New Dental Technology 2022

The Stuff That Actually Changed Clinics in 2022

The big shift in 2022 was less about one miraculous gadget and more about the scanner-CAD-CAM ecosystem finally catching up to what everyone promised a decade earlier. If you walked into a general practice that year, the thing you'd notice first was the intraoral scanner taking over from polyvinyl siloxane trays on the back counter. The second thing was the chairside mill running CEREC or equivalent, putting out a crown in roughly 30 to 45 minutes instead of the two-week wait. Here is how it actually works when you are not reading marketing copy.

New Dental Technology 2022

At the hardware level, the dominant scanners in 2022 were form-framing or light-sectioning devices from companies like 3Shape, Ivoclar, Trios, and Medit. They produced STL or OBJ files that fed into CAD software. You designed the restoration, exported the toolpath, and fired it into the milling unit. For same-day crowns, the material was almost always a layered zirconia or feldspathic ceramic block. The full chain from scan to delivery typically takes 40 to 90 minutes in a well-run setup, which means the patient does not sit in a phantom bite for an hour. I ran a full workflow for a Class II on a maxillary first molar last year, and the part that nobody warns you about is the isolation requirement. These scanners read light reflected off wet surfaces badly. A little bit of saliva on the prep margin will create a ghost artifact, and the CAD software will happily design a margin line over that ghost. The fixture then sits open at the margin when it arrives in the mouth. My workaround was straightforward: cotton rolls, micro-mousse, and a light stream of air every 60 seconds during the scan. I also re-scanned the margins after the final pass rather than trusting the first sweep. That extra three minutes saves you from a cement failure check appointment two weeks later. The milling side is where most people get sloppy. Pressed ceramics like e.max CAD require specific grinding parameters, and layering zirconia is very different from milling high-translucency pre-sintered blocks. If you run a generic program across both, your surface finish will be wrong and the sintering shrinkage compensation may be off. The fix is to match the material library to the actual block lot, check the diameter and height parameters, and verify the shrinkage factor listed by the manufacturer rather than using a default number. I once had a crown that was 0.3 millimeters too tall on the buccal cusp because I used the old block catalog value instead of the current one. It took five minutes to adjust in the design software before milling.

Another thing that is not obvious from the brochures is the occlusal checking process. Digital articulation is available in some platforms, but it still does not replace a physical check with shimstock under actual load. The scan can show contact points, but it cannot replicate the way a patient's musculature and jaw position alter the contacts. I use a combination of the software's occlusal analysis and a quick manual articulation check before firing. It adds about four minutes and prevents adjustment headaches after cementation. There are real bottlenecks. Cost is the first one. A mid-range scanner in 2022 ran between $12,000 and $20,000, and a chairside mill was another $20,000 to $40,000 depending on the model and whether it handled multi-unit cases. Block inventory ties up capital, and every new material introduction requires a new certification cycle. Staff training is another quiet cost. The learning curve from impression tray technique to digital design is not two days. It is closer to three to six months for a clinician to feel comfortable, and longer for a technician who is used to analog workflows. The technology also fails in specific edge cases. Deep subgingival margins with active bleeding are very difficult to capture reliably. Severe rotation or open contacts that prevent proper retractor placement will produce incomplete scans. Bruxers with heavy occlusal loads can challenge the bond between the milled restoration and the finishing glaze if the internal fit is not excellent. In those situations, sending the case to an external lab with stronger post-processing equipment is the right call, not a sign of weakness.

For labs, 2022 also saw the rise of cloud-based design platforms and the integration of scanner data with lab ordering systems. The result was faster turnaround for complex cases, but it also meant that data transfer times and file compatibility issues became part of the daily workflow. I encountered a situation where a scanned file from one system would not import cleanly into the lab's design software because of a minor mesh error. Re-exporting with a different triangulation setting fixed it, but it added an hour to the job. Knowing how to troubleshoot those file issues is now as important as knowing how to design a crown. If you are looking at entering this space, start with the scanner rather than the mill. You can still send to a lab while you build design skill, which reduces the upfront investment and lets you learn the digital workflow without the pressure of same-day chairside turnover. When you do add a mill, pick one that matches your typical case volume and material palette. Running a machine for only a few crowns a week rarely makes financial sense. The digital workflow is solid now. It is not perfect, it requires discipline, and it demands that you manage isolation, calibration, and file quality the way you used to manage impression technique. But for the cases it handles well, it cuts appointment time significantly, improves consistency, and removes the distortion errors that used to come from tray removal and pouring. The main thing is to respect the process, learn the edge cases, and keep a fallback plan for the situations where scanning just does not cut it.