August 2013, Volume 9, Issue 8
Published by AEGIS Communications
Digital Dentistry: Is It Right for Your Practice?
Systems are available to meet every practice’s comfort level and budget
Digital platforms are the future of dentistry, and they are changing the way we all provide dental care. Digital dentistry is allowing us to gather and store more accurate data on patients than ever before. Digital radiographs have become the norm. CAD/CAM-created restorations are proving to meet and even exceed our expectations of fit accuracy esthetics. We use computerized tomography scan technology to identify implant placement with accuracy never before thought possible. Our charts are paperless and contain various types of digital data such as x-rays, scans, intraoral photos, video, and models of teeth. We use e-mail and texting to notify patients of appointments and other office news. Seeing the impact that digital dentistry has had on the general practice, it’s obvious that the general dentist cannot just watch from the sidelines.
One of the newer exciting and growing aspects of digital dentistry is digital intraoral impressioning. This technology is designed to eliminate the traditional silicone putty or other impression material that is loaded into a tray and then placed into a patient’s mouth. These new scans provide the same data but in a cleaner, more accurate fashion and they give the dentist a permanent model of teeth, which is storable indefinitely.
Some of these systems, such as CEREC® (Sirona, www.sirona.com) and E4D® (D4D Technology, www.e4d.com), were designed to just scan a portion of the mouth with the objective of producing a crown, onlay, inlay, or veneer. Those systems have expanded their capabilities and now offer full-mouth scanning and model production. Other systems, including 3M ESPE’s Lava™ C.O.S. (www.3mespe.com) and Align Technology, Inc.’s iTero®, were designed to be full-mouth scanners since they were first launched. Their initial systems produced a full-mouth scan that could be e-mailed to a lab for restoration and or model production. 3M ESPE’s 3M™ True Definition Scanner system features an open platform that allows you to use same-day CAD/CAM technology chairside or with a lab. It can also scan healing caps over implants, which allows a lab to fabricate custom abutments and crowns. iTero allows dentists to complete Invisalign® (Align Technology) procedures with a digital impression. Finally, all of these systems allow dentists to create and store permanent preoperative and postoperative models.
So should a general dentist switch to digital dentistry? To make that decision, the dentist should evaluate the benefits and the obstacles, and then decide the significance each has on the practice. Table 1 lists some of the benefits and obstacles associated with digital impressioning systems.
Making the Investment
Many dentists will consider the pros and cons of buying a system and reach the conclusion that they will buy. The next decision is determining which digital impressioning system is the right fit. The best approach is to learn what each system can do well and then go back to the office and decide how each would integrate into the practice. An integration plan for technology is imperative. This plan should align with one’s personal, clinical, and business goals for the practice. Obviously, not all general dentists practice the same way. The technology in which one invests should match up with and help advance these values. If it doesn’t, success will be elusive.
One example of this involves CAD/CAM dentistry. Many dentists buy a chairside same-day dentistry system only to have it end up in a closet. Other dentists enjoy tremendous success with these machines. The author has personally used every CAD/CAM system, and has found that they all work. So what is the problem? There are dentists out in practice who just don’t have the desire or confidence to make their own restorations. Perhaps they just feel they are more productive preparing crowns but not making them. These dentists should be very careful when considering the purchase of a CAD/CAM-based system. Instead, they may want to look at systems that allow clinicians to send digital impressions to the lab.
One of the biggest obstacles to buying a system is cost. The dentist must make a sound business decision for their practice. Many of these systems price out at more than $100,000. The expense must be made up with increased profits or a decrease in costs. CAD/CAM systems like CEREC and E4d allow the dentist to eliminate expenses such as laboratory bills and impression supplies. For dentists who wish to use laboratory services, systems that send digital files enable better communication with the lab for better results. This results in savings from fewer remakes, adjustments. These systems also would have savings from using less impression material and supplies.
There are other benefits of digital impressioning the clinician needs to consider before purchasing. Some of the manufacturers of intraoral scanners have teamed up with other digital companies and their technologies. Some digital impressioning systems are integrated with 3-dimensional imaging and allow final restorations to be fabricated over implants. Other systems are designed to scan healing caps over implants that allow a faster and easier fabrication of implant abutment and crown. Both of these technologies allow the dentist to bypass traditional time-consuming impression techniques. A general dentist placing implants should, therefore, find out which system would be the most compatible. The same is true for orthodontics. Companies that create orthodontic aligners are only compatible with some of the digital impressioning systems on the market. So if a practice does a lot of orthodontics, that should be taken into account.
Another important factor in your decision should be how the practice will incorporate the new technology and overcome the learning curve. It is important that the dentist evaluate what kind of training comes with the system, along with what kind of onsite support the dental team will have once the initial training is complete. Some companies provide onsite training at your office, usually for 2 to 3 days, and include a limited number of doctors and assistants. Others provide training at their headquarters. This has the advantage of eliminating outside distractions. It also gives you the opportunity to interact with other users, and gain insight from their experiences.
A final thing to consider is which system will grow with your practice. It would be ideal if the system purchased has options for the clinician to add technologies as the practice evolves. All of these systems require a sizeable financial investment. Most dentists will finance this purchase, which means paying it off in 3 to 5 years. At the same time, we all know how fast technology is evolving. It is critical from a business standpoint that the system one purchases today continues to meet the needs of the practice going forward. Trying to predict the future is difficult, but the dentist must consider future goals of the practice, and how the system fits with those goals.
In the author’s office, the dental team tried to think about the future services our practice may offer. Adding services such as implants and orthodontics was of interest, so the system needed to be compatible with those services. Taking time to speak with different manufacturers and sales forces can help a practice get an idea of what additional technologies may be developed in the future. Researching the different systems and looking at the practice’s goals will allow a more confident decision to be made.
Open systems, such as that offered by the 3M True Definition Scanner, may be the way of the future. They can provide seamless access to traditional workflows without limiting the clinician to a single design or production solution. In other words, the dentist is not limited to one philosophy. The dental practitioner could start out taking digital impressions and sending them to the lab, but eventually move to same-day dentistry. This would require the purchase of a design center and milling machine that is compatible with the digital impression system. In the future, dentists may be able to choose separate scanners, design software, and mills. If things do indeed move in that direction, all of the systems in the marketplace would have to open their platforms to stay competitive.
Now is truly an exciting time in dentistry, as digital technology continues to step forward and make the delivery of dental care more comfortable, predictable, and precise. The obstacles keeping dental practices away from digital technology are becoming fewer. The general dentist still has many factors to consider when purchasing a digital intraoral scanner, however. The biggest factors continue to be cost, clinical outcome, ease of use, and the ability to integrate the technology. Achieving success requires evaluating these key factors and matching them up with one’s own personal and practice goals.
About the Author
Brent Fredrickson, DDS
St. Paul, Minnesota