The latest digital milling technology is transforming dental practices. It allows you to take full control of the quality of materials and work you are fitting, and accelerate the process for you and your patients – the ability to turn around a single restoration in one day can make a world of difference for a busy or anxious client. The complexity of bringing milling in-house depends on your level of ambition, but with digital systems and their efficient and user-friendly workflows you can take your first steps into the field.
Intraoral scanning and digital production tools
Intraoral scanning within dental surgeries is becoming more widely accepted – for a good reason. It saves time, as there's no need to post physical impressions to the lab, and saves money on impression material. You may also achieve a higher level of accuracy and find it acts as a valuable diagnostic aid; you can refer to the scans at any point. All this adds up to a better patient experience.
Adding digital production tools is the next logical step. Any practice could invest in a milling system to produce in-house, single-unit restorations, cemented or screw-retained, crowns, inlays/onlays and veneers, while more ambitious practices could go further by creating a full practice lab with in-house technicians. Study models, full arches, bite splints and RPDs could all be possible for a surgery open to investing in this genuinely practice-changing technology.
The workflow for digital milling systems is fairly straightforward, with a smooth learning curve for any computer-competent dental professional. As an example, we'll look at the workflow for Millbox CAM software in combination with the Roland DGSHAPE DWX-42W wet dental milling machine. First, select the material type and the machining location.
Then, select the STL file from your job list, confirm the restoration type and review the design; you can then choose a suitable block size from the library available.
The restoration is placed automatically by the software, taking into consideration minimising undercuts and support for screw channels, but full manual override is possible in terms of positioning, rotation, support size and location – for example, there are many new multi-shaded materials available, while careful positioning of the restoration vertically will maximise the aesthetic qualities of the material. Once you're happy, you can start the next step: the toolpath calculation process.
You have a choice of options in how to process the job and, based on your choices, the software will confirm which tools are needed and in which positions they should be located. Once the calculation is complete, a full 360-degree simulation will show you whether the final milled results will meet your expectations. If you have concerns, you can make the judgment to adjust and re-calculate as you wish, without wasting any material or milling time – it's an extremely efficient process.
The DGSHAPE DWX-42W is managed through a virtual control panel, called the VPanel, which alerts the operator to any maintenance required and guides them through the necessary steps. Any required tools are kept in the integrated storage area for easy access. Simply secure the required material in the machining location you've previously selected and send the job; tool changes are automatic, and the cooling system operates automatically too, while compressed air ensures moisture does not enter the spindle. The job's progress and estimated remaining time is displayed on the screen so you can keep up to date, but you can leave the mill to simply process the restoration by itself – allowing you to get on with other tasks.
Finishing Milled Restorations
It really is an exciting time for dentistry: digitalisation is enabling a revolution in material innovations. For instance, there's far more scope to use composite resins and hybrid ceramics that do not need crystallising, and that can be polished, glazed or fully stained depending on the required level of characterising. Glass-based ceramics offer superb levels of translucency, while PMMA can provide temporaries that are almost too good. The popularity of zirconia in the UK, meanwhile, is exploding. There's an enormous market waiting for dental practices with the ambition and investment resources to enter it.
Completing milling work in house will create a stronger business, but it will also strengthen relationships beyond your four walls. Through being an integral part of the production process, you will improve your understanding and appreciation of the digital workflow – helping you to gain, in turn, a greater appreciation for the skill of a technician and, unless you are planning to invest in a practice lab, you will gain a more resilient relationship with your existing lab. Crucially, you will also build valuable links with your patients – happy clients are loyal clients.
With the current workflow, you prep the patient, provide a temporary and send them home for a week or two – a testing time for them and their family as they struggle with not eating well, perhaps not going out and even shying away from smiling. Instead, an in-house digital workflow could enable patients to go home with their restoration on the same day – certainly convenient for the patient and rewarding for you. It also removes a psychological burden - something that is truly valued by many patients.
There are many options for digital milling processes, the complexity of which varies depending on a number of factors. And with so much potential in the market it is definitely worth exploring.