Straight Talk on In-Office Milling

The rapid-fire evolution of digital dentistry is showing no signs of slowing. In fact, the pace may be accelerating as more clinicians embrace in-house milling technologies that allow the design and delivery of crowns and other prostheses in one visit. And while the high-tech aura of “same-day dentistry” is definitely a practice builder, it offers the additional advantages of cost savings and clinical efficiency — which support a healthier bottom line.

Even as intraoral scans and computer aided design/computer aided manufacturing (CAD/CAM) have become staples of modern practice, advances in milling units, materials, and open-architecture formats are increasing the utility of CAD/CAM dentistry. To help explore clinicians’ options when implementing digital technologies, we asked Fadi AL Farawati, DDS, MS, MClinDent, a tech-savvy prosthodontist based in Lewisville, Texas, to lend his perspective.

For those just starting out, AL Farawati notes that clinicians can gradually incorporate digital scanning into practice and outsource production to labs. They also have the opportunity to utilize design software that allows control over the final restoration, which can be made by the lab or produced with in-house mills or three-dimensional printers. Initially, many providers adopt a hybrid approach by starting with a scanner before transitioning into restoration design and, finally, in-house milling.

“Digital dentistry requires a learning curve, but manufacturers provide training and typically offer a supporting platform to resolve technical difficulties or design questions,” he reports. “Investing in an in-office milling setup is a big decision, so clinicians should do their own research into what suits their budget and specific plans for the mill.”

Choosing a closed system (i.e., a proprietary system from one manufacturer) offers the advantages of having a more reliable workflow and easier access to customer support, AL Farawati notes. This means the dentist calls one place with any questions, whether they involve scanning, milling, software or materials. “The downside is that a closed system is more expensive, and the practice is limited to the materials available from that manufacturer,” he says. “In comparison, an open system provides access to more materials, but this also means contacting multiple call centers for support, which can be frustrating.”

In terms of capabilities, AL Farawati believes that in-office mills are more efficient and reliable than they were five years ago. “And while the milling process has not really changed, the variety of materials and applications the new systems can handle has increased, which reduces dependence on dental labs,” he says. Another consideration is that digital technologies boost practice efficiencies at the diagnostic, treatment planning and production levels, where quick decisions and immediate revisions can improve outcomes.

Characterizing same-day dentistry as a key addition to any practice, he emphasizes the importance of “normalizing” the CAD/CAM process in order to achieve a productive digital workflow. Toward this goal, AL Farawati asserts that offices cannot realize the true benefits of chairside milling without utilizing digitally trained assistants. “Ideally, the dentist’s role should be limited to preparing the tooth, quality control during the scanning, design and fabrication stages, and then delivering the prosthesis,” he says. “In an optimal workflow, an in-house technician handles much of the design, fabrication and post-production work, which frees the dentist to concentrate on clinical care.”

Of course, besides greater practice efficiency and reduced cost, an additional benefit of in-house fabrication is the patient’s chairside experience. In this sense, AL Farawati suggests the process helps build confidence and promotes patient loyalty and referrals. “After all,” he says, “it’s inevitable that patients will draw comparisons between the need for multiple appointments in one office and a practice that can take a 60-second oral scan and deliver a definitive crown the same day.”

From Decisions in Dentistry. April 2023;9(4):46.