Use of CAD/CAM technology for Michigan splints fabrication among dental laboratories in Germany: A cross-sectional survey study
A cross-sectional survey of German dental laboratories reveals that while CAD/CAM technology, particularly subtractive manufacturing, is widely adopted for Michigan splints and significantly reduces active working time despite higher costs, hybrid workflows remain predominant due to reliance on conventional clinical data acquisition.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The Digital Workshop Revolution
Imagine your mouth as a bustling construction site where teeth are the buildings. Sometimes, due to habits like grinding or clenching (known as bruxism), these buildings get damaged, or the joints holding them together (the jaw) start to ache. To fix this, dentists often prescribe a "night guard," a custom-made plastic shield that fits over the teeth to stop the grinding and protect the structure. For decades, making these shields was a very hands-on, old-school craft. It involved taking messy goo impressions of your teeth, pouring them into plaster to make a physical model, and then a technician manually carving and heating plastic over that model. It was like sculpting a statue by hand.
But recently, the world of dentistry has been buzzing about a new way to build these shields: the digital revolution. Instead of clay and plaster, technicians are now using computers to design the shield (CAD) and robots or 3D printers to build it (CAM). This sounds like a sci-fi dream where everything is instant and perfect. But does this high-tech magic actually work better in the real world? Does it save time? Does it cost less? And is everyone actually using it, or are they still stuck in the old ways? This is the mystery that a team of researchers set out to solve by peeking into the workshops of dental laboratories across Germany.
The Great German Lab Survey
In this study, researchers from RWTH Aachen University and the Medical University of Graz decided to take a digital census of dental laboratories in Germany. They wanted to see how the "Michigan splint"—a specific, gold-standard type of night guard used to treat jaw pain and grinding—is actually being made today. They sent out a massive online questionnaire to nearly 3,500 dental labs, asking the technicians to spill the beans on their tools, their time, and their wallets.
The results were a bit like finding a workshop that has bought a shiny new robot arm but still keeps a pile of clay on the workbench. Out of the 192 labs that finished the survey, a whopping 82.8% said they were using CAD/CAM technology to make these splints. That's a clear signal that the digital age has arrived. However, the way they use it is a fascinating mix of old and new.
The "Hybrid" Reality
The most surprising finding is that almost no one is going "fully digital." Only one lab out of the 159 digital users claimed to make a splint entirely without a physical model. Instead, the vast majority are running a "hybrid" workflow. It's like a chef who uses a high-tech sous-vide machine to cook the meat but still insists on chopping the vegetables by hand. In this case, technicians are often taking traditional physical models (made from old-school impressions), scanning them into a computer, designing the splint on a screen, and then sending it to a machine to be made. They are bridging the gap between the analog past and the digital future.
Time vs. Money: The Trade-Off
When it comes to speed, the digital tools are the clear winners. The study found that labs using CAD/CAM reported significantly shorter "active working time." More than half of the digital users finished a splint in less than one hour, whereas those sticking to traditional methods (like vacuum thermoforming or wax pressing) usually took one to two hours. It's the difference between a 3D printer churning out a part while you grab a coffee versus a sculptor chipping away at stone for an afternoon.
But there's a catch: the price tag. While digital methods save time, they cost more money. The study reported that the material cost for a single printed splint was about €7.60, but for a milled (subtractive) splint, it jumped to €22. Furthermore, the machines themselves are expensive investments. A milling machine costs a lab about €74,600 to buy and requires around €2,400 a year just to keep it running. In contrast, the old-school vacuum machines are much cheaper to maintain. So, while the robot arm works faster, it eats up more of the budget.
Who is Using What?
The study also revealed that bigger labs are the ones leading the digital charge. Larger laboratories are more likely to use CAD/CAM, likely because they can afford the expensive equipment and have enough work to make that investment pay off. The most popular software for designing these splints is DentalCAD (used by 52.6% of digital users), and the most common method for making them is "subtractive manufacturing"—which means the machine carves the splint out of a solid block of plastic, rather than printing it layer by layer. Even though 3D printing (additive manufacturing) is growing, carving remains the king of the hill for now, partly because the carved materials seem to hold up better clinically.
The Human Element
Despite the cool tech, the study highlighted a few hurdles. Many technicians admitted they felt their knowledge of this new digital world was a bit shaky. They learned mostly by teaching themselves or through company courses, and some felt they lacked a solid foundation in the theory behind the therapy. It's like being handed a Ferrari without a driving manual; you can drive it, but you might not know how to tune the engine.
The Bottom Line
The researchers concluded that while CAD/CAM technology is definitely the dominant workflow for making Michigan splints in Germany, it hasn't completely replaced the old ways. The process is still a hybrid: the design and manufacturing are digital and fast, but the data collection (taking the impressions and bite records) is still largely done with traditional tools. The study suggests that while digital methods are faster, they come with higher costs, and the full transition to a "paperless, model-less" future is still waiting for the rest of the dental world to catch up. For now, the dental lab is a place where the future is being built, but it's being built on top of the foundations of the past.
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