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    Inside Dental Assisting

    Mar/Apr 2010, Volume 6, Issue 4
    Published by AEGIS Communications


    A Team Approach to Digital Impressions: Achieving Independence and Efficiency

    Jessicah Whipple, CDA; Shannon Fuller, CDA

    In the past 7 years of working together, the authors have achieved an independence that they had not foreseen when they began their careers as dental assistants. The leadership of the dentist in their practice has allowed them to develop a strong, productive team, and encouraged them to expand their knowledge palette through the use of advanced technology. Through the opportunity to use some of the latest advancements in digital dentistry, the authors have been both challenged and rewarded.

    For example, the practice uses the Lava™ Chairside Oral Scanner C.O.S. (3M™ ESPE™, http://www.3mespe.com/ LavaCOS), a digital impression system that enables the motion capture of accurate and precise impressions. The Lava C.O.S. supports conventional processes, including indirect fixed restorations, such as porcelain-fused-to-metal and full gold crowns, inlays/onlays, and bridges, as well as CAD/CAM processes. Other digital impression systems are available, including the CEREC® AC from Sirona (http://www.sirona.com) and the iTero™ from Cadent (http://www.cadentinc.com); however, this article will focus on the authors’ personal experiences with the Lava C.O.S.

    This technology has helped streamline the impression-taking process, enabled staff participation in the digital workflow, and improved office productivity. By using this new system, the authors are able to perform additional clinical duties and help better manage the entire practice schedule, facilitating greater efficiency daily.

    Training for Digital Impression-Taking

    When the practice decided to purchase the Lava C.O.S., the dental assistants were invited to participate in the 2-day training course offered by 3M ESPE. The authors learned the capabilities of the system and how to effectively capture a digital impression—information that proved invaluable. Attending the training provided opportunities to ask the 3M ESPE trainers firsthand about the system and digital impressioning in general. This training was convenient and efficient and helped reduce the learning curve. By attending the course as a team, the authors were able to work together and ask practice-specific questions. The authors recommend this training to any member of the dental team who will be using the system.

    Assuming a new task enables dental assistants to gain more responsibility in the practice and function better as a team. As is the case with all new technologies, the authors experienced a learning curve for taking accurate digital scans at the beginning. However, after practicing scanning technique with the trainers, the team’s confidence and comfort increased. Once the training was complete, the team began using the system immediately with patients and within a few months had mastered the technique. The authors are completely confident performing the scans for all indications—including bridges, which are the most complex.

    The Digital Impression-Taking Process

    With a digital system, dental professionals have the ability to create an accurate digital impression to produce a precise-fitting restoration, thereby eliminating several steps in the traditional impression-taking process. Dental assistants can achieve much more independence with the digital process. The conventional procedure required filling the impression tray and giving it to the dentist. Now the dental assistants are the ones capturing the impression, reviewing the details with the dentist, and ensuring the scanned image is accurate before sending it to the laboratory.

    The authors’ distinctive stepwise process is:

    1. Seat the patient, and place a topical anesthetic gel to numb the site of injection.

    2. After anesthesia is complete, take a conventional impression with bite material to create the temporary restoration with Protemp™ Plus Temporization Material (3M ESPE) that will be seated at the end of the appointment.

    3. Use a system such as Isolite™ (Isolite Systems, http://www.isolitesystems.com) in the patient’s mouth to suction and dry the oral cavity, as well as keep the tongue out of the way. The device serves as a cheek retractor: only one team member needs to be present to take the scan.

    4. Apply powder on the opposing arch to prepare for the scan (Figure 1) so the laboratory will know how to craft the bite. The scan takes only 1.5 minutes.

    5. Have the dentist prepare the tooth, which takes 10 minutes to 15 minutes.

    6. Use an astringent to stop the bleeding on the tooth to be scanned.

    7. Place a retraction cord to move all tissue aside so that a scan below the margin of the crown can be obtained (Figure 2). Let the cord set for 5 minutes, remove, and ensure the bleeding has stopped.

    8. Powder the preparation and adjacent teeth in the remainder of the quadrant (Figure 3).

    9. Scan the preparation. The Lava C.O.S. allows immediate review of the scan on-screen (Figure 4).

    10. Have the dentist return to approve the scan, in accordance with legal regulations.

    11. Complete the quadrant scanning and remove the Isolite.

    12. Take a 30-second bite scan. With traditional impression material, this process would take 5 minutes to set, and the bite was not completely accurate. This new process is much shorter and more accurate, ultimately contributing to greater efficiency for each patient.

    13. At this time, the device can be wheeled into the next room for another team member to use immediately. These authors find this to be a well-organized process that enhances their efficiency.

    14. Construct and place the temporary restoration (Figure 5).

    Increasing Practice Productivity

    Using a digital impressioning device has resulted in better productivity and significant time-savings in the authors’ practice. Because they handle most of the digital impression-taking process, the dentist is able to spend more time with patients who need other procedures. While some dentists conduct the entire scanning process themselves without the help of an assistant, the authors strongly believe that this impedes efficiency and productivity for a dental team. Allowing auxiliaries to handle the digital impression-taking process frees the dentist’s time considerably. In this practice, seating times have decreased significantly because of the level of accuracy achieved with the digital impression, which translates into a precise-fitting restoration. Less time is devoted to making adjustments when seating restorations.

    If a practice’s sole reason for adopting this technology is to increase revenue and the entire team is not involved in its implementation and use, a digital impression device will have minimal effect on productivity. Incorporating technology of this nature enhances teamwork and allows everyone to contribute to a heightened level of patient care.

    The authors appreciate the level of independence gained with the digital impressions process—the dentist is involved only in the preparation of the tooth and then approval of the scan. It takes less than 30 seconds for the dentist to approve or reject the scan before it is sent to the laboratory with the digital prescription. If the scan does not meet the dentist’s standards, the team can easily rescan the area in a couple of minutes: in terms of time-savings, this is a major benefit compared to traditional impression-taking. The authors do not have to repack cord or have the patient remain for an additional 10 minutes while they prepare the tray and material and take the impression.

    Being trained in this new technology has not only challenged the authors in their roles as dental assistants but has also generated excitement for expanding their knowledge base and advancement within the profession. The authors have been able to take on more responsibility in the practice without having to pursue additional schooling or continuing education.

    Great Patient Impressions—In More Ways Than One

    Incorporating a digital impression system enhances the high-tech image of a practice. Patients have expressed approval of this new technology and asked a lot of questions. Digital impressioning also offers patients a more convenient and comfortable experience than with traditional impressions (Figure 6). Showing patients a 3D digitalized model of their dentition helps educate them.

    Anything that can be done clinically or managerially to allow the dentist more time for examinations, paperwork, and seeing more restorative patients helps make better use of everyone’s time. Employing advanced technology such as the Lava C.O.S. offers a number of important advantages to a dental practice: immediate benefits for the patients and long-term benefits for the team.

    About the Authors

    Jessicah Whipple, CDA
    Olympia, Washington

    Shannon Fuller, CDA
    Olympia, Washington


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    Image Gallery

    Figure 1  Applying powder to the opposing arch.

    Figure 1

    Figure 2  Using a retraction cord technique for a successful scan below the margin of the crown.

    Figure 2

    Figure 3  Powdering the preparation and adjacent teeth in the remainder of the quadrant.

    Figure 3

    Figure 4  Reviewing the details on-screen to ensure accuracy.

    Figure 4

    Figure 5  The temporary restoration is placed for seating until final crown placement.

    Figure 5

    Figure 6  Using the Lava C.O.S. to capture a patient’s digital impression.

    Figure 6