Diagnostics Digital Impressions Management Theraputics

SomnoDent and Digital High Tech

A SomnoDent sleep apnea oral appliance is a premium, custom-fitted dental device developed for the treatment of snoring and obstructive sleep apnea. It is an effective, comfortable, and durable alternative to CPAP therapy or corrective surgery.

Source: Sleep Apnea Oral Appliance – SomnoMed

Sleep therapy lends itself well to digital technology. We are using the following for our sleep patients:

  • i-Cat CBCT for a general dental evaluation and measurement of the airway.
  • 3 shape TRIOS scanner and software to take a full upper and lower impression as well as a digital bite.
  • Telemedicine for the medical consult needed for a diagnosis and treatment plan.
  • SleepMed ARES home sleep test, remarkable technology that tests the patient for OSA at home rather than at an expensive sleep clinic.

The technology is amazing and works well. The SomnoDent device is simple and effective.

The most challenging part of the process by far is the paperwork and dealing with medical insurance.

CAD CAM Diagnostics Theraputics

Impression Gremlins

CS3500In case you missed it: Dentalcompare article from Dec. 2012.

An impression can distort or in some other way betray us at numerous stages along the path from the moment it is taken until the restoration is ready to deliver.

Each of these items: the impression material, the stone, the wax, the investment, the metal, various acrylics and finally the oven fired porcelain has some sort of setting and shape change with time, temperature and humidity. There’s also mechanical distortion if the tray bends, the die is abraded, the material compresses or is pulled slightly from the tray. And of course there are bubbles, contamination and tears.

Any one of these errors—lurking like little gremlins—can easily go undetected by the lab or the dentist. The result – remake.

When you take a digital impression you eliminate all of those chemical and mechanical gremlins.

via Emmott On Technology: Go Digital to Eliminate Pesky Impression Gremlins |

Since I wrote that article several new digital impression systems have come on the market. Recently I took a hard look at the Carestream 3500. I like many aspects of it including ease of use. You just plug it into any USB capable computer there is no need for a dedicated cart. The images are easy to get with simple software and most important the digital impressions are saved in an open standard which can be shared with any open architecture lab or mill.

Internet Management Theraputics

Connected Inside Dental Technology

I was interviewed by Pam Johnson for the linked article in IDT Magazine. We discuss online lab communication and interoperability, or more accurately the absence of interoperability in dentistry.

In our personal and business lives, we have come to expect fast, reliable connectivity that seamlessly allows us to bank online; remotely control our smart homes or smart cars; buy anything from books to furniture to airline tickets; take accredited university courses remotely; hold virtual business meetings; socialize with friends; and even monitor our heart rate via a smart watch, regardless of location…

Unfortunately, the same open transfer of data that is experienced when a digital picture is taken and then shared via text, social media, or email does not yet exist in dentistry. “We still have barriers to that process,” says Emmott. “Proprietary software from various vendors won’t allow communicating with the software from other vendors. So unless the dentist and laboratory have compatible software programs, we can’t communicate on that seamless level.”

Source: Connected – –

Future Tech Hardware Paperless

Augmedix raises $16 million to make Google Glass a must-have for doctors

Augmedix has announced a $16 million Series A funding round as the company looks to build out its Google Glass-powered medical tools for doctors.

via Augmedix raises $16 million to make Google Glass a must-have for doctors.

Google Glass isn’t dead yet.

The potential for dentists and physicians to use hands free wearable computers is amazing.  On the other hand if the technology is developed just for dentistry and medicine it will be very as in very  very expensive.

Alternatively if it can be developed to use existing consumer tech the cost can be controlled.

Sadly, up until now, dental tech developers have tried to sell us massive and expensive standalone devices. There is no reason a CAD CAM camera cannot plug into a well-designed chairside computer. For that matter many devices could interface with a smart phone.

CAD CAM Office Design

At the ADA

I heard at the ADA meeting that Planmeca was showing a new impression scanner built into the dental unit. The Planmeca system now called PlanScan was the old E4D system. I went looking for it eager to find out more and predisposed to really like it. What a disappointment.

The PlanScan instrument uses a USB plug in, that’s good but they insist you only plug it into their special laptop. The sales woman even tried the old line that it was in my best interest to use their closed system. The unit can only communicate using their closed network and then they stick a mini tablet on the unit taking up very valuable chairside real estate that can only be used with their system. I can’t run Dentrix or anything else on it I can only view what they let me. All for my own good…please…really?

Just let me plug it into my chairside computer, let me use a standard monitor and let me store the scans on my server and transmit them to the lab of my choice using the Internet. Don’t make me buy yet another laptop and don’t insult my intelligence by insisting it benefits me for you to keep me captive in your private garden.

CAD CAM General Hardware Radiography

Proprietary vs. Interoperability

Definitions from Webopedia

Interoperability:  The ability of software and hardware on different machines from different vendors to share data.

Proprietary:  Privately owned and controlled. A proprietary design or technique is one that is owned by a company. It also implies that the company has not divulged specifications that would allow other companies to duplicate the product.

You can see a real world example of interoperability with consumer electronics. A user can buy a Phillips TV, plug it into a Toshiba DVD, add speakers from Bose and play a Sony DVD from Japan to watch a movie made in Hollywood and it all works together.

For an example of a typical proprietary system, consider the imaginary digital radiography system, ProprioRay. It will only work with the ProprioRay sensor plugged into a ProprioRay connector. The image can only be captured and displayed using ProprioRay software and images are stored in a proprietary ProprioRay format.

More recently we have been introduced to the imaginary CAD CAM system Ceroscan. You can only use a Ceroscan camera plugged into a Ceroscan computer running Ceroscan software. You can not transfer the digital impression to another software or to  a mill or lab of your choice you must use a Ceroscan mill and Ceroscan approved labs. Ceroscan even has a restricted version of the Internet you must use with their products.

Manufacturers like proprietary systems. Consumers prefer interoperability. Experience has shown that vendors will attempt to maintain control unless consumers demand interoperability. When you do they will try and tell you why it is actually to your benefit that they keep you hostage in their private garden.

Future Tech Theraputics

Print your own makeup (or tooth?)

The Mink 3D printer uses the same ingredients you would find in a store and lets you print out both eye and lip colors. But what makes it even better is that you can print a color from any palette, whether it’s from a photo you saw online a color you’ve picked out of Photoshop or the color of your favorite dress. Once you have your color, you find its hex code with a color picker and then pull it up in a graphics program like Photoshop or Paint. All that’s left to do after that is press print and out pops your brand new makeup.


via Save time and money by printing your own makeup | DVICE.

If you can print any color as makeup why not print a tooth color. Take a photo of the tooth or adjacent tooth and have the printer copy it as a veneer or crown.

Future Tech Theraputics

Implants Made to Fit a Beating Heart Perfectly

heartFrom MIT:

Researchers recently demonstrated a new kind of personalized heart sensor as part of an effort to change that. The researchers used images of animals’ hearts to create models of the organ using a 3-D printer. Then they built stretchy electronics on top of those models. The stretchy material can be peeled off the printed model and wrapped around the real heart for a perfect fit.

via Implants Made to Fit a Beating Heart Perfectly | MIT Technology Review.

Essentially what they are doing is what we have been doing in dentistry for decades. That is taking an impression of a body part and fabricating a customized device to fit it exactly.

In the pre-digital past we needed to take physical impressions, create physical models and fabricate physical devices with wax and metal. The digital present allows us to do the same thing with a digital scan, virtual models and devices fabricated with mills or printers.

This evokes one of my favorite high tech themes; “A horse is not merely a faster car.” A digital impression is not merely a faster alginate. A digital impression is to PVS as word processing is to typing.

What makes the heart implant so amazing is that the impression is taken with a scanning device outside the body. In theory we could have cracked the chest, enclosed the heart in alginate, poured a model and made the implant sensor like we used to make a partial denture. But of course that was impractical and foolish. Digital methods make it both possible and sensible.

The development of new methods to capture digital data that can be converted to virtual models coupled with the incredible advancements in printing* will soon lead to treatment options we cannot yet even imagine. The future is coming and it will be amazing!

*The term 3D printer is too pedestrian. It evokes images of plastic geegaws. Printing now includes metal and even biologic material.


Dentalcompare Future Tech Internet

The Future of Lab Communications

futureIn case you missed it: Dentalcompare article from August.

If you have ever bought an airline ticket online or purchased a book from Amazon you have a good idea of what dental lab communications of the future will be like. It won’t be printed forms, scribbled notes and plastic baggies; it will be an Internet connection..

At the point in the procedure when in the past you reached for the printed lab slip, you will instead log on to the dental lab website. As you log on the system will recognize you and automatically know all the basic details about your practice such as address, account number and phone number. In addition, it will know your preferences as to materials, design and technicians.

via Emmott On Technology: The Digital Future of Dental Lab Communications |

The rapid development of digital impression systems will make digital lab communications even faster and better. It will be like snail mail compared to e-mail.

One of the biggest obstacles to universal digital lab communications will be proprietary systems. When you take a traditional PVS impression you can send it to any lab in the world using whatever delivery system you choose.

With certain digital systems like CEREC you can only use their network and their designated labs. Closed systems that keep dentists prisoner are great for the vendors but not so great for the dentist. When you are shopping for a digital impression system be sure to let the salesperson or better yet the product manager know that open interoperability is an important element that will affect your buying decision. Until we as a profession demand open systems vendors will keep us locked in their private walled garden.

Future Tech Theraputics

Hybrid Machine Combines Milling and Additive Manufacturing

The future of dental CAD CAM


…parts produced through additive manufacturing almost invariably need machining as a follow-up step. Only the subtractive process can achieve the most narrow tolerances and smoothest finishes. Far from being opposite or competitive processes, additive manufacturing and CNC machining actually go together. They belong in the same machine.

via Hybrid Machine Combines Milling and Additive Manufacturing : Modern Machine Shop.

Additive 3D printing machines are amazing. There are already consumer versions on the market for around $2,000.  Compare that to the $60,000 price tag of a dental milling unit. As great as they are current additive machines do not have the precision needed for dental restorations. However a hybrid machine like the one linked above could be the answer. It could also be used for removable proth frameworks and longer spam bridges that are not possible with current milling devices.

Dentalcompare Diagnostics Theraputics

Eliminate Pesky Impression Gremlins

gremlinsIn case you missed it: Dentalcompare article from last Dec on Digital Impressions.

Each of these items: the impression material, the stone, the wax, the investment, the metal, various acrylics and finally the oven fired porcelain has some sort of setting and shape change with time, temperature and humidity. There’s also mechanical distortion if the tray bends, the die is abraded, the material compresses or is pulled slightly from the tray. And of course there are bubbles, contamination and tears.

Any one of these errors—lurking like little gremlins—can easily go undetected by the lab or the dentist. The result – remake.

When you take a digital impression you eliminate all of those chemical and mechanical gremlins. The result is better and more reliable restorations with almost no remakes. Studies show a remake rate of just 0.3% with digital impressions compared to 4 -5% with traditional methods.

via Emmott On Technology: Go Digital to Eliminate Pesky Impression Gremlins |

Since that article was published E4D has introduced a new low cost impression camera the NEVO. It is powder free and takes continuous images to stitch together a model. It can be used with an E4D milling chamber or as a digital lab impression.


CEREC 4.2 Virtual Articulator

Another very well done video by Todd Ehrlich. Check out Todd’s online CAD CAM magzine DigitalEnamel.

CAD CAM Future Tech

3D Printing and Plastic Guns

This relates to the concept I wrote about in Dentalcompare, A Car is not Merely a Faster Horse.

We (all of us) need to understand how different the actual world is from the world most of us think we’re living in.  Most people believe that tomorrow is going to be substantially identical to today.  The sun will rise, you’ll have breakfast, go to work, etc.  But, those are the things we try to keep constant in our lives … technological advances don’t work that way.

Technology is evolving at an accelerating rate and we really have no chance of keeping up with it – not legally, not legislatively, not socially, not strategically … not at all.  The best we can do is position ourselves to quickly adapt to change – it is the only guaranteed part of our reality…

…3D printers are not limited to printing in plastic.  There are 3D printers that print in wood (a mixture of wood particles and binding agent that dries as wood) ceramic, carbon fiber, bronze, iron, steel, cellulose, human tissue (certain body parts for human transplant are grown using 3D printed frameworks) … there are limitations to the range of additive manufacturing materials, but the technology is evolving rapidly.

Read the Full Article:

The article was inspired by the kerfuffle surrounding the printed gun. However it has a lot more and explains 3D printing well. The article makes the point that printed objects will fundamentally change our world. I certainly see it changing dentistry.


CAD CAM and Marginal Fit

From a D4D press Release:

Richardson, TX, January 2, 2013 – A recent study by faculty and students at the Medical University of South Carolina College of Dental Medicine found clinically acceptable marginal fits — regardless of the quality of the preparation  — with restorations fabricated with the E4D System. There was a statistically significant correlation between the marginal fit and the quality of the preparation, however. Walter Renne, DMD,, reported on the study, which investigated the impact of deviations from the ideal preparation, in The Journal of Prosthetic Dentistry (November 2012)*.

The investigators used preparations placed in three categories (excellent, fair, or poor) and fabricated 75 ceramic crowns with the E4D Dentist system (D4D Technologies, Richardson, TX). They then examined the marginal gap values for each category.

CAD CAM General

Cerec Doctors – Blog

Cerec Doctors, a great online resource for CEREC and CAD CAM users.

With buccal bite we are able to reproduce the patients existing occlusion with incredible accuracy. But when should you take the buccal bite? You will get varying opinions. I prefer to take the buccal bite before I start preparing the teeth. There are few reasons for this.

via Cerec Doctors – Blog – Why take the buccal bite beforehand.

Dental Speaker Diagnostics Future Tech Theraputics

Eliminate Pesky Impression Gremlins

Dentalcompare Article:

Consider the lowly impression and the many ways an impression can go wrong

via Emmott On Technology: Go Digital to Eliminate Pesky Impression Gremlins |

CAD CAM Theraputics

What’s the Big Deal?

I wrote what follows as part of an article for Dental Economics back in 2009. Three years later it is still quite valid and even more important for dentists to understand. We are seeing numerous new digital impression systems come to market like the CEREC Omnicam and the new 3M True Definition as well as new software from CEREC and E4D.

What is the big deal? The big deal is simply that it is digital:

Infrastructure: Back in the olden days, you know, last century, BC (before computer) we took photographs with a film camera. This required a complex infrastructure that was purpose built and exclusive to photography. That is the film, the camera the chemicals the processing equipment and the printing materials were all exclusive to photography. In other words you could not use the photography system to send a post card or take an impression.

Conventional impressions also need single purpose systems from trays to impression materials and various stones, vibrators, mixers and vacuum pumps to create a model. You cannot use the impression system infrastructure to send a postcard or take a photograph.

Since the infrastructure is single purpose, complex and expensive most people do not try and do it themselves. They instead send the film to a special lab to be processed and printed.

Of course the same is true of impressions. Most are sent to a special lab to be processed and the restoration created.

Process: In addition to the infrastructure there was the process. You would take a photo but you would need to put it through a long and complex process of developing and printing before you could use it, usually hours or even days later. If there was an error, like poor focus or over exposure, you would not know about it until the photo was developed printed and returned to you. Then of course it was too late to fix it. If the photo was unneeded or just ugly (Aunt Tilly blinked) too late you already spent the time and money to create it.

The conventional impression process is similar. You take the impression but do not get to see or use the model for hours or days later. If there is an error, a bad margin a void or distortion it is too late to fix it.

Storage: Once you finally get the film photo print or slide that you want you then have to store it. At home that means throwing the snapshot in a shoebox randomly with all the rest or taking the time to put it neatly in a photo album. At the office it means labeling and dating the image and putting it in a patient chart.

Impressions are even harder to store. They need to be labeled, dated, boxed and stored on shelves in a manner where they can be found later. Because this is so tedious most models end up stored with the random shoe box technique or just thrown away.

Distribution: If you want to send a film photo to a friend or a clinical film photo to a colleague then it would need to be copied back at the lab, put in an envelope and mailed. The process would be expensive, the quality of the image would be degraded and it would take days to accomplish.

Sending a copy of an impression would be similar but even more complex time consuming and expensive.

Digital: With digital photography everything changes. The infrastructure is a computer network. This digital infrastructure can be used to capture, process, display, store and transmit the photograph. However it can also be used to send a post card; that is an e-mail. It can be used for impressions, records, diagnostics and a whole lot more.

With the digital photo process the user can see the image immediately. If there is an error it can be corrected right now. There is no need to pay the processing costs simply hit the delete button. The same is true of a digital impression. The user sees the image immediately and can make corrections if they are needed and discard the mistakes.

Digital photos don’t fill up shoe boxes or bulge out of files but are stored as part of the patient record on a hard drive. Digital impressions can also be stored on a hard drive. The storage process usually requires three or four mouse clicks and the hard drive is smaller than a shoe box and costs less than a file cabinet.

Sending a digital photo to a friend or colleague can be done online with just a few mouse clicks. It costs nothing, it happens instantly and the image is exactly the same quality as the original. The same is true of a digital impression.

Digital impressions are to conventional impressions as digital photography is to film photography.

CAD CAM Theraputics

E4D Sky

I have been harping on dental vendors to provide interoperable machines and data for years.  The following from E4D release seems to indicate they have taken a big step in that direction.

Interoperable systems would mean that I could use a Dexis sensor with Schick software and exchange the image with another dentist using Carestream (Kodak). It will also mean that I can scan a tooth with CEREC and send the image to any lab or CAD CAM machine. Until now that is has not been possible, however it looks like E4D has made a major move in this direction,

D4D Technologies announced the creation of a truly open network of chairside restorative solutions for patient treatment. The E4D Sky communication network enables E4D system operators to exchange case data via the internet with internal and external service providers, greatly extending the range of treatments they can provide their patients.

E4D Sky is supported by Henry Schein’s DDX (Digital Dental Exchange) and connects E4D systems running version 4.5 software with a variety of outsourcing options for restoration design and fabrication:

  • E4D Digital Services experts design, mill, or complete restorations, as well as make models or bridges
  • E4D Certified Laboratories offer a variety of services
  • Any third party provider can be sent an .stl open platform file

“E4D Sky takes the E4D system to the next level while supporting the launch of our E4D Solo scan only options. Operators will also be able to exploit the flexibility of the .stl open platform file export to access numerous other services with their scanned data,” said Glen Freeman, D4D Technologies. “

This also ties in with the release of the 3M True Definition scanner at the ADA meeting. The True Definition can be used with the E4D CAD CAM mill or as an impression device only.

CAD CAM Diagnostics Theraputics

3M True Definition Scanner

3M ESPE introduced a new digital scanner at the ADA meeting in San Francisco. It is called the 3M True Definition Scanner and takes the place of the Lava COS system. 3M claims it is more accurate and consistent than other systems.

Two great features: It is priced much lower than the other impression scanners on the market. Like about half price. Even better, in my opinion it produces an open file impression that can be imported directly to the E4D milling unit. This makes it both a lab impression device and a CAD CAM device. It is also the first device to be truly and easily interoperable and not strictly proprietary.

It does require powder and a monthly fee for cloud storage and support.

Digital Impressions 3M True Definition Scanner 3M ESPE : 3M ESPE Dental Products US.

CAD CAM Diagnostics Theraputics

CEREC Omnicam Video

A nice video by Dr. Greg Campbell with the new Cerec Omnicam in action.