Digital dentistry in daily practice

Can you describe your present workflow?

For a simple implant restoration, first I see the patient for a consultation. Then they see a nurse, to go over the treatment and give their consent. The nurse does the intra-oral scans, pictures and digital shades. The technician makes a scanning template on the gonyX, which the nurse uses for the CBCT scan.

When it is all ready, I get a digital prompt on my project management software. I combine the information on soft and hard tissue from the intra-oral scan together with the CBCT scan, position the implants virtually on the computer, and export the data to the technician. We may dialogue by email. He makes the stent (template) for the guided surgery as well as temporaries if we are doing immediate loading. Next, I perform the surgery, which is video recorded. In non-esthetic sites, we often scan on the day of surgery for the final model. The final crown is screwed into place after three to 12 weeks, and we see the patient once more to take photos and x-rays. As before, it usually takes 12 appointments, but I’m only in four of them, so I have more chair time for other patients.


How did you arrive at this workflow?

We got a scanner out of curiosity and were amazed what we could do with it – more than what the manufacturers described. Now we have an intra-oral scanner in both our offices. We are constantly refining what we do and are excited about ideas for new uses. Evidence-based dentistry is very important, but with some technologies 20 years’ research is not necessary – they either work or they don’t.


What other digital technologies do you use?

We have a paperless office. We use animated digital presentations to show possible procedures, and we email copies so the patient can view them as part of getting their consent. We build relationships on Twitter and YouTube. Recently we performed a guided surgery with 25 dentists watching in the practice. We fed a live stream onto Facebook, and people were typing in questions as they watched.


Are digital technologies forcing changes in the dentistry business?

Yes. Some dentists see websites as marketing, but the old way of making contacts through a small network of people was also a form of marketing. Some dentists resist digital dentistry, but it’s racing ahead. It is almost essential to use CADCAM because it avoids spending a fortune on gold alloy and lab bills. The change will be hard on technicians. Finally, the business model will change as more technology comes on line. I don’t think dentists will pay much for the software or for the scanners because companies will make money by selling services, not machines.


What innovations are needed next?

We need more accuracy and standardized data formats so we can lay scans on top of each other without losing information, and do new things. A computer design environment where you could simply ‘move the teeth around’ would be nice. There are many fantastic things that could be just around the corner, like optical coherence tomography scanners that image hard and soft tissue or 3D printers that make ceramic components and even tissue.