CAD-SCAM, help me understand

[Jo Chen]

I work in a lab retooling to CAD and I am not impressed with the results. New technology should be better, faster and cheaper. We use 3shape for scanning. Wieland mills, D4D and the CEREC mill. Envisiontek printer and some other printer capable of printing 200 units in one and a half hour.

First the quality: The printed copings once cast fit badly and require more time (25%) to seat than hand waxed units.

Second speed: Spending extra time to seat the copings erodes the speed factor.

Third cost: 3shape scanner $35000 to $40000 for a scanner not tied to a milling center. Mills and printers how much? Employees to work the scanners, printers and mills. Profit margins are thin to begin with, how can a small or even medium size lab be profitable with this set up? Let alone good quality.

Would you rather have Al make a crown for you or CAD-CAM? Sometimes I sense a consensus that members on this forum would prefer pressed e.max over milled e.max. Why are we like lemmings jumping on the CAD-CAM bandwagon? Some on this forum seem to have it figured out (***).
Please enlighten me

 

[DMC]

I passed on every system out there for years and years.

The 3M Lava Systems has a great complete package, and it was $$ at the time. I really thought I needed it.

The software is now a little behind, and will never be any better. It's done.

The scanner data and final results are still the best out there by far.

3x better info (scan data) than a 3shape scanner to start off with.

Are you unhappy, or are your customers unhappy. Who do you work for?

Why do you work?



Do you have a 3D Systems printer?



I know plenty of labs that make it work, and make $$.

 

[DMC]

I buy a lot of used equipment.

I pass on all service agreements.

I void all warrenty. I cheat.

I need to make $$ God Damn it!!!

If you play the game....you will not gain. Those are the rules.

I didn't make'em....

I use my 3D printer forr all I can! I will print a joke, or a fart if the price is right.

I whore out everything I have in a frantic race to pay it off to just go out and buy more!

It's a sickness.

 

[TheLabGuy]

There is a learning curve for sure...You can't go into thinking this will do all your work at all. Then learning scanning and designing is only half the battle, finding out who mills consistently and/or using your own milling is a whole different battle. I've gone back to waxing my full contours because the PMMA being milled wasn't consistent enough. So I feel your pain, however, it's nice to see some of the FCZ and the custom cad/cam implants we are doing. Also, nice to see the possibilities, but accuracy and time will come, keep at it.

 

[Jo Chen]

I am pulling my hair out over this. Well, not much left anyway. I am supposed to pass work I would have never passed when it was handmade. All of a sudden it is ok because it was made through CAD.

Am I too picky? I am a CDT for over 20 years and have seen plenty of gadgets, tools and techniques come and go. I am by no means a technology stalwart.

Are we lowering our standards to compete with China?

"Do you have a 3D Systems printer?" The fast printer is a black, tall rectangle with a red door and window.

Why I work? The landlord shows up every thirty days or so and demands I pay him for the privilege of inhabiting his dwelling and the kiddo will go to college in a couple of years.

 

[Jo Chen]

Rob,
Thanks for the encouragement.
We have seven 3shapes operated by two people simultaneously, four Wieland mills, three D4D's, one CEREC and four printers. Putting out a serious number of units every day. We have been at it for a while but it does not seem to improve.
For implants it is great, abutments and bars. Almost like jewelry. Copings and bridges are another story.

 

[TheLabGuy]

Rob,
Thanks for the encouragement.
We have seven 3shapes operated by two people simultaneously, four Wieland mills, three D4D's, one CEREC and four printers. Putting out a serious number of units every day. We have been at it for a while but it does not seem to improve.
For implants it is great, abutments and bars. Almost like jewelry. Copings and bridges are another story.

Dang, you have some serious hardware brother. As for copings and bridges, I just think there is preps out there that aren't scannable and a lot of them. That's why implants do so well and the feather-edge PFM plays hell for the cad/cam folks. Just my thoughts.

 

[NicelyMKV]

I received printed copings and bridgework from *** and Bego. They all fit perfectly under magnification. Both are different printers with different materials. I have tried milled pmma a few times in the past and it was not accurate enough for me. Emax CAD is a whole different story. I have two accounts that give me text book shoulder preps. Emax CAD works flawlessly for them. If I use it on anything other than that I end up with a diamond under a scope seating minor spots internally and along the margin. I normally have to take a 35 diamond fg and re detail the occlusion slightly as well.

 

[stt672]

In a way I think many doctors have lower their standards. How many had a Cerec sitting in their back room milling crap and seating it, open margins no problem "cement will fill the gap." There are times Im stunned at how well they fit and other times Im stunned at how pathetic they are. Bottom line you have to care what you are sending out. In 30 years of doing this I haven't lowerd my standards. If I would put it in my mouth it goes out. Jo, you have legitimate concerns Im glad there are people like you still in this profession.

 

[DMC]

Joe...you need to pull out all tricks and options to get something back from your investment. If you are using 2.5mm tool for roughing, then go to 2mm. You now get much more units out of material.

You have to shop around to find the best tools for the $$. This helps.

Fix your own stuff. Sounds like you have enough to hire a guy to do that.
Don't get replacement parts from manufacture. Dig deeper to find more savings!
I get my parts for almost next to nothing, compared to what I would have paid.

Are you wasting material on printing? Well, figure out how to cut it down.
You should not have tyo re-touch the margins or alter the interior of crowns. That's the magic of CAD. It removed undercuts and makes cement spacer for ya. I see saving in those steps. You don't?

Can you scan in a more efficient way? Design Two or Three at a time as fake bridge?
Export them as a Trio-team?

What do you spend every year in service agreements? That is pretty much my only profit. If I had to pay for that....I'd be broke! 4-5 mills, a printer, scanners, ovens, etc = $70k a year+ in service!! LOL That's what I save every year. Almost what I make.
I bet I could help you guys rock and roll with this stuff.

All employees at my lab have minimum of Two screens to do multi-tasking while at a scanner. Some of us run Three or more.

I have a guy, Brad, who runs over Ten programs at once on many many screens. He divides up and calculates Zirconia all day, converts files, fixes CAD stuff, and re-works many files brfoe going to the printer in another facility. No scanner at all. It is pretty tough, but the day flys by fast when you are occupied. He sees 2-300 teeth every day and remembers almost all of them. The whole time he is also on the phone. You have your team whipped into shape like this? You have to make each day fun, or your team will go mental and slack-off.

I'm sure there are other ways to get the job done? This works for me so far?

 

[DMC]

If the quality is not acceptable, then this is another story.

Not all machines are good. IMO Some will be very hard/impossible to recoupe your $$. Some just plain stink!

 

[Al.]

Everything in the industry is about cad cam now.
Look at these fourms. How many post about cad cam vs other stuff.

With so many cad cam techs now, I wonder if we will see a shortage of skilled hands on techs in the future?

Alot of ceramists or guys doing final coutouring have come from the waxing department especially full crown waxers.
With waxing departments dissapearing I wonder how that will effect future positions in the layering dept.

I personally think with so many rushing to abandon their hands on skills and automating as much as possible we may be left with a void or a shortage of techs in the future.
Mabey good opportunities for some that dont abandon working with their hands.

The way I see it, Drs dont care how its made they just want the finished product consistant and to their standards of quality and at a price they can afford.

Mabey I am wrong but from what I see with the technology as is, and with my business model, the time savings is not that much if at all,the consistancy in my quality may drop but most important my profits would take a big hit.

When the prices come down on systems, and the consistacy and quality increases Ill probably jump in.
Right now I am afraid Id loose too much money automating unless I really steped up the volume and Im already doing way too many units.

 

[DMC]

Al, I simply don't see that happening.

Embrace the change. Don't be hard-headed.

Of course all this stuff will improve (quality) and get cheaper and cheaper.

Why focus on materials that you know will be replaced. It's only a matter of time.

Do you see job openings for old school techs? I don't. No computer/machine skills = no job.

Did you ever see a reverse in the progression of technology, like you suggest?
Give me one example....

 

[NicelyMKV]

Al, I agree with you to a point. You are abnormally productive with extremely high quality! lol! I have nit been able to find anyone anywhere close to you as far as skill and productivity go. I HATE to say it because I am a pretty social person, but I am fed up with dealing with employees. I am also kind of a computer nerd and I take everything apart, at some point, that I ever own. So CAD is a very comfortable progression for me. I am still concentrating heavily on improving my ceramics work as well. I feel like substructures at the very least should be handled by machines. I am handling full wax ups differently due to some of the same concerns you have. We design 60% with CAD and hand wax the other 40%. The 40% is usually the cases with really bad margins etc and it keeps my waxer and myself in good practice hand waxing as well. FCZ is what really drove me so quickly into CAD. Once I started using it I realized how much more I could do with it, very accurately, as well. I don't think guys like you Al will have to worry if you don't adopt the technology.

 

[Tom Moore]

I know how hard it was to abandon how I did things especially when it was from down my arms to my hands from that hard drive between my ears. Seemed like I was abandoning myself. Not so, I found out I am much more than Tom the dental technician.

We are still in the early innings of this game and I have had the privilege to peek at some of the things coming, after signing non discloser agreements. Believe me we ain't see nothin yet.

 

[DMC]

It's time to get your "nerd" on!

Pocket-protectors are coming in style for the Spring I hear.

 

[NicelyMKV]

 

[Jo Chen]

I can see where CAD-CAM can be incredibly efficient. What is disturbing is the quality I have seen.

***,
I would like to send you two dies, one anterior and one posterior to print copings so I can compare what we are putting out. Maybe the problem is entirely on our side.

 

[Jo Chen]

All three pictures below are pleasing in their own right, painted in three different time perids. Which one took more skill?

 

[NicelyMKV]

Those are beautiful Jo. Just look at computer aided design as another medium Thats all.