shopping process:
The rapid evolution of digital technology in the past decade has given laboratory owners and managers an incredible array of systems, materials and fabrication options. While this is one of the most exciting technological periods in the history of dental technology, it also poses a challenge for many who are wondering if and when to get involved, what to purchase and how to make their buying decisions.
If you're caught in the quagmire of digital technology, LMT offers 10 important tips to help you with the shopping process:
Decide Whether to Outsource or Buy With so many laboratories and manufacturers offering scanning and milling services, outsourcing CAD/CAM-fabricated restorations is often the first logical step for getting involved with digital technology. It's an ideal way to build client demand and test the technology. While it's valuable to see "real-world" restorations of the type of work you want to fabricate, keep in mind that the quality and fit of the copings are only as good as the CAD/CAM technician doing the scanning and designing, so it's a good idea to try the same brand restoration from more than one source. Watch for LMT's June/July issue for more information on outsourcing digital restorations.
Determine Whether You Want a Complete System or Stand-Alone Scanner More and more manufacturers are selling stand-alone scanners, giving the laboratory the option to scan and design in-house and send the data to a centralized milling center. Stand-alone scanners and the related software typically sell in the $16,000-$34,000 range. While the scanner-only option saves on equipment, maintenance and training costs, you're dependent on an outside source for milling, which means less control and additional expense. If you want ultimate control over the scanning, designing and milling process, a complete system is the better option; system prices range from $60,000 to over $300,000.
Consider Open vs. Closed Systems The prevalence of open systems--meaning you can use a scanner that communicates with output devices from different manufacturers via STL files--is growing. While this trend offers more versatility and flexibility in system configuration, output options and future updates, it also means you have to make sure the two components work together successfully. In some cases, the manufacturers have already chosen certain open system partners and can give you this information. Also, keep in mind, if you're working with a system that has a dongle fee, the fee still applies even if you're just using the scanner and outputting to another manufacturer's system such as a 3-D printer. Closed systems--bought as a complete package from one manufacturer--are typically easier to install and maintain, and give the security of knowing you can turn to just one manufacturer if problems arise.
Choose Which Types of Restorations You Want to Fabricate CAD/CAM and rapid prototyping technology now gives you the option of fabricating metal and metal-free copings and bridges, inlays/onlays, veneers, implant abutments and full coverage crowns in a variety of materials, including zirconia, leucite-reinforced glass ceramic, lithium disilicate, gold, titanium, nickel chrome, chrome cobalt, alumina, composite and resin. Restorations and material choices vary by system so you need to decide which services you want to offer and shop accordingly.
Match the System to Your Daily Output Requirements For example, a lab that simply wants to offer zirconia restorations to its existing dentist-clients will need a lower daily output than a milling center. Be sure the capacity of your scanner and milling unit are evenly matched. For instance, if you can scan 60 units per day, can your milling machine fabricate the same number of units, or do you need two milling machines? Also, if a machine has two capabilities you want to maximize simultaneously--such as milling zirconia and milling resin copings--multiple systems may be necessary.
Evaluate the Scanner and Software Features Most scanners can scan the original die, waxup, full arch, bite/opposing model and adjacent teeth. However, the latest trend in scanning technology is the ability to scan impressions as well as models. While a scanned impression is only as good as the quality of the original impression, these units are one more way lab owners are augmenting their digital workflow. It's also important to evaluate the type of scanner. For instance, a grid scanner takes scans from the top down, so it requires you to manually reposition the die at different angles. In a scanner with lasers and cameras, the process is automated but the hardware is also more expensive. Software developments are outpacing hardware advances as manufacturers are making their software more user friendly, comprehensive and easy to learn. Some of the more common software features include wax-knife; buildup; measurement grid; automatic margin locator; digital blockout; digital cement gap; proper connector size, shape and placement; and automatic alignment of milling path. Another popular feature, file splitting, allows you to design a virtual coping/framework and full contour simultaneously and then fabricate them out of two different materials. The coping can be milled out of zirconia and the full contour can be milled out of resin, then invested and pressed using traditional techniques. If newer features like this are not available, what updates does the manufacturer have planned?
Ask About Number of Axes In general, a three-axis mill works for most indications while a five-axis system can handle more complex geometry such as angulated abutments and divergent bridges. When asking about the number of axes, be sure to check how many of them are actually milling axes as opposed to axes for other automated features such as loading and unloading frames.
Research the Material Costs if You're Purchasing a Complete System With some systems there's a set number of units you can mill from one block; other systems allow you to "nest" units, meaning you optimize the number of units you can fabricate from one block, reducing your material costs. Find out if the manufacturer allows you to buy materials from any source; this can help keep material costs down but it also might invalidate the system manufacturer's warranty. If you do decide to use an alternative source for material, ask the vendor to provide written information backing up the materials and ask for the names of other lab clients as references; some lab owners report problems with the fit of the understructure when using an after-market material.
Find Out the Unit's Requirements Manufacturers will typically give you detailed information on the system's total footprint and energy requirement so you can be certain you can accommodate the unit. Also ask about electrical, dust evacuation and floor support requirements; it's sometimes necessary to upgrade.
Assess the Potential Manufacturer Partner Ideally, the manufacturer pulls out all the stops when it comes to marketing its brand to dentist-clients so you can ride the coattails of its efforts. Since the digital world is moving full speed ahead, buyers also recommend partnering with a manufacturer that has a commitment to evolving with the technology.
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