Lauren Krzyzostaniak

	When the Tornado handpiece was introduced to the market in 2015, Bien-Air was surprised to see that its sales numbers were three times higher than anticipated. Dentists liked the powerful but quiet handpiece, which could explain why more than 90 percent of the dentists who tried the handpiece ended up purchasing it.

 has turned some minor adjustments into major improvements, unveiling the new Tornado

“Our first priority was to come out with the most powerful handpiece in the world, so we launched the Tornado,” says Daniel Call, western regional sales manager at Bien-Air. “It set the benchmark and established the brand that was able to achieve the most power with the longest warranty. The next job was to make a handpiece that could be used more generally but still have the most power in its class, the lowest noise in its class and the longest warranty in its class.”

	With a head size that’s 30 percent smaller than the Tornado, the Tornado

 is the most powerful small-head handpiece in the market, thanks to the fact that it utilizes a miniaturized Pelton turbine.

Related reading: The power of a handpiece

	“This Pelton turbine creates very efficient exhaust, so the air escapes before the next rotor blade comes in contact with it, generating a very high power of 24 watts,” Call says. “That’s the same amount of power that’s generated by the standard head sizes of a lot of major brands, so we’ve been able to accomplish the power of a large head in a small head with the Pelton turbine technology.”

	That power is paired with ease of use offered by its air-cushion swivel.

	“The handpiece literally swivels on a cushion of air,” Call says. “All of the other couplers on the market are retention swivels. There is contact between the swivel and the handpiece, and that friction makes it difficult to swivel.”

	With a handpiece that was already known to be lighter, quieter and more comfortable to use, why did the team at Bien-Air feel the need to make improvements? The answer, it turns out, is visibility.

	“In the rest of the world, dentists order handpieces in sets,” Call says. “They order a large handpiece for their very large, heavy-lifting jobs like removing non-precious metal crowns and doing bulk enamel reductions on molars and anterior teeth. They want a very strong handpiece and for those jobs, the power is the most important quality. In combination with a very high-powered handpiece, they also have on their dental unit a smaller head handpiece. This is for their finishing work. It’s the handpiece that enables them to get into those smaller and tighter areas.

	“In the U.S., it’s a little different,” Call explains. “Dentists usually pick one handpiece and use it exclusively.”

	For dentists who rely on one tool to do a range of tasks, it’s important to have the best of both worlds, and that’s what the Tornado

	“The number one concern with air-driven users in the U.S. - after reliability and power - is visibility,” Call says. “The smaller head design provides a visibility angle of 21.5 degrees - the highest on any small-head handpiece in its class.”

	For dentists who have tried the Tornado and appreciate the power but are looking for something with a smaller head, the Tornado

	“It will give them the power that they’re not used to experiencing in a size that allows them to work in space-restricted areas,” Call says. “We were looking to fill in that gap.”

 blows the existing concept of a small-head handpiece out of the water.

More from the author: 8 ways to make insurance less of a pain

	“Usually what you expect when a brand has a big-head handpiece and a small-head handpiece is that the small-head handpiece will have a shorter warranty,” he says. “But with the Tornado

, we are able to offer the same available three-year warranty. It’s more of an all-in-one handpiece.”

	Bien-Air’s goal is to simplify the day-to-day work of practitioners, and Call says the Tornado

 does that by reducing the time that the patient is in the chair.

	“It simplifies the working life of the practitioner by offering the lowest noise level in its class, which puts the patient at ease,” he says. “It’s a lot easier to work in the mouth when the patient is comfortable.

	“Also, the reliability and warranty of the handpiece let dentists do what dentists do best. We want them working at the chair, but when they have a handpiece that breaks down all the time, they are forced to focus their attention on maintaining and repairing these handpieces. But with our available three-year warranty, the clinician can get back to doing what he or she does best."

Articles

How the team at Bien-Air made minor adjustments to create the most powerful small-head handpiece in the market.

An inside look at the new Tornado S handpiece

Insurance can be frustrating for any practice, but these tips can put you and your patients at ease.

8 ways to make insurance less of a pain

	Roland Sanchez, DDS, has been in practice in Belen, New Mexico, for eight years. His clinical focus is on restorative and cosmetic dentistry and oral surgery, although he says his practice is unique because it resolves issues “from limited care all the way to full-mouth rehab.”

	He takes pride in having a diverse group of patients in his private practice, which he says is the largest rural-serving practice in the county.

	“We take all forms of insurance, from Medicaid to cash, which makes our practice very unique,” Dr. Sanchez says. “Most practices label themselves to a certain market and only use a limited amount of products to meet the specific market need.”

Trending article: How to improve patients' oral health in one step

	Dr. Sanchez strives to separate his practice from the pack by trying out new products and recognizing that it’s not always about brand loyalty; it’s about finding the best products for his patients.

	“We’ve always looked for the best products,” he says. “You can’t build quality without the right tools.”

	After years of using many composites, he found one of his favorites: 

. “It has blown me and my patients away,” Dr. Sanchez says.

	What Dr. Sanchez likes about G-aenial Sculpt

 is just an unbelievable staple,” he says. “GC will keep working on a product and make necessary changes to its formulation until it’s right. G-aenial Sculpt is one of those tried-and-true products.”

	While Dr. Sanchez says he has been using GC products for a long time, he had previously relied on 3M™ Filtek™ products to finish anterior cases. That is, until G-aenial Sculpt came out.

	“There are a ton of cases where patients want veneers or high-end cosmetics, but they can’t afford it at the moment,” he says. “If they need a one-tooth touch-up or chairside veneering, G-aenial Sculpt is unbelievable. The translucency and the camouflaging effect is like nothing out there. I can’t tell you how many times we’ve had someone come in with a chipped crown or broken composite veneers. I’ve used so many other composites that leave a visible color difference, even after polishing. None of them will blend or camouflage like G-aenial Sculpt.

 provides great results,” Dr. Sanchez continues. “This universal bonding agent contains no HEMA, added MDP for zirconia bonding capability and a low film thickness (3µm), which allows for a thin layer with high strength. Plus, you can get fantastic bond strengths with any protocol: self etch, selective etch or total etch.”

	Dr. Sanchez says G-aenial Sculpt’s excellent translucency and camouflaging effect help cut time from polishing and cutting angles.

	“Patients are ecstatic when we do touch-ups or fillings with this product because they look so natural,” he says. “The products are esthetically and functionally pleasing, and they hold up very well. Patient satisfaction is very important to us.”

More from the author: Why a perfect crown may not always be the best option for a patient

	Dr. Sanchez encourages other dentists to keep an open mind and try out new products in the market.

	“I think it’s tough because doctors get stuck in comfort zones, but stagnancy never produces much advancement,” he says. “After trying other GC composites, none of them compared to G-aenial Sculpt. I’m happy to say that I’ve been using it for over a year now, so it is worth the time to try. Of the composites I’ve used, this is the best so far.

	“I’m not branded to any one company; I just use the best of every company,” Dr. Sanchez adds. “If I’m going to stay ahead of the game, I have to make sure that I have the best products for my patients.

One dentist explains why he switched to using this universal nano-hybrid composite.

I Use That: GC America’s G-aenial Sculpt

	When Dr. Charles Blair first started out as a dentist, he says you could run a practice the way you wanted to. Profits were higher back then and dental school debt was lower (if it existed at all). Even reimbursements were better.

Now, the margins are tighter, the PPO fee is 30 to 40 percent off the dental fee, and dentists today are graduating with student loan debt that tops $100,000. All of these things, Dr. Blair says, come into play when dealing with dental benefits in the practice.

	We spoke with dentists and dental benefits experts to find out what solutions are best for easing the stress of dental insurance. Here is their advice.

	Continue to the next page to see the top tips.

	“What I have found to be most helpful is documentation,” says Erinne Kennedy, DMD, a dentist at a community health center in Boston. “The insurance company is looking for specific criteria in your documentation, so if you are able to give them exactly the information they need with the correct verbiage, reimbursement is easier. Accurate and detailed documentation, including radiographs or intraoral pictures, reduces an opportunity for the insurance company to deny the claim.”

	Patti DiGangi, author of “DentalCodeology,” calls documentation one part of the “two Ds” -  documentation and diagnosis. “What’s the diagnosis, and what’s in your documentation to support that diagnosis?” she says. “That’s called a dental medical necessity. We don’t think that way in dentistry yet, but we need to because there’s not a medical claim that’s paid anywhere that doesn’t have a documented medical necessity.”

Related article: 4 things you didn't know you could do with a digital scanner

	She believes that documentation and coding is a team sport that can’t be left to one person. “The clinical professionals have to provide the information and the data that needs to go on claim forms,” she says. “The one thing we’re missing most often in dental offices is diagnosis. We’re not currently required to use diagnosis codes, so all we think of is procedures. The biggest question I get is about how to code things, but they don’t know the diagnosis, they just know the treatment.”

	If you’re not sure of the criteria that insurance companies require for documentation, Dr. Kennedy advises calling the insurance company to ask.

	“Personally, I keep a little list in the office of the insurance company’s criteria,” she says. “When I send in a pre-treatment estimate or claim, I know that I am sending the exact documentation needed for that procedure.”

	“The problem that I see in offices is that they don’t understand coding,” DiGangi says. “They don’t know the difference between coding, fees and coverage, and those are separate but related entities.”

	“Every company has 30, 40 or 50 different policies that they offer,” says David Rice, DDS. “Knowing which procedure codes a given policy works with and which ones they don’t, and which ones you can bundle together as opposed to which ones you can’t, is really important. With some policies, you can come in and get an exam and I can take X-rays, but I’m not allowed to take other types of X-rays with it. But if you literally came back tomorrow, I could take those X-rays and they would be covered. So, having a coding expert is really important.”

Related article: The 5 biggest misconceptions about imaging coding and reimbursement

	“They should have a copy of the current code set,” says Teresa Duncan, dental insurance educator and host of the “Nobody Told Me That!” podcast, which focuses on managing issues in the dental office. “A lot of people depend on the practice management software having the codes, but it often doesn’t have the full code descriptor. They need a book that has the full description of the code in it, so they can make sure their doctors are doing exactly what is in the code and that it matches the best. We’re supposed to do the procedure and then see if there’s a code that accurately describes it, not find a code and then only do what’s in that procedure code description.”

	“Where there’s a disconnect of information is on insurance administration,” Dr. Blair says. “We’re up to the point where there are about 14 PPO plans per each indemnity plan.”

	Dr. Blair says that the lack of knowledge that practices have in the PPO arena is “troubling.”

	“For instance, everybody knows that there is a contract with the PPO, but nobody knows that the contract says you are supposed to adhere to the processing policy manual. That manual might be 150 pages. It really spells out the relationship between the practice and the PPO.”

	The manual outlines several aspects of reimbursements that many practices may not be aware of such as how to handle optional services, the need to report all charges, the option to reject or disallow procedures, and how to handle “dual” insurance.

Related article: 5 best practices for fee schedules in the dental practice

	For handling optional services, Blair gives this example: “If I were doing a very complex case - a $25,000 or $30,000 case - and my crown fees are $1,000, I can’t level arches and do provisionals and everything for $700, which is the PPO fee,” Dr. Blair says. “So, I get an exclusion. That’s one thing in that processing policy manual.”

	 Blair also stresses the need to report all charges, which he says includes tooth whitening. “They are supposed to be sent to the PPO for review,” he says, “even though they’re not going to pay for certain procedures. For instance, they would not pay for tooth whitening, but they might control the fee. We call that fee capping for non-covered procedures.”

	Plans can also deny or disallow procedures. “Deny means they’re not going to pay it, but you can collect from the patient,” Dr. Blair says. Disallowing a procedure “means the insurance won’t pay and you’re prohibited from charging the patient.”

	He argues that a lot of offices leave money on the table between denied and disallowed procedures.

	Dual insurance comes up about 15 percent of the time, Dr. Blair says, and many practices don’t realize that the benefits are coordinated and that the practice can collect up to its full fee.

	If the dentist treats a dependent who is under both his or her mother’s and father’s insurance plans, the doctor can be reimbursed through a coordination of benefits. “The doctor could be in two low-fee PPO plans and actually get their full fee,” Dr. Blair says. “That means that we get two checks. A lot of offices don’t realize that - they want to give money back because they think they’ve been overpaid. But if I put $1,000 on the claim form, then I can keep up to $1,000. I have not been overpaid unless I get above the fee that I place on the claim form.”

	“Outsourcing is definitely where offices are realizing a lot of efficiencies, so they may want to investigate those options,” Duncan says. “What I mean by outsourcing is to farm out benefits and eligibility checks and also answering of the phones. So many services are doing it very well that it’s not unheard of anymore.”

	She advocates outsourcing for cleaning up outstanding claims as well.

	It’s also important to support dental organizations like the 

	“In Massachusetts, there has been a lot of conversation around certain insurance companies in our state,” she says. “I think supporting organized dentistry (either local, state or national components) as a profession is an important way to make sure that dentists and patients are being represented in the legislation.”

	“There is no other large voice out there,” she adds. “Insurance companies have lobbyists. The ADA and AGD are there for the same purpose. When people want to effect change but are not part of a large organization, it’s a harder task. When you have a large body advocating on your behalf, your concerns will get more attention, as opposed to trying to knock down doors on your own.”

	6. Have a knowledgeable insurance coordinator

	Dr. Blair says that it takes more and more sophistication to run the front desk, so having a well-equipped team there to handle the business side of the dental practice is essential.

	“I have a receptionist in my office who knows all of the insurance companies, their pricing and their coverage, down to some of the individual plans in my state,” Dr. Kennedy says. “I think that alleviates a lot of communication issues with the patient if you can say, ‘I’m going to connect you with so-and-so. She knows your insurance inside and out and if there is something she doesn’t know, she’ll help you find it.’ Having that person makes it easier on the patient and the doctor and ensures that when you submit all of the information to the insurance company, you’re reimbursed in a timely manner.”

	Unfortunately, many practices don’t have an official insurance coordinator. Instead, they lump in the duties of an insurance coordinator with the rest of the duties that the front desk manages.

	“There are very few people who take any kind of training because there is limited training,” DiGangi says. “They learn what they think they know about dental benefits from articles, speakers, the internet and social media, and all of those contain misinformation.”

Related article: 3 keys to training a new employee

	Because the CDT codes are owned by the ADA, one must be licensed to write or speak about them in an educational capacity. DiGangi is licensed.

	“People say all kinds of things from the podium, but it’s not necessarily accurate because nobody polices it,” she says. “There’s a lot of missing information from which we create our treatment plans, which is unethical. A treatment plan shouldn’t be based on coverage. And if someone creates or doesn’t code accurately or changes the code just to increase insurance payments, that could be fraud. Whether it’s by accident or ignorance, it’s still fraud.”

	She says that, in order to make the process better, there needs to be a better understanding of how it works now.

	“We need to understand the system versus fighting the system,” she says. “We spend more time fighting and complaining instead of getting involved in it and trying to understand it so that it can be fixed - because it needs to be fixed.”

	7. Identify your patients’ benefits and eligibility ahead of time

	Duncan asserts that checking patients’ benefits and eligibility ahead of time is essential, though not that common.

	“It sounds intuitive, but I still run into a lot of offices where they don’t do it because of time,” she says. “They should focus on identifying benefits and eligibility for at least their new patients. Then, focus on those who have big procedures upcoming so that we are confident in our co-payment estimates. If your practice management software automatically checks it or you have it done through an outside service, then you don’t have to worry about the time issue. You’d be able to open your software and have it be right there.”

	She also advises logging in to the insurance company websites regularly to check benefits.

	“The biggest issue I run into is that people don’t know patient benefits and don’t even bother checking on eligibility,” she says. “And they also don’t do it often or consistently enough. That leads to lower confidence in the information given to the patient. That’s where the breakdown happens between the patient and the office. Patients are never happy to receive an unexpected bill.”

	Duncan says that knowing patients’ benefits ahead of time raises the level of customer service in the practice.

	“Hospitals make you sign a million forms to acknowledge that you’ve been given a cost estimate,” she says. “In dentistry, we don’t do that consistently. That leaves your office and the patient open to all sorts of confusion.”

	8. Commit to yearly courses and stay updated

	The rules are complicated and they change often. That’s why Duncan believes that the insurance coordinator should take a refresher course every year on the new codes.

	“At least once a year, take a webinar on the new codes,” she says. “Lots of people provide that. I give a webinar every January that goes over what’s coming up for the next year and any noticeable trends.”

	She also advises keeping up on the trends outside of your own practice.

	“When they go to study clubs or society meetings, they’re finding out what’s going on in other offices, which is super helpful,” she says.

	“A good insurance coordinator today is not someone who’s just entering checks and filing claims all day. It’s such a changing market. They really need to be proactive about staying on top of it. If a doctor hears from their insurance coordinator that they don’t need any classes or if they notice that the person hasn’t taken any classes in the last two or three years, the landscape has already moved on. That person may be working inefficiently.”

	Many of the sources interviewed for this piece are experts in the arena, with lots of resources available: Sign up for Teresa Duncan’s newsletter or podcast, “

, which includes books like “Coding with Confidence, the ‘Go To’ Dental Coding Guide.” 

2017 has been a year of advancements ­- not in tools themselves, but in how they impact the industry.

The top 10 developments in dental technology in 2017

	When we look at crown restorations, they often mimic the form an ideal tooth in color, translucency and contour. But while the replication may be “ideal” in the broadest sense of the term, it may not be ideal for any particular patient.

	That’s because wear patterns in patients’ mouths are as unique as the patients themselves, so putting in a crown that hasn’t been designed for that patient is asking for the restoration to fail.

	“The challenge is that, for most patients presenting a need for a crown, there is some sort of wear on the tooth, but when technicians close their eyes to design a tooth, they are thinking of the most natural looking tooth,” says Adam Hodges, DMD, a general dentist practicing in Asheville, North Carolina. “When dentists start thinking about that, they realize that if the lab knows what the dentist is trying to do, they can actually make crown procedures more predictable and make the results better for patients.”

	Why restorations should not be made into the 'ideal' tooth

	Every lab technician wants to create the most beautiful, functional crown possible, but there are limits to how “ideal” a crown should be.

More from the author: 5 surprising ways digital tools can boost your abilities 

	“The tooth structure of a 50- or 60-year-old does not look like the tooth structure of a 20-year-old,” Dr. Hodges says. “For most patients presenting a need for a crown, there is some sort of wear on the tooth. It could be because of an existing filling or because of a wear pattern in their mouth.”

	If a technician creates the most natural looking tooth, he or she will include the ideal contours and form of the tooth. But that can pose a problem if those contours are in violation to the contours the patient has created, Dr. Hodges says. If that happens, it’s likely that the restoration will fail.

	“There is a very high likelihood that the patient will return to the practice with either the crown knocked off or a sore tooth,” he says. “It is like walking down the street in the same way that you have walked for thousands of years. There is probably a line in the street where you walk. If you change that topography just a little bit, you could stub your toe. The same thing happens with the teeth. If you have a contour that the patient spent the last 40 years milling into their mouth and you do not replicate that contour or a contour that is short of that, there is a very high likelihood that the patient will end up with pain.

	The patient could even end up needing root canal therapy, which could have been avoided had the crown mimicked their teeth’s natural form.

	“We like to think that if you cut down that wear and make an ideal tooth that everything is fine, but actually it creates a lot of problems,” Dr. Hodges says. “If you are doing single-tooth dentistry, which is the lion’s share of what is being done out there, you must pay attention to and respect the contours that are there. If you don’t, you are going to end up with those situations.

	“I have a new patient who has had a crown cemented four times over the last three years, and now this tooth is going to be extracted,” he continues. “I know the crown was put in in a way that violated the contours and rather than respect and recognize that those contours were violated, the dentist kept recementing the tooth, thinking it was a cement problem. Our cements are fantastic, so if a tooth keeps coming off, you had better learn the lesson, or something is going to happen. In this case, the tooth broke, so we are going to extract it.”

	Digital scanners help replicate the patient’s natural tooth

	Most dentists don’t send preoperative models to their labs, but digital scans can fix that.

	“With a digital scan, it can actually make the process quite simple by allowing you to take a preoperative scan and then take a postoperative scan after preparing the tooth,” Dr. Hodges says. “If you are going to give them a new crown, your best bet is to replicate the existing tooth in a stronger form. We all like the beauty of the brand-new tooth and what can be possible if a technician gets their artistry involved in making the perfect-looking tooth with perfect-looking anatomy. But we all hate crowns coming off or increasing patient sensitivity. Replication of the pre-operative form is a paradigm shift that should happen more often, and digital impressioning machines make that simple. It can also be digitized and created in the digital world by the labs, which mostly work in the digital world now.”

	“For the patient to be able to choose their own smile design is the biggest thing,” says  Jason Atwood, CDT and digital integration specialist at Core3dcentres NA. “There is even an option now to have a ‘donor smile’ where the patient can choose someone else’s smile.”

Related article: The state of dental implants in 2017

	This is a good option specifically for patients who want to recreate the natural, beautiful smile of their youth. Thanks to digital scanners and the phenotype of a younger generation, dentists can look to a more youthful copy of their mouth to create their patient’s ideal smile.

	“We did a case recently where a mother was getting restorations done and said her daughter’s teeth looked like hers when she was younger,” Atwood says. “The dentist took a scan of both of their teeth and we were able to copy the daughter’s smile for the mother. By copying her daughter’s smile, we were able to open the fountain of youth for the mother and make her feel like she had gone back 30 years.”

	This is a significant change from the “old days,” when a dentist would make most of the decisions, leaving little room for patient involvement.

	“It is not just make it function anymore, it is much more of a personal connection,” Atwood says. “The traditional way, most of the decisions were left up to the doctor. You would get impressions taken and they would be sent off to the lab and the doctor and the lab would discuss a diagnostic wax-up. The lab would send it back to the dentist, who would show the patient a model and ask if it looked nice and the patient would say yes or no. There was not a lot of input from the patient.”

	With digital scanners and design software, everyone is now more involved, from the dentist to the lab tech to the patient. That saves time on reducing chairside adjustments, ensures a more predictable and successful restoration, and allows the dentist to place the most ideal restoration for each patient, who can go home with a smile that looks and functions at the highest level possible.
	 

Putting in ‘ideal’ crowns without considering other factors can lead to restoration failure.


Why a perfect crown may not always be the best option for a patient

	Digital scanners offer many benefits that aren’t possible with traditional impression techniques, from time savings to patient education and accuracy to the ease of storing electronic data. Combine the benefits with the fact that the learning curve is small, and it’s clear that implementing a digital scanner in the dental practice is a “no brainer,” says Adam Hodges, DMD, a general dentist in Asheville, North Carolina.

“It’s not a hard transition for the dentist,” he says. “The digital impressioning wand is similar to taking a picture with an intraoral camera or using a handpiece. The mechanics of moving the scanner to capture the data is actually very familiar to a lot of dentists. That transition isn’t typically hard because it’s something familiar. That’s a huge benefit. I had a half-day of training, and I’ve only become more efficient in taking digital impressions.”

	Click through the slides to find out the five biggest benefits of switching to digital impressions.

	At first, Dr. Hodges wasn’t sure that digital scanning would bring about a level of efficiency that would be financially rewarding. Although he knew there would no longer be a need to spend money on polyvinyl siloxane impression materials, the saved expense wasn’t noteworthy. Plus, he knew that there would be some revolving costs with a digital impressioning machine.

	His initial suppositions were soon eradicated. “I was pleasantly surprised to see an efficiency to my workflow that is cost beneficial,” he says. “The efficiency comes with decreased time to acquire the data and accomplish a laboratory prescription as well as the transportation of that data back and forth to the lab.”

	Dr. Hodges says he is already seeing improvements on the lab side as equipment becomes better, but the biggest benefit for him at this point is the rapid turnaround time.

More from the author: What digital dentistry means for implants

	“I can have information travel back and forth to California in a few hours, which was not possible before,” he says.

	Dr. Hodges also sees digital impressioning systems as a way to get dental assistants and other auxiliaries more involved. It offers the chance for team members to learn new things and be stimulated by their role.

	“My employees usually take the opposing digital impression and Invisalign impressions,” he says. “In those cases, they’re responsible for some of the outcome of the case, and that responsibility grows personal and job satisfaction. There are a lot of positives for the staff members in keeping them engaged in furthering their career. It’s a technologically-oriented life.”

	Dr. Hodges and his team enjoy working with digital impressions and want to do even more with the technology, so they are excited and interested in the future. Moving forward with its potential capabilities is made simple by the fact that patient and laboratory prescription data is stored digitally with intraoral scanners.

	“The fact that you can get the information quickly and store it makes dentists much more efficient,” Dr. Hodges says.

	For most dentists, digital impressioning - though practice-changing - is old news. But for many patients, it’s a novel, exciting experience.

	The novelty, and the drastic improvements digital impressions make to the patient experience, help improve patient relationships and patient care.

	“One of the first things they say when they sit down for a crown procedure is, ‘Do I have to have that goop in my mouth today?’” Dr. Hodges says. “It’s something that you remember because it’s not comfortable to have someone force-feed you silicone and have to bite on it for three minutes.”

	With digital impressions, Dr. Hodges no longer feels the need to coax patients into taking an impression.
	“When you scan it, you can do both arches efficiently and give the patient breaks so that they don’t have to hold still for as long,”  Dr. Hodges says. “The patient’s convenience factor is improved and the experience is better because it’s not as invasive.”

Read more: Why a perfect crown may not always be the best option for a patient

	It doesn’t matter that digital impressioning has been around for years, he says. There is still a very prevalent “wow” factor involved for many patients.

	Using an impression wand to show the patient a 3D representation of his or her mouth is definitely something they don’t see on a daily basis.

	“Your average patient doesn’t experience 3D topography replicated on a screen from a wand,” Dr. Hodges says. “They consider it state-of-the-art, so the marketing in your practice goes way up because patients identify advanced technology that they’re not familiar with, which is impressive to them. It’s something they talk about.”

	The thing that Dr. Hodges is most excited about is digital smile design, particularly in regards to the patient’s evaluation of the eventual smile. Dentists can now create mockups on the computer of the patient’s current situation and his or her planned outcome.

	“Even now, it’s possible within a video to change the person’s appearance to give them a fundamental understanding of what their teeth will look like in their head,” Dr. Hodges says. “That kind of engagement certainly helps further the cause of providing quality cosmetic dentistry for patients.”

	3. Narrowing the gap between craftsmanship and technology

	Every subset of the dental industry is getting involved in the digital realm because it can be done anywhere, Dr. Hodges says. In turn, that erases the barriers - both physical and otherwise - that used to separate professionals around the world.

Trending article: 5 steps to a pain-free dental career

	“It shrinks the world so that you can get different options. You might get a digital wax-up from China or Switzerland or Sweden or Spain, and you can have incredible turnaround time because it’s all digital,” he says.
	Erasing those barriers means that patients can get the best level of care possible.

	“It’s also possible to have your local lab tech improve their level of care through working with these resources to provide form and esthetic,” Dr. Hodges adds. “One of the biggest limitations in dentistry with regard to final results is the limitations of the artistry of the technician you’re working with. When we can narrow the gap between the greatest craftsman and the best technology, then we’ll be able to provide the highest level of care at an affordable cost for all patients. I think digital is going to allow that gap to get very close.”

	Digital scanners also drastically improve patient education. “It’s about visualization of the condition for the patient,” Dr. Hodges says. When cases are theoretical, he says, there is a disconnect between the procedure and the need.

	With digital impressioning systems, the dentist can show the patient both the preoperative scan as well as the postoperative scan as well as illustrate the circumstances that might make a procedure more difficult than normal.

More from the author: The state of intraoral scanning

	“For example, for patients who feel like we’re cutting their tooth down to nothing, you can show them that we’re barely reducing it down enough to get the job done in a lot of cases because of the severe wear they have,” he says.

	“Visualization is a tremendous part of patients’ understanding of the procedure. And when they understand the procedure, their acceptance of the need for care goes way up.”

	Digital impressions, he says, are just as accurate - if not more accurate - than traditional analog impressions.

	“When you take an impression, you have an inaccurate material that you then have to pour into stone, which has a certain amount of inaccuracy,” Dr. Hodges says. “We have found that digital impressions are more accurate for single-tooth crowns.”

	That accuracy affects bite registrations, too.

Related reading: 4 things you didn't know you could do with a digital scanner

	“When you take an upper and lower digital impression and then take a bite scan, the computer is measuring the bite in a very accurate sense, with the mouth together,” he says. “Whereas typically when we take a bite record, we use bite registration material between the upper and lower teeth.”

	There is also a chance of an inaccurate mount from the laboratory, which means that there are three opportunities for mistakes to occur, resulting in the impression material, stone and mounting to all be inaccurate. With digital impressions, however, the problem is avoided.

	“With the digital impressioning machine, the computer is registering all that,” Dr. Hodges says. “If there are errors, they’re easier to detect in the system because the workflow is improved for a greater patient outcome, greater patient experience and greater efficiency for all.”

	He adds that the learning curve for laboratory technicians is much faster in the digital world than in analog. “That’s reinforced in the fact that, if you talk to companies like Invisalign or ClearCorrect, they will tell you that digital impressions that they receive are more accurate and that the aligners that they make in those cases fit better than they do with regular impressioning techniques,” he says. “They prefer it in their workflow as well for the accuracy.”

	From that standpoint, he says, it’s a win-win.

Implementing a digital scanner in your dental practice may be a wise investment.

The 5 biggest benefits of digital impressions

	Over half of the 500,000 dental implants placed in the U.S. every year are placed by general dentists-and that number is growing, according to the American Academy of Implant Dentistry. Thanks to the digital workflow, specifically CAD/CAM technology, more general dentists are gaining the tools and confidence needed to offer implants to their patients. 

	“There are many dental professionals who, understandably, are wary of new ways of working and prefer to continue using the processes they were originally trained in,” says Dr. Pascal Kunz, vice president of product management for digital dentistry at Nobel Biocare. “The number of early adopters in dentistry remains relatively small, but those that embrace emerging technologies stand to benefit.” 

Technology should help dentists become better, not force them to leave their traditional education and skills untapped. “We have to create even better synergies within the treatment teams,” he says. “I think overall
	the industry leaders have realized that digital dentistry has arrived and are beginning to embrace the change that is happening.”

Trending article: What digital dentistry means for implants

How CAD software is impacting the implant workflow 

Computer-aided design and milling have revolutionized the implant workflow, according to David Rice, DDS.  

	“Our ability to diagnostically work up a patient where we can digitally create the final restoration prior to any surgical procedure is amazing,” he says. “We can design and then mill or 3D-print surgical guides, which will give us the exact location for where that implant should go before we begin. When we get to the healed portion and actual placement of the restorative phase, we already know that our final restoration will be in a perfect position, safe from the vasculature and any nerve issues and built for a perfect occlusion and perfect esthetics.”   This  kind of technology also ensures that labs get more accurate information in regards to timing and relative location of the implant to adjacent teeth. “The laboratory doesn’t have to worry about taking the impression post, manually inserting an analog into it, and putting it back into the impression to then fabricate a custom abutment and crown for the patient,” says Paresh Patel, DDS. “Everything will just be totally in the digital world and not have to go into a tabletop laboratory scanner to then turn it into something that the doctor can give to the patient.” 

That ensures a more accurate and streamlined process, increasing communication between members of the treatment team and creating a better patient experience, says Priya Menon, director of marketing, North America at Dentsply Sirona Implants. “It’s also a key contributor to the rapidly growing trend of integrating a more flexible and complete digital workflow,” she says. 

	“We have certainly seen a very strong uptake of Nobel Biocare digital solutions for dental implant treatment,” Dr. Kunz says. “We are seeing significantly more software installations and more cases planned digitally. The option for guided pilot drilling only has also proved popular, with clinicians understanding the importance of achieving the desired position, depth and angulation of the first drill, but then appreciating the flexibility of a freehand approach. 

	“The importance of fully understanding the clinical situation, including prosthetic requirements prior to treatment, is greatly valued by clinicians. [...] It’s about looking at the bigger picture to help ensure the best possible approach to treatment.” 

Trending article: 5 surprising ways digital tools can boost your abilities

	The role of CAD/CAM in implant dentistry also plays a huge role in creating custom abutments. 

	“We are able to create a custom abutment, just like we used to with a laboratory, and send it,” Dr. Rice says. “Except now, we have total control chairside to design or move a margin on a custom abutment. The number-one reason implants fail today is because dentists are leaving cement. The custom abutment is so impressive because not only can we esthetically design how we’d like our implant placed and positioned, but we can move the finish line where a crown and that custom abutment will interface. That process is super simple. Between zirconia and e.max, we have two very durable and highly esthetic materials to mill our custom abutments out of, from a CAD perspective.” 

	Dentists also have the benefit of printing surgical guides. 

	“Using the 3D imaging data, digital treatment planning software enables the clinician to virtually plan their implant case prior to surgery, taking into account vital anatomical structures, bone quality and prosthetic requirements,” Menon says. “From the plan, surgical guides can be produced that allow for the exact replication of the plan to be carried out during surgery.”  

	According to an October 2012 literature review in the 

Types of Implant Surgical Guides in Dentistry: A Review

,” by Kathleen Manuela D’Souza, Meena Ajay Aras) implant software cannot override human error, so it is imperative that dentists have the education to understand what goes into placing a long-lasting, esthetic restoration. 

	“The various complications recorded were related to inaccurate planning, radiographic stent error, intrinsic errors during scanning, software planning, the rapid prototyping of the guide stent, and the transfer of information for the prosthetics,” the authors write. “However, if the clinician recognizes these sources of inaccuracy, efforts can be made to minimize the error and optimize patient treatment.” 

	Still, companies continue trying to compensate for human error. 

	“Dentsply Sirona Implants’ VAD (Virtual Atlantis Design) software takes the specific edentulous space, surrounding teeth and soft tissue anatomy into consideration, providing prosthetic solutions that mimic true natural tooth function and appearance,” Menon says. “Engineering principles are built into the software to ensure the requirements for manufacturing precision and integrity of the design are maintained, thus eliminating the errors that can occur with human designs using computers.” 

Patients are getting in and out of the chair faster 

	Another result is time saved. “Once the clinician has the information of a patient’s dental anatomy captured digitally, they can perform all the treatment planning in a virtual environment,” Menon says. “Having this information and plan allows the implant procedure to be executed with precision with surgical guides, and even allows for a temporary restoration to be designed, manufactured and available on the day of surgery.” 

	“If you did a direct comparison of chair time, it may be the same,” Dr. Rice says. “But it’s much more efficient for patients. Sometimes a patient will stay for a longer appointment and sometimes they’ll choose to come back for a second appointment, just like they have in the past.” 

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How technology has changed the placement procedure and the ability of doctors to ensure implant success 

Our annual look at innovations in the implant workflow.

Over half of the 500,000 dental implants placed in the U.S. every year are placed by general dentists-and that number is growing, according to the American Academy of Implant Dentistry. Thanks to the digital workflow, specifically CAD/CAM technology, more general dentists are gaining the tools and confidence needed to offer implants to their patients. 