September 2016
Volume 7, Issue 9

Give Your Dentists the Answers They Need

Key questions clinicians will ask about intraoral impression scanners

By Steven Pigliacelli, MDT, CDT

To scan or not to scan—that is the question. One of the most common debates in dentistry today is whether to purchase a digital impression scanner. Digital dentistry is not new, as dentists have been scanning and laboratories have been employing various degrees of digital dentistry for more than 20 years. Laboratories in particular have been quicker to adopt CAD/CAM technology than their clinical counterparts.

Today, it’s the dentists who are being bombarded with information about numerous intraoral impression scanners and other digitally connected technologies. A market that had been dominated by only a few closed systems now features a larger number of open-architecture scanners that can send a scan anywhere the dentist wants it to go. Although the percentage of dentists using digital devices has traditionally been rather low, the pressure from both laboratories and manufacturers to digitally connect is pushing that percentage upward. For laboratories that understand the advantages of digital impression scanning from both the accuracy and workflow vantage points, there is a unique opportunity to research the various systems currently on the market and help clients find the best solution for their practice.

Here are eight questions that dentists are likely to ask about the technology and every laboratory owner should be prepared to answer:

1. How expensive are they? This is always the first question asked, particularly because in the past these were such high-ticket devices. Price varies significantly depending on the manufacturer, but is usually based on the features and extras the standard device comes with as well as future costs for service and support. It is best to discuss price last, after all the other important information has been presented.

2. Is the impression scanner open architecture? This point is important to discuss with your clients because the purchase of an open or closed system can impact your production workflow and their freedom of choice. In a closed system, the dentist is limited to sending files to a chairside milling unit or to a manufacturer-authorized laboratory. An open system, on the other hand, offers the dentist several benefits and advantages, including the abilities to: send cases to any laboratory that can accept STL files; purchase and connect future in-office open-architecture digital equipment of choice; utilize corporate services directly; and merge with other software packages for the fabrication of products such as surgical guides and orthodontic appliances.

3. Is the detail quality of the scan as good as that of the traditional impression? The quality of intraoral impression scans has been heatedly debated for years. Many dentists ask, “Can it give me the same detailed die as my impression material?” This is the same question they asked in the early 1980s when asked to move from copper bands to polyvinyl impression material. Just as with any new protocol, the quality of the end result depends on the user. In experienced hands, a digital impression can be just as, if not more, accurate than one taken with conventional impression material.

It is important to point out to clients that intraoral scanners do have limitations. The scanner can only scan what it can see. If the preparation is too subgingival, the scanner may not be able to capture the margin, in which case a traditional impression will be required. Some scanners require powder to make the teeth reflective. Even scanners that advertise no need for powder sometimes require it in the event of very translucent teeth, bleached shade teeth, or for capturing soft tissue for denture fabrication.

4. Can the impression scanner be used for implant restorations? Most digital impression systems can scan an implant scan body. The availability of scan bodies, however, is a big issue and depends on whether they are available from the implant manufacturer or from another vendor. Some scanners can measure the emergence profile, while others cannot. Some are better suited for scanning single units than for scanning a full arch.

Meanwhile, not all implant manufacturers have digital capabilities. Some now accept scans from 3Shape scanners, which means a scan body scanned by a dentist with a 3Shape TRIOS can be sent to a laboratory with a 3Shape model scanner for the digital design and milling of an abutment.

5. How easy is a digital impression scanner to use? Intraoral impression scanners are all relatively easy to operate. The software is the issue. Just like any software package we use on a computer, ease of use varies. We’ve all experienced photo editing software that can either be as easy as a click of the mouse or as difficult as requiring both hands to press three separate keys while tapping the space bar. The same holds true for digital impression scanning software for which the interface, ease of use, and amount of control are crucial factors. Some software is very basic while others have numerous screens and direct options. If the overall goal is to scan and then send the scan to the laboratory, basic software is usually sufficient. If the dentist prefers to mill in-house or maintain more design control, specific software is available to help.

6. What happens when the device breaks down or a new software upgrade is released? All manufacturers offer service contracts. Some are part of the purchase cost; most are yearly fees. Usually the package includes software upgrades and a login for online software support. Some companies also offer in-office repair services.

It is usually helpful for the user to simply be computer-savvy. If the dentist is someone who finds it frustrating to call a cable provider for support, dental digital support can make them crazy. It’s a good idea to contact the customer support team prior to buying the system to test how easy and helpful it is to make contact. Building a relationship with one great support technician who understands the user and the system can be invaluable.

7. Can I see a demonstration on real patients? Dentists should schedule a few patients and have the sales representative bring a scan system to the practice so that the dentist can perform scans for at least three crowns. The dentist should send the scans to the laboratory for fabrication of the crowns, and evaluate the finished products. If a second set of patients is required to accurately gauge the quality of the scan, then the test should be repeated. It is critical to observe results firsthand on real patients, and not on didactic models. The dentist will be using this machine every day and should get a real feel for it prior to making such a large capital investment.

8. Now, let’s readdress price. The ability to answer the following questions for your clients is important:

a. What is the base cost of the scanner?
b. Is all the software included or is additional software required?
c. How much does a software upgrade cost?
d. How much does the yearly service contract cost?
e. Is training included?
f. What will the monthly payment cover?

All the fees should be rolled up into one yearly fee and broken up into a monthly payment. This is important to know because many times sales representatives quote the cost of the machine and nothing else. No one wants to find out later that more fees are required after making such a large investment. Some companies include everything from the start.

Once dentists go digital and survive the learning curve, there is no turning back to traditional methods. However, it will be an ongoing investment for the rest of their careers and, just like investing in a new computer system or cell phone, a better version will be released shortly thereafter. The best way for your clients to look at digital dentistry is to realize that once they start paying for the device, they will be making monthly payments for the rest of their careers. No system is the final one. They, like you, will be continually upgrading and buying new systems to better the patient experience and the accuracy of the final restorative outcome.

Steven Pigliacelli, MDT, CDT, is Vice President and Director of Education for Marotta Dental Studio in Farmingdale, NY.

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