Small town CAD/CAM

If you think high-tech is synonymous with big city... think again.

With a population hovering around 2,000 and an agriculture-based economy, Westby, Wisc., is the type of small town found all across the United States.

Situated on the west side of the state near the Minnesota border, the city is located in Vernon County, one of the most economically depressed parts of Wisconsin. Dr. Daniel Iverson, one of just seven practicing dentists in the county, describes his practice as "nuts and bolts" work.

When a dentist friend who practices in Madison, Wisc., asked if he was adding cosmetic services to his practice, Dr. Iverson explained that those developments in the industry are, "not really addressing the needs of rural dentistry."

"I'm trying to keep a tooth in the mouth, let alone make it look pretty," he said. "Guys like me, we're kind of in the trenches."

But that doesn't mean he's averse to making life in those trenches a little easier with the latest dental technology. In fact, Dr. Iverson was the first dentist in all of Wisconsin to add an E4D Dentist CAD/CAM system to his practice. There might not be a big market in Westby for high-tech whitening systems or laser dentistry, but the ability to provide same day crowns is proving to be a perfect fit.

"Because I'm in a rural community and there's not that many dentists, I have lots of crowns. I have a list that's as long as my arm for people trying to get in to get these crowns worked," he said. "The machine is humming all the time basically. We've had tremendous success with this."

Adding the system

Dr. Iverson first saw how useful a CAD/CAM system could be after preparing and placing 65 traditional crowns from December 2007 through February 2008. Working with a lab to produce the crowns required two or three appointments per patient spread out over several weeks. It became difficult to fit in all the appointments, and describing himself as "fastidious" when it comes to placing a crown, those appointments often pushed him to the limits of what his practice could handle.

"My scenario is I have more work than one dentist can handle, but not quite enough for two," he said.

A CAD/CAM system seemed to be the perfect solution to Dr. Iverson's time crunch, and he went to the 2008 Chicago Dental Society Midwinter Meeting in Chicago with the express purpose of looking into both D4D Technologies' E4D system and Sirona's CEREC system. Dr. Iverson said he spent an entire day on the tradeshow floor reviewing both systems.

He left the meeting impressed by both systems, but felt that despite the higher price tag, D4D's system was the way to go. To make sure he wasn't going to back out of such a major decision he wrote out a check for the down payment and scheduled a trip to D4D's Texas headquarters where he and assistant Lindsey Blatz were taught how to use the technology.

While Dr. Iverson described the training as intense, Blatz found it to be a whirlwind. She had only been assisting for a short time prior to heading to Texas and dental terminology was almost as new to her as the cutting edge dental technology. However, she said the experience was good and she learned a lot about both dentistry and using the CAD/CAM system.

"It was overwhelming at first because there's so much to learn. Once you get into it, you figure things out and it comes pretty easy," she said. "I didn't expect to be doing as much as I do on it, but I kinda like that because I get to do a bunch on my own which is nice."

Workflow in Westby

The E4D system has proved to be a natural fit with Dr. Iverson's practice and he averages one crown a day with the technology. In fact, after two major employers in the next town over closed at the beginning of the year the recession started to impact his practice, but the same day crown side of things kept patients coming through his doors.

"Using this machine basically brought me through January, February and March," Dr. Iverson said.

When using the machine to prepare a patient's crown, Dr. Iverson said he actually devotes more time to the initial appointment to make sure the preparation is done correctly. However, the real time savings come on the back end of the process because he is able to have additional appointment times freed up so he can see additional patients. One of the biggest benefits to CAD/CAM dentistry is that the patient can leave with a new crown the same day, rather than have to return for multiple visitis.

While the E4D system is designed to take its digital impression scan intraorally, Dr. Iverson said he likes that it has the capability to also scan off a traditional impression, and he often does this to allow his patients to leave the practice while he finishes the scan.

Once he gets to this point he turns things over to Blatz who does much of the computer design work. Dr. Iverson said she probably knows the system better than he does in terms of the design software.

For her part, Blatz said when first starting with the E4D system she found the manufacturer's online support system to be very useful. Now she is very comfortable with the design process and knows what to do in most situations if she hits a snag. While Dr. Iverson is often working with other patients while Blatz is busy designing a case, he double checks her designs before they are sent to the mill.

"It definitely makes me feel like a more valuable employee. It is nerve racking sometimes because I know a lot of it lies in my hands, but I do enjoy it, " Blatz said. "Once we have a finished product it's just nice to see especially when the patient's happy with it."

Patient response

More often than not the patients are very happy with the results. Blatz said the patients enjoy having some free time between the prep and the final seating, and even patients who are not in need of a crown ask to see the system while visiting the office.

Word about the system has travelled around the Westby region and it has directly led to some new patient referrals. With his rural practice regularly attracting patients from 35 miles or more away, Dr. Iverson said he is not sure if CAD/CAM dentistry is spreading his appeal farther away, but it certainly is setting his practice apart from others in his region.

Now, more than a year after adopting the system, Dr. Iverson said his experience has been overwhelmingly positive, and he recommends chairside CAD/CAM to any dentist who regularly does crown and restorative work.

Dr. Iverson admits the upfront investment is not small, and besides purchasing the system, he also invested in a furnace and stains and glazes to finish the restorations he mills. However, the benefits the system offers in terms of long-term cost savings and efficiencies in scheduling and being able to provide same day crowns help the system come into use often enough to pay for itself.

"I just cannot imagine going back to doing particularly crown work the old fashioned way using a lab," Dr. Iverson said. "If you're doing any kind of crown and restorative work, you're crazy not to invest in this machine."

This article was written by Noah Levine, Senior Editor of Dental Products Report. You can read the original article at http://www.dentalproductsreport.com/articles/show/dpr0909_we_smalltown.