cad/cam feature PRODUCTIVE CAD/CAM DENTISTRY by Bruce B. Baird, DDS CAD/CAM technology was first introduced in E urope in the 19 7 0s. The advances from CE RE C 1 to today’s digital optical readers have been transformative. If you’ve been sitting on the sidelines waiting until CAD/CAM becomes mainstream, the time has come. I have the privilege of lecturing on productivity throughout the country, and typically I see that dentists spend most of their time focusing on diagnosis using risk factors, patient relationships and personal communication skills rather than efficiency. Without the ability to treatment plan the entire need, and communicate it in a way that makes sense to the patient, you’ll never realiz e your full clinical potential. I’d like to share some of the fundamental clinical techniques and scheduling tips that help me to provide outstanding care and produce more than $ 2 ,5 00 per hour. The cornerstones are technology and a highly trained team. I use lasers, digital radiography, cone beam imaging, sleep apnea technology and a paperless charting system. B ut, by far CAD/ CAM has had the biggest impact on my productivity. continued on page 70 68 OCTOBER 2014 » dentaltown.com General Practice_Baird_Productive CAD-CAM2.indd 68 9/23/14 12:46 PM cad/cam feature “ If you’ve been sitting on the sidelines waiting until CAD/CAM becomes mainstream, the time has come." 69 dentaltown.com « OCTOBER 2014 General Practice_Baird_Productive CAD-CAM2.indd 69 9/19/14 1:10 PM cad/cam feature continued from page 69 To be productive with this technology, I think we first have to take a look at some of the common myths and misconceptions. As I lecture, doctors who don’t use CAD/CAM share fears and beliefs like: • The materials are not as durable as lab milled restorations. • I am more efficient with current techniques. • I can’t figure out how to schedule it properly — I’m always running late. • I just can’t afford it. I use a lab that is very reasonable. Here is the startling truth: These technologies become cost prohibitive unless you have a system in place to diagnose, enroll and schedule patients for care. L et me ask you this: If you needed five or six crowns, would you rather do them one at a time over the course of five years, or take care of them all at once? The reality is that most of us, if money were no problem, would prefer to have the treatment completed in one or two visits. Our patients are no different. We’ve simply conditioned them to take care of one tooth at a time. I was shocked to hear G ordon Christiansen last year state that single-tooth dentistry has risen from 7 0 percent to 9 0 percent over the past decade. We are actually providing less care than in 2 004 . Practitioners who’ve embraced CAD/CAM know that new materials such as e.max, E namic and L ava Ultimate, and the ability to make our own custom abutments for implants produce high quality results in fewer visits. That is a patient wow factor — and a great thing to be known for in your community. I believe in this technology so much, I recently had my entire mouth rebuilt from the ground up in one day using the techniques I’m about to teach you. I have a combination of inlays, onlays, full crowns and veneers using e.max materials. My good friend, E ddie Coralles, flew in from San Diego to be the ceramist. So how do we do this? How do we overcome the obstacles of scheduling and materials handling to make this procedure productive and profitable? Here is what I do in my office. Technique and efﬁciency "I believe in this technology so much, I recently had my entire mouth rebuilt from the ground up in one day using these techniques." B egin by knowing you are not leaving the room from the time you give the injection until your smile designers take over to mill the restoration. With new software like 4 .2 software from Sirona, it literally takes minutes to design a beautiful restoration. With the MCX L milling machine using e.max blocks it’s possible to make a crown in less than an hour with doctors’ time being less than 2 0 minutes. With the advent of onset anesthesia buffering, which allows the patient to be pulpally anesthetiz ed in 9 0 seconds, I can walk in the room, give the anesthetic, wait 9 0 seconds, and then begin the preparation. I prep dry using electric handpieces and spend about 10 to 15 minutes prepping. For years I did my own design on all of my CAD/CAM restorations. Today I have trained two team members (smile designers) to do all of that work for me. When I’m complete with prep, I walk out of the room, go see other patients while one of my smile designers scans, designs, mills, tries in, bakes, polishes, isolates, takes a pre-cementation radiograph, steams, treats and then comes and gets me 4 5 minutes to an hour later. I am currently using Scotchbond Universal Adhesive from 3M E SPE to treat the inside of the restoration and the tooth. Next, I apply RelyX Unicem 2 Automix self-adhesive resin cement to seat the restoration. Clean up is quick and easy. I then recheck the bite and fi nish my margins. This entire process takes less than 10 minutes. Is this productive? You bet. Average production per hour nationally is $ 4 00 per hour. I’ve spent 30 minutes working on a crown and produced $ 1,000 worth of dentistry — that’s equivalent to $ 2 ,000 per hour! The best part is that patients thank me for not wasting their time and creating such a great result. continued on page 71 70 OCTOBER 2014 » dentaltown.com General Practice_Baird_Productive CAD-CAM2.indd 70 9/23/14 12:42 PM cad/cam feature continued from page 70 Scheduling and team work Although the prep visit is longer with CAD/CAM restoration, you are eliminating an entire non-productive second visit. In designing your office, I recommend adding a couple of treatment rooms with the intent to utiliz e these as holding treatment rooms while the design, milling, polishing and final preparation of the restoration can be accomplished by your smile designer. Over the last 10 years my productivity has steadily risen from $ 7 00 per hour to $ 1,2 5 0. Today we average over $ 2 ,5 00 per hour. As I said earlier, I was doing most of the CAD/ CAM design myself because I loved doing it and seemed to have plenty of time to do so. Now I think a little differently and it’s bumped my productivity another $ 5 00 per hour! It’s amaz ing to grow 2 0 percent when you think you’ve topped out. We still schedule to productivity in my primary two ops. The difference is that I’ve now added two additional ops for my smile designer. Her goal is $ 5 00 per hour and she has two chairs to work out of. Same principles of time management apply: 1 crown 2 inlay/onlay 8 units $1,000 = $2,000 = $8,000 = 2 hours in one chair 4 hours in one chair 16 hours = one patient all day! Advanced cases Now that we’ve covered the basics, let’s think about the fun stuff — multiple units using CAD/CAM. For the last 17 years while using CE RE C, my preference for anterior restoration has been to send out to the laboratory. I use Root L aboratory in K ansas City. They still do a significant amount of my dentistry, especially anything where there are multiple units with teeth missing and I’m doing crowns and bridges, and extensive fullmouth rehabilitations. With the new 4 .2 software from Sirona, I have been venturing out on veneer cases, and smile design cases up to 12 single units. I am using a ceramist, E ddie Corrales, who flies in from San Diego once a month for three or four days and we will do three or four smile design cases start to finish in a single day. E ddie’s company is CAD Smiles. With these cases E ddie does cutbacks and adds porcelain for custom incisal edges and characteriz ation. He also is a teaching expert in all aspects of CE RE C 3 software and technology. Yeah … but This all sounds good for you, B ruce, but you don’t understand my patients, you might say. They would never go for something like this; they barely do one tooth at a time! I understand, I used to think that way too. Today, when I do a comprehensive examination on a patient, I diagnose everything in the mouth that needs to be done. I don’t look at one tooth at a time, and I don’t look at one quadrant at a time. My preference is to gain permission from the patient to ask them the question, “ Is it okay if I look around your mouth to get an idea of what’s going on?” I then give them a treatment plan with 7 0-8 0 percent of the posterior restorations utiliz ing CAD/CAM technology. The other posterior restorations in non-loadbearing areas are usually done with composite resins. I take the pressure off the patient by saying, “ It doesn’t matter if it takes us four months or four years to do this work, we can do it at whatever pace you would like. Does that make sense?” L earning the verbal skills to help patients connect the dots is step one. Step two is making sure they are able to afford the care they need. I’m a fee-for-service practice in the very small town of G ranbury, Texas. Trust me, I know people struggle. B ut we found 72 OCTOBER 2014 » dentaltown.com General Practice_Baird_Productive CAD-CAM2.indd 72 9/22/14 3:17 PM cad/cam feature a way to overcome that. We offer traditional third-party options for the 50 percent of our patients that may qualify, and use Comprehensive Finance for those whose credit score may have been impacted by the rough economy but are still very payment worthy. Comprehensive Finance provides us with online tools to quickly approve patients, generate truth in lending statements and set up payment arrangements. The future of dentistry is brighter than ever, and I’m so thankful for the cool technology we have to make this easier! ■ Was this article helpful to your practice’s productivity? Comment after this article on Dentaltown.com. Author’s Bio Dr. Bruce B. Baird has long been known as one of the most productive dentists in the country. He has lectured internationally for over 25 years on technology, dental implants, cosmetic dentistry and full mouth reconstruction. He is the founder of the Productive Dentist Academy and Comprehensive Finance. B E S T A N D Q U I C K E S T W AY T O INCREASE OFFICE EFFICIENCY NEW OPTIONAL TOUCH FREE RADIO CONTROL • No more yelling down the hall • Reduce trips to find people, materials, or instruments • Eliminate morning huddles communicate all day • Quick communication between departments • Business model with built-in privacy feature ature $25 $ rebate per radio when w buying 6 or more m before 12/31/14. 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