The truth about chairside dentistry
Chairside dentistry has been touted as the next evolution in dentistry—and it’s whispered about among dental technicians as something to be feared. What’s the reality of this burgeoning technology?
From a purely technological perspective, chairside dentistry is, undoubtedly, an exciting new stage in CAD/CAM evolution. If you’re a tech geek who loves to learn about how digital tools are shifting dentistry, you’ve probably done more than your share of research into these powerful chairside tools. The technology is so new and exciting, however, that only a small percentage of dentists utilize it.
And even more dynamic is the fact that there doesn’t seem to be any hard and fast rules about what a doctor should do chairside and when that case should be sent to the lab.
But chairside dentistry is one of the biggest question marks for labs and dentists—if work can be done chairside, what will happen to dental labs? If dentists are doing their own restorative work, will patients be satisfied with their esthetics and fit? Can everything even be done chairside? And what are new technologies doing to this fledgling workflow?
Of course, a lot of it depends on the individual doctor and his or her comfort level, but what sorts of guidelines should doctors follow to get the best results?
Where we are now
There are no professional standards or guidelines for when doctors should send cases to the lab. It is mostly a judgment call on the restorative dentist’s part.
“I think there’s sort of a fuzziness and I think it’s a fairly recent fuzziness, because everything has gone so digital in the last five years or so,” says Dr. John Flucke, DDS, Dental Products Report Technology Editor. “It used to be all very straightforward and it had been done the same way for an extended period of time. There’s a lot more digital stuff going on both on the lab end of it and on the dental office end of it. But even if the dental office isn’t embracing the digital aspect of it, a lot of labs are, and a lot of doctors don’t realize they’re sending impressions to a lab and the lab is scanning those impressions and doing a lot of digital things on their end.”
Dr. Paresh Patel, DDS, an implant specialist at Implants by Paresh in Lake Norman, North Carolina, recognizes his limitations and sends cases to the lab when he knows he can’t achieve the esthetic look that he needs.
“Our rule of thumb is, if I don’t have, in my mind’s eye, a very clear picture of how to apply stains to make it look as esthetic as possible, or if it’s a high-value case, where I may want to have laboratory cut back and hand-layer porcelain over the top of the CAD-milled coping or frame, I’m definitely going to go to the laboratory for that,” he says. “And some of that is just that I don’t have the skill of the laboratory technician to get that done.”
Not all doctors have that self-awareness, and their results may have been better achieved had they used a lab.
“I have seen several lectures where dentists proudly show chairside restorations that are esthetically quite poor,” Bob Cohen, Executive Director, Product Development and Clinical Education at Custom Automated Prosthetics in Stoneham, Massachusetts, says. “I have also attended meetings where others show great-looking work. I would suggest that there are dentists in each group.”
Training and education are important determinants of how well chairside restorations are fabricated.
“With the right training and support, nearly anything is possible via in-office fabrication with CAD/CAM dentistry,” Adam Busch, CEREC Product Marketing Manager, says. “Certainly, there are many non-CAD/CAM users who think that it must be difficult to fabricate quality, long-lasting restorations chairside. It is not until they try a good system for themselves that the ease of use can be clearly seen and experienced.”
Chairside is a moving target and it is something clinicians should keep an eye on.
“It seems like new chairside technologies and materials are being developed every day,” Jason Atwood, CDT, Senior Digital Solutions Adviser, Core3dcentres, says. “Many manufacturers are trying to push the limits of what can be done chairside, coming out with more and more offerings for dentists to do in-house. The sales pitch is that in-house manufacturing is more cost effective, but that is debatable.”
Next: How is this evolving?