Digital Impressions???

[BobCDT]

Hi,
I wanted to start a thread on digital impressions. I know this is a lab site and digital impressions are a dentist tool. But, this will have a significant impact on us when and if the technology is widely accepted.
I really believe IOS devices will replace analog impressions. Currently, I think buying digital must include better, faster, cheaper and more indications. Is the slow adoption of IOS's is due to cost? *$20-30K for the scanner. $22-33 for model kits. Yearly fees, and dongles to name a few.
My questions to you . Are you supporting any of the existing IOS devices? If so which one? And why? What do you like and what do you dislike. How about those model fees? How is the integration with your CAD programs?
Thanks,
Bob

[Rex Kramer]

For what its worth, I just bought the 3M COS margin marking software ($1k) and finished my cert cases Sunday (waiting results now). I do not have any clients that have this system.
Why I purchased, I have the lava7 system from Jensen, while in Chicago lot of "rumors" about a new 3M IOS in the works, so my thinking is should this pan out, I want the cert out of the way now.

We shall see.....

rex
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[JohnWilson]

Rex I guess 3m changed things up and didn't mandate "Their" computer system? It cost me 3k to get involved with the margin marking with the COS 18months back.

Anyhow when we got involved it was because we had 2 heavy hitters that were looking for the next best thing for their practice. In both offices the impressions were better than average before going digital. As I have stated in the past I had thought this technology would best help the guys that could not take a decent impression because of moisture and poor visuals. Having it on their screen prior to hitting send I had hoped would improve the communication and the quality of the impression. Unfortunately sub g preps are not the easiest to control moisture no matter if taking a digital or a static impression.

The C.O.S. system at the time was the leader in this technology. The new hand holds look quite a bit easier to use but who knows about their accuracy or if the Dr.’s will jump on board with them. The flaw in 3m's system was that they expected labs to "Absorb" the model printing costs and it made zero sense to do that from a labs perspective. What I always wanted to find out is the labs that were leasing these for their clients if it was found to be a successful endeavor or a bad marketing idea. I vote on the latter.

As a lab owner I am all for anything that can eliminate gypsum from my lab and control accuracy and increase throughput in my lab, but it has to be cost effective. I have yet to see any system at the moment that can do all three.

[CoolHandLuke]

shot answer: yes the digital impression age is coming to fruition. it will not take off though, for another 20 years.

why 20 years? well, examine your dentists. i know my pool of dentists is somewhat past their prime, in late 40's to late 70's. few of them have emails, fewer still have facebook or a webpage.

slow to adopt the technology - they didnt grow up surrounded in it, they do not understand it. no amount of training will get them there. they will adopt new products that come out of the lab for insertion sure, but new technology - no. a lot of my DDS's and denturists still use Impragum, the stuff they use in schools to teach impressions.

not to say its a bad material, but they have not progressed past the use of what they know, into something they do not know. theyve not grown.

so until the new generation of now 20-ish students grows up and out of school and into the practice, we wont see this digital age come to fruition.

[BobCDT]

Rex I guess 3m changed things up and didn't mandate "Their" computer system? It cost me 3k to get involved with the margin marking with the COS 18months back.

Anyhow when we got involved it was because we had 2 heavy hitters that were looking for the next best thing for their practice. In both offices the impressions were better than average before going digital. As I have stated in the past I had thought this technology would best help the guys that could not take a decent impression because of moisture and poor visuals. Having it on their screen prior to hitting send I had hoped would improve the communication and the quality of the impression. Unfortunately sub g preps are not the easiest to control moisture no matter if taking a digital or a static impression.

The C.O.S. system at the time was the leader in this technology. The new hand holds look quite a bit easier to use but who knows about their accuracy or if the Dr.’s will jump on board with them. The flaw in 3m's system was that they expected labs to "Absorb" the model printing costs and it made zero sense to do that from a labs perspective. What I always wanted to find out is the labs that were leasing these for their clients if it was found to be a successful endeavor or a bad marketing idea. I vote on the latter.

As a lab owner I am all for anything that can eliminate gypsum from my lab and control accuracy and increase throughput in my lab, but it has to be cost effective. I have yet to see any system at the moment that can do all three.

Hi John,
I would think that the companies providing COS devices would want labs on board. Charging a fee to get involved is probably not a good model. I know Itero want $5K for their "partner lab" level involvement. They have an additional On line partner lab that is $2K. There is an "external Lab
that pays $300 and then has no access to digital files and a model kit runs $33. Not sure what they are thinking!!!
Fees such as this is going to make it more difficult for these companies to get labs on board. And, not having labs on board will make it more difficult to sell the scanner.
We are currently an Itero External Lab paying $33 for a quad model kit. We do a $23 up charge to the docs for model kits. How do you all handle the increase cost in this area?
Bob

[Rex Kramer]

John, I hear ya, anything to eliminate cast and die work. Im a one man studio ever since my wife fired herself, so I do my own cast work and its the number one reason im a slow poke. Its also why I bought the NobelProcera scanner when it launched in Chicago, they said it could scan impressions..showed us milled casts that looked gorgeous....well I ended up returning that machine...that's another story...( It couldn't even render a coping on a shoulder'd prep.)

For me it actually might be worth paying for the casts in exchange for the time savings alone. Would defiantly let me do more ceramic layering... Bob, a package deal? Casts and Coping :-)

rex
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[BobCDT]

Rex,
Interesting thought!

[Rex Kramer]

Rex,
Interesting thought!

What would be 'ideal' for me anyway is receiving digital impression data, mark margins etc, design coping or whatever the case may be (implants might be multistage?) outsource the data to ONE place and get casts and coping/framework back. This would give me the ability to take on more clients and not increase my hrs.

rex
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[CoolHandLuke]

What would be 'ideal' for me anyway is receiving digital impression data, mark margins etc, design coping or whatever the case may be (implants might be multistage?) outsource the data to ONE place and get casts and coping/framework back. This would give me the ability to take on more clients and not increase my hrs.

rex
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Aurum Group in Calgary can do that for you with iTero stuff. i'm sure quite a number of others can as well. just throwing out there what i know. just check off export iRx in the script, along with any notes for the design of the coping/anatomy, and additional information (such as return in Green state if you wish to stain it and sinter yourself, or return unglazed, etc....) just mark it down in the notes.

[BobCDT]

Hi Rex,
So, the work flow you are suggesting is as follows:
Your docs have a iOS device.
The digital impression goes to a central manufacturing facility.
From there the outsource facility manufacturers a model kit and coping (or whatever is perscribed).
You then receive models and a coping ready for porcelain application.
I love this workflow for the small lab. In the small lab the money is made doing ceramics. This workflow enables one to specialize in ceramics and outsource the lower profit laborious models, dies and frames.
I think this is a win win for everyone.
Bob

[Rex Kramer]

Hi Rex,
So, the work flow you are suggesting is as follows:
Your docs have a iOS device.
The digital impression goes to a central manufacturing facility.
<SNIP>
Bob

I was thinking it all goes to me first then I decide where to get casts made etc.... Guess its all going to depend who has the hands in the till, as DMC posts 3M has burned some bridges...not sure how they can create a new digital workflow that makes everyone happy. They just posted they went over 100k impressions with the system.

I can see the lab being a big part of selling/leasing the right IOS system to their accounts that take lousy impressions. And your right my income is from ceramics and implant work. I wont hire employees been their done that... my growth will come from being efficient and outsourcing where its smart. I'd love to get a mill at some point but that means I have to run it...

rex
--

[mastert]

The new 3shapes scanner looks good. I think there is a future in model fab, but I also think virtual designs will be more common as well.

[PDC]

I would think that the companies providing COS devices would want labs on board. Charging a fee to get involved is probably not a good model. I know Itero want $5K for their "partner lab" level involvement. They have an additional On line partner lab that is $2K. There is an "external Lab
that pays $300 and then has no access to digital files and a model kit runs $33. Not sure what they are thinking!!!
Fees such as this is going to make it more difficult for these companies to get labs on board. And, not having labs on board will make it more difficult to sell the scanner.
We are currently an Itero External Lab paying $33 for a quad model kit. We do a $23 up charge to the docs for model kits. How do you all handle the increase cost in this area?
Bob

I've been a CAD-CAM Partner lab with Itero for a few yrs. now. I paid $3500 at the time for this. Initially they wanted 5K and install a new computer. I told them I didn't need another computer because I already had 3 so they installed it on one of my existing computers and only charge me $3500. At this level I only pay $18 per model and $2 per die. No Shipping. No file export fee. When you figure what shipping costs from Juarez Mexico would be as well as the savings on the models and export fees is, it doesn't take long to justify the initial expense. Add those things together and your probably looking at a conservative estimate of $25-30 per case. 100 cases x 30= $3000.

Aside from that expense, I have saved a tremendous amount of time by not having to pour, pin, base, trim, saw out, and articulate models. In addition, I save even more time by not having to scan models.

We do experience some issues from time to time, but overall I've been satisfied with this business model.

[BobCDT]

In order to move the industry forward with digital models what do you think the appropriate price point needs to be. I am interested in wide spread acceptance. I believe the average M&D cost in production labs is $10-12.

[PDC]

In order to move the industry forward with digital models what do you think the appropriate price point needs to be. I am interested in wide spread acceptance. I believe the average M&D cost in production labs is $10-12.

IMO, the patients of dentists who are using the IOS devices will be the impetus behind other dentists moving into the digital age...not by choice necessarily. Patients of IOS docs already appreciate the technology (especially the gaggers). The materials are more accurate and the docs notice it. My accounts have told me that their hygenists can not even feel that marginal bump with their explorers anymore. My business load has definitely shifted toward all ceramics over the past couple of years. Given the choice between metal or all-ceramic, most patients will opt for the latter.

It's not real cost effective for a lab to try and be "part" of digital dentistry such as the Itero external lab model. It will be hard to justify the added cost like this. You have to be pretty much totally involved to take advantage of reductions in labor, materials, and other expenses.

[BobCDT]

Is there anyone from Europe that can provide an update on the Trios scanner? Just wondering if acceptance has been wide spread and generally how do you feel about the device. I would assume it's fully integrated with 3Shape. How is it working with other open CAD systems. Also wondering how long it takes to receive files after the docs finishes the scan. I know the Lava COS is a few hours and Itero is about 4 days. Looking for an IOS that provides instant data.
We had the Trios here a couple of months ago and it seemed to be easy to use and the data collected looked very good on the monitor.
Thanks,
Bob

[DMC]

Bob, did you ask Mark Jackson?

Give him a shout.

[BobCDT]

Good idea.

[rshark]

Hi Guys, just a quick comment from down under. I've been an Itero partner lab for 2 years, I got a really good deal on the fees since I am one of the first here to adopt the technology. My experience has been mixed but not from a quality or cost perspective mainly shipping and billing issues. Calgary to Australia is a big jump. Having said that, the milled models are great as far as accuracy and fit goes, but my biggest complaint is that the adjacent teeth are not milled to the same level of accuracy as the die. My clients have reflected that the fit and occlusion are fantastic, they have significantly reduced the time taken to fit their cases, in fact one guy I work with does a lot of gold crowns, and he told me that sometimes he doesn't bother to try it in. He just takes off the temp and cements the crown on, and not adjustments. My issue is more about surface texture. The die and the model are milled separately, one is to a high definition, but the model is much lower making it faster for the machine to spit out. This low definition model has very poor surface texture and if you are doing an anterior crown it makes it hard to accurately match the adjacent teeth. I get around this by ordering the adjacent teeth as removable dies as well therefore making them milled at the same high definition as the die. Still not as good as a good die stone model but better. What I ask is that the dentist uses a PVS material to make the temp, and then send that to me so I can pour it up. Hmm so much far a quick comment. I still have more to add to this about cost effectiveness and also about Trios, so watch this space. meanwhile work to do. Cheers.

[rshark]

Hi Guys, just a quick comment from down under. I've been an Itero partner lab for 2 years, I got a really good deal on the fees since I am one of the first here to adopt the technology. My experience has been mixed but not from a quality or cost perspective mainly shipping and billing issues. Calgary to Australia is a big jump. Having said that, the milled models are great as far as accuracy and fit goes, but my biggest complaint is that the adjacent teeth are not milled to the same level of accuracy as the die. My clients have reflected that the fit and occlusion are fantastic, they have significantly reduced the time taken to fit their cases, in fact one guy I work with does a lot of gold crowns, and he told me that sometimes he doesn't bother to try it in. He just takes off the temp and cements the crown on, and not adjustments. My issue is more about surface texture. The die and the model are milled separately, one is to a high definition, but the model is much lower making it faster for the machine to spit out. This low definition model has very poor surface texture and if you are doing an anterior crown it makes it hard to accurately match the adjacent teeth. I get around this by ordering the adjacent teeth as removable dies as well therefore making them milled at the same high definition as the die. Still not as good as a good die stone model but better. What I ask is that the dentist uses a PVS material to make the temp, and then send that to me so I can pour it up. Hmm so much far a quick comment. I still have more to add to this about cost effectiveness and also about Trios, so watch this space. meanwhile work to do. Cheers.

Ok so a little more to add. I charge only a little more for the Itero models than I do for my normal dies, about AU$45.00, but my cost is much higher. I offset this against the fact that I don't have to articulate, pour up and trim, or pay somebody to do it. The model is already cut and trimmed, and ready to start work on. The single biggest advantage the system makes for me, is the conversion and importation of the file into the 3Shape software. I can design the restoration for production in wax, Emax, monolithic Zirconia, PMMA or whatever else people come up with that can be milled. This whole process from the time the scan file arrives in my lab, to the final minor adjustments to fit to the model takes about 45 mins working time. Not with standing the over night processing of the scan file, milling and delivery of the models (5-7 days, but less soon when the models will be produced in Australia), and the milling of the restoration, about 2-3 days. Usually the restoration arrives before the model. My over all fee for say, a monolithic Emax case, is the same as if I had waxed and pressed it and made the working die. The big difference is, it took me about 1/3 of the working time to produce. Sure there were additional expenses but my time is more expensive than the extra costs involved. Not to mention the fact that I actually just do the QA for these cases, my assistant does all the CAD work, and fitting. When I say fitting I mean adjust the contact points, and paint on some Emax CAD stains. The fit of the milled restorations is about 99%, sometimes we need to do a little margin adjustment too, but rarely.

My experience with the digital impressions and models has been in general positive and profitable. There are lots of improvements to be made on the Itero CAD system, but to date it is the best in my opinion.

The 3 Shape Trios system is on the way still, but to the best of my knowledge is still not ready for the general market. There are a lot of trials out there but all have bugs that I know of. Even when the bugs are ironed out there is still the issue of the models. I've worked on some of the "printed" models and found them wanting in so many ways. In my opinion the milled model is still going to be the most accurate.

cheers