Dr. Jack Ringer

	Over the last few decades our entire culture - from industry, education, entertainment and healthcare - has changed and evolved for the better due to the development of computer technology. 

	This includes the field of dentistry. Computers (hardware) have become more and more powerful and less expensive while the programs (software) on the computers are becoming more and more robust, e.g. computer graphic imaging (CGI). 

	Dentistry has benefitted from the incorporation of computer 

, as everything from communication (doctor/patient, doctor/lab and doctor/specialists); diagnostic options, treatment design, restoration manufacturing and practice management have assisted dental practices in becoming more and more efficient and streamlined, resulting in better predictability and higher quality care for their patients.

	The typical collaborative digital workflow in a dental practice today begins with electronically communicating with the patient utilizing programs such as 

 (DemandForce, Inc.). This type of software allows for more efficient appointment scheduling and tracking and is fully automated as patients receive notification straight to their mobile devices allowing them to communicate back to the dental practice in real time. This and other communication software such as 

 (Podium Corp.), also allow offices to collaborate with their patients to improve their social media presence and generate reviews. 

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	One of the main reasons these products have become so successful has been due to the development of the smartphone. Smartphone technology led to the explosion of apps, which are tiny or watered down software programs that run on mobile devices. Programs that were developed for computers have been modified into an app version so doctor, labs, patients and specialists can utilize collaborative software while on the go and don’t have to be tethered to their desktop computers. An example of is would be a doctor who can have his practice management software app on his phone allowing him to check his/her appointment schedule without being in the office.

	The core software for every practice is their practice management software such as 

), which besides handling the internal aspects of the practice such as charting, X-ray, accounts and appointments; can be very collaborative as elements of it can be shared with other disciplines, such as specialists, labs and insurance companies.

	Where there has been a dramatic evolution of software in the dental industry over the last 10 years or so is in the diagnostic, design, impressioning and manufacturing side of dentistry. 

	For many years, dental professionals have relied on digital intraoral radiography, panoramic radiography and conventional tomography for diagnosis and treatment planning. These commonly used imaging modalities produce only two-dimensional and/or distorted images with superimposition of structures outside the area of interest. 

	There has always been a need for three-dimensional (3D) imaging, but the technology has only recently become readily available mainly because the technology has advanced plus the costs have come down. Cone Beam Computed Tomography (CBCT), e.g. GALILEOS (Dentsply Sirona) is compact in size, capable of producing high-resolution 3D imaging of hard tissues, and are compatible with computer-aided imaging software for improved diagnosis and treatment planning. These images can be merged with design software creating a very accurate and predictable collaborative workflow between all involved, i.e. dentist, surgeon and lab.

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	Design software allows dentists and lab technicians the ultimate in collaborative therapy. This type of software allows the operator to create a digital design of anything from restorations to guided implant therapy with the option of taking this design and superimposing or merging it with a CBCT scan giving the entire team an extremely accurate 3D rendering of the proposed therapy. 

Digital impressions can, and have, replaced analog impressions for those who adopt this technology as the scanners have become extremely accurate, cost have dropped and are easy to use; plus the impression software has also become extremely accurate and robust, e.g. the True Definition Scanner (3M).  As with the CBCT imaging and the design software, the digital impression image can be merged with those software elements completing the entire digital diagnosis, design and preparation. 

	The last step in the digital workflow is to get the actual restoration fabricated and today a large portion of restorations, from crown and bridge to implant abutments are being milled by machinery. As milling units are becoming more and more precise along with the development of extremely strong and esthetic monolithic zirconia, such as Lava Esthetic (3M) or lithium disilicate, e.g. e.max (Ivoclar Vivadent) materials, laboratories can manufacture restorations very quickly, extremely accurately and inexpensively because of collaborative approach with the various hardware and software systems available. 

	Most of these systems and the companies that develop them have designed their products to be “open” architecture meaning that the different components to “talk” to each other or work in a collaborative manner. Systems that have or had “closed” architecture forced the dentist to only work with in the confines of that manufacturers system. 

	Technology is here to stay and is evolving every day, and that includes the dental world. Dentists need to stay abreast of the technology and work with collaborative systems to provide the optimum care for their practice. Careful research by the dentist is necessary before purchasing these systems to make sure they fit into the workflow and financial structure of the practice along with taking into consideration how long any of these systems will be replaced or upgraded as newer technology emerge. λ

Articles






How software and technology are ushering the dental industry into the future.Over the last few decades our entire culture - from industry, education, entertainment and healthcare - has changed and evolved for the better due to the development of computer technology. 

Exploring a new era of collaborative dentistry

	What is the dream scenario for the dentist and laboratory’s workflow? The simple answer is that the final result is achieved in an easier manner, more accurately, with less cost and in a shorter time frame. Thanks to the ever-evolving world of dental technology, we are able to experience that scenario today!

	We all know in the business and service industry that costs are higher and errors more frequent when the human element is incorporated into the workflow, versus a machine that is designed to do the same job. This is evident in virtually every industry such as automotive, aerospace, medical and yes, even dentistry. As 

 has become more sophisticated and less costly, areas where it was thought that only humans could fill are now being replaced by machinery. 

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	So, how does this apply to the dental world? From the dentist’s perspective, machines have not replaced the human diagnosing and treating the patient… yet. Nor have machines replaced the design and artistry of the ceramist… yet. However, there is technology now that has improved the laboratory and dentist’s 

 to be more accurate, more efficient and less costly. Where this is most evident is in the area of digital impressions. 

	Conventional dental impression-taking is an aspect of dentistry that by its nature can be riddled with errors that can cause greater expense and inefficiency for both the dentist and laboratory! It is estimated that a dentist pays as much as $60 per impression, not including any redoes that may occur for a bad impression. The dentist also incurs greater costs if his/her impression results in the laboratory notifying the office that they need to take a new impression thus the office incurring the expense of another appointment for the patient; let alone the frustration and inconvenience for the patient and office. From the laboratory in this scenario they also incur the expense of pouring a model they won’t use plus needing to have a new pick up for the new impression.  Conventional impressions also require the lab to pour up a stone model, which costs man-hours plus the potential for human error when stone mixing and trimming the dies. 

	Digital impressions eliminate these errors and reduce cost by getting most of the human factor out of the equation. Capturing digital impressions is easy and is as accurate, or even more accurate, then conventional impressions. There is no distortion and no need to pour a model; though if a model is desired; that model can be imprinted or milled, also eliminating any material or human error. Since the impression is sent via the Internet, there is no cost for delivery and the lab receives it immediately. Once received by the laboratory, the impression can be immediately uploaded into the design software (CAD – computer assisted design) where the technician designs the restoration and then imports that into the milling machinery for manufacturing, followed by finishing. 

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	With today’s highly esthetic strengthened monolithic ceramics, the lab can produce single or multiple unit crowns and onlays efficiently, accurately and inexpensively while getting them back to the dentist within a few days verses the traditional two plus weeks. Another huge advantage for the laboratories is that they can plan and design dozens of restorations to be scheduled for milling overnight when the laboratory is closed. Again, a huge time saver plus an enormous financial savings as there are no human labor costs. Obviously the one area in the digital workflow that can allow for human error is whether the person is using the digital devices correctly or not. So be it for the dentist or laboratory technician, proper training and instruction on the use of these technologies is imperative and once this is done, the potential for errors being created becomes very rare.

	Needless to say there is an initial cost to both the dentist and laboratory to purchase the equipment, i.e. digital scanner, design software and/or milling machinery. However, as with every industry, it is still, in most cases, more profitable and efficient to produce using the newer technology, even while recapturing the cost of the initial purchase. In regards to technology purchases, this author suggests that the dentist and laboratory do extensive research before making any acquisitions. One downside to newer technology is that it changes rapidly, so before purchasing anything, make sure the item one plans on purchasing meets the needs of the practice and laboratory, plus that if the technology improves or changes in the short term that the item can either be upgraded or replaced for a reasonable cost. In some cases the device’s initial cost is so reasonable that even if it is replaced in a few years, it still was smart financial investment.

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	Another area, which has made laboratories and dental practices more profitable, more efficient and more simplified, is the area of milling (CAM – computer assisted manufacturing) restorations. Due to the advancements in CAM technologies, millers have become extremely accurate and less expensive. Along with this has been the development of newer ceramics that have the strength to be used in stress bearing areas, can be milled with extremely high accuracy and though they are monolithic, they have beautiful esthetics combining translucency and strength. 

	The process of milling restorations is far more efficient and less expensive then conventional manufacturing as the impression is virtual, the design is virtual and the restoration itself can be milled without the need of an analog model. This eliminates a lot of human labor and a greater potential for error. Dentists have the option of sending their digital impression to the laboratory for the milling process or can purchase a chair side miller and manufacture the restoration in house. However, the latter requires the dental office to not only purchase the miller, but need to have someone trained to design and import the data into the miller, plus the equipment and skill set to finish the restoration for optimal esthetics.

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	It was not too long ago that the above-discussed technology was thought to be science fiction in the dental world. Now it is reality and who knows what lies ahead! Nevertheless, dentists and laboratories need to stay abreast of the evolution of technology in order for them to stay relevant in today’s marketplace.

Shaun Keating, CDT and Dr. Jack Ringer explain why staying abreast of technological developments is crucial for lab success.