Episode Transcript
Citations
Revilla-León, M., Aragoneses, R., Arroyo Valverde, E.M., Gómez-Polo, M. and Kois, J.C. (2025), Classification of Scanning Errors of Digital Scans Recorded by Using Intraoral Scanners. J Esthet Restor Dent, 37: 1363-1371. https://doi.org/10.1111/jerd.13419
Mitrani, R. The Use of a Plaster Verification Jig to Ensure Accuracy of the Master Cast. Spear Education. Published August 12, 2019.
https://www.speareducation.com/resources/spear-digest/the-use-of-a-plaster-verification-jig-to-ensure-accuracy-of-the-master-cast-jig/
[00:05 - 00:35] Rob: Welcome back to the Evolution of Dental Podcast, brought to you by Evolution Dental Science. We share the stories of the people and the technologies shaping the world of dentistry. I'm your host, Rob Norton. Today's guest is a pioneer in the workflows of exocad. He is one of the earliest on the scene to do just CAD design on his own. He's a well known trainer across, what, at least three continents, and a hero of digital dentistry. Daniel Portal. Welcome!
[00:35 - 00:37] Daniel: Thank you. Thank you for having me. I'm very excited to be here.
[00:37 - 01:05] Rob: Thank you for being here! So one of the things I'd really love to share is your story. You came into this at a time when all the designers out there were working in labs, on their own, as part of a bigger whole. And you kind of broke the mold with going your own direction and training and sharing the technology and also just designing on your own. Completely free from an association with a particular lab. What was that like?
[01:05 - 02:42] Daniel: It was, it was an adventure. I was kind of thrown into it because of the situation that was going on at the time. I was kind of forced into it. I had a really good friend push me into it, and I always thank him for it even though he's left dentistry. But he told me you should just do your own thing and offer your own services on your own. And it was the scariest, but the best decision I've made in my career thus far. But yeah, I got acquainted with exocad back in 2011. I worked for B&D Dental at the time. They were the first exocad distributors in the US, and I was hired pretty fresh off after the software came so that I could provide tech support in Spanish. That was the main purpose, why I was hired. And, I helped write a lot of the instruction manuals and and all that in Spanish, like the, I guess would be the first versions, at least for this company that I was working for. Whether they use that at exocad at GmbH or not, I don't know. But that's how I was introduced to the software. I was handed a CD, and they asked me, they told me I needed to be productive with it. And my idea up to that point of CAD is what I very briefly heard during school about CAD design, and I was promised by my instructor at the time that CAD/CAM would never take over dentistry. And boy, was he wrong. So yeah, now, here I am!
[02:42 - 02:58] Rob: And here you are! So you were working at B&D, and you started translating it into Spanish. And you, what, you took a deep dive into the software in the process of translating it, or you were already a technician? What, how did that come about?
[02:58 - 03:55] Daniel: Okay, so I went to school for, I'm going to call it, like, a quick “crash course” into dental technology. It was a 13 month program, at a Utah school called Ameritech. They don't offer that program anymore. And, they taught me about anatomy, waxing, metal casting and layering. And from everything I learned in school, anatomy was the only thing that carried over. My first job out of school was with a big lab in Utah, and I remember that I came in and the waxing department had about 20 people, and then they brought in CAD/CAM. And I think at the time it was CEREC, is what they brought in. And within a couple of weeks, my department went from 20 to about 5 people, because they were able to do that much. And at that point, I look back on my instructor, I'm like, this dude was so wrong about CAD/CAM not taking over.
[03:56 - 03:57] Rob: Couldn’t have been more wrong.
[03:57 - 03:57] Daniel: Yeah,
[03:57 - 04:00] Rob: Especially a 75% cut. That's pretty extreme.
[04:00 - 04:55] Daniel: Right. And so, then at the time I was- I had just got married. So obviously I was struggling financially, but I was making ends meet. Then I got this other offer from B&D Dental, they offered me at the time it was like $1.50 more an hour. I was like, yeah, man I made it! So I switched over to B&D, mainly for financials at the time, but I was introduced to exocad. And I remember at the time I was thinking, I went to school for dental technology, but I would love to actually get behind the software and program something like this. Like, this is awesome. And so I thought to myself one day, I would love to work for this company as a programmer. And so, yeah, that's how I got thrown into the whole CAD/CAM thing, because of this job.
[04:55 - 05:05] Rob: How did you end up linking up with exocad? Because anybody who has been on the exocad website in the last year or so has probably seen your face at this point. What was that jump like?
[05:05 - 06:53] Daniel: So I was- now, this is a few years after. I [was] living in Baton Rouge, Louisiana. I was working for a great lab there, and I remember I was thinking myself like, I need a second job. Like, I feel like I could do. I could generate more for my family. At this time I had my second kid already. And so, I decided to take a job, look at Papa John's. And I remember after, like, the first couple days. Now we'll do the math. Like, I've been here for hours, and I just made, like, 30 bucks. I'm like, no, like there’s gotta be some better. And so talking to my dad, my dad's like, why don't you start teaching exocad? Like do that on your own? And I thought to myself, like, that sounds insane. Like, who am I going to talk to about it? So I remember I reached out to exocad who had finally opened an office here in the US. So before there was no exocad America, and I called in and said, hey, I'm looking to get certified to see if I could teach people how to use the software. And at the time they had no such program. And Carolina, who still works at exocad, answers the phone. She said, look, I know that we don't do that, but we are looking for people who are bilingual. So why don't you send me your resume and, I'll put it on through. And at the time, exocad had, what, like four people working there, maybe five. And so, after, like, they received my, my resume, I was brought in for an interview to Boston. At the time, Larry Bodony was the president of exocad America. And he's like, yeah, you know, it sounds good. So we'll get back to you if we’re interested, I’m like okay. So like, there was nothing after that. And he made me wait, I think it was four and a half months before I got an answer. This whole time I was just like-
[06:53 - 06:56] Rob: Yeah we’ll just get back to you in a quick four and a half months.
[06:56 - 07:10] Daniel: Yeah. Just tell me yes or no, man. Like I'm so close to this dream of mine, working for this company. And he wouldn't answer, like, I would send emails and texts and no answer whatsoever. And then eventually I got the offer and it was awesome. It was a great time.
[07:11 - 07:18] Rob: That's incredible. What's it been like? Being a hero of digital dentistry, as they have you labeled now?
[07:18 - 07:56] Daniel: To me, I'll be honest with you, it's more than anything, it's just been an honor to represent exocad. It's the one product I will say, that I've wanted to represent, that I want me to be related to. A product that I've used, and I've used its competition and, I've used it in different settings. And I do believe that it is the best overall, CAD solution or dental CAD solution. And so to me, it's just been exciting representing the exocad. Aside from anything else that may or may not have come because of it, it's just an honor to represent.
[07:57 - 08:09] Rob: That's excellent. It’s changed a lot since you said 2011, right? That's even earlier than I was into it. That's, it's been a big evolution. What has that been like watching? What have been some of the big changes you've seen, big improvements, leaps forward?
[08:10 - 08:27] Daniel: Whenever exocad would come to market, it would change the market. So they would come in with a much more well thought out tool to address whatever the needs were. And, we, specifically, I see that with, now with 3.3 Chemnitz with the split bar solution.
[08:28 - 08:29] Rob: Yeah.
[08:29 - 08:48] Daniel: It's a very smooth workflow and it does everything that other softwares can't, specifically, generate a proper construction-info file for CAMing. And so that again, it changed it. And SmileCreator, I think also, is better than anything that's out there.
[08:48 - 09:04] Rob: They bring out a new take on it, a leap forward in a direction that's more comprehensive in a lot of ways, I feel like, better thought out. Like the split bar is a great example I think of that. Like for those who don't know, talk a little about the split bar, if you don't mind.
[09:05 - 09:09] Daniel: So then, I hate to put it this way, but it is true. It's, it's it's-
[09:09 - 09:13] Rob: Or do you have any examples of that that you can share with.us?
[09:13 - 10:37] Daniel: Yeah, I can do a couple of cases, but it ends up being- I'm going to call it like that. I'm probably going to get a lot of flack for this, but I'm going to call it the iBar killer. Like there's no need for Blender anymore, and fight me over it. That's fine. But yeah, it just introduces the workflow very smoothly into dental CAD, and there's not much that that, like, there's- you don't have to go through the learning curve of learning a brand new software to try to achieve the same result. To me, that's number one. And, as an aside, I've tried to make it almost like my life's goal, when it comes to dental technology. It is how to do everything that everyone is doing in other software in exocad. And, I've been able to come up with solutions for just about everything. So iBar’s have been out, I was doing them, or let’s call them the split bar. I was doing them three years ago in exocad. So there were always workarounds. They weren’t as practical or as sexy looking, which is fine. But you could, you could do that. And my point was, having had to teach the software or learn the software on my own, I know how difficult it is to climb that learning curve. So why would I push somebody into learning yet another software to come up with a solution? So let me show you within the tools you're already familiar with, how to come up with the product that you're trying to achieve.
[10:37 - 11:12] Rob: Absolutely. The split bar solution with exocad is so slick that it's almost too easy. I have yeah, I obviously do a lot of instruction myself. And, some of the, heh, some of the times I'm helping somebody who's moving from like version 3.0 where they were doing like, the workaround, like you're describing where you design like a wax up, and then you design a bar and then you try to merge that together in like a third case where you bring the components together or they're shipping it out to something like mesh mixer, which, like you said, another software that you have to learn. And then and then you have this split bar technique.
[11:12 - 12:25] Daniel: So typically or at least back in the day, what you would do is you would get a patient's picture and then you would try to make it very good and then send it back to your doctor. And everybody gets excited about the possibilities of what can be accomplished. Right. But then the truth of the matter is, you had no idea whether this is possible considering the patient's anatomy. And so through the Smile Creator, as we can see here, I actually have 3D objects that I'm moving in space in relation to the patient's anatomy. And so if I end up with my tooth here, hopefully if I'm worth my salt, I have considered its position from every point of view so that I'm improving upon what the patient currently has and I'm making- if I'm making any type of correction, I'm not making this so crazy that it's not achievable. So for example, here I'm shifting the midline over to the left just a little bit. So it's not right in the middle where it used to be. I'm trying to correct it. And so but I'm not. I'm not shifting all of my teeth over that much where this midline will be impossible to achieve. Right? I'm playing within-
[12:25 - 12:28] Rob: They make for great pictures, but an impossible treatment.
[12:28 - 13:51] Daniel: Correct. And so that was, in my opinion, that's what was missing. A true connection between your 2D image beautification, if you will, and prosthetic viability. And so exocad helps you address both simultaneously. And I can visualize my design in a more photorealistic rendition. And I know these colors aren’t pretty, but as I make movements here, I can see how my 2D image is affected by it, but also everything else, like the 3D position of the tooth structure that I'm proposing in relation to his natural dentition. So I can determine whether maybe I have my tooth way over here. And although it may look good in the 2D image, well, now I'm proposing a grotesque amount of preparation, which is not going to be possible. And so I can have those things, and I can keep those things in consideration throughout the entire design process. So I'm not expecting a dog to do something that he can't. Right. And at the same time, I'm managing if the doctor says to share this with the patient, I’m managing the patient's expectation that although you may want a correction of your midline. I'm sorry, but your two structures don't allow for that. So this is the best we can do based on what's happening.
[13:51 - 14:09] Rob: It's a very realistic preview. And I mean beautiful work, beautiful work. The possibilities. It's also useful to use as a diagnostic tool. Right. Like you could kind of assess whether or not you can just keep this a purely additive case or if you need to do crown preps, or how much you need to prep back. Right.
[14:09 - 14:22] Daniel: Yeah. And so, because of that and, kind of not pivoting but a jump into a different subject, that's one of the reasons why I like this restoration-type. So all of my, mockups-
[14:22 - 14:23] Rob: That’s the mockup right?
[14:23 - 15:08] Daniel: Yes. The mockup restoration type I think is the most versatile restoration type in exocad. From what I design here, I can take into a model, into a snap-on smile, into a non-prep veneer, into all kinds of different ways without having to redo the case or recreate the order form. There are some limitations to it. Like, for example, if I, and a lot of people like to do this, if I create my order form like this, but then I get the implant position files, I cannot change these into an implant-supported structure inside of the design software, so that I can make a quick adaptation. So there are some limitations to it. However, the way that I like to work on the software, this is the way that I like to-
[15:08 - 15:33] Rob: Right. And it's exocad. There's almost always a workaround with exocad. In fact, there's almost always at least 2 or 3 ways to do any one thing in exocad. And you could, for example, export those tooth files and then bring that into the new scan. And then there's your tooth position right there. And so yeah, it's not- you can't just pivot over. I would love for that. You know, tune in, exocad! If you're listening, we'd love to see that as a new feature. But right now at least that there's a way to work around it.
[15:33 - 16:50] Daniel: On that subject, I will say something that hopefully doesn't get me in trouble, but if you ever go to any training, any exocad training and whoever's teaching the course tells you this is the way to do X. You can, with authority, get up, walk away and call that person a charlatan. No one has the gospel truth on how to use the software. It however makes the most sense to you. Now your workflow may not be practical to me, but if it makes sense to you, then that is exactly how you should use the software. And so I've, I've been in different courses where people say, oh, this is the right way of doing this and that person is full of it. There's no such thing within the software I've seen. I personally have seen Tillmann be surprised about ways of using software. Like, I didn't even know that the software could do this. And so there's no one way of using software, which is a very beautiful thing. But it's also a very daunting thing because now you can come up with your own workflow and that's awesome, but then that's on you type deal. So just know that no one has the gospel truth. I don't care who it is that's teaching the course. If they tell you this is the way to use a software, walk out of that course. It’s not worth your money.
[16:50 - 17:24] Rob: Amen to that. The gospel truth from Daniel, hehe! Truly though, like it's one of my favorite things about the software is just the unbelievable versatility that you have, which, as you said, can be, can be a daunting thing to get into at first. But just learning different workflows, it only builds your abilities, because as you encounter different cases, you know, like, well, actually this other workflow that I really haven't used before, but I've seen other people use or maybe I've seen pieces of this online. This is a really good application for this particular little avenue.
[17:24 - 18:08] Daniel: Right. Correct. And so you get to pick and pick and choose different things you've seen from different users. Like for example, I feel terrible every time I show this because this is not something I came up with. I saw somebody post online, but I don't.. I remember seeing the workflow, but I don't remember who posted it. But there's a way for you to add like an extra tooth in the middle of your design process. So there's all these ways I, I had no idea you could do this, but you could cheat the software into thinking, oh, look, there's another prep here, when you didn't select your order form properly. So there's all these different tools that if you dig in deep enough, you'll find out that you actually don't know the software as much as you may have used it.
[18:08 - 18:24] Rob: Endlessly deep. What's your opinion on facial scanners? They seemed to be a huge growing trend for a while, and now it seems to have fizzled back a little bit. They were incredibly expensive. They've gotten a little less expensive. What do you think, is it essential? Useless? Somewhere in between?
[18:24 - 18:25] Daniel: I personally think they're useless.
[18:25 - 18:27] Rob: Ha! Okay.
[18:27 - 20:01] Daniel: And, the way that I like to put it is, as a doctor, if you want to show your patient you have a face scanner, to kind of show that you're a high tech doc, great. But when it comes to the design portion of it, at least this, and I'm gonna, I'm going to say this just to be safe, but at least the scans that I've gotten are never good enough. Okay? And this is one of the reasons why. Let me share my screen here real quick. This is one of the reasons why I don't like using 3D scans. So here's my face and it looks alright. Right. But so on the esthetic side of things, number one, no one looks good in a 3D scan. You look dead, you look- And sometimes your eyes are like- you come out cockeyed. You just never look good on a face scan. And so to sell the case, it doesn't help you typically. Okay? Then for me, as a designer, this is the main problem that I see with face scans. And again, with the results I've gotten so far, is that when you're supposed to be able to use this for your scan alignment, but then when you look at the surface of the scan, my intraoral scan could align to this very- to this part of the surface here. Or it could align down here to where the incisal edges are. But regardless, now, I'm not sure exactly where they should be. So I don't like using 3D scans because of that. And then also because of that surface, then I don't know if my alignment is true.
[20:01 - 20:02] Rob: Right.
[20:02 - 21:03] Daniel: And so, at the end of the day. To me, I'm fixing the alignment so much that it creates more work for me that I don't want to have. And so I believe that you're better off taking a very good quality 2D image. So you set up like a mini booth in your practice or wherever you are, your camera’s on a tripod and the whole thing. Like you actually spend time setting that up or getting that set up. You take a good quality picture and at least for me, I would rather have that. And then you tell me, based on the patient's current setup. So based on the intraoral scans that you sent me, how do you feel about the lip support? How do you feel about the midline? Do you see any cant’s blah blah blah blah blah. And then you give me all that information. I could take that into consideration when I'm designing. But again, off of this, I'm not going to get a good result. And people say, oh, well, you want to have the sagittal view because then you can determine lip support. Yeah. But if I can’t align my intraoral scans correctly then it’s worthless.
[21:03 - 21:05] Rob: I was about to say, like, what sagittal view?
[21:05 - 21:06] Daniel: Right, right.
[21:07 - 21:16] Rob: Yeah. And you get excellent, especially with the new update, you get excellent automated AI alignment of the 2D photo to the 3D scan.
[21:16 - 21:17] Daniel: Right, right.
[21:17 - 21:31] Rob: With exocad, like it can, it can make alignments that are well beyond what a human could deliver on their own. I continue to be impressed with it. So long as you've used a camera produced in the last 20 years, you can still come up with a perfect alignment every time.
[21:32 - 21:46] Daniel: The whole picture thing is another can of worms. I usually go on little rants whenever I'm doing a course. It's like whenever, like I get a lot of pictures of- it almost seems like the doctor forgot to take the picture and so the patient is already numb. Laying, leaning back on the chair.
[21:46 - 21:47] Rob: Oh, right.
[21:47 - 22:04] Daniel: They're like walking out so they just like, throw the phone up. Oh, hold on, let me take a picture. And the patient’s, just like [makes a dazed expression] hey, like, what am I supposed to do with that? Right? So yeah, that's another can of worms that I get really passionate about. Because if I could get good quality stuff, I can give you good quality designs.
[22:04 - 22:10] Rob: Photos are very important. We had Doctor Adamo, he was on a previous episode, which, if you haven't heard that, please go check that out.
[22:10 - 22:10] Daniel: Will do!
[22:10 - 22:17] Rob: Talking about all the techniques with photography. He said it's one of the tools that he can't live without in his practice.
[22:17 - 22:18] Daniel: Aww, bless that, man!
[22:18 - 22:21] Rob: And there's no reason to not take pictures these days.
[22:21 - 22:4 9] Daniel: Yeah, yeah. Because, like… the software or the whole CAD/CAM process has the potential of being plug and play, right? But only the potential for the most part there. There's going to be some sweat and tears that are going to have to be spent on fine tuning things. But however, that is how it is sold, to most people, Oh, he just, you know, whatever. Just anything will work and we can always make it work.
[22:50 - 22:50] Rob: Oh, yeah.
[22:50 - 23:37] Daniel: But the reality is, because of the precision of CAD/CAM, then your mistakes or mistakes in general can be highlighted. Because now I can zoom in, times a thousand and I can show you exactly where you made a mistake and so on, things like this on, on, on pictures. It just comes to the foreground so fast. Like this picture is no good. I can tell you that the patient's face was tilted up and he was looking off to the side a little bit. Now my midline is going to be completely off. So there's all these things that you can actually point out to the doctors. And I've worked with some doctors that tell me, okay, whatever you see wrong, please give me feedback. And we become a freaking awesome team. Then there's those that are like, eh, do your best. And it’s like, well, my best is going to suck.
[23:37 - 23:38] Rob: Just do the best you can.
[23:38 - 23:39] Daniel: Yeah.
[23:39 - 23:42] Rob: Everyone's favorite phrase in dentistry. Especially as a technician.
[23:42 - 24:23] Daniel: So anyway, this is one of the reasons. These are the reasons why I'm at least as of right now, not pro, 3D scans. Now, there's some scanners that actually capture this image or this surface a lot better. But again, based on what I've seen, now the patient has to be wearing glasses or they have to have their eyes closed. And now it once again defeats the purpose. Now I have my interpupillary lines. So it’s one thing for the other, at least as of right now. And again, if there's new technology that I haven't seen, I want to see it. And I'd like to use it. As of right now, doctors always ask me, should I get a face scan? And I say, no.
[24:24 - 24:36] Rob: And that’s a good point. I love future technology, but at the end of the day, we have to work with what's in front of us right now. We can dream about future stuff and aim for that later. But you can't make restorations with technology that hasn't come out yet.
[24:36 - 24:38] Daniel: Right, exactly.
[24:38 - 24:47] Rob: But speaking of scanners and speaking of digital data acquisition, what's your take on photogrammetry?
[24:47 - 26:20] Daniel: I think if you're doing all-on-x cases and you don't have photogrammetry, you're trying to cut corners. That would be my bottom line. You're trying to nickel and dime yourself into a result that you're just not going to get from any other system. And again, hopefully it doesn’t get me in trouble. But, I think photogrammetry is the gold standard and you should get it. With that being said, now I don't know if they're technically considered photogrammetry, things like what Shining3D is doing and TruAbutment, it's like photogrammetry, AI powered or something like that. I've gotten really good results, with those options as well. So I'm not going to diss on them, completely, but it just seems like you should at the very least get that type of technology. The overreliance on the accuracy of intraoral scans or intraoral scanners, which doesn't really exist. They're not accurate devices. If you scan the same mouth twice, you will not get the same results. And I don't care what system you're using. How good of a scanner you think you are. You scan the same mouth, the same arch twice in the software it will show you discrepancies between the two scans. So you should not over-rely on your intraoral scanner for accuracy. I think it's good enough for more simple things like crowns and such. But when it comes to input placement, especially on large, edentulous areas, photogrammetry, if you’re not using photogrammetry, you are cutting corners.
[26:20 - 27:10] Rob: Yeah. The localized accuracy of the scanners is unbelievably impressive these days, which, like you were saying: simple crowns, bridges, you know, three, five, six-unit bridges, whatever. But the cross arch, you know, when you're spanning the whole arch, you can start to see some better than others, for sure. And some of the software's I'm not going to call anybody out specifically, but some of the softwares do a little, like, visual tweak to make you feel good, but you end up with like warpage in the shape of the overall scan. And you can even bring those into exocad, lay them over each other and see exactly where those discrepancies are. But for those who don't understand what photogrammetry even is- beyond just what the advantage is, what's the difference in the workflow there that really defines the accuracy, as a whole other echelon?
[27:11 - 27:25] Daniel: So I don't understand the technology to try to explain it in simple terms. All I understand is that it uses an actual camera that captures the exact position of the implants in relationship to one another.
[27:25 - 27:29] Rob: In relationship to one another. So basically a digital matrix.
[27:29 - 28:01] Daniel: Correct. And so it is the same thing as what you will get from a verification jig. Right. But in the digital world. And so it gives you the position of the implants very accurately, extremely accurately. And then you can overlay that on your, on your intraoral scan, which has its own problems doing that workflow also. But I think that's kind of a limitation of where we are right now. But that's pretty much what it does. Think of it as a digital verification jig that gives you your input positions in a more accurate manner.
[28:01 - 28:06] Rob: So regardless of any other influences, all the implants are always going to be in the right place.
[28:06 - 28:32] Daniel: Correct. So even if your intraoral scan as you were pointing [out], it’s warped. I will still get the position of the implants correctly. And so in cases like that, what you will see is that my intaglio adaptation is going to be off. So maybe I have the space or I am putting too much pressure because the intraoral scan was warped, but the fit on the MUA’s for example, should be very good. It should be dead on. So that's what photogrammetry does.
[28:32 - 28:37] Rob: So that sounds like it's made a really big difference in some of the work that you're doing and what you're doing.
[28:37 - 30:11] Daniel: Absolutely, yeah. And again, so all-on-x is kind of my bread and butter. Been designing those now for about ten years. I started this lab, again going back to my history between Utah and Louisiana that I told you, I worked for this awesome lab in Miami. Zahntechnique. Shout out to my boss there Alexander Wünsche, awesome technician. But I started designing all-on-x cases with him, and he taught me a whole bunch of things. Yeah, I got a lot of information from him. But that was always the problem, it’s if you fit over the implants and how many verification jigs and whether the impressions were correct and all that and all that has kind of been swept away by the use or the integration of photogrammetry. Any doctor asks about that, tell them that, like, if I understand, if you don't have the volume, it doesn't make sense to make the investment. However, everybody comes out with solutions. Now I pick mobile and, again , TruAbutment has their own thing. Shining has come up with their own system. And then you also have these other systems like Scan Ladder and such, which do work. I don't have any numbers to compare the results, but it just seems to me that in my experience, I get better results with photogrammetry overall than using like Scan Ladder. And there's a couple others I can’t think of the name right now, that do that. But, yeah, that's my assessment on the whole thing.
[30:11 - 30:30] Rob: It sounds like you really changed the accuracy approach quite a bit. So, what would you say some of the dangers or concerns are with, not having that perfect implant alignment besides just not having a passive fit? Are there other challenges that that bakes in, or problems that that will bring up later?
[30:31 - 31:23] Daniel: Well, I mean, implants not being exact, like your whole case is shot. You pick whatever you want. It’s just going to go off at some point, whether it's too much stress on the implants, too much stress on the structure, it’s going to crack, your screws are not going to go in. So like, you name it, there's going to be a problem. So, in fact, the way that I see it is I align my entire case to the implant position, not the other way around. And so the implant position file becomes the anchor for the entire case. So I will realign my, let's say we're working on the upper jaw, we will realign my upper jaw so that it matches the implant position. And then I will realign my design so that it matches that up, and so on and so forth. But my anchor point is going to be my implant position file. So, yeah, it's-
[31:23 - 31:26] Rob: That makes sense, they're not going anywhere.
[31:26 - 31:27] Daniel: Right.
[31:27 - 31:39] Rob: Like if they are, we've done something horribly wrong.
[31:39 - 31:40] Daniel: Right.
[31:40 - 31:54] Rob: So speaking of, new technologies and new techniques, what are you, what are you excited to see come down the pipeline next? I mean, a lot of people are talking about AI stuff. Exocad has its own AI Crown design built, and there's a lot of other technologies on the horizon. Some new 3D printers are coming out. What are you excited to see? What do you think is, say overhyped? And what do you think is not being paid attention to? I know I threw a lot of questions at you, but.
[31:54 - 34:32] Daniel: No, it's fine. So, on the whole concept of AI, I think AI is wonderful. What I've seen in exocad, for example, like the automatic segmentation, the TruSmile design, TruSmile video, the photorealistic rendition. I think those are all awesome. Where I reject AI for the most part is on the design side of things, at least as it stands right now. I'm sure it's going to get better. It can only get better, but it seems to me, based on the results that I've gotten and not just through exocad, but through just about any other software, that the quality of the design decreases. And because you're able to save a few bucks on the design fee, you're willing to accept a more mediocre design. I don't like that, right? Now I do sound a lot like the people who were like, oh, I don't like zirconia because it lowers the quality of my ceramics. I know I sound the same way, and it may be a moot point here in the future, which I hope it is. But as it stands right now, I think for the most part, the proposals from AI out there are not good, not good enough. If I was to send that design to a doctor or to my doctors, they would reject that and laugh at me, right? But because now they can do it and save my design fee, then they're like, oh yeah, you know, we'll make it work, ideally. So they are willing to lower the standards to save a few bucks. So on that side of things I don't like what AI is doing. Again, I'm hoping that it gets better. When it comes to technology in general. I do want to see printers become- better materials to be available for printing. I do have this hunch that printing is going to be the future. I think eventually milling machines are going to get, they'll become obsolete as better materials get developed. I do like a lot, like, what companies like Stratasys is doing. The full coloring. I think that's awesome. If the material could be good enough for a final restoration, I think that'll be a game changer. And I can only hope that it develops into that. Right. So you can. Now, my design is not just going to be like the shape of the tooth, but now I can go in and mess around with, like, what you would call micro-layering. I could do my micro-layering, but on the digital side of things, and then have my printer give me that type of result. So I think there's a lot of potential there, which I hope comes about. But yeah, this is kind of what I'm looking forward to right now.
[34:32 - 34:47] Rob: Yeah. That's a super exciting technology. And for those who aren't, you know, as nerdy as I am and on the edge of every bit of 3D printer tech all the time, the Stratasys that you're referring to is the jet printer, right, where you can get multiple colors, all at the same time.
[34:47 - 34:48] Daniel: Polyjet. Yeah.
[34:48 - 35:02] Rob: Yeah. It works almost like an inkjet printer, except in 3D, where it can use multiple colors going in and create a particular chroma. And built that straight in. So you have full color, full color prints, which is pretty awesome.
[35:02 - 35:08] Daniel: And it prints it, a way to visualize it, prints from the inside out. And so-
[35:08 - 35:10] Rob: That's a good way to put it. Yeah.
[35:10 - 35:48] Daniel: And so they were showing some demos in Chicago. They are now printing models for surgery that have different tissue hardener, hardness levels. So you can cut into what will be tissue and then it bleeds because you can build that into your print. And so it bleeds. But then if you cut a little too deep and you hit bone and you feel like a harder surface. So you can create all these layers, which I think is fantastic. And again, I can only hope that the materials get to the point where you can print things, with a lot of detail.
[35:49 - 36:19] Rob: Absolutely. Yeah. I think that's a big thing on the horizon. And, we had the privilege of, speaking with, the Chief Product Officer of SprintRay, Hossein Bassir, a couple episodes ago. And, which, again, if you hadn't seen that episode, go check it out. But one of the things he was saying that I thought was fascinating is that it's kind of a hopscotch where the materials will get way ahead, and then the printer technology has to catch up, and the printer technology will surpass the materials. And from what he was describing-
[36:19 - 36:19] Daniel: Interesting.
[36:19 - 37:06] Rob: We're in one of the cycles right now where the printer technology is there. The materials have to catch up and get ahead of it again. There's a lot of exciting stuff on the horizon. I do agree with you there that the future is additive, that milling machines have carved out, no pun intended. Maybe a little bit. Their place in history. And it's that they're still here for a while. They're here to stay. Especially with materials like zirconia. I think 3D printed zirconia. I don't know if you've seen it. I'm not sure that there's really a future there? It does exist. It's a possible future that we might enter into, but it seems like a lot of these ceramic filled resins that are coming up are going to take that, take the throne away from zirconia sometime in the next decade or so. I mean, you think that sounds right?
[37:06 - 37:19] Daniel: Yeah. The last time I was pushed that I was at a course on the push, like, how much longer do you give? And I gave about that, that length of time about a decade before we're kind of fazing mills out.
[37:19 - 37:23] Rob: Yeah. It's an interesting transitional period for sure.
[37:23 - 37:24] Daniel: Yeah.
[37:24 - 38:04] Rob: And also with the manufacturing challenges with, say, titanium bars, slowly but surely coming out of the equation, that seems like and also like you were just demonstrating earlier how we can do the split bar technique so much easier than before. It also seems like it's going to help support that, pun fully intended, with the 3D laser printed bars or I mean milled bars too, being much more accessible and giving you that extra rigidity and strength underneath the restoration. Not to mention they're kind of heavy. Titanium is not.
[38:04 - 38:14] Daniel: And then you can also get these titanium structures via SLM where they have their, they're empty inside, or they're, they're. Well, what’s the word I'm looking for? They're hollow.
[38:14 - 38:14] Rob: Hollow. Right.
[38:14 - 38:20] Daniel: So you can get strength without weight. And so, yeah, you get the best of both worlds.
[38:20 - 38:25] Rob: That's fascinating. I hadn't seen that yet, but I'll have to check into that. That's really cool.
[38:25 - 38:34] Daniel: Yeah you print like meshes or you can, you can frame the titanium bar with holes in the middle of it to take away from the mass.
[38:35 - 38:36] Rob: Take away from the mass.
[38:36 - 38:41] Daniel: Yeah. You get a lighter, a still titanium supported structure.
[38:41 - 38:42] Rob: That's super exciting.
[38:42 - 38:43] Daniel: Yeah.
[38:43 - 38:52] Rob: Anything you're excited to see come down the pipeline from exocad? I mean, I know we just had an update, so a lot of stuff is fresh and new already, but they're always working on stuff.
[38:52 - 38:55] Daniel: The ART thing I want to see is important. Yes.
[38:55 - 38:57] Rob: And what does ART stand for?
[38:57 - 39:56] Daniel: Advanced restorative treatment. That's exocad and Align’s kind of baby where you can now offer orthodontics and restorative treatment from the very beginning. But what they're trying to do is mix in orthodontics with restorative. And so rather than creating crowns on a patient that has their teeth all out of line, they can propose your orthodontics first and then create the crowns and you can propose all of that from the very beginning. And so it's a more comprehensive treatment rather than just slapping a quick solution on an esthetic for something like that. You can propose a better result and a more long lasting result. So I'm excited for that to be implemented more widely. I know right now they're still in test mode. A few labs in Europe, a few labs here. But I want to see where that goes. And that's what I'm excited about with exocad.
[39:56 - 40:19] Rob: It’s a big jump, though, being able to incorporate tooth movements into your restorations and all be on the same page together. Orthodontics, dentists, technicians, and of course, the patient, and and and really embrace the minimally invasive ethos by. All right. Let's get these teeth in the right position before we start cutting on stuff and grinding out, dentition.
[40:19 - 41:20] Daniel: And pulling things. Yeah. Unnecessarily. Yeah. There's also, there's this doctor called Miguel Stanley. He's another one of the heroes, with exocad. I had a chance to talk to him. He's excited about the possibility of AI bringing the patient into the entire process in a way that hasn't been done before. To where the patient can now say, okay, who designed my case? Where was it manufactured? What parts were used, blah, blah, blah. And AI will be able to provide all that information to the patient so the patient can then hold everyone else accountable and make sure they're getting either legit parts or good materials, or with the working with, maybe there will be some patient like, oh, American made only. So now if you're shipping that out, they'll be able to reject it, type deal. So he says that he wants that to be brought about, for accountability purposes. I think that would be a good thing overall.
[41:20 - 41:21] Rob: That’s super exciting.
[41:21 - 41:22] Daniel: Yeah.
[41:22 - 41:29] Rob: Anyone sending stuff out of the country would be on notice, but I think everyone else would be much happier to see where their stuff is coming from.
[41:29 - 42:02] Daniel: Or at the very least, people can be upfront about it and say, hey, I'm going to send this out, but I can give you a better price, right? But then people can gauge that and say, okay, well, but do I want to have a chance on- they will be using who knows what material? Do I want someone that's going to charge me more about it? I don’t know if I'm getting these exact same things that I'm looking for. So at the very least it will make the purchase if you want to call that way more informed. And so that the user will be better informed to make their decision.
[42:02 - 42:07] Rob: Yeah, I love that. I mean there's nutrition facts at the grocery store. Why shouldn't there be that in dentistry as well?
[42:07 - 42:11] Daniel: There you go. Yep. Yeah. So we'll see. We'll see if that comes about.
[42:11 - 42:15] Rob: Daniel, thank you so much for being a part of this. This has been a lot of fun.
[42:15 - 42:20] Daniel: Of course, man, I agree. Hopefully we'll do it again. It's been awesome.
[42:20 - 42:26] Rob: Definitely. Where can people find you online? Where can they sign up with you? Where can they work with you? What's your socials?
[42:26 - 42:49] Daniel: So my social on Instagram is, Daniel Portal CAD. And on Facebook, I'm Daniel Portal. Just come find me. I have a website which I'm reworking, portaldigitaldentistry.com. That is the name of my company. And, I'm available for training. I'm available for design services as well. And, yeah, hopefully we can connect again.
[42:49 - 43:08] Rob: Excellent. I look forward to it. Thank you so much for being a part of this. And thank you all for watching the Evolution of Dental Podcast. Please remember to share this show like, subscribe and remember, never stop evolving.
