3 ms·

This is fun can't believe all the grumps here! Here's the thing though: I've been brushing with a high tech brush for years but lately I've been developing an

This is fun can't believe all the grumps here! Here's the thing though: I've been brushing with a high tech brush for years but lately I've been developing an ache under an old crown. I delayed the dentist visit due to Covid but finally got it checked out. High tech CT scan revealed a big bubble of infection and bone loss right between the roots! Now I have to get another root canal or an implant, we'll see. I was super impressed with the imaging technology the dentist/endoguy had, much more useful than a toothbrush with gyro.

aspenmayer 6y ago
A guy I know uses 5-axis milling machines and special forges to make replica teeth from different substrates. According to him the cubic zirconia is the better option. I have seen many of these scans, and the instruments he uses are pretty impressive. The software that runs the scans allows him view them in 3D with full rotation, correct for scanning errors and make adjustments in real-time, and has a library of cadaver teeth which can be used to automate creating a suitable replacement, which can then be modified to suit. It’s really amazing. Then the milling machine picks its tools and does the carving out of a circular puck of the desired substrate. It’s a closed box and talks to the software over the LAN or USB. After milling the tooth, he color matches it with powders and color swatches and then cures it in a desktop forge. Really quite amazing technology, and it fits in a couple small rooms in his home lab. He makes good money and employs his wife and another tech. Not bad for being your own boss. He gets orders from local and distant dentists, and he loans out his own scanners, as many dentists still use older or lower resolution units. Apparently the milling machine costs around $150K, and the software is also pretty pricey. Not sure about the forge, but it’s also expensive. Not really sure how you would get into this field, but many of the skills seem to be something you can learn on the job. No idea about qualifications or licensing requirements, etc.
- CrazyStat 6y ago
  My dentist used this setup last time I got a crown. I got to watch as she adjusted the shape and then watch the milling. I didn't get to see it come out of the kiln, which I'm told is quite a sight since it's still glowing red hot when they take it out. It's impressive tech and the crown fit better on the first try than my previous crowns that were done the old fashioned way.
  - aspenmayer 6y ago
    I forgot to mention the fit is better due to the software; it can simulate occlusion from adjacent teeth and also from opposing teeth, and marks in red areas of overlap before you even mill the part, which helps get consistency and minimizes repeat visits and rework. Thanks for mentioning the bit about the forge/kiln, as I haven’t seen that part either. The major pain point in his workflow is working with scans from older scanners and their file format quirks. He usually opens those scans in a less-capable but more compatible software, then exports to the format his main software uses, which is made by the vendor of his milling machine. Definitely risks of vendor lock-in, but he is aware of the trade-offs and is always looking for better technology. The pricing of the hardware and software seems pretty steep and maybe ripe for disruption, but for his workflow, he’s still pretty happy with how much he makes for how hard he works.
- kwhitefoot 6y ago
  My dentist (in Norway) has had a machine for doing this on demand while you wait for years. Both of my crowns were done this way: - take X-rays to diagnose the problem - take photographs of the existing tooth - set the machine running to make the crown - grind away the surface of the old tooth, drill out whatever needs removing as usual - apply adhesive - fit new tooth - adjust tooth slightly to fit by grinding as usual for any filling. From arriving at the dentist to paying the bill is less than an hour.
  - aspenmayer 6y ago
    One of the major differences is the scanning tools involved, which also eliminates the need for redundant xrays, as the scanner is an oral device that scans the mouth digitally using a 3D scanner inserted in the mouth and passed along the gumline and on all sides of the teeth.
    - kwhitefoot 6y ago
      What redundant X-rays?
      - aspenmayer 6y ago
        The person I replied to said they needed xray(s) to get their replacement tooth made, and worded their reply to imply that Norway has had this tech for some time, implying or assuming that the tech in Norway they experienced is the same as what I described. It is not the same in this key way: the system I described doesn’t use or require xrays, surely not additional ones over and above the ones many dentists already do with new patients. Xrays are potentially harmful and exposure to them should be limited to those medically necessary. The system I described does not require “extra“ xrays or any additional xrays at all, thus my characterization of any xrays the person I replied to received as redundant compared to the treatment plan I was describing. Is that clear? Hard to assume what the person in Norway got from their care but they didn’t get the same thing I described. Edit: I see now you’re the same person I was replying to; I don’t mean to be pendantic, but the absence of xrays in the workflow I described is kind of a big difference, as what I described uses visual 3D scanning with an orally-inserted imaging device with no need for more xrays if the dentist doesn’t otherwise need them.

aspenmayer 6y ago

A guy I know uses 5-axis milling machines and special forges to make replica teeth from different substrates. According to him the cubic zirconia is the better option. I have seen many of these scans, and the instruments he uses are pretty impressive. The software that runs the scans allows him view them in 3D with full rotation, correct for scanning errors and make adjustments in real-time, and has a library of cadaver teeth which can be used to automate creating a suitable replacement, which can then be modified to suit. It’s really amazing. Then the milling machine picks its tools and does the carving out of a circular puck of the desired substrate. It’s a closed box and talks to the software over the LAN or USB. After milling the tooth, he color matches it with powders and color swatches and then cures it in a desktop forge. Really quite amazing technology, and it fits in a couple small rooms in his home lab. He makes good money and employs his wife and another tech. Not bad for being your own boss. He gets orders from local and distant dentists, and he loans out his own scanners, as many dentists still use older or lower resolution units. Apparently the milling machine costs around $150K, and the software is also pretty pricey. Not sure about the forge, but it’s also expensive. Not really sure how you would get into this field, but many of the skills seem to be something you can learn on the job. No idea about qualifications or licensing requirements, etc.

CrazyStat 6y ago
My dentist used this setup last time I got a crown. I got to watch as she adjusted the shape and then watch the milling. I didn't get to see it come out of the kiln, which I'm told is quite a sight since it's still glowing red hot when they take it out. It's impressive tech and the crown fit better on the first try than my previous crowns that were done the old fashioned way.
- aspenmayer 6y ago
  I forgot to mention the fit is better due to the software; it can simulate occlusion from adjacent teeth and also from opposing teeth, and marks in red areas of overlap before you even mill the part, which helps get consistency and minimizes repeat visits and rework. Thanks for mentioning the bit about the forge/kiln, as I haven’t seen that part either. The major pain point in his workflow is working with scans from older scanners and their file format quirks. He usually opens those scans in a less-capable but more compatible software, then exports to the format his main software uses, which is made by the vendor of his milling machine. Definitely risks of vendor lock-in, but he is aware of the trade-offs and is always looking for better technology. The pricing of the hardware and software seems pretty steep and maybe ripe for disruption, but for his workflow, he’s still pretty happy with how much he makes for how hard he works.
kwhitefoot 6y ago
My dentist (in Norway) has had a machine for doing this on demand while you wait for years. Both of my crowns were done this way: - take X-rays to diagnose the problem - take photographs of the existing tooth - set the machine running to make the crown - grind away the surface of the old tooth, drill out whatever needs removing as usual - apply adhesive - fit new tooth - adjust tooth slightly to fit by grinding as usual for any filling. From arriving at the dentist to paying the bill is less than an hour.
- aspenmayer 6y ago
  One of the major differences is the scanning tools involved, which also eliminates the need for redundant xrays, as the scanner is an oral device that scans the mouth digitally using a 3D scanner inserted in the mouth and passed along the gumline and on all sides of the teeth.
  - kwhitefoot 6y ago
    What redundant X-rays?
    - aspenmayer 6y ago
      The person I replied to said they needed xray(s) to get their replacement tooth made, and worded their reply to imply that Norway has had this tech for some time, implying or assuming that the tech in Norway they experienced is the same as what I described. It is not the same in this key way: the system I described doesn’t use or require xrays, surely not additional ones over and above the ones many dentists already do with new patients. Xrays are potentially harmful and exposure to them should be limited to those medically necessary. The system I described does not require “extra“ xrays or any additional xrays at all, thus my characterization of any xrays the person I replied to received as redundant compared to the treatment plan I was describing. Is that clear? Hard to assume what the person in Norway got from their care but they didn’t get the same thing I described. Edit: I see now you’re the same person I was replying to; I don’t mean to be pendantic, but the absence of xrays in the workflow I described is kind of a big difference, as what I described uses visual 3D scanning with an orally-inserted imaging device with no need for more xrays if the dentist doesn’t otherwise need them.