Making the Switch to E4D for a Better Fit

I first looked into chairside CAD/CAM technology when I got out of dental school. In 1999, I saw the results of the process firsthand, a full-coverage, all-ceramic restoration, and I was not impressed. I stayed away from CAD/CAM for nearly a decade because, in my opinion, it was a poor substitute for laboratory-fabricated restorations – the quality just wasn’t what I needed and what my patients expected. Ten years later, I looked again, and the change in the results was dramatic. That fact, combined with the ability to offer same-day restorations, made me a believer, and I purchased my first chairside CAD/CAM system (CEREC, Sirona).

I immersed myself in the new system and attended most of the courses offered at various training centers. I even became a mentor for the system, sharing my experiences with my peers. I enjoyed this new dimension to my dentistry, designing and placing my own restorations. If I didn’t like the fit, look, or function of a restoration, I could make a change and mill it again, on the spot, and still place it the same day. What a great service and WOW factor for my patients. Just being able to provide this type of dentistry – modern dentistry – and meeting the needs of my patient base, generated numerous referrals. My practice flourished because of it.

Although I’ve had no regrets on the technology I’ve used over the years, I did get frustrated with the upgrade treadmill it seemed I was on. Every couple of years I was expected to essentially “buy a new system” because of the introduction of a new technology that would have improved and made my dentistry easier and more efficient. It felt like I was encouraged, and even intimidated, to buy a whole new cart or whole new mill every couple of years. I do understand the investment needed for advances in technology. We don’t expect to be given a new car to replace ours each year a new model comes out, and we’ll all stand in line to get the next best iPad® and pay full price. However, this seemed a little different. Like clockwork, just when I was starting to make a dent on my last investment, I’d be back discussing finances again. Don’t get me wrong, it’s not mandatory to upgrade to new equipment, and the new features are nice with expanded opportunities, but sometimes if additional hardware or equipment are added all from the same company, there’s really no chance to get out of the “loop” you’re in.

I had heard from my peers that there wasn’t anything that compared to what I had – that my technology was way ahead of what was out there. I repeated this to my students and the peers that looked to me for guidance without really checking out the facts about what other products offered or claimed. Well, after doing a little research on my own, I found that wasn’t necessarily so.

After researching the E4D System (D4D Technologies) for several months and seeing what it could do, I purchased one in December 2012. Right out of the gate, the whole experience was different. It started when I took advantage of the opportunity to “test drive” the E4D at a Preview at D4D Technologies headquarters in Dallas, TX. They introduced me to the software, and I could scan and design a crown. They tell you the philosophy of the company. While it is a selling opportunity for them, they take the time to make sure their product is right for you and your practice and vice versa. There is probably no other company in dentistry that meets all of its customers firsthand. You can meet the founders, see where the system is built, where it is taught and meet those that support it – a total vertical integration of a company and a system right in the United States.

Tooth #30 Full Crown (E-MAX)

After my decision to purchase, I went back to Dallas with my associate and assistants for two days of intensive training (flights, lodging, and training for two people are included in the E4D purchase). D4D insists that you actually know how to use their E4D system before it is installed in your practice. We learned everything from scanning techniques to how to virtually design multiple units simultaneously. Each person had a full system to work with, so it was completely hands-on and we even covered how to do routine mill maintenance so that my investment would be properly cared for. Then, back in our office, we had our Integration Day (also included with the system purchase) for practical, hands-on production restoring posterior crowns on three patients. The integrator was an experienced E4D dental integrator who was able to provide practical tips and tricks to guide us in using the system with patients, and made my team members feel confident that they, too, could become masters of this technology.

The training element is key. They want you to perform the very best dentistry that you can. They have online live support called Support on Sight (SOS). If you have a problem, a question, or are stuck on something, just place a call to SOS. The technician at SOS can easily log in to your E4D system, diagnose the issue, assist you with clinical applications or even diagnose a hardware issue to expedite the fix. SOS service is included with the warranty provided at the time of purchase and includes quarterly on-site preventive maintenance. The SOS team can also help you remotely with software challenges that you may run across. They can watch you scan, help you design, even access your mill from Dallas. Now, with the introduction of E4D Sky, we can utilize E4D restorative services to design, mill and even finish restorations, send scans or designs to E4D Certified Laboratories, or even export any scan as an “open” .stl file and use any digitally capable laboratory for additional services. The various E4D Sky Services have fees associated with them, but they’re competitive, and you can’t beat the convenience and accuracy of digital communication.

Their philosophy is for doctors and their teams to learn the product and produce excellence. This is the cornerstone of the E4D System and D4D Technologies, and in reality, it is indeed the case. After using another chairside CAD/CAM system for years and fabricating approximately 2,300 restorations, I have to confirm that the E4D system does produce a great product and has excellent technology that is considerably different than I was led to believe.


But the entire experience of E4D surpasses that on so many levels. Even at this relatively early stage with my E4D, the intuitive software takes me about 3–4 minutes longer to scan, design, and start milling a crown, but I save much more than that on the final finishing/adjusting. I am still learning, and I am faster than when I first started, but speed is not the most important factor to me, quality is. My end results have been nothing short of phenomenal. I have not had to adjust my contacts, ever. I have not once had to adjust my final restorations occlusal contact points. Marginal integrity is perfect. There is no need for the bonding cement to “fill in” marginal discrepancies, because I have not seen any. The try-in marginal fit is exactly the same as the cemented restoration; no marginal gaps whatsoever.

I have fabricated approximately 30 E4D restorations to date, a small number when compared to my previous experience. However, given my total experience and knowledge of CAD/CAM dentistry, I have to say, in my opinion, the E4D provides a superior product and service, not only in precise-fitting restorations, but also in customer support and training. They want to facilitate an honest relationship based on trust and superior product development. They have loyalty from the users of the E4D system because they show the dentist the same level of loyalty. My hat is off to D4D Technologies for producing a phenomenal system for the practitioner who wants to elevate his/her office to another level of performance.

This article was originally published in Sidekick Magazine.

About the Author:
Dr. Michael Moroni was raised in Northern California. He attended California State University at Hayward where he received his B.S. in Biology. In 1997, he graduated with his doctorate in dentistry from Case Western Reserve University in Cleveland, Ohio. He completed his dental residency at the world-famous Cleveland Clinic, with emphasis in the treatment of HIV/AIDS and Alzheimer’s Disease patients. In 1999, he moved to Colorado where he opened his private practice. Dr. Moroni is committed to quality care and has taken over 200 hours of continuing education yearly with emphasis in cosmetic dentistry.

Dr. Moroni has many professional affiliations. This allows him to be better equipped to serve you with continual interactions amongst colleagues. His professional memberships include:

  • American Academy of Cosmetic Dentistry
  • American Dental Association
  • Colorado Dental Association
  • Metropolitan Denver Dental Society