Going Digital In-House

Over the last few years, I have seen a shift in our industry with Dentists and Prosthodontists moving to digital technology. That change can be scary and exciting at the same time.

I recently had the pleasure of speaking with a dentist who has been contemplating going digital for quite some time now. Her end goal is to update her office with digital technology to improve quality and save time. She sent me an email with a list of great questions and concerns. I am sure that there are many that have similar thoughts, so I decided to put them into this blog hoping that it will help someone else in their decision-making.

Here are some things that the dentist wants to do to update/improve/do faster/do better, and with more predictability, compared with her current way of doing things:

Dr.: Design my implant cases digitally (singles, bridges and full arches).

Me: Definitely. You will be able to save time and have full control over your design.

Dr.: Print surgical guides.

Me: Great application! Printing them yourself saves money PLUS time. It will cost you on average $2.13 in materials to print a surgical guide and will take approximately 20 minutes.  To do guides, you will need Implant Studio software from 3Shape, which will add approximately $5,000 onto your 3Shape design software.

Dr.: We take a ton of alginate impressions, pour a ton of models and duplicate a lot of wax-ups to make vacuum custom trays, recording bases, occlusal guards, and interim dentures and RPDs. We also make impressions for lab-manufactured provisionals. Can I speed that up and make all of those more accurate with a scanner?

Me: YESSSS!!!! Scanning and digital designing has been proven to be extremely accurate AND fast. When adding 3D printing to digital scanning, lots of the things you do – or pay to have done – can be done quicker in the office and are also less expensive. Once you are trained, you will be able to substantially increase your workload in the same 8 hour day.

Dr.: Can I scan my interim dentures and merge them with the CBCT for the treatment planning?

Me: Yes. You would need to take the CBCT scan with the denture in the mouth with radiopaque markers, then coat the denture completely with the radiopaque material and scan that. Then you would align it in software, such as 3Shape Implant Studio.

Dr.: I need to learn to use an intraoral scanner for my singles and simple things, but is that my first purchase?

Me: An intraoral scanner (IOS) does not have to be your first purchase. You can buy a lab scanner with the design software and integrate an IOS later. In that case, you would have to scan either the impression, or poured models in order to get the digital file you would need to make any of the things we’ve mentioned. If you do buy an IOS, you do not have to purchase a lab scanner. Just get the design software.

Dr.: That sounds great. It would help me to make my office more modern and up to date.

Me: This would definitely set you apart from the majority of other practices and make your space more modern and advanced.

Concerns: 

Dr.: Will I need intensive training for my team? Does it mean I need to hire a lab technician? I want all of us to be able to pick up the process quickly and move on fairly smoothly.

Me: In-depth training for at least one of your staff is IMPERATIVE!!!! Your time is most valuable with patients in the chair, and not designing restorations. If you want to take the work home at night or the weekends, you could, but what fun is it if you aren’t living life? Personally, I would strongly suggest you hire a technician OR take a look at your current staff and see who has the passion and drive and train them to do it. I have several dentists that do this themselves, but frankly it is for one of two reasons… they absolutely love being hands-on with the work or they are control freaks and won’t let anyone else do it. I think it is a great idea for you to know and have a full understanding of the workflow, but pay someone else to do the work.

Dr.: Will we really save time? What is the benefit for the office?

Me: Yes… you really will save time! You will be able to cut down patient visits with certain workflows and your turn-around time will be faster as well. There are many benefits in going digital.

Dr.: Getting "married" to one brand and pay "club dues".

Me: I get what you are saying. The advice I will give you is to go with an open system. With open systems, you can mix and match CAD, CAM and 3D printing materials. Unfortunately, if you want to stay current with your software, you are going to have to pay annual renewals with 3Shape or fees for upgrades with Exocad on the CAD side. I don’t know much about Exocad, but what I can say about 3Shape is that they have over 450 software developers on staff and they are constantly moving their technology forward. Your annual renewal pays for their salaries. The hardware is going to go out of date every 5 to 7 years… but with software, it is ever changing and they are always making it better. So, generally speaking, it is worth paying that annual renewal to be using the most current software in your practice.

Dr.: I do very little Invisalign, and don't think I like the iTero too much, but truly don't know other aligner options and benefits/drawbacks.

Me: Clear aligners can be a very profitable segment in our industry. In fact, 3Shape has Clear Aligner Studio, which is easy to work with. Here is a link to a YouTube video showing you the workflow of the software. https://www.youtube.com/playlist?list=PL-jAAawc6LWS0mTBJ2xBVwKauswGWFb6B

Dr: I am pretty proficient with conventional PVS impressions, so…

Me: …and with proper training and a little experience, you will also be proficient with intraoral scans!

Dr: I have been told multiple times "we are not there yet" with intraoral scanners.

Me: Everyone has an opinion. I believe that maybe 3 or 5 years ago I would be on board with that statement. But, honestly, I have seen a lot of success with this technology. I have a peer to put you in touch with. He is a young, passionate, driven Prosthodontist that has embraced this technology and he can give you a lot of sound advice.

At the end of the day, going digital isn’t for everyone and may not even be on your radar. The best thing you can do is educate yourself and what better way is there to do it than by asking as many questions as you can?