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Dental Tribune Middle East & Africa Edition | 4/2016 26 CAD/CAM The impact of CAD/CAM on dental practices Interview with Dr Jonathan L. Ferencz who shares his experiences with CAD/CAM technology in dental practice By3Shape In what way has CAD/CAM made a major difference to your dental prac- ticeandpatients? The first time I really experienced the difference CAD/CAM has made formypatientswaswithonepatient, a very successful partner at a well- known architectural firm. He came in on a Friday afternoon around 2 p.m. and said, "John, I'm very sorry to bother you but the crown on my front tooth just cracked. I've got a re- ally important dinner tonight with clients and I'm going away on a 14 day ski trip with my family. If I don't make the trip, I'm in trouble. If you made me a temporary, I would be mostappreciative." His crown was in two pieces. I told him that I believed that we could do more than just make him a tempo- rary. I thought we could make him a new crown with CAD/CAM and the laboratory. Of course, he did not thinkthiswaspossible. Itookthebrokenpieceandslippedit backintohismouth;itfittedperfect- ly, like a jigsaw puzzle. I then had my assistanttakeapre-preparationscan. I next took the broken piece off, ad- ministered a little Novocain to the patient and ground away the piece that was still cemented. I placed a cord and scanned the preparation withourTRIOSscanner(3Shape).The technician in the laboratory then de- signed and milled the patient a new crown. Ninety minutes later, the pa- tient left with a final crown and not atemporary. As a follow-up, he later told me that he must have really bored his clients at dinner that night, because the only thing he talked about was the crownwemadeinthatonevisit. If you look at this case and compare it with what used to happen in the olddays,thatsameprocedurewould havetakenthreevisits. Now, whenever I see an emergency in our schedule that involves some- thing broken, I think that we can turn it into a definitive solution and not just a stopgap of placing a tem- porary and the patient returning the nextweek.Iknowthatnowwecanfit acrownusingaTRIOSdigitalimpres- sion and our laboratory. For patients liketheoneinthisexample,digitalis alifesaver. Istherenot afinanciallossbynot hav- ingthefollow-upvisits? No, not at all. One charges the same feeregardlessofthenumberofvisits becausethepatientischargedforthe procedureandnotpervisit.Soforus, we actually save time and money. In addition, not having to wear a tem- porary crown is of great benefit for patients. They do not have to come backtoouroffice. Are there more advantages of this technology? Anotherimportantadvantageofdig- ital technology is its potential for pa- tient education. For example, I had a patient with a lateral incisor that was perfect from the facial aspect, but from the lingual, there was an amalgam restoration, a composite restoration and a vertical crack from the incisal edge to the gingiva. But howcanyoushowthattothepatient whenitisonthelingualside? In the old days, I would have tried with a mirror or taken a photograph and loaded it on the computer or an iPad. This would have taken 20 min- utes. The patient would have been looking at his or her watch, thinking about getting out of the office. The key in situations like these is speed. So, now what I have started doing is taking a scan and obtaining a color digitalimpressionin3-D. If I scan the patient, I can take the image of the lateral incisor, flip it and point out to the patient what I see that he or she cannot. The scan shows the crack. The patient would ask me to suggest treatment and I would recommend scheduling a crown. The patient would agree be- cause it is such a convincing demon- stration. We are helping patients to codiagnose. Sothescanservestoeducateand,ina way,empowerthepatient? The best patient is an educated pa- tient, but the communication or educational process has to be quick and intuitive. It cannot entail cap- turing an image, loading it on to the computer, locating the image, etc. So now, rather than taking out the cam- era and iPad, I reach for the TRIOS. Theideaofhavingascannerinevery room and having a hygienist pick up the scanner is becoming a reality in ourpractice. Do you envision scanning being a rou- tinepart ofapatient visit? There is so much information that I can now see from looking at the en- larged scan. It is like looking through my loupes that give four and a half timesthemagnification.Withascan, Icanexpandtheimageonmyscreen to be as large as I like. Basically, I can imagine us using a scanner for not just some patients, but EVERY pa- tient. I definitely see a day when we scan each patient as part of our rou- tine. Do you think that one day decisions on treatment could be made by just reviewingdigitalscans? Do you mean do I imagine a day when I could be sitting in my beach house in the Bahamas leaf- ing through scans on my laptop? It would be nice, but it will not happen because so much of our success is based on relationships and personal contact. Dr Jonathan L. Fer- enczisadiplomate of the American Board of Pros- thodontics and Clinical Professor of Prosthodontics and Occlusion in the Department of Prosthodontics at the New York University College of Dentistry, where he has taught since 1972. He is also Adjunct Professor of Restorative Dentistry at the University of Pennsylvania School of Den- talMedicine.