It’s hard to put into words the overwhelming sadness that our team here has felt ever since Chiwen suddenly left us last Sunday. He was a healthy, 34-year-old and dedicated father of two small children, and had simply been dealt a terrible hand. His work at CEREC Asia was his passion, and has left his mark on every aspect of our accomplishments.

We are lucky to have known Chiwen, and I know I will miss my dear friend very much.

Rest in peace.

The post Among the Stars appeared first on CEREC Digest.

沒想到就在今天，Dentsply Sirona 決定自己超越自己，推出了新一代的診間用研磨機： CEREC Primemill

它究竟是超越了哪些部分呢？以下是我整理的官方資料：

1. 更高的精準度以及成品完成度

提高精準度主要由三個方向著手：改良馬達的硬體零組件、更新軟體研磨策略、推出更細的直徑 0.5 mm Extra Fine (EF) 鑽針。

就原廠提供的數據，玻璃陶瓷能達到 25 – 45 um 的 marginal gap；氧化鋯是他們這次更新重點所在，可達到穩定的 19 – 21 um (標準差小表示意外的 Chipping 發生較少)；至於本來就最不怕銑銷的 Hybrid ceramic 更是可以達到最低 15 um 的精密度。如今，研磨傷害終於能控制到低於 Resin cement 的 film thickness，未來關於邊緣完整性這件事就只剩參數調整了。

除此之外，Primemill 會在研磨過程中順便拋光打亮，讓產出的成品表面更光滑，大大減少後續手工調整的時間。

2. 更快的研磨速度

看上面好像多做了更多事，也用了更細的鑽針，那理論上研磨時間就要拉長吧？結果相反，新的軟體研磨策略讓路徑走的更短了，可以從展示的影片看到它一開始就使用了兩個維度的 Carving Mode，馬上就把瓷塊切得差不多了；而最細的鑽針也只會經過上一號鑽針走不到的地方以及 Margin 收尾，這個流程他們稱之為「Super Fast mill」。

對我個人來說這個模式最特別的地方，就是它兼顧了「高速研磨」以及「細鑽針」。CEREC User 們都知道，以往 MCXL 的研磨分為三種模式：快速、標準、高精細，而以研磨玻璃陶瓷單冠來講，所需耗費的時間分別為 5 分鐘、10 分鐘、20 分鐘，越精細磨越久這非常合理，但現在使用「Super Fast mill」研磨任何陶瓷材料都只要 4 分鐘，但卻還能保有大量細節，兼顧了速度與精細，這樣我已經想不到用其他模式的理由了。

另外在開始 Prep 或口掃之前，如果已經先確定材料，也可以先置入瓷塊讓機器開始校正、測量等前置步驟，這樣一來在掃描完設計完之後，研磨一按下去就可以直接開始研磨流程，這原廠稱之為「Pre-touch」。

3. 使用者介面改良

右上角的小螢幕擴大為七吋的觸碰螢幕，可直接在上面操作機器、軟體也會提供步驟引導進行機器維護工作以及日常研磨。

在螢幕下新增的小鏡頭是掃描瓷塊條碼用的，可以直接讓研磨機知道將要研磨的瓷塊尺寸、顏色、以及氧化鋯收縮率，不再需要手動輸入。

新增的 RFID (Radio Frequency IDentification) 功能則是讓機器可以辨認每一支鑽針使用的次數提醒更換，就算鑽針有被拆下來過，不過這也代表會更難騙機器用一些特殊的磨法了吧。

4. 兼容更多可研磨材料

在軟體上整合了更多市面上瓷塊，可自由選擇 wet/dry milling 與 wet grinding，也加入了以前沒有的鈦金屬。附帶一提，新的研磨艙在乾式研磨後造成的粉塵會被吸得更乾淨，希望這能讓乾濕互換這件事不再那麼麻煩。

5.外觀更新

參考了 Primescan 的設計語言，還在外面加了一條燈光進度條，就是要讓它看起來更潮一點。

結論

總結來說，CEREC Primemill 的進化目標很明顯，就是三個：市面上最準、最快、最簡單。

不過，這些終究是原廠提供的資訊，待機器抵台後，我們 CEREC Asia 教育中心必定會進一步驗證。但在那之前，實際把玩起來的感覺會是如何呢？這就請現在正在 KOL 大會會場的陳鉉醫師，為我們帶來更多消息了！

The post CEREC PrimeMill – 重新定義精準與效率的挑戰 appeared first on CEREC Digest.

A Year for Everyone

In 2019, we saw the release of Primescan from Dentsply-Sirona, and it created this sort of awkward situation for a lot of digital dentistry enthusiasts. Prior to this, many have advocated that striving for the most accurate scanner is the fundamental and ethical obligation for dentists from a treatment perspective. With Primescan, we finally achieved accuracy very close to traditional impressions, but it turned out to cost an arm and two legs. To make things more complicated, an updated Medit i500 scanner can achieve a decent accuracy at half price of a 3Shape Trios (the previous reigning champion of accuracy), and a quarter of a price of Primescan.

While this does put a lot of dentists in a bind, from a technological standpoint its all good news, because things can only get better, faster, more accurate, and less expensive (fingers crossed). There is, indeed, something for everyone.

Side Note: Trends and Intrigue

This year, I personally gave 23 lectures, 14 of which were at international venues, and I am just but one member of our CEREC Asia team. The topics that I focus on are primarily chairside anterior esthetics, chairside material selection, and chairside CAD/CAM implantology. Judging by our reception in many different countries, dentists are not just interested in the evolution of digital dentistry, but also acutely aware of the potential that chairside dentistry brings.

The term chairside, if you are unfamiliar, means that our treatment protocols revolve around us, the dentists. For restorative dentistry, this means that we no longer offload part of the workflow (and responsibility) to the dental lab. Instead, our team has in-house technicians that work with us to decide on the most suitable materials and methods for that particular patient. We need more knowledge to make more decisions, and are rewarded with better control of the outcome quality.

But it’s not all positive. Chairside dentistry is a lot of commitment in time, energy, and cost. It’s certainly not for everyone, and for most of the dental professionals in our audience, they are looking for something in between what they’re doing now, and what we’re doing. A way to apply digital dentistry in a gradual manner with more security and less risk. This is a trend being followed by even the most stubborn traditionalists, and in 2019, we saw several notable dentists begrudgingly shift from the conventional impression to intraoral scanners. They’re baby steps, but progression is progression.

For the ambitious, who wished to participate in the chairside world, CEREC Asia has trained over 500 dentists in 2019 in courses ranging from fundamental concepts in scanning and material selection, to advanced techniques in staining and contouring. It is extremely gratifying to see the interest and positive feedback of everyone involved. The train for digital dentistry is going full blast, and it’s stopping for nobody.

The post Dear Readers, Happy 2020! appeared first on CEREC Digest.

看到這裡大家以為我要寫遊記…哈！真是服了數位牙科學會 ( Digital Dental Society, DDS ) ，把年會辦在這樣高雅的地方。

DDS 是一個成立於歐洲的學術型學會，旨在數位牙科教育與推廣，有相當強的國際社群連結及學術動能，還辦了個 SCI 期刊 BMC Oral Health Journal。此次是他們首次舉辦全球性的研討會。

這次研討會我稱之車輪戰，來自各國的講師每位只有18分鐘，一整天25位講師 / 25個題目，時間有限，講師的語速也超快。參與研討會的人數目測大概 200 +。

這天的演講由 DDS 主席 Henriette Lerner 揭開序幕，從會場佈置的就看得出這位女性主席精緻優雅的風格，她傳達的訊息很清楚：數位時代已然到來 ( “Digital Dentistry: the future has arrived “ )。她從世界各地邀請許多優秀的數位牙科工作者，包含醫師、技師、工程師，在在展現這句話所言不虛。

完整的數位工作鏈

這次幾乎絕大部分的講師都有提供完整的數位流程，而且許多都是用開放式系統。大家都知道開放系統的整合有一定的困難度（ You know the pain! ），值得敬佩的是這些醫師努力跨過磨合期，從掃描、設計、製造、後製展現有一定成熟度的治療流程。至少 5 組以上的講師有展示 guided implant – supported denture 的手術及贗復全數位流程。

一再被提及的是數位流程優化及標準化的重要性，也有一些團隊正在做相關的研究。比如來自義大利的 Fabrizia Luongo 美女醫師將數位影像、檔案疊合、導板製作進行精準度優化，最終得到的植牙結果也較準確。

數位導引手術

數位導引手術 ( digital guided-surgery ) 已是大家都相當熟悉的，這次有兩位講者提到不同的設計概念。Jaafar Mouhyi 醫師提到在需要修骨頭的植牙案例上可以使用雙層的植牙導版，第一層導板利用骨釘固定在齒槽骨上，利用上面導引的高度來修磨骨頭，接著再將第二層植牙導引板利用卡榫設計安裝於第一層，便可以繼續植牙手術。

另外的亮點來自美國的 Marcus Abboud 醫師介紹的手術導板，他提到過去數位植牙導板的 CBCT 影像與口掃檔案有時定位不是那麼準確（尤其是病人口內有高散射物時）。他們的 idea 是利用簡單的零件輔助，或可跳過口掃檔案這步。首先先把預製型零件利用 silicon 固定在病人要植牙的區域，接著讓病人去照 CBCT ，在該廠商設計的軟體中可輕易地對合 CBCT 中這個零件的形狀，接著在 CBCT 上設計植牙位置，並用三維列印做出符合該方向的零件二號，安裝到原先的預製零件上，就可使用這個導板來植牙了！Dr. Marcus 說使用此類導板的植牙精準度約在 ± 0.3 mm，比過去數位導板的 ± 0.8 mm 來的準。在最終假牙位置比較容易預測的病例上，這個方法降低影像疊合誤差，可謂簡潔又快速！

數位美觀設計

DSD ( digital smile design ) 也是另個大家都相當熟悉的概念，這次也有許多講師展示自己將 2D 照片或 3D 臉掃整合到數位設計軟體的流程，之前來過台灣的羅馬尼亞技師兼攝影大師 Miladinov Milos 推薦 AFT dental system 的臉掃系統，可整合到許多設計軟體（如 exoCAD） 中。（有興趣請參考官方影片：https://www.youtube.com/watch?v=jM37UyCu6Ds）

也有一些數位微笑設計的 app 被提及：比如跟 Christian Coachman 合作的 DSD App，與來自保加利亞的 Rebel Simplicity App。數位微笑設計概念如何更好地整合進入數位工作流程與最後的臨床結果是許多醫師與牙科團隊正在努力的方向。

機器人

這次主辦方還準備了一個小驚喜：機器人。從旁觀察了一陣子，有些人沒注意到它、有些則閃避它，但有更多人對它有相當的好奇心，試著跟它互動，得到了許多新的體驗，也許它還能幫些忙。新科技也是如此，當它來到我們這個房間，你會試著跟它說聲 Hi 嗎？

PS. 我試了，它說很擠叫我讓讓 = _ =

（To be continued…）

The post 2019 Digital Dental Society Global Conference – 1 appeared first on CEREC Digest.

There were several jaw movement tracing systems ( JMT systems ) in IDS 2017. This time, we didn’t see many new companies join this field, but each of them has improved their software, function, and integration with CAD software. It is now easier than ever before to use JMT record to design restorations.

System Introduction

Modjaw

During the last IDS in 2017, Modjaw was one of the underdogs that came out swinging, because it was able to record jaw movement without data from a CBCT. It was an amazing feat, considering that even now most of the JMT systems are still unable to achieve it. Since 2017, Modjaw has been improving itself, including automatic calculation of occlusion parameters, such as Bennett angle. In the previous version, it was only able to make the jaw movement into a Functional Generated Pathway (FGP), and export it as a non-movable .stl file, and then import to CAD software as reference model. But now,  it can be exported as .xml data file, which contains the full animation data to be used in the CAD software.

Zebris

At the dental show, if the products are not innovative or eye-catching, it was difficult to attract visitors. The booth of Zebris was quite deserted two years ago because there was nothing new. But they were different this year. To enhance accuracy, they developed an optical position-locator version of the original ultrasonic position-locator system. The ultrasonic transmitter has been downsized to a small light triangle block, and the little box that is placed in front of your chest is no longer needed. The original version was almost the same as SICAT Function, but the new version is much more compact.

Several companies have worked with and incorporated Zebris’s innovative technology into their products. It is a sign of their brand’s logo was on many of the products on display at the symposium. We can export as .xml file from Zebris, then import it into CAD software.

3Shape

Two years ago, 3Shape announced that they can record the dynamic occlusion with their TRIOS intraoral scanner. Back then it was only a video demonstration, but this year they’ve shown it to be a reality. After scanning the upper, the lower and the static occlusion, you can now make an additional scan with the jaws moving to capture the motion. This dynamic occlusion can be used to help design restorations.

This dynamic occlusion is different from JMT because by using an intraoral scanner to record the movement of jaw, we need to scan both upper and lower jaws at the same time. Considering the small size of the scanner, this places a limit on how wide the mouth can open.

When performing the buccal scan for full mouth scanning, we either scan a larger area or scan bilaterally. For dynamic occlusion scan, we use the small area of the scanning field to map the whole arch. Dynamic occlusion scan is not recommended for full mouth rehabilitation or JMT diagnosis as the result would not be accurate. Regardless, this innovation should be helpful for localized restoration.

SICAT Function

Dentsply Sirona’s SICAT Function didn’t get much updates as the original version is already pretty comprehensive. JMT records can diagnose TMD. It can also be used to design a full mouth rehabilitation. If the volume of the CBCT is too small to locate the condyles, the software can calculate the condyle positions automatically.

Planmeca

Planmeca did not change a lot over the past 4 years. They still use the cameras mounted on the CBCT machines to locate the jaws and recording the movement. So far it can only be used to diagnose TMD. It has not been integrated with CAD software.

Ways to integrate JMT with CAD

Besides using JMT records for TMJ diagnostics, it also serves an important role ,especially for clinical dentists, by aiding the development of the restoration. This greatly decreases the chair-time for functional adjustment and minimize the time needed for the patient to get used to the new restoration. Here are two applicable workflows:

The Trend of JMT system

1. Optical positioning becomes more popular: In the past, most of the systems were ultrasonic or magnetic positioning. Nowadays, more and more systems are developing an optical positioning system integration. Optical positioning has grown in popularity and so has its technological advancements.
2. Integrating the information from JMT with CAD:  To use JMT exclusively as a diagnosing tool cannot satisfy the user anymore. Therefore, companies have been dedicating themselves to integrate JMT with CAD smoothly. After all, using the real jaw movement to design the restorations is more accurate than using an articulator.

Conclusion

For cases with localized treatment, we can use the virtual articulator for the occlusal design. This equals to working with a fully-adjustable articulator for every case. Using the dynamic occlusal record to design can also reduce the time needed for adjustment when delivering. For full mouth rehabilitation, using a JMT device to record the jaw movement, or favorable VD, CR, and is helpful throughout the design stages. Dr. Lucky Lee published a case of full mouth rehabilitation at our annual event last year. In that case he produced three set of restorations using three workflows. Two of them were designed with different JMT workflows, the third one didn’t use JMT record , and then he made a comparison of these three. For further understanding of the clinical application, please check it out.

The post 2019 IDS Jaw Movement Tracing Systems appeared first on CEREC Digest.

兩年前的 IDS 就有不少下顎運動追蹤系統 ( 以下簡稱 JMT 系統 )，這次的沒有太多新的廠商投入，但各自都加強了軟體的介面、功能，也做了更多整合。想運用 JMT 的資料進行修復體的設計，變得越來越輕鬆，也越來越多系統可以做到。

系統介紹

Modjaw

上屆 IDS 的大黑馬，原因是因為不用拍 CT 即可記錄下顎運動；截至今日，仍是少數能做到的系統。兩年來 Modjaw 做了不少更新，包括自動測量咬合參數，如 bennett angle 等等。另外，以前只能將運動軌跡合併成為 Functional generated pathway (FGP)，匯出一個不會動的 .stl 檔案，再匯入設計軟體當參考，今年更可匯出 .xml 檔案，也就是可以將會動的顎間運動紀錄匯入設計軟體，在每個不同的顎間位置來調整咬合。

Zebris

在 IDS 會場上，如果沒有創新的東西通常就會冷冷清清。兩年前 Zebris 的攤位看起來就有點死氣沉沉，因為很久沒有新的產品。但今年可厲害了，除了本來的超音波定位系統，今年新出了 optic 版本，下顎的物件從笨重的超音波發射器變成小小的三角形，掛在胸前的小盒子也不再需要了。舊版和 SICAT Function 幾乎一樣，新版變得輕巧多了。也有幾家廠商的產品貼了 Zebris 的牌子，可以說今年表現亮眼。而 Zebris 也可以匯出 .xml 檔案，再匯入設計軟體。

3 shape

兩年前 3 Shape 公佈可以用口掃機紀錄動態咬合的消息，當時只有示範的影片，如今最新的版本真的做到了！掃完上顎、下顎與靜態咬合後，可以再請病人往前後左右磨磨牙齒，紀錄動態咬合，再用來設計修復體。而我稱之為動態咬合紀錄，而非 JMT 的原因是以口掃機紀錄下顎運動，需同時掃到上顎、下顎足夠的範圍，因此嘴巴張大一些就無法記錄了。此外，以口掃機的小範圍紀錄動態咬合，若要做全口重建或顳顎關節診斷，精準度仍會受到質疑。無論如何，這項創新對於局部修復應該是很有幫助的。

SICAT Function

Dentsply Sirona 的 SICAT Function 並沒有太大的更新，畢竟原來就已經整合的很完整了。JMT 的紀錄可以診斷 TMD，也可用來設計修復體，做全口重建。如果 CBCT 拍攝的容量較小無法拍到 condyle，軟體也能自動計算出 condyle 的位置。

Planmeca

Planmeca 的部分和四年前大致相同，利用 CBCT 機器上的相機進行定位，並記錄下顎運動。目前只能當作 TMD 的診斷工具，仍無法整合進入設計軟體。

JMT 與 CAD 整合方式

JMT 的資訊除了顳顎關節的診斷，對於我們臨床醫師很重要的是能拿來設計修復體，減少臨床的調整與患者適應時間，以下兩種方式是目前可行的 workflow:

整體趨勢

1. 光學定位蓬勃發展：相較於以往大都使用超音波或磁力來定位及追蹤，光學定位似乎是個趨勢，目前大部分的系統都朝這個方向發展。
2. 將 JMT 得到的資料和 CAD 做更緊密的整合：只把 JMT 資訊當成診斷工具，已無法滿足大家；因此各個廠商都把 JMT 和 CAD 連接得更順，畢竟用患者真實的下顎運動來設計修復體，理當比使用咬合器更準，當然也比只看靜態咬合好得多。

結語

對於局部修復的 case，我們可以使用虛擬咬合器來設計咬合，相當於每個 case 都放上全調節咬合器；也可以使用動態咬合紀錄 ( 3shape ) 的資訊來設計，降低臨床調整的時間。對於全口重建的 case，用 JMT 系統記錄下顎運動，或記錄想要的 VD 、 CR 位置，對於設計或臨床調整都相當有幫助。李承翰醫師在 2018 年會發表的全口重建案例，使用了上述兩種不同的 JMT workflow 來做設計，並和不使用 JMT 的組別做比較，有興趣的朋友可以參考看看。

The post 2019 IDS 下顎運動追蹤裝置 appeared first on CEREC Digest.

事實上導航手術之所以會發展的原因有三:

1. 神經外科(Neurosugery):

神經外科的整個歷史就是盡可能微創地進行手術，由於腦神經和血管在頭顱裡盡可能地擠在狹小的空間裡，因此手術風險相當高，而且腦神經常缺乏解剖學標界，因此導航是具有減輕手術風險和增加手術成功率的科技，導航手術也是從神經外科開創的先例。

2. 立體定位術手術(Stereotaxy):

原裡是利用頭架將頭固定，配合CT或MRI的立體影像，將確實位置和影像做結合，並精密的進行手術。

3. 醫學影像(Medical Imaging):

自從Hounsfield在1970s 推出了第一台CT成像設備，由於它允許3D定位，從此立體定位手術開始爆炸性的飛躍。

植牙導航的發展

根據以上三項科技的發展，植牙導航手術 (Dynamic Navigation implant surgery) 也在同時萌芽

植牙導航是「及時的」computer guide system，利用 CBCT 和運動追蹤技術，將鑽針和病患的位置進行及時的運算。

透過CBCT影像和導航軟體，植牙醫師可以規畫最終贋復體外型(Prosthetic restoration) ，骨頭最佳位置，和解剖標界(anatomic landmark)，決定植牙體的角度和位置。接著利用傳感器(sensor)定位在植牙手機跟病患口腔傳送3D位置至攝影鏡頭或是接收器(detector)。連續性地發出訊息到運算電腦，就可以得到一個及時的病患和手機的位置定位。

那植牙導航為何不普及? 主要原因是它的價格和設備，在早年的導航設備，光是攝影鏡頭和運算電腦就非常大一台，另外定位裝置也充滿笨重和干擾，並且手術導版的方便性和低價性使得植牙導航在世界上並不普遍。但目前廠商致力於將設備的體積縮小，輕量化，以及提升性價比，也許未來可以提升植牙導航的購買力。

市面上植牙導航廠商簡介

我在IDS所見到的植牙導航廠商有三，在這邊一一做介紹。

X-Guide Dynamic 3D Navigation (X-Nav technologies, USA)

要進行植牙導航必須要有以下裝置:

1. 導航車，包含運算的電腦及軟體和攝影鏡頭。
2. 手機附連裝置(handpiece attachment)。
3. 病患附連裝置(jaw attachment)。

X-guide 的運算軟體可以使用Dicom檔，意味著所有的CBCT廠商幾乎都可以用，導航軟體可以結合口掃檔將數位模型輸入，結合CBCT後，未來植牙贋復物的型態即在影像上，接著擺放理想植牙的位置，導航車的攝影鏡頭利用即時運算將鑽針的位置和CBCT做即時的定位，X-guide 使用專利 X-point technology ，讓鑽針的定位更加簡單。

DenX image-Guided implantology (Image Navigation, Isreal)

要進行植牙導航必須要有以下裝置:

1. 導航車，包含運算的電腦及軟體和攝影鏡頭。
2. 手機附連裝置(handpiece attachment)。
3. 病患附連裝置(jaw attachment)。附連裝置叫IGI horseshoe 上面的參考點可以和CBCT 做定位。

使用DenX image前，必須要先取模型做定位版，定位版上並接上IGI horseshoe，接著請病患帶著裝置拍這CBCT，上面的陶瓷球可以和CBCT上面的影像做定位，影像和定位板的定位即完成，手術的時候IGI horseshoe 接上tracking guide ，這樣就可以把病患的口腔和CBCT做結合，接著導航車的攝影鏡頭會偵測handpiece以及horseshoe 上的tracking guide，得到一個立即的影像位置，接著就可以進行植牙手術。

Navident (ClaroNav, Canada)

要進行植牙導航必須要有以下裝置:

1. 一台筆記型電腦
2. 手機附連裝置(handpiece attachment)。是一個叫DrillTag 的裝置，主要成分是塑膠，蠻輕的。
3. 病患附連裝置(jaw attachment)。附連裝置叫JawRef，另外會接到叫JawTag的外接裝置。
4. 攝影鏡頭，可以接收到DrillTag 和JawTag的位置，得到即時的資訊。

首先病患須將附連裝置JawRef定位至口內拍攝CBCT，接著定位至病患口內，外接JawTag，JawTag和DrillTag會將即時位置訊息傳輸給攝影機，得到一個立即的影像，目前Navident研發出了不須帶著裝置拍CT的技術，直接在口內做定位，不過會增加定位的時間。

基本上這三家使用的原裡是類似的，不像是腦神經外科醫師事前會先將病患的頭部固定，在植牙手術的時候病患是會移動的，因此我們必須要偵測病患的位置，因此他們都使用了附連裝置在病患的口內，而鑽針的位置也需要同時被偵測，藉由即時的運算，使得運算軟體和螢幕顯示影像讓植牙導航手術能夠成功地進行。

植牙導航的優點

1.    Flapless surgery: 植牙導航相較於傳統植牙手術提升了flapless 術式成功的機會，由於flapless無法明確判斷骨頭的形狀和位置，而植牙導航可以即時結合影像和鑽針位置，因此牙肉下的組織將無所遁形。

2.    Anatomy landmark: 和傳統植牙手術相比，導航手術可以即時反應鑽針和重要解剖構造的位置距離，讓手術醫師能夠提升警覺性，和減少手術傷害。

3.    減少手術時間: 手術過程由於可以即時精確的定位，因此減少手術時間，提升病患的接受度。

植牙導航的缺點

1.    Pre-surgical planning: 術前定位需要時間，甚至要至做定位板才能讓病患去拍攝CBCT，增加了病患的約診次術，另外軟體操作也需要時間規劃。

2. Cost: 設備費用高昂，通常一整套設備需花費動輒1-200萬新台幣，對於一般醫師這種 ”可需要但非必要”的設備來說，通常看到價位都會打退堂鼓，更何況軟體更新都是額外的花費。

3. Devise Size: 目前的攝影車已經縮小的很精巧，放置在診間還算是放得下。但是鑽針和病患的位置的感知裝置還是相當大，有時候會有點阻礙視野，並且還是帶有一些重量來影響手感。

結論

植牙導航系統確實可以提升植牙口術的精準度，減少手術對於重要節剖構造的傷害，減少手術時間，提升手術的品質和病患的接收度，但是就我在展場實際使用上來說還是有些不方便的地方，比如說像鑽針的定位和影像的疊合速度，還是有些微微的時間差，握把上的裝置容易影響視野和手感等等，但是科技是日新月異的，我們期待導航技術的進步和發展。

The post Dynamic Navigation In Implant Surgery appeared first on CEREC Digest.

Table of Contents

CNC, Computer Numerical Control，是指由程式輸入精確指令，經由電腦編譯計算，透過位移控制系統，將資訊傳至驅動器以驅動馬達之機器，來切削加工所設計之零件。由於有著比三維列印更為穩定的成品，以及在陶瓷輸出上的獨佔性，在數位牙科領域廣為運用。

兩年前，世界各大 CNC 廠商紛紛加入數位牙科領域，一時間各式研磨機百花齊放；時至今年，已經只剩下幾家廠商挺立戰場，也與其他上下游廠商建立起聯盟，這些廠商都是在兩年前就已經專心致力於牙科用 CNC，力求將繁雜的工業用儀器調整成非工業背景的牙醫師或牙技師也能操作的儀器，而不是那些從其他產業 CNC 聞香跨足而來的廠商。由此可見，專注目標客群與重視客戶需求才是在市場上存活的關鍵。

這些廠商有：Dentsply Sirona、Planmeca、Ivoclar Digital、imes-icore、vhf、DGSHAPE (Roland)、 IDC (Amann Girrbach)

每間廠商也針對不同使用者的用量與材料需求，推出不同取向的研磨機，從自動收納切換盤、自動乾溼切換清洗槽的大型技工室用研磨機，到追求安靜效率的診間用研磨機。一直以來我個人都相信 Chair-side 才能發揮數位牙科的完全價值；再者，越簡單越困難，要把大型的銑銷儀器縮小到診間用，也考驗著一家硬體商的實力。於是，本文評測的主要目標，是 2019 年市面上主流的診間用研磨機。

研磨機評測要點

1.幾軸 : 影響適應症

目前市面上研磨機可粗分為兩種，四軸 (XYZA) 與五軸 (XYZAB)，這兩者最大差別就在無法銑銷到的區域大小，如下圖示，四軸機無法銑銷到的範圍如圖一，五軸機理論上不應有無法銑銷到的地方，但由於鑽針進入的路徑以及支持的位置，仍有部分是無法銑銷到（圖二），只是範圍相對較小且較不怕倒凹。這個限制也直接導致了臨床適應症不同，大部分的贗復物由於有其置入徑，不應會有倒凹，唯一四軸有可能車不出來的是長徑距植體牙橋與多顆植牙導板。但這兩者也鮮為 chair-side 治療的項目，故多數 chair-side 研磨機為四軸機。

2.最細鑽針大小 : 影響邊緣完整性與 Prep 要求

由於精細度的需要，理論上鑽針是越小解析度越好，在研磨時過切的狀況會越少。但不幸的是，任何材料在越細的時候強度也會降低，過細的鑽針研磨時就算沒有因而折斷，單純鑽針自身因受力造成的彎曲，就會導致誤差。因此，在不過度減弱自身強度的前提下能達到的最細鑽針大小，就是一台研磨機的解析度，而這也是與我們牙醫師最常要求的邊緣完整度還有 Prep 的圓潤度最相關的一項。以目前的進度，0.5 – 0.6 mm 是各家研磨機的極限，少數廠商在研磨氧化鋯的情況下能使用 0.3 mm 的 round bur。

3.適用 block 種類 : 影響適應症

基本上 chair-side 研磨機都能研磨所有的玻璃陶瓷、氧化鋯、樹脂 block，最大的差異是有些研磨機能額外銑銷燒結完成的金屬，用來製作植體的 customize abutment 。

4.最大瓷塊尺寸 : 影響產品尺寸限制

一般診間用研磨機因為其目的多是置入 block，較少使用 disk，而通常會有較大尺寸的 block 多為 PMMA、e.max、氧化鋯，用來製作牙橋或是手術導板，尤其氧化鋯會燒結收縮必須放大研磨，所以需要更大的體積。因此能置入的 block 大小就限制了臨床贗復物能製作的體積

5.最多排程瓷塊數量 : 能無人操作的成品數量

在技工端的研磨機中，由於產量較大，時常會有過夜研磨、或是工作排程好就自動化減少人力介入的需求，這時候研磨機能排程且自動換盤自動研磨的數量就會大大影響產量與種類。雖然大部分的 chair-side 研磨機由於研磨時間短、多為當天完成或是單顆贋復物，不太需要這功能，但仍有些機器有提供排程功能。

6.單冠銑銷耗時 : 數位工作流程效率、總產量

在 Chair-side CAD/CAM 單顆牙冠產出的速度是非常重要的，如果只製作單顆，從十分鐘變二十分鐘是還好，但做到同時四五顆以上的贗復物時，時間從五十分鐘變成一百分鐘就會產生非常大的差異。尤其是在有多醫師同時進行數位治療的情況下，排隊等待機器造成的延宕、約診困難甚至是加班也是一個無形的成本。

7.乾溼式銑銷 : 影響氧化鋯燒結時間

氧化鋯燒結時，需要從乾燥的狀態開始，如果是在潮濕的狀態下就必須額外增加 30 分鐘的 pre-dry 乾燥流程，因為有這個需求廠商也推出了乾式研磨，或是可以乾濕切換的機型。但根據大多數位牙科工作者的經驗，到頭來許多乾溼合併的機器也常只固定在單一個模式，主因是乾濕切換時如果殘餘的氧化鋯粉末清理得不夠乾淨，隨著水流進入管線容易造成研磨機的損壞，目前只有少數技師端研磨機有自動切換槽洗淨功能。

8.空壓機、外接水箱需求 : 影響診間噪音以及空間

研磨機需要氣壓推動，所以早期的研磨機通常都必須外接空氣來源，可能是來自於中央機房的高壓空氣，或是單獨外接空壓機。但外接的空壓機如果置於診間會造成過多的噪音以及空間佔據，所以現今的診間用研磨機多將空壓機直接整合進機體內，由於銑銷的物件較為單純且小，需要的高壓氣體量也相對較小。研磨機的水通常是循環使用，隨著銑銷的進行粉末混入水裡會逐漸造成水質汙濁，一定的研磨量就必須換水一次。所以技師端研磨機因為產量大，大多會搭配外接式大容量水箱，而診所端研磨機則是縮小水箱內置為多。

9.軟體操作方式 : 影響使用者學習曲線、偵錯能力

研磨機的驅動與研磨策略需要軟體控制，軟體中也會有許多參數供研磨需求調整，以前有些研磨機在研磨時通常需要在旁邊連接一台筆電來操控，現在除了高度整合的系統 (如 CEREC、Planmeca) 已經將 CAD 跟 CAM 軟體整合為一之外，許多診所端新機型也直接將電腦內置，改成機身上的觸碰式介面，同時簡化參數以及輸入流程，讓醫師或診所內技師可以更直觀的使用，免除很多工程上的繁雜設定。

10.特殊研磨策略 : 影響銑削效率、細節完整度、材料限制

隨著不同贗復體臨床需求以及效率上的提升，很多廠商一直持續改進研磨策略，這包含了：研磨路徑、鑽針選擇、移動速度、接觸角度、扭力 … 等，比較常被提起的是 Curving mode，在一開始一次性切除用不到的範圍，大幅度減少需行走的路徑來節省時間； Thrilling mode，可以直接垂直方向鑽孔，做出植牙贗復物用孔洞，讓沒有內建孔洞的瓷塊也能接上各種植體支台； 以及 Margin protection，在軟體上標示出醫師最重視的邊緣區域，研磨該區域時使用最精細的車針最輕柔的力道，以防 chipping 發生。

11.價錢 : 影響銀行帳戶數字

嗯…需要解釋嗎？本文紀載的售價為 IDS 2019 展場問到的官方售價，實際零售價勢必有所不同。

市面上常見診間用研磨機 簡評

Dentsply Sirona – MC XL

由 Sirona 在 2007 年推出的長青四軸研磨機，承襲了自 CEREC 2 開始的左右雙鑽針同時研磨提高效率。並加入了第二組更細的研磨鑽針 (EF Bur 0.6mm)，研磨過程中不換取鑽針，而是直接旋轉馬達運用另一組鑽針，進一步減少替換工具時間。研磨機的操作軟體已與口掃、CAD、一同整合成 “CEREC” 一套軟體，因此隨著軟體更新，穩定性、表面特徵、邊緣完整度等研磨策略也一起更新，也因為與設計軟體連動，研磨時提供 margin 保護功能，也內建鑽針檢查與錯置防呆功能。雖上市至今已 12 年，但跟今年看到的機器比較起來仍絲毫不遜色，是所有診間用研磨機中，單冠研磨時間最短的。

PLANMECA – Planmill 40 S

Planmeca (前身E4D) 於2017 年推出的 Planmill 40 後續機種，S 是 SMART 的縮寫，它代表了會自動計算最佳研磨路徑、自動引導清潔與保養、自動切換受損或斷裂鑽針，旨在減少牙醫師請工程師來維護的需要。Planmeca 也提供一個完整整合的 workflow，一樣是雙邊鑽針設計，單冠研磨時間約在 10 分鐘左右。使用獨家的瓷塊柄，不過目前常見的材料商也大多有出 for Planmeca 的柄，不成問題。有著本次評測中最便宜的售價。最大的缺點是最小的鑽針直徑 1mm，相較於其他廠牌顯著較粗。

Ivoclar Digital – Programill One

於 IDS 2017 隨著 Ivoclar 新產品線 Ivoclar Digital 一併推出的診間用研磨機，最大的特色，就是他是目前市面上唯一的「五軸」的診間用研磨機，並且可以排程五個瓷塊自動更換，使用平板 app 遠端操控研磨，當初上市時因其簡潔美觀的設計以及五軸銑銷展示轟動一時。不過仔細探究細節後，會發現這台機器只能使用 Ivoclar 自己的瓷塊，選擇較為受限，更大的缺陷則是因為空間較小，只能銑銷短於 45 mm 的修復體，無法製作長牙橋或導版，我今年在展場詢問原廠何時會改善這部分，目前是還沒有這個打算。

imes-icore – CORiTEC One

德國研磨機大廠 imes-icore 於今年 IDS 2019 推出的四軸新機型，乾濕兩用。市場主打 Chairside，但體型略大，類似技師用研磨機，有內建空壓機以及水箱，可同時研磨三顆瓷塊，也可研磨特定廠牌的金屬 Prefabricated abutments 與 PEEK。我覺得最大的改良就是操作軟體的內建以及介面人性化，更為直觀的操作讓醫師端的操作人員更好上手，是一台很有臨床潛力的研磨機。

vhf – Z4

vhf 是一間專精於各領域研磨機的德國重工業公司，該廠的牙科商品定位相當明確，Z4 定義為 Same-day dentistry 使用的機器，機型小、有內建水箱跟空壓，附帶軟體操作介面不需外接電腦，軟體附帶防呆裝置，放錯鑽針會提醒。使用標準瓷塊柄，提供 2 秒快接功能，一次能車一顆，最多能研磨到鈦金屬的 Prefabricated abutments，基本上在市場上定位接近 CORiTEC One，但尺寸更小一些。

DGSHAPE – DWX 42W

DGSHAPE 是 2017 年由日本 Roland 拆分出來的子公司，由於看見了三維列印的商機，這子公司成立目的就是要擴展原品牌，從純牙科用研磨機的業務，轉向 3D 列印以及醫療用快速成形。因此，今年 DGSHAPE 推出了一台新的牙科用 3D 列印機，研磨機則沒有顯著更新。DWX-42W 有著 Curving mode 與為了此目的設計的特殊鑽針來提高研磨效率，可同時研磨三顆瓷塊，但缺點是因並非完全定位在診間用研磨機，所以仍需外接空壓機，也需要另外外接操控用電腦，沒有內建控制顯示器，材料選擇也較少。

IDC – MIKRO IC

IDC 是硬派德國研磨機咬合器廠商 Amann Girrbach 今年推出的子品牌，旨在建立一條完整的 Chair-side Digital Workflow。這台機器其實就是 Ceramill matik ic，差別在因為其 chairside 導向，把原本的外接水箱縮小藏到機身裡去了，但保留了 Amann Girrbach 專精的多種研磨策略 (Curving mode、Thrilling mode…等)，也有著所有機型中最小的鑽針直徑。這台機器目前也被 Straumann、Carestream 等大廠牌所貼標，為廠商端整合數位流程最喜歡的 chairside 研磨機。

Chairside CNC 規格比較總表

最後，最重要的，附上我在整個 IDS 2019 展場東奔西跑詢問下整理出來的規格比較表。 (因為我那幾天真的跑得很累，所以我也希望大家先幫我個小忙)

總結

根據這次的整理，可以依每台診間用研磨機的特長簡單地下個市場定位：如果你想找的是操作簡單、一條龍整合完整、研磨效率最高的機器，CEREC MCXL 會是你的選擇；如果你有預算上的考量，Planmill 40 S 是最經濟實惠的機型；如果你工作上會運用到很多類型的材料，CORiTEC One 提供了幾乎所有材料的選擇；如果你希望有最高細節的成品，或是想跟各大廠商用同一台研磨機，Amann Girrbach 血統的 Mikro IC (PL900S) 是最受歡迎的機器；如果你希望診所有品味看起來很時尚，Programill One 絕對是一個點亮你診間的高級藝術品；如果你行事穩健，低調不愛出鋒頭，Z4 各項數據表現雖皆未達頂尖但也沒有出現明顯缺點。

以上，期許本文能夠在這數位牙科風起雲湧的時代，給想跨入 Chair-side CAD/CAM 的同好們一點協助，讓挑選研磨機這最昂貴卻資訊最不完整的的一塊變得清晰。

The post 2019 年診間用研磨機總整理 (Chairside CNC) appeared first on CEREC Digest.

We originally wrote this article back in March, immediately following the International Dental Show this year. However, at the time we chose not to release this for reasons I will describe at the very end of this whole article. But due to popular demand, we’re now releasing our original text. Everything until the Last Three Questions section was written in March, but we’ve read it over numerous times, and our opinion stands. Enjoy!

Hsuan. June, 2019.

Foreword: Learning from Our Mistakes

Two years ago, I wrote a piece called Review of Intraoral Scanners at IDS 2017, comparing 14 intraoral scanners at the dental show in Cologne. Based on hands-on first impression data gathered by the CEREC Asia team, we rated each scanner using four criteria: speed, size, ease of use, and scan completion.

Amazingly, that article has since garnered over 200,000 views to date, drawing plenty of comments and questions from dentists and dental technicians around the world. It also spawned a bunch of similar review articles and, more importantly, helped generate discussions on intraoral scanners around the world, particularly in Asia.

At CEREC Digest we pride ourselves in writing investigative articles based on factual evidence. While we are actually not affiliated with Dentsply-Sirona in any way, we are acutely aware of the presumptions that people have based on the “CEREC” in our name. However, we do not consider this a handicap. Instead, it is a constant reminder to go the extra mile and ensure the validity of our claims.

But we are human after all, and some of our decisions, even after all things considered, are still somewhat subjective. Unsurprisingly, the same 2017 article that was so popular also attracted a fairly large wave of criticism, especially from the manufacturers who were ranked low on the list. While most of the complaints were unproductive and self-serving, we acknowledge that a few of them were legitimate concerns.

Over the last year, we’ve discussed internally to see how we can do better, and perhaps make the whole review process more meaningful. So far, we’ve recognized a few places that could be improved, and in this article, we are pleased to show you a new system of rating intraoral scanners that is more clinically relevant.

Cutting to the Chase

If you’re in a hurry and just want a quick summary, here’s the section for you. Since there are many important complications and nuances in our analyses, however, I recommend reading the whole article before you do anything rash, like sending me a stern letter of disagreement.

Without further ado, here are the our overall ratings for the intraoral scanners shown at IDS 2019:

The vertical positions indicate the rankings from top to bottom. The classes do not affect ranking, and are simply for categorical purposes. Read on for more information.

The Big Picture

To say that the intraoral scanner is very important to my work is an understatement. At our modest clinic with 10 dental chairs, we fabricate an average of 500 chairside CADCAM restorations per month. With clinical experience in CEREC, 3Shape, and Planmeca (though substantially less than the other two), I have first-hand accounts of the best (and worst) of these different systems.

Back in 2017 when I last visited IDS with our CEREC Asia team, it felt as if there were only two intraoral scanner systems that were truly clinically viable: the Omnicam from Dentsply-Sirona and the Trios 3 from 3Shape. This is not to say that other scanners are unusable, but they really did leave a lot to be desired. While part of this was reflected in their overall score, there were definitely little things that bothered us, and yet were difficult to quantify in our review.

Has this changed in 2019?

As you would expect, the overall hardware and software quality of intraoral scanners have improved over the last two years. That being said, the overall ranking of the scanners relative to each other, for the most part, did not see drastic changes. This is, after all, complicated technology, and so it’s understandable for development to be incremental. The 3Shape Trios 4 is the prime example of the difficulty in upgrading from a scanner that was already one of the best, the Trios 3.

That is why I was very excited to see new scanners designs showing up at IDS this year, whether they performed well or not. Because it shows that these manufacturers have at least received sufficient demand from the market, or at least enough positive reinforcement to make the investment. I’m talking about scanners such as the Virtuo Vivo from Dental Wing, the Aadva IOS 200 from GC, the X Pro from Kavo, and the Primescan from Dentsply-Sirona. I think it’s quite risky to reinvent new tech, and applaud these companies for trying.

The Difficulty of Rating Scanners

The point system that we used in 2017 provided a quick and easy way to gauge how one IOS performed relative to each other. Here was our 2017 summary.

The system that we used was suitable for a superficial comparison, but consider this: the Planscan Emerald, Carestream CS 3600 and Dental Wings DWOS all received 16 points, so are they equally good?

The DWOS was significantly slower than the other two scanners, yet won serious brownie points for being the smallest of the three. This raises an interesting question: does the size matter if the scanning speed is inadequate?

I would argue that if the scanning speed makes a scanner unsuitable for clinical use, then size is kind of irrelevant. But you don’t have to take my word for it. Of the three scanners that have received the top score of “5” for size, the DWOS was discontinued, and the 3M True Definition was nowhere to be found at IDS. Meanwhile, the iTero scanners are still rapidly gaining market share around the world despite getting punished hard for its size in our rating system. Why? Because it’s actually a decent scanner overall, numbers notwithstanding.

Now what about the CS3600 and the Planscan Emerald, both of which I’ve used on real patients. After spending some time with them, I think Carestream scans are a bit more consistent. However, the design software on the CS 3600 workflow is significantly handicapped when compared to the Planmeca. So if you’re looking to scan, design, and mill your own restorations, Planmeca is actually the better choice between the two. And this nuance is lost with our previous rating system

Once we start factoring in things like scanner weight, touch screen, caries detection, and other supplementary features, the whole pictures becomes something of a mess. Faced with this same struggle last time around, we decided to abandon the complexity in the end. Instead, we went with a generalized but easy to comprehend approach. Clearly, it wasn’t perfect, and a new method of rating scanners was needed for a more meaningful discussion real clinical settings.

A Rating System that is Clinically Relevant

We began by asking ourselves: What do we care most about an intraoral scanner? After our last review article, many people messaged me to complain about the fact that the price wasn’t factored into the rating. Clearly, people think pricing is important, but is it the most important? Would you rather buy a cheap machine that is barely usable, or invest in an expensive one that actually increases clinical productivity?

From my own experience, I argue that usability is the most important. In other words, being able to complete a scan with ease and efficiency is the most basic requirement for an intraoral scanner. Everything else, in comparison, is secondary.

Instead of using arbitrary numbers, however, our team compared notes, analyzed our scanning videos and picked the top scanner based on the three components of scanning efficiency: scanning speed, data capture, and software intelligence. Using our top choice as a reference, we then rated all the other scanners based on these criteria.

Since our rankings are qualitative, we wanted to provide a visual aid for clinicians to reference. Digital scanners are used to replace traditional impressions, so we developed a three-tiered system based on traditional timings for easy reference.

• Tier 3: The scanner is able to complete a full-arch scan and export an STL model successfully, without time limit.
• Tier 2: The scanner is able to complete Tier-3 tasks faster than silicone impressions (around 5 minutes).
• Tier 1: The scanner is able to complete Tier-3 tasks faster than alginate impressions (around 1 minute).

How are the classes defined?

Not all scanners have the same set of functions, and we wanted to show this explicitly in our review. Therefore, we’ve divided them into three different classifications based on system capabilities. However, the intraoral scanners are rated purely on their own merits, and their classifications are not taken into account. The classifications are as follows:

• Class A = The manufacturer offers its own scanner, CAD software, and CAM (milling) unit.
• Class B = The manufacturer offers its own scanner and CAD software only.
• Class C = The manufacturer offers its own scanner only.

It’s like buying a computer: all of them can do word processing, web browsing, and Youtube shenanigans, but some of them are also able to play games, render 3D models, and perform parallel computing. Whether these additional specializations are important to you will depend on what you’re looking for.

Similarly, if you are simply looking to buy a scanner to replace traditional impressions, then any of the classes A, B, and C will do. If, however, you are also thinking of designing your own surgical guides, then you’ll need at least a Class B system. For us here at CEREC Asia, one of our primary focus is on single-visit restoration, and so having a Class A system is imperative for clinical efficacy.

A Word on Scanning Efficiency

The Koenigsegg Agera RS, seen above, holds the current Guinness World Record for fastest street-legal car, capable of reaching an incredible 278 MPH (447 KM/H). But in the real world, getting from A to B is more than just raw horsepower. Instead of a straight road, we have to navigate sharp turns, traffic issues, and weather conditions to reach our destination in one piece. A similar logic can be applied when testing intraoral scanners.

Completing an intraoral scan is not simply a matter of whipping the scanner around as fast as you can. The scanner needs to also consistently acquire useful data for 3D model reconstruction. In the event that the scanner has captured bad data (i.e. tongue, cheeks, fingers, etc…) it needs to be able to fix them, preferably on the fly and without user intervention.

In short, scanning efficiency can be divided into three parts: speed, acquisition, intelligence.

This idea of being able to efficiently complete a scan is so integral to the our clinical experience that we’ve placed it above all else in rating intraoral scanners. In other words, we prefer a scanner that does what it was meant to do, and does it well.

While we’re still on the topic of scanning efficiency, I would like to address a fundamental problem with testing on a model as opposed to a real oral cavity.

As shown at the top in the above graphics, each digital scanner has a theoretical maximum speed that is limited only by its hardware. Unfortunately, this number is meaningless to clinicians because it represents an ideal condition that’s unattainable in real life.

At dental shows, we often go for the easy option: scanning dental models. Digital scanners are particularly good at scanning homogeneous and opaque surfaces, so if you have a hard time scanning models, that’s not a good sign.

Unfortunately, our teeth and restorations are not homogeneous and opaque, but translucent and opalescent. So what can we do to test the scanning efficiency on a heterogeneous mixture of enamel, ceramics, resin, and metal? When you see sales reps scanning themselves at dental shows, that’s essentially what they’re doing. Self scanning shows you how well the scanner is able to pick up real-world data, so it’s a slower but better representation of reality than model scanning.

But that’s not the whole story either. With self-scanning, you can minimize the impact of soft-tissue and environmental interference through a lot of repetitive practice in the same mouth. When we scan a new patient, however, these issues are unpredictable and will inevitably slow you down. You might need to pause scanning and delete some unwanted parts of the 3D model. You might need to stop for fluid evacuation or lens clearing. Some teeth might be hard to reach for certain patients, and you’d have to make adjustments on the fly. In the office, there are plenty of little problems here and there to significantly impact your scanning efficiency.

As far as we could see, the only booth at IDS 2019 with a dental chair setup and actively encouraging visitors to try scanning a real person (other than themselves) was the Primescan at Dentsply-Sirona. Unlike live demonstrations, hands-on scanning cannot be practiced ahead of time, and is the only reliable method to evaluate both the clinical performance and learning curve of an intraoral scanner.

Unfortunately, since most of the manufacturers only offered model scanning, we will stick with that for controlled comparison. As you read the review here and others on the interwebs, however, keep this important detail in mind.

CEREC Primescan

#Disclaimer 2019-06: I wrote this review immediately following IDS in March, but have since used the Primescan routinely at CEREC Asia and our clinic. I’ve decided to not add any additional feedback and experience to my original text so as to be as fair as possible to other scanners.

Primescan is the brand new scanner from Dentsply-Sirona. I’ve written an analytical article on it when it was first announced back in February. In it, I discussed our hands-on experience and tested the manufacturer’s claims on accuracy. For anyone interested, here is the link to the article:

New Kid on the Block: Primescan and What It Means for Current and Potential Users

The claims for Primescan were fast, accurate, and easy to use. We’ve dealt with accuracy quite thoroughly, so just exactly how fast and how easy to use was it to use? Here’s a video followed by our impressions.

Efficiency

• SPEED: Scanning traversal speed was definitely one of the fastest compared to all the other scanners at IDS.
• ACQUISITON: Data capture also feels significantly faster than the Trios 4 and the Omnicam in a single pass, thanks to the Primescan’s large scanner head and depth of field.
• INTELLIGENCE: The AI powering the Primescan is simply amazing. Its ability to fix soft tissues, and other mistakes, makes for scanning experience that is significantly less stressful.

Addressing the Elephant in the Room

Yes, Primescan is a big scanner. When you hold it, the pen grip also feels quite different due to the wider girth, and the size of the scanner head felt almost comically large, especially if you’re comparing it to an Omnicam. If I’m being honest, I thought it looked like a fat Omnicam.

But since we were able actually scan someone intraorally at the booth, it was easy for us to see that the size was not an issue at all. Instead of trying to convey this through paragraphs of exposition, I encourage our readers to try the scanner on a real person and see for yourself. In our opinion, the decrease in mobility is more than made up for by the image capture capabilities and the AI in the software.

Our Verdict

As much as we’ve agnoized over how partial our decision will look, we have concluded that the Primescan is, without a doubt in our mind, the #1 scanner of 2019. While the Omnicam was already one of the fastest scanners available, the clinical efficiency of Primescan is simply unmatched in our tests, especially considering that we also tested on real people. Keep in mind, however, that its price is also unmatched, and not in the good way.

3Shape Trios 4

The Trios 3 tied for top score the last time we were at IDS in 2017. It was fast, relatively easy to use, and was definitely one of the best options available at the time. With the release of Trios 4, we were curious to see how much of an improvement 3Shape was able to make on such a great scanner. The short answer: not much.

Efficiency

• SPEED: The reps kept telling me that the new Trios 4 is faster than Trios 3, but once I pressed them on the details, they weren’t able to pinpoint exactly what made them faster, other than “new hardware and software”. We tried scanning with both generations back to back and I honestly could not tell the difference.
• ACQUISITION: Data capture was on par with the Omnicam in a single pass, and I’m much more proficient with the Omnicam, so extra points to the Trios 4.
• INTELLIGENCE: The AI was very impressive but not as aggressive as the AI in the Primescan. I actually had a special opportunity to scan a live person with the Trios 4, and it was able to remove most, but not all, of the soft tissue interference. Unfortunately, we were supervised and not allowed to film this extra test.

What’s the difference between Trios 4 and Trios 3?

In terms of the core scanning capability, Trios 4 is essentially the same as the Trios 3, but with a bigger battery (if wireless), new scanning tips, and caries detection. During the exhibition, we were told by a sales rep that the Trios 4 is faster and more accurate than the Trios 3, but we couldn’t find anything to support that claim.

After doing some online digging and looking up relevant patents, we are convinced that the Trios 4 is a rehashed Trios 3 with more bells and whistles. Yes, the fluorescence detection was interesting and the infra-red diagnostics was pretty cool, but I would’ve like to see more improvement on the the scanning latency and stability issues.

Our Verdict

The Trios 3, the Trios 4 and the CEREC Omnicam are tied at #2 on our list. In terms of clinical efficiency, the Trios 4 continues the 3Shape legacy of great scanners. As a Class B scanner, 3Shape’s biggest advantage, in my opinion, is actually not just its superb scanner, but also the sheer number of clinical indications covered by their CAD software and modules. The best part is that for €10,000 less, you can get essentially the same scanning experience with the Trios 3.

Changes to the New Omnicam 5.0

During our last review in 2017, we rated the Omnicam and the Trios 3 with the same overall score. This year, with our focus on scanning efficiency, we have given a slight edge to the Omnicam. While the the Trios 3 did receive new software updates, they were not drastic changes. Even the 3Shape sales reps weren’t able to clearly articulate how the Trios 3 had improved, which is understandable as their marketing was heavily focused on the Trios 4.

The Omnicam, on the other hand, has received the new CEREC 5.0 update, powered by the same AI as the Primescan. Not only is acquisition considerably more reliable, but the software is noticeably more intelligent in fixing stitching errors and soft-tissue issues as well. Whereas the Trios focused on extra features like motion jaw tracking and caries detection, Omnicam 5.0 improved its core function. However, since this new version of the Omnicam has yet to be publicly released, we will rank the old Omnicam on our list for now.

Medit i500

Released in 2018, the Medit i500 is the new scanner coming out of South Korea, and is definitely a game-changer in terms of the kind of performance you can get without breaking the bank.

Efficiency

• SPEED: Very impressive scanning speed on the model (see video).
• ACQUISITION: The small scanner head means less data capture overall on every pass pass. The capture speed makes up for this deficiency and is very smooth, but seems to be missing a bit more data than 3Shape and CEREC scanners.
• INTELLIGENCE: We sometimes ran into stitching problems if we didn’t follow the recommended scanning strategy (see video).

Small Reservations About the Medit i500

During our tests, I thought the i500 performed just as well as the Trios 4 in terms of scanning speed and acquisition. In some respects, it almost seemed to scan faster and smoother than the 3Shape scanners. Its software did not seem quite as polished or intelligent, but it did give us decent results for the most of our tests. We’ve placed the i500 in Tier 1, albeit with reservations. As we’ve mentioned earlier, intraoral efficiency is drastically slower than model scanning, and we haven’t been able to test this scanner intraorally (unlike the other scanners in the same tier).

Our Verdict

We’ve decided to place the Medit i500 at a respectable #5 in our Top Ten list. Since there is a three-way tie at #2, the Medit is really #3 in our minds. At €16,000 and without subscription fees, its value is currently unbeatable by any other scanner, especially given its Tier 1 scanning efficiency. If you are on a budget and looking for a no-frills replacement for traditional silicon, the Medit i500 is the perfect balance of cost and performance.

Dental Wings Virtuo Vivo

If we could give out imaginary awards, the Virtuo Vivo would get my vote for Best Newcomer. This was a completely redesigned scanner that looked nothing like the previous iteration, the DWOS. Not gonna lie, I was personally very surprised at how well the Virtuo Vivo actually performed. There was also a live demonstration of intraoral scanning, and it gave us a very good reference for its acquisition capabilities and software intelligence.

Efficiency

• SPEED: The maximum travel speed was surprisingly fast on the Virtuo Vivo. It’s not at the Medit or 3Shape level, but it’s definitely one of the faster and smoothest Tier 2 scanners we tested.
• ACQUISITION: The scanner was able to capture most of what its camera saw, and the scanning field also seemed a bit bigger than average.
• INTELLIGENCE: The software was able to fix basic stitching issues. The live demonstration also showed how it was able to remove some software interference by repeatedly scanning over the same area.

To the Top of Tier Two!

It’s always a difficult call to review a brand-new scanner. On one hand, the Virtuo Vivo had very good speed, smoothness, and acquisition capabilities. Upon first use, we had a feeling that it would probably be ranked right behind the Medit i500. But is it Tier-1 material? The live demonstration did nothing to convince us one way or the other, because it showed good acquisition, but the operator was moving at such a slow pace that there was no way to gauge the actual efficiency. In the end, we asked ourselves: we would be able to scan a full arch in one minute? And the answer was not definitive.

We would be happy to be proven wrong, however. Let us know in the comments below.

Our Verdict

We rank the Virtuo Vivo from Dental Wings at #6 on our list. With its design software and milling unit, this scanner seemed to be a Class A system at first. However, since the milling unit is actually manufactured by Amann-Girbach, it’s technically a similar setup to 3Shape, where part of the workflow is dependent on a third party. At €19,000, it’s a cheaper alternative to 3Shape, albeit at lower but decent performance. If you are already invested in the Dental Wings ecosystem, the Virtuo Vivo is a promising front-end to your CAD/CAM workflow.

iTero element 5D

The iTero element 5D is an incremental update from the previous generation, the iTero element 2. The wand looked very similar to the old design, and there didn’t seem to be much changes made on the actual scanning capabilities. The primary selling point of the element 5D was its ability to perform near-infrared imaging (NIRI). Unlike the 3Shape Trios 4 infrared capture, which requires you to activate image capture individually, the element 5D records all the NIRI data so that you can view it at a later time. Pretty neat!

But what about the core scanning function? Here’s a video

Efficiency

• SPEED: The element 5D uses the essentially the same hardware as the element 2, so there was no appreciable speed improvement. The scanning speed is decent, but not quite at Tier 1 level.
• ACQUISITION: Latency during the scan was very noticeable (see video), but seems to only be a visual effect with no actual negative impact on data capture. The large and deep scanning field of the iTero have always been its strength.
• INTELLIGENCE: The software is able to correct minor stitching problems, but does not seem to have the ability to remove soft-tissue interference. (see video)

Its Ranking Explained

If you saw the iTero scanning video above, you might have noticed that its scanning speed seemed to be a bit slower than other scanners around its rank. In our prolonged tests, we found that the iTero, although not exactly a speed demon, was much more consistent in its data acquisition than Carestream and Planmeca.

Our Verdict

The iTero Element 5D is #7 on our list of top ten scanners. While its definitely clinically viable, the Element 5D’s core scanning efficiency is still not quite Tier 1 level. Unfortunately, its quoted price of over €36,000 puts it in the same price range as the 3Shape Trios 4 and the Omnicam, which are both higher class and higher tier. Even if we’re comparing within the same class, the Medit i500 represents another tough competition for the iTero.

The iTero does, however, have one saving grace, and that is its association with Invisalign. Due to the marketing efforts of from Align Technology, this scanner has done better in sales than its performance would suggest.

Carestream CS 3700

The CS 3700 is yet another evolutionary update to the CS 3600. Unlike the big jump in hardware between the CS 3500 and the CS 3600, this new scanner is essentially the same scanner with a different design for the handles.

Efficiency

• SPEED: It was very difficult to tell the difference between the 3700 and the 3600, even with a side-by-side comparison. The speed was still decent, mind you, but it was definitely one of the slower scanners on our Top Ten list.
• ACQUISITION: For the most part, data capture was very good on the 3D printed model they provided. The scanner produced only a few holes on a single pass, and most of them were embrasures so that was understandable.
• INTELLIGENCE: The software is able to correct minor stitching problems, but does not seem to have the ability to remove soft-tissue interference.

About that Porsche Design

One of the selling points about the CS 3700 is the fact that its new design was by the same minds who designs for Porsche, the sports car manufacturer. But… why? Consider the fact that other companies are adding clinically-relevant functions such as caries detection, fluorescence, and motion capture of occlusion, or just straight up rebuilding a better scanner from scratch. I’m not saying that Porsche engineers have no chance of coming up with a better handle design for an intraoral scanner. In fact, we quite liked it, but is it really the critical detail that’s holding the scanner back?

Our Verdict

We give the new scanner from Carestream the #8 spot. It might seem like the CS 3700 is a step down from the CS 3600, which was ranked at #3 in our 2017 review, but it’s all relative; since most other manufacturers came out with more tangible improvements to their scanner, the CS 3700 felt about exactly the same. However, this device is scheduled for release later this year, so it’s possible that they make last-minute changes for the better.

Planmeca Emerald S

A few years ago, I got to scan, design, and fabricate an onlay for the first time on a class A system. It wasn’t the CEREC Omnicam, but rather the Planscan, the last-gen scanner from Planmeca. However, the nostalgia did nothing to dampen my disappointment when I saw the Emerald S. In keeping with the trend set by 3Shape, iTero, and Carestream, the Emerald S is also an evolutionary update to the previous scanner, the Planmeca Emerald. In other words, don’t expect to see significant changes to the core scanning functionality.

Efficiency

• SPEED: The Emerald S is a fast scanner on the model, and the speed is also very respectable in the mouth. We are able to vouch for its intraoral speed because we’ve used the previous generation, the Emerald, on numerous real patients.
• ACQUISITION: For the most part, the Emerald has very good data capture, both on model and enamel.
• INTELLIGENCE: The ability of the software to fix stitching issues was quite poor. The scanner also had a bit of difficulty resuming a scan once the flow was broken.

The Achilles Heel

For the gamers out there, the Emerald S is the build where the player invested equally on every other stat except for intelligence. So while you have decent hardware, robust design functions, and a very comprehensive workflow, somehow the scanning software gives you the most trouble. The inability to fix some basic stitching errors wouldn’t have been such a big problem if the scanning deformations were rare, but these problems occur quite frequently during our clinical tests with the Emerald (not the “S”).

We wanted to see if things have improved with the new scanner, but were instead told that the scanning issues were due to improper scanning technique. Perhaps. Thought we’d like to note that there were other scanners that performed just fine using the identical scanning techqniue.

Our Verdict

We give the Planmeca Emerald S the #9 spot on our Top Ten list. The scanning speed is almost the same as the iTero, but due to its software issues, you are sometimes forced to stop, delete, and re-scan certain portions. Despite our complaints, however, these are not frequent issues, and we feel that the Emerald S is a about the same efficiency as the Carestream CS 3700. On the plus side, it’s also a decent and less-expensive alternative to the other Class A systems in our list, the CEREC Primescan and the Omnicam.

GC Aadva IOS 200

Out of the top 10 scanners that we’ve reviewed, the new Aadva IOS 200 from GC had the most interesting design. The tip of the scan head sports a simple mirror that’s not completely enclosed, giving the whole thing a very minimalist look. So how well does the scanner perform? Here’s one of our tests during IDS 2019.

Efficiency

• SPEED: The Aadva IOS 200 can reach about the same speed as the Carestream CS 3700 before breaking the scan flow.
• ACQUISITION: The data capture was fairly decent on the stone model, but during a self-scan demonstration the number of holes in each pass increased significantly.
• INTELLIGENCE: The nice lady at the booth mentioned software artificial intelligence, but it looked like basic clean-up capabilities of noisy data.

How does the Aadva IOS 200 compare with the last generation from GC?

The Aadva IOS 200 is definitely a much more efficient scanner overall. It’s faster and has better data capture. The software doesn’t seem to have improved too much, but it’s sensible for manufacturers to use the same software for different hardware. We also gave the last-gen GC scanner, the Aadva IOS, another try this year, and it didn’t really improve very much, at least not enough to enter Tier 2.

Our Verdict

The GC Aadva IOS 200 is a solid #10 on our top-ten list. I can appreciate the new design, but at the moment this device does not seem to have too much advantage over other competitors. As a Class C scanner, it can only perform the most basic functions of an intraoral scanner: scan and export to a third party. Yes, at around 16,000 Euros, the Aadva IOS 200 is one of the less expensive scanners. Unfortunately, the Medit i500 is also around 16,000 Euros, and is a significantly better scanner of the same class. But I wouldn’t count GC out yet, seeing as how they were willing to take a risk and invest in a totally new scanner. Let’s see what they have to offer in 2021.

Last Three Questions

Why was this review article published so late?

I remember sitting in a hotel in Maastricht a few days after IDS in March, proofreading the final draft of this article. More than 5000 words of what our team set out to do, and yet it didn’t feel right. As I was doing additional research to support my claims in the article, I constantly questioned if I was biased in favor of Primescan. Maybe because it’s new and exciting? Maybe because I’m much more familiar with CEREC ecosystem? My draft was able convince everyone on the team except for myself.

In the end, we decided that if we were going make a claim, we’d better be able to prove it. So we waited until after receiving our Primescan, and I tested the crap out of it over the next week. The results were even better than I expected, but by that time a few other websites had copied our format from 2017 and released their review. We didn’t agree with their findings, because all of them seemed have made the exact same mistake we did, but alas it seemed that the window of opportunity had closed.

In the month following IDS in March, I had received a large number of requests online for the 2019 version of our article. As I lectured in many different countries, a lot of the audience member had asked me about our thoughts on different intraoral scanners. Many of them are in the market but don’t have any headway on how to choose. You can probably guess the rest.

Which is the right scanner for me?

Isn’t this the ultimate question? Right now, the choices are becoming diverse and there is a scanner for every need.

Just to list a few: If you are looking for an inexpensive scanner that is easy and efficient, there is the Medit i500. But if you also want to do your own design on a lot of different indications, then the 3Shape TRIOS series are a good choice. For the ultimate system for accurate scanning and chairside restoration, the Primescan currently has no competition, but there’s literally a high price to pay.

But whether it is price, accuracy, or how many indications you can use it for, the one thing that most people overlook is the availability of training and education. Maybe you don’t need too much training for Class C scanners, but if you are considering Class B and A systems, a good community that can support you is paramount.

At CEREC Asia we do a lot of technical and clinical training, but our most popular courses are actually the Marketing and Management lectures for CEREC. People are interested to join the world of digital impression, but are unsure of what to do and how to start. As dentists, most of us don’t have the time to figure stuff out, and having access to good education can help you immensely on riding that learning curve.

What about (INSERT NAME) Scanner?

As I’ve mentioned at the very beginning, our last review article in 2017 has gained over 200,000 views so far. This means 200,000 good exposures for the top scanners, but also 200,000 bad exposures for the bottom scanners.

When my colleague and I planned this project last time, we simply wanted to see how the Omnicam that we use everyday performed relative to other scanners. It was not our intention to damage the reputation of anyone, but rankings dictate winners and losers, and for the latter we frankly didn’t work hard enough to ease the pain.

The fact is, intraoral scanning is not just one kind of technology, but consists of several different approaches to reaching the same goal. Through years of competition, some newer methods have begun to mature while others have been made obsolete. Right now confocal technologies reigns supreme, but who knows what the future will bring.

As both an engineer and a dentist, I can appreciate the manufacturers pouring time and resources for the betterment of patients. This is why for this year, even though we’ve tested almost every single intraoral scanner at IDS, we’ve decided to list only the top ten. For the scanners that did not make it into our review, we sincerely wish them the best of luck and look forward to what they bring to the table next time around.

Conclusion

Thank you for taking the time to read our review and analysis. We’ve tried to be as fair as we could, but I’m sure we’ve made mistakes somewhere. Let us know what you think in the comments below, or contact me some other way, and I will make sure to respond to each of your concerns.

The post Our Top Ten Intraoral Scanners of 2019 appeared first on CEREC Digest.

CNC, Computer Numerical Control, means inputting precise commands, translate and calculate via computer, and transmitting the information to the driver and motor through the positioning control system. It is widely used in digital dentistry because its product consistency compared to 3D printing and its exclusivity in ceramic output.

Two years ago, the world’s major CNC manufacturers joined the digital dental field, and all sorts of milling machines emerged. Now, only a few manufacturers still exist, and they have established alliances with other upstream and downstream manufacturers. These manufacturers have been focused on dental CNC since the beginning, and strive to adjust the complicated industrial instruments into machines that dentist or dental technician without industrial background can operate, unlike the other manufactures in the CNC industry. This shows that focusing on the targeted customer and paying attention to customer needs is the key to survival in the market.

These manufacturers are: Dentsply Sirona , Planmeca , Ivoclar Digital , imes-icore , vhf , DGSHAPE (Roland) , and IDC (Amann Girrbach).

Each manufacturer also introduces different milling machines for different users’ required production quantity and material requirements, ranging from huge lab machines with automatic storage tray, automatic wet/dry switching cleaning tank to quiet and efficient chairside milling machines. I personally believe that only chair-side milling machines can fully unleash the potential of digital dentistry. Moreover, the simpler the more difficult it is. Minimizing huge milling machines for chairside use challenges the hardware capability of the manufacturer. Therefore, the main purpose of this article is to review the mainstream chairside milling machines in the market in 2019.

The evaluation checklist of milling machines

1. How many axes: affects clinical indications

Currently, the milling machine on the market can be roughly divided into two categories, four-axis (XYZA) and five-axis (XYZAB) . The biggest difference between the two is the size of the area that cannot be milled. The area that cannot be milled in four-axis machines is shown in Figure 1. Theoretically, there shouldn’t be places that a five-axis cannot mill. However, due to the path of the bur and the ceramic block mounting area, there are still some parts that cannot be milled (Fig. 2), but the area is relatively small and less susceptible to undercuts. This limitation also directly leads to different clinical indications. Most restorations shouldn’t have undercuts due to the need for path of insertion, so the only contraindication of four-axis miller is long span implant bridge and surgical guide for multiple implants. However, both of these are usually not included in chair-side treatment cases, so most chair-side millers are four-axis machines.

2. The size of the smallest bur: affects marginal integrity and preparation requirements

In theory, the smaller the bur is, the better the resolution will be, and the less over-milling will occur during milling. But unfortunately, smaller burs are more fragile. Even if the smaller burs do not break, the bending of the bur when under stress will introduce errors. Therefore, the smallest bur size that can be achieved without excessively weakening its own strength is the resolution of the miller, which affects the marginal integrity that dentists care so much about and is also effected by the roundness of the preparation. Currently, 0.5 – 0.6 mm is the limit of most milling machines. Few of the manufacturers can use 0.3mm round burs during the milling of zirconia.

3. Applicable block type: affects clinical indications

Basically, most chair-side millers can mill all kinds of glass ceramics, zirconia, and resin blocks. The biggest difference is that some millers can also mill sintered metal used for customized implant abutments.

4. Maximum ceramic block size: affects size limitation of product

Most chair-side milling machines mill blocks and not disks. Larger blocks are usually in PMMA , e.max , and zirconia, which are used for bridge prosthesis or surgical guide. Because of its shrinkage during sintering, zirconia blocks tend to be bigger. Therefore, the size of the block that can be placed in the miller limits the size of the prosthesis that can be fabricated.

5. Maximum scheduled milling amount: affects the automated productivity

Due to the large output quantity requirement of lab millers, overnight milling or automated milling is needed. Therefore, the amount that can be scheduled and change blocks automatically greatly affects productivity and variety. Although most chair-side millers have short milling time (single restoration or same-day delivery cases) and do not require this function, some machines still have scheduling capabilities.

6. Single crown milling time: affects digital workflow efficiency and total output

The speed of milling a single crown in chair-side CAD/CAM is very important. For only one crown, the difference between ten minutes and twenty minutes doesn’t seem much, but when you have four or five restorations milling at the same time, the difference between fifty minutes and one hundred minutes makes a big difference. Especially when multiple dentists are performing digital treatment at the same time, the time wasted waiting for the machine to mill and difficulty to arrange appointments deliver or even working over-time adds intangible costs.

7. Dry and wet milling function: affects zirconia sintering time

When zirconia is sintered, it needs to start from a dry state. If it is wet, an additional 30 minutes of pre-dry drying process is required. Because of this, manufacturers also introduce dry milling, or models that can switch between wet and dry milling. However, according to the experience of most dental workers, most dry/wet combined machines are still often fixed in a single mode. The main reason is that if the residual zirconia powder is not cleaned thoroughly during dry and wet switching, it will flow into pipelines of the machine with water and cause damage to the miller, and currently only a few lab millers have automatic switching tank cleaning function.

8. Air compressor, external water tank: affects noise and space

The milling machine is powered by air pressure, so early models usually had to be connected to a source of high-pressure air, either from a central control room or an external air compressor. However, placing external air compressors in the clinic causes excessive noise and space occupation. Therefore, the air compressor is usually integrated into the chair-side milling machine nowadays. Since the milling subject is relatively simple and small, the amount of pressured air needed is also relatively small. The water used in the milling machine is usually recycled. As the powder produced during milling is mixed into the water, the water will get dirty eventually and needs to be changed. Therefore, due to the large output of lab milling machine, most are equipped with an external large-capacity water tank, while the chair-side milling machines usually use smaller internal water tanks.

9. Software operation mode: affects the user’s learning curve, debugging ability

The drive and milling strategy of the miller requires software control. There are also many parameters in the software for the adjustment of milling. In the past, some millers need to be connected to a laptop when milling. Nowadays, in addition to highly integrated systems (such as CEREC, Planmeca) that integrate CAD with CAM software, some new chair-side models also have built-in computer with touch interface, simplifying the parameters and input process for dentists and technicians.

10. Special milling strategy: affects milling efficiency, detail integrity, material limitations

As the requirement for clinical efficiency is increased for different restorative types, many manufacturers have continued to improve their milling strategy, which includes: milling path, bur selection, moving speed, contact angle, torque… etc. There are a few modes that are often mentioned.

Carving mode: cutting away large portions of material that will not be used at the beginning of milling, greatly reducing traveling path of the bur and saving time

Thrilling mode: Drilling vertical holes for implant restorations, so that ceramic blocks without built-in holes can also be connected to all sorts of implant abutments.

Margin protection: Marking the margin area that dentists care most about on the software, and uses the lightest force and finest bur to mill this area to prevent chipping.

Price: affects your bank account numbers

Um … does this need explanation? The price mentioned in this article is the MSRP quoted at IDS 2019. The actual retail price may differ.

A brief review of milling machines in the market

Dentsply Sirona – MC XL

A four-axis miller announced by Sirona since 2007, inherits the simultaneous milling of left and right double-bur starting from CEREC 2 to increase efficiency. A second set of finer burs (EF Bur 0.6mm) was added. The burs do not need to be changed during the milling process. A rotating motor is used to utilize the second set of burs, reducing the time required for bur changing. The operating software of the miller has been integrated into the “CEREC” software package along with oral scanning and CAD. As the software is updated, stability, surface characteristics, marginal integrity and milling strategies are also updated. Also, because CAD software is integrated, it provides margin protection when milling, along with built-in bur check and foolproof function. Although it has been on the market for 12 years, it is still on par with the other new machines seen this year. It has shortest milling time for single crown in all the chair-side milling machines.

PLANMECA – Planmill 40 S

Planmeca (formerly E4D) introduced the Planmill 40 follow-up model in 2017. “S” is the abbreviation of SMART, meaning it can automatically calculate the optimal milling path, automatic cleaning and maintenance, automatically change damaged or broken burs, aiming to reduce the need of maintenance by engineers. Planmeca also offers a fully integrated workflow, the same double-bur design, with a single crown milling time of about 10 minutes. It uses exclusive porcelain block handles, but most of the current material suppliers offer handles for Planmeca, so that shouldn’t be a problem. It is the cheapest in this review. The biggest drawback is that the smallest bur diameter is 1mm, which is significantly bigger than other brands.

Ivoclar Digital – Programill One

Programill One is a part of Ivoclar Digital, the new product line announced in IDS 2017, and is the only “five-axis” chair-side milling machine on the market, with the capability of scheduling five blocks for auto-change. It is capable of being remote controlled by apps on tablets. Due to its minimalistic and beautiful design and five-axis milling capability, it caused a sensation when it was first announced. However, after a closer look, you will find that this machine can only use Ivoclar’s own porcelain blocks, which limits the choice. The bigger problem is its small space. Only restorations shorter than 45 mm can be milled. Longer bridge or guiding plate cannot be milled. I asked the manufacturer this year if this will be improved, but it seems that they have no such plan at the present.

imes-icore – CORiTEC One

The German milling machine manufacturer imes-icore launched their new four-axis model in IDS 2019 this year, which boasts wet and dry milling capability. It is targeted for chairside, but it is slightly larger, similar to a lab-use milling machine. It has a built-in air compressor and water tank. It can mill three porcelain blocks at the same time, and can also mill metal prefabricated abutments and PEEK of specific brands. I believe the biggest improvement is the integration of operating software and the user-friendly interface. The more intuitive operation makes it easier for the user. It is a milling machine with great clinical potential.

vhf – Z4

Vhf is a German heavy industry company specializing in grinding machines in various fields. The dental product positioning of the factory is quite clear. Z4 is defined as the machine used by Same-day dentistry . It is small in size, has built-in water tank and air pressure, and comes with software. The operation interface does not require an external computer, the software comes with a foolproof device, and the wrong drill pin will remind you. Using a standard ceramic block handle, it provides a 2 second quick-connect function, only single mill at a time, and can be ground to a pre-prefabricated abutments of titanium . It is basically positioned close to CORiTEC One on the market , but in smaller size.

DGSHAPE – DWX 42W

DGSHAPE is a subsidiary that was split by Roland in Japan in 2017. Since it saw the business opportunities of three-dimensional printing, the subsidiary was established to expand the original brand, from pure dental grinder business to 3D printing and medical use. Rapid prototyping. Therefore, this year DGSHAPE launched a new dental 3D printer, which was not significantly updated. The DWX-42W has a Curving mode and a special burr designed for this purpose to improve the grinding efficiency. It can grind three porcelain blocks at the same time. However, the disadvantage is that the internal air compressor is still needed because it is not completely positioned in the clinic. There is also an additional external control computer, no built-in control display, and fewer material options.

IDC – MIKRO IC

IDC is a sub-brand launched this year by Amann Girrbach, a hardcore German grinding machine articulator manufacturer , to create a complete Chair-side Digital Workflow . This machine is actually a Ceramill matik ic . The difference is that the original external water tank is hidden in the fuselage because of its chairside orientation, but the Amann Girrbach specialization of various grinding strategies (Curving mode , Thrilling mode, etc. ) is retained . It also has the smallest drill diameter of all models. This machine is currently labelled by major brands such as Straumann and Carestream , and is the favorite chairside grinder for the manufacturer to integrate the digital process.

Chairside CNC Specifications Comparison

Finally, the most important one, I attached the specification comparison table that I sorted out under the IDS 2019 exhibition. ( Because I was actually tired in the past few days, I also hope that everyone will help me a little. )

Sum up

According to this arrangement, you can use the characteristics of the grinder in each clinic to easily locate the market: If you are looking for a machine that is simple to operate, integrated and complete, and the most efficient grinding, CEREC MCXL will be your choice; If you have budgetary considerations, the Planmill 40 S is the most affordable model; if you work with many types of materials, CORiTEC One offers almost any choice of materials; if you want the highest detail, Or want to use the same grinder with major manufacturers, Amann Girrbach ‘s Mikro IC (PL900S) is the most popular machine; if you want the clinic to have a taste that looks fashionable, Programill One is definitely a light up in your clinic. High-level art; if you act steadily and low-profile, Z4 data performance is not up to the top but there are no obvious shortcomings.

Above, I hope that this article will help the practitioners who want to step into the Chair-side CAD/CAM in the era of digital dental, so that the most expensive and least informative piece of the grinding machine becomes clear.

The post 2019 Review of Chairside Milling Machines (CNC) appeared first on CEREC Digest.