Lauren Krzyzostaniak

	The team at Nobel Biocare was quite busy on the IDS show floor, as attendees from around the world gathered to view their latest innovations.

	We sat down with senior product managers at Nobel Biocare to get the first-hand scoop on some of their newest innovations, such as the On1 concept, which was announced last summer at their Global Symposium in New York, and the Trefoil concept, which will be available in the US in 2018.

	The On1 concept is a modular solution designed to “bridge the gap between surgical and prosthetic workflows,” according to an earlier press release. The On1 Base connects to the implant during surgery and remains connected throughout the lifetime of the restoration. “Whenever you place the implant at time of surgery, you place the On1 Base, and from that moment on you are basically on tissue level, so the soft tissue can heal undisturbed,” notes Christian Ebener, Global Head of Product Management.

Related: What Nobel Biocare unveiled at the Global Symposium 2016

	Trefoil is a prefabricated framework that passively fits over three implants. The benefit is that it makes fixed, final, full-arch restorations possible on the day of surgery. Martin Gerlach, Senior Global Product Manager Implants at Nobel Biocare, demonstrated the mechanics behind the new Trefoil concept for the edentulous mandible. As the framework is adjustable, clinicians can compensate for any inaccuracy in the placement of the implants.

	“The advantage of this system is that we do not have any temporary solution,” Gerlach says. “We want to offer more patients a fixed and screw-retained solution instead of a removable one.”

	Also noteworthy was the joint announcement with KaVo Kerr of DTX Studio, an implant module that connects diagnostics and treatment, benefiting professionals in every capacity, from clinicians to technicians. 

 offers diagnosis, design and treatment planning modules in an open system, making it easy to connect to KaVo imaging devices and import images from any X-ray or scanner.

	“We have everything integrated into the software for diagnostics, treatment planning, and prosthetic design, so it’s everything in one suite,” says Lilibeth Brogna, Global Product Manager of Digital Workflows.

Articles

Exploring the cutting-edge new product offerings from Nobel Biocare.

Nobel Biocare unveils new solution for faster full-arch restorations

	At this year’s IDS in Cologne, Germany, BEGO was attracting crowds with its newest developments, including the newest edition of the Varseo 3D printer, the Varseo S, which now allows for an open STL file.

	The Varseo S building plate is about 30 percent larger than the previous model, enabling it to print more objects simultaneously. Despite expansion of the building plate, the housing is quite a bit smaller-about 40 percent smaller, in fact.

	Aside from allowing open STL files, the Varseo S also ensures a safer process. “The device can recognize if you’re using the wrong material, which is important for ensuring a safe process,” says Andreas Röthig, Key Account Manager for BEGO. “If it’s the wrong material, you can read on the display that it’s the wrong material for the data file.”

	The Varseo S also includes a new light-curing unit: the BEGO Otoflash. Otoflash will quickly and reliably cure the VarseoWax resins. Users of the Varseo S will also be happy to know that BEGO’s printing systems are in compliance with the MDR.

Related: Read about the original Varseo 3D printer

	Also on display at IDS were new materials in the VarseoWax spectrum, including the VarseoWax Splint E for 3D printing of occlusal splints. Digital Esthetics learned on the show floor that BEGO will soon be providing VarseoWax Base for 3D printing full denture bases and VarseoWax Temp for 3D printing long-term temporaries.

 powered by exocad, which features two rotating 4.0 MP cameras with ultra high definition quality, and the 

, which features two high-definition 5.0 MP cameras.

	BEGO also used the IDS floor to highlight the expansion of their 

, including the Mediloy cobalt-chrome and titanium milling blanks, the Wirobond C+ for orthodontic appliances, the KATANA Zirconia UTML and the BEGO PMMA Splint E.  

BEGO’s latest 3D printer shown at IDS 2017

	Another company helping to make dentistry more efficient for the clinician and more comfortable for the patient is Innovato Holdings, a new company out of Greece. Its founders, Ioannis Vergoullis, DDS, and George Papadopoulos, CDT, founded the company “to innovate and create game-changing, essential products for the dental industry,” according to the company’s literature.

VPI Emergence Profile Management System (EPMS) kit

, which is designed to contain all of the tools needed to create the optimum natural emergence profile, including the VPI EP Indicator and VPI EP Mold.

	The VPI EPMS includes a mold template that assistants can use to simply fabricate a custom healing abutment that replicates the natural shape of the emergence profile, regardless of size. The VPI EP Indicator helps clinicians determine the proper size and shape of the healing abutment that the patient needs. It can also be used to mark or initiate the implant osteotomy. The kit also includes guide pins to evaluate the correct position and angulation of the implant.

Must read: The latest options in implantology

	“This is a complete range of tools that can help the clinician generate a natural emergence profile and record it accurately every single time,” Dr. Vergoullis notes. The kit allows clinicians to identify the optimal emergence profile and select the ideal healing abutment for the patient.

	“We want to pass the message to the dentist that the end result is very important and every patient deserves the best,” Dr. Vergoullis says. “Either [dentists] pick this system or they use another methodology, but what’s important is to get the best result. We just offer a system that makes the process easier and faster.”

	The kit is currently available in Europe and will be available in the U.S. this year. 

DPR looks at the offerings of new company Innovato Holdings, which showed off a new emergence profile kit at IDS 2017.

New company Innovato Holdings shows off innovations at IDS 2017

	When the general public thinks about orthodontics, they likely still have an image of an awkward teenager sporting a mouthful of metal, hoping for the day when she can chew caramel again. But for many general dentists, that image is not only archaic, but it bears very little similarity to what they can do for their patients-and, for many general dentists, what they can do in their offices. 

	More adults than ever before are requesting orthodontic appliances, and while there are a multitude of benefits for improving tooth alignment and occlusion-such as better oral health, improved digestion and reduced headaches, just to name a few-it is largely thanks to the improved esthetics of invisible orthodontics that adults are requesting it. In fact, the invisible orthodontics market is expected to grow by 13 percent in the next five years-twice the rate at which dental imaging equipment is anticipated to grow in the next few years (6.8 percent), according to one study.

 And it is thanks to companies like Invisalign or Progressive Orthodontics Seminars that more general dentists are offering it. 

	Age of the patient and whether the dentist is a specialist are no longer considerations for orthodontics. What was once reserved for gangly, acne-ridden teenagers as just another impediment on their quest for status is now the hard-earned reward for dissatisfied adults who have a couple thousand dollars to spare. 

	It is widely accepted that adding procedures, performing more high-profit dentistry and adding new patients are solid steps on the path to increasing practice revenue. With orthodontics, a general dentist can do all three at once. By adding orthodontics as a treatment option, dentists offer a low-cost, high-profit procedure. Case acceptance goes up, along with referrals, and no marketing is necessary. It seems like a win-win scenario. 

	After all, orthodontists have years of education on the specialty; what makes general dentists think they can grab a piece of the pie just because they want to?

 to in order to stay competitive. And for two: Despite the common one-day training programs, comprehensive training programs do exist. Those programs, offered by organizations like 

 (AGpO), aim to equip general dentists with the tools necessary to perform more complex orthodontic cases. 

	Whether those programs compare to years of studying orthodontics in school is inarguable. But the onus is on the dentist to accept cases that require the skills in which they are confident and to refer those that are out of reach. 

	One thing that helps to bring more procedures within reach is new technology. General dentists can now perform simple surgery, thanks to surgical guides. They can print their own chairside restorations, thanks to milling machines and advances in 3D printing. So why not do ortho? 

	“The fact of the matter is that esthetically, orthodontics is a fairly minimally invasive way to get fantastic results,” says Amisha Singh, DDS, a practicing dentist in Denver. 

	Dentists know that offering invisible orthodontics is a great way to grow their business. It’s becoming more popular for new dentists to use ortho as a primary method of increasing revenue. “It used to be four or five years into their practice before they took the course,” says David Dana, DDS, education director at Progressive Orthodontic Seminars. “Today, I’m seeing newer graduates coming into the course.” 

	Invisible orthodontics encompasses clear aligners, such as the highly popular Invisalign and ClearCorrect brands, as well as ceramic, clear and lingual brackets. The more attractive option from the patients’ perspective is a clear aligner: the appeal is that nothing is attached, they can be removed at any time, they are easy to clean and they are virtually invisible when worn. The downside is that many experts feel that clear aligners are best for simple restorations such as minor crowding or orthodontic relapses. 

American Journal of Orthodontics and Dentofacial Orthopedics

 that compared Invisalign to braces, Invisalign did not treat malocclusions or large anteroposterior discrepancies and occlusal contacts as well as braces in the sample study. Its strengths were “its ability to close spaces and correct anterior rotations and marginal ridge heights.” 

	Many young people are finding their way back into the realm of orthodontia, paying for their mistake of inconsistent (or non-existent) retainer use. But it’s unclear just how many patients in the U.S. wear some kind of clear aligner. Invisalign claims 3 million patients, while ClearCorrect claims 15,000 providers. Then, of course, there are the doctors who make their own aligners with a chairside CAD machine. 

	The benefit of clear aligners is that training is simple: general dentists can start treating patients after a one-day training program, in the case of Invisalign. With ClearCorrect, the training is online. And both offer online content as a constant resource. 

	“Invisalign has hundreds of hours of recorded, free CE for dentists to watch, from seminars all over the world,” says dentist Jason Watts, DMD, of West Cape Family Dental in Cape Coral, Florida. 

	Meena Barsoum, DDS, owner of Impressive Smiles in Chicago, appreciates that he is in charge of the training schedule. “ClearCorrect’s program is based on your time,” he says. “They have a web portal that includes videos, articles and tutorials to get you started. You follow along at your own pace.” 

	There are also no materials or tools to invest in: just the cost of the trays themselves. Dentists can take impressions with whatever material they already have and then send the digital scans directly to the manufacturer. Intraoral scanners make the process even easier. 

	“It’s cost effective,” Dr. Watts says. “All you really need is an impression tray and PVS material. You don’t even need a scanner. You can take photos with a handheld, iPhone or professional camera. You send the pics into Invisalign, coordinate the technology and pay the fees. 

	“Once you send the case to Invisalign, their lab techs help you design the ClinCheck. It shows you the alignment of how your patient’s teeth are going to be structured and how many trays you’re going to have. We can edit that as we please because we as the dentists are the drivers of the treatment. We approve the treatment, they cut the aligners and you just need some flowable composite. So your returns are anywhere from 250 to 400 percent, depending on how much you charge.” 

	Dentists can expect to spend about $4,000 on training and the aligners for their first three cases with Invisalign. The return on investment is immediate: the average cost of one patient’s case is $5,200. 

	Competition is strong between Align Technology (makers of Invisalign) and ClearCorrect, but the differences in their training styles and indications are notable. 

	 “I do mild to moderate cases that are done in six months or a year, so ClearCorrect was more cost effective for our practice,” Dr. Barsoum says. “We don’t get into open bites or extrusions or any complex occlusion changes.” 

	Dr. Watts is doing more complex cases-the kinds of cases that orthodontists would feel comfortable doing. But he is confident that he has the training and skills required to complete the cases successfully. 

	“It’s like riding a bike,” he says. “You want to start off with safe, Class I cosmetic cases and then you take the training wheels off and go. Once you’re on your own, you can experiment with smaller movements and minor turns before you start poppin’ wheelies.” 

	“Wheelies,” in Dr. Watts’ case, include Class II bites, distillation and occlusion. “I’ve taken on more advanced cases than simple alignments,” he says. “As you educate yourself further and take the necessary CE and ask questions, you start to understand the process, mechanics and fundamentals more and more. The cases become more selective and the success is 100 percent if you pick the right case.” 

	When it comes to revenue, Class I cases are sufficient and common. And there are plenty of people who missed the boat for orthodontics as teenagers but could benefit from simple alignments. 

	“I’m trying to stick mostly to crowding and mostly young adults who are comfortable with their bite and might just need some crowding fixed,” says Leah Capozzi, DDS, owner of Metropolitan Dental in Buffalo, New York. “I had a 68-year-old woman who wanted straight teeth for her 50th high-school reunion, so clear aligners were perfect for her. I also had a patient in his mid-60s who was unhappy with the alignment of his teeth. These patients would probably not even consider going into metal braces, but clear aligners give them that more cosmetic option.” 

	But there is more to invisible orthodontics than just clear aligners. Some of the big players in ortho-such as 3M, Dentsply Sirona and 

-all offer ceramic and lingual braces. Ormco also offers clear brackets for another esthetic option. For dentists that want to take on more complex cases and are ready to invest in training and materials, these more traditional options might be a good idea.

	Progressive Orthodontic Seminars, the United States Dental Institute and the Academy of Gp Orthodontics all offer “comprehensive” weekend training programs for dentists that span a period of two years. Topics covered range from how to diagnose and treat “bread and butter” cases to what to know about vertical dimension. To compete with training programs for clear aligners, POS offers a one-day introductory seminar, while USDI’s includes an Invisalign certification at a reduced cost. 

	These comprehensive courses train on both brackets and aligners, which means that dentists have the option to expand into one or the other upon completion of the course. The cost of training is significantly higher than that required to use clear aligners, but the cases are also more complex (and more profitable). Then again, it’s nothing compared to the $100,000-plus tuition that orthodontists are responsible for. 

	The cost ranges from $10,000 to $20,000 over the two years, but the organizations all assert that the return on investment is solid. POS even claims that general dentists can break even after 10 cases. Because of that return, it’s a great way for dentists to drastically increase their revenue. 

	“In my own career, it took me about six to eight years to add orthodontics into my practice,” Dr. Dana says. “If I could do it again, I would start doing ortho as soon as I started my practice.”  

	Adding ortho as a revenue stream is catching on and recent graduates are on top of the trend. 

	The initial investment when working with traditional orthodontics materials is between $7,000 and $18,000, according to POS. General dentists will have to invest in building an inventory of orthodontic tools and materials. “The orthodontic tools are a little different than what most general dentists have, like sets of pliers, wires and brackets,” says Dr. Dana. “The initial investment is about $10,000, but that is enough to get any general dentist going.” 

	Altogether, the investment in materials and education for a traditional, comprehensive ortho training program is between $20,000 and $40,000 total. While that number may certainly seem steep, there are two cushions: the time it takes to spend that much (about two years) and the chance to start making returns almost immediately. By offering orthodontic treatment just a few months into the course, dentists can start making their money back before they have spent most of it. How much money? That depends on how aggressive the approach is. 

	“It all depends on the practice and how many cases they’re willing to take,” Dr. Dana says. “In my situation, I was willing to take as many cases as I could. Within one year, I recovered all my education investment, which was about $20,000 for tuition plus expenses (such as traveling) over two years.” 

	He more than recovered the investment. Because Dr. Dana had 200 active cases at any given time, he claimed a revenue of $1.2 million that year. But a general dentist who wants to take a more relaxed approach to ortho could still garner a hefty sum. Taking one ortho case a week, at $3,000 per case (the low end of the spectrum), facilitates a return of $150,000 a year. 

	That is not just POS’s math: USDI asserts that dentists can add $200,000 a year with ortho. The math is simple. The average material cost per case is under $500. With a typical markup of 600 to 1,200 percent, dentists can earn $2,000 per orthodontic hour. 

	Here’s a hypothetical: A general dentist is interested in taking the occasional, straightforward ortho case. She is looking for relapses and adult cosmetic procedures, focusing on those Class I cases that she can wrap up within eight months or so. 

	To really understand the potential, let us say she spent $40,000 on her orthodontic education and startup materials: the high average. And we’ll say that she charges the low average of $3,000 per case. (And remember that she spends less than $500 a case on materials.) She has a lax approach to recruiting her patients to do ortho, so maybe she gets two cases a month. 

	She still profits by $20,000 within her first year of offering orthodontics. 

	Using the same formula, but for a dentist who trained on clear aligners, the number is about $72,000 in annual revenue from ortho. The estimated revenue from two cases per month at $5,200 (the average) is $124,800. 

	Although it is possible and common to take impressions for ortho, new technology such as CBCT and intraoral scanners simplifies the workflow. 

	The dentist can take a scan and immediately view the results in his ortho software. From there, he can plan the treatment and then 3D print the appliance or model, or the send the digital file to his preferred lab (thanks to the open STL files) and wait for them to send the appliance back. 

	The benefit is not only a quicker, more efficient workflow, but also improved patient perception. 

	“Obviously, there are many clinical benefits, such as faster impressions and the ability to send digital files,” Dr. Barsoum says. “But what some companies don’t understand is patient perception. Our patients don’t want impressions because they’re not used to it.” 

	Dr. Barsoum attributes his practice’s growth to expanding his services and using more technology for the benefit of the patient. 

	“We designed everything around technology and that’s what I attribute to our growth: using technology to provide better care and better understanding for our patients,” he says. 

Technology improves case acceptance in several ways: By presenting your office as cutting-edge, patients may perceive your skills and knowledge to be higher. They also appreciate the comfort that technology brings to standard dental procedures. It also improves patient education, since you can show instead of tell. 

	That reaches beyond showing them the current state of their oral health: dentists can also show them the potential state of their smile with a photo mockup of their teeth after treatment. 

	It also keeps patients from changing their minds. “If a patient needs crowns or fillings, you usually want to do it before [orthodontic] treatment is started,” Dr. Watts says. “It’s hard to do fixed work like crowns while they are wearing aligners because they might not fit trays. That’s why having an in-office milling unit is great. Instead of prolonging the case to deliver the crown, you can do the crown that day, take the impression right after and then schedule the next appointment when their trays arrive.” 

	Getting the ball rolling keeps patients from second-guessing their decision, says Dr. Watts. 

	“Patients are more likely to reconsider treatment that is costly once they leave the office,” he says. “The longer someone has to think about something and analyze it, the less likely they’re going to want to do it. Milling can aid in orthodontic treatment because you can do restorative work faster.” 

	Orthodontic software is comprehensive, making it easier to plan, analyze and track cases from beginning to end. Pretty much every major manufacturer offers software to help with the orthodontic workflow, so the process can be completely digital, at least for cases indicated for clear aligners. When used in combination with CBCT imaging or an intraoral scanner, orthodontic software replaces the need for extra inventory such as plaster and saves time. There is no need to produce, ship or store traditional stone models. 

	“I can attain an STL file of the patient’s teeth and import them into the newer software to virtually move the teeth and virtually place the attachments,” says orthodontist Jack Fisher, DMD, owner of Artistic Smiles Orthodontics near Memphis. “The software then tells me how many aligners are needed. I import them into the 3D printer and print out the models. We then construct the aligners in our office.” 

	Certain companies partner their software with clear aligner manufacturers, such as the partnership between iTero’s OrthoCAD and Invisalign. The partnership allows dentists to send their scans either to their preferred laboratory or to Invisalign. Those files can be used for a variety of products, from orthodontic appliances to printed models. 

	ClearCorrect is in partnership with CEREC, although they have their own web-based software. The benefit is that dentists can use whatever browser and computer they prefer. 

	Digital files replace physical storage in the dental practice, but they also enable digital analytics, such as teeth width, space, overbite measurements, jaw alignment, arch length and other data points, helping any general dentist determine and analyze relevant details in each case. 

	Orthodontic software’s open STL files improve communication among dentists as well as between dentists and laboratories. 

	“Let’s say I need a fixed retainer,” Dr. Barsoum says. “We’ll use our CEREC Ortho scan and send it directly to one of our orthodontic labs and they’ll fabricate the final appliance based on our scan. The labs like it because they get a clean digital impression that they can print or modify and it can be turned around really quickly.” 

	Providing orthodontics as a general dentist is about more than increasing revenue, of course. Many dentists find that having that extra service as a solution to their patient’s functional issues is a major benefit. 

	“People look at aligners as an esthetic solution, but there are definitely biological and periodontal considerations that we have to make when we’re making that treatment,” Dr. Barsoum says. “It goes way beyond making your teeth look good. Crowding, especially of the bottom teeth, makes it harder to maintain healthy gums and teeth because it’s not a natural position. We’ll take photos of our patients’ teeth and educate them on why aligners would be a benefit for them and we continue to take photos throughout the process, showing how much healthier their gums are and how easy it is to maintain that health.” 

	“Because I’m a general dentist, I see a lot of patients with wear on their teeth, which might be related to the position of their teeth,” Dr. Capozzi says. “If I’m going to ask you if you’re clenching or grinding your teeth, I want to have available treatment options. If your teeth are out of position or you’re getting recession, we can discuss a mouth guard and clear aligners because they are services that I provide.” 

	For many general dentists, the option to tackle the cause of the problem, rather than treat the result, is a major consideration. By keeping teeth healthier longer, dentists can avoid temporary options like restorations and veneers. Patients get the benefit of improved oral health and stronger teeth, which impacts digestion, stress, headaches and the health of supporting tissue. 

	The benefits of improved function are not enough to earn the blessing from every member of the dental community, however. Technology, opines Dr. Fisher, does not make orthodontics easier: It makes it more difficult. 

	“If I were a general dentist, I would not consider doing aligner treatment or brackets on patients for orthodontic purposes,” Dr. Fisher says. “Now that we can see the roots in 3D, we can see all of our mistakes with aligners and brackets. It is extremely risky for a general dentist to place braces and not even consider the placement of the roots in bone by evaluating with 3D imaging.”

	It is interesting to note that general dentists are not any less likely than orthodontists to use 3D imaging as a tool to evaluate root placement. Dr. Fisher himself claimed that only 2 percent of orthodontists in America use 3D imaging to diagnose their patients-a sign of what he calls an “education deficiency.” 

	The solution is training, says Dr. Dana. “With proper training, general dentists can do whatever they want,” he says. “It’s like anything else: if you learn it and you do it, you master it. The main concern is confidence. But the truth is that anyone who can do dentistry can do orthodontics."

	Education, of course, is merely the first step. It is just as imperative to have mentors in the field and to be honest about your expertise and limits as a dentist. 

	“The more we are able to collaborate with general dentists, specialists and labs, the better our final treatment for our patient becomes,” Dr. Singh says. “Gone are the days of waiting for a response. We can have conversations about the patient’s care and send digital visual markers for our discussion in real time. That helps the general dentist significantly because they can use the specialist’s knowledge to help build their own scope of practice while still being able to refer the more difficult cases. It also helps with diagnosis because now we can see right away which cases are difficult.” 

	Knowing when to refer is crucial, but it’s also important to have guidance from expert peers in order to continue honing those specific skills. 

	“I have a great orthodontist that I work with and that I refer cases to that are beyond my comfort level,” Dr. Capozzi says. “If there are cases I’m not sure about, he’ll sit down with me and go over the case before I start.” 

	“It is so important to be comfortable with your skills,” Dr. Singh says. “My advice is to take comprehensive orthodontics continuing education courses until you feel comfortable. Most of all, know when to refer. If a general dentist attempts a very complicated case, it is easy to go from having orthodontics as a practice grower to a practice tanker.” 

	All dentists vow to continue studying for the rest of their careers. Dr. Capozzi favors learning from those around her. 

	“Working closely with the people you’re referring to allows you to get better results for your patients,” she says. “And for me as a younger general dentist, it helps me learn. Who would you rather learn ortho from: your computer or a specialist who went to school for three years for it? I wouldn’t have the confidence to do what I do if it weren’t for those specialists that I can work with.”

	In the end, orthodontics is going to continue to grow. It has already been planted in the offices of general dentists, so there is no sense in trying to contain it within the walls of orthodontists’ offices. The most responsible and realistic option is to focus on education and have a solid sense of one’s own limitations. 

	“In everything we do in dentistry, the better trained you are, the less risk you have,” Dr. Dana says. 

Orthodontics is an arena more accessible to general dentists than ever. So how are general dentists embracing this trend-and what challenges have they found?

How ortho is changing dentistry

	Philips Zoom Take Home is exactly what it sounds like: a take-home whitening kit for patients. It uniquely offers amorphous calcium phosphate as a key ingredient, which added to potassium nitrate and fluoride, not only reduces sensitivity but also delivers enamel protection and helps improve tooth luster.

	It is available for daytime use, nighttime use or touch-ups, and each kit uses specific ingredients best designed for those situations. 

, a cosmetic dentist who has repeatedly been voted one of Denver’s best dentists, about how his practice uses Philips Zoom. 

Related reading: Why one practitioner uses Philips Zoom Professional Whitening products

	By testing out several take-home whitening kits, Dr. Radz is confident that his opinion about Philips Zoom has been tried and tested. 

	“I have tried many different take-home 

 just to see what’s out there and stay current on my knowledge of the bleaching market, but we continue to use Philips Zoom Take Home,” he says. 

	“I have been using Philips Zoom products since the material first came out many years ago,” says Dr. Radz. “I have consistently provided  this to my patients because of the extensive and ongoing Philips research concerning safety and efficacy. In addition, the product provides excellent clinical results. The product packaging and consumer communication are done in such a way that it represents the image and professionalism that reflects our office’s commitment to patient care.”

	It’s the excellent clinical results that Dr. Radz appreciates the most. “Quite simply, I like that it consistently provides excellent results,” he says. “The packaging and instructions for use are very patient friendly and is a positive reflection of our office image.”

	It goes without saying that teeth whitening is a major aspect of cosmetic dentistry, and it’s important for Dr. Radz to offer his patients a product that is as effective and sensitive as the dentistry he performs in the practice. 

	“As an esthetic-based practice, take-home bleaching is the foundation of many of the more extensive cosmetic procedures that we provide,” he says. “Getting good results is important, as it is the patient’s first experience with our cosmetic procedures. Future cosmetic procedures will only look better if we get a good whitening result.” 

	Most important is the patient response, which has been unfailingly positive, says Dr. Radz. “The product is easy to use, provides excellent results and incidences of sensitivity are extremely rare.” 

Trending article: What 101 dental practices told us about their perspectives on in-office whitening

	Part of what makes the patient response so positive is that patients who enroll are automatically entered into the “Endless Whitening Program,” which offers free whitening gel at each six-month appointment. That encourages patients to develop loyalty to the practice, keep their appointments and provide referrals. 

	Dr. Radz recommends Philips Zoom to other dentists because of its effect on the practice, the patients and the team. 

	“In our office, our team is very well educated in the area of whitening,” he says. “Anyone on our team is able to have an educated conversation with a patient on the subject. Bleaching, in our office, is driven by the team members. They welcome the ownership of this aspect of our care and are very involved with the conversation with our patients.”






One practitioner shares his experience with the take-home whitening kit.Philips Zoom Take Home is exactly what it sounds like: a take-home whitening kit for patients. It uniquely offers amorphous calcium phosphate as a key ingredient, which added to potassium nitrate and fluoride, not only reduces sensitivity but also delivers enamel protection and helps improve tooth luster.

I Use That: Philips Zoom Take Home

	There are many ways that technology helps push dental practices forward, and the fact is that patients expect dental offices to be up to date on technology. Dentistry is no longer a service; it’s a commodity. People now view themselves as both a patient and consumer, and they’re shopping around.

	“It is a must to use new technology to stay competitive,” says Peter Yang, DDS. “Patients are expecting dental offices to have digital technology nowadays.”

	Digital technology is key for a successful dental practice. To grow, it is essential to have both decent case acceptance as well as a solid influx of new patients. Without certain systems, it’s impossible to ensure either. The impact of digital dentistry on practice management and patient education (through tools such as intraoral imaging and digital X-rays, in particular) is spectacular.

Trending article: 25 ways practice management software can save you money

	Practice management systems are crucial to the health of a dental practice. They help automate time-consuming tasks so that both the clinical and front office teams can focus on face-to-face interactions with patients.

Scheduling, patient communication and accounting are all automated in practice management software, such as DentiMax’s Practice Management Software. Because appointment reminders and confirmations are automated and easy, fewer scheduling mishaps reportedly happen and the books are filled with patients who can actually make their appointments.

	Patients can even store personal and financial information, such as IDs, insurance cards, signatures and other documents, securely in the practice’s server. They can be accessed online from anywhere, which means the dentist can go above and beyond and put in less effort. Have an after-hours call with a patient? His or her health records are available from any computer. Need to issue a prescription from out of town? Do so online.

	It also helps patients view the dental practice in a more positive light. Patients are now hyper critical of any experience they pay for (or get for free - there are reviews of public parks on Yelp). The dental office is not excluded.

	It takes around one minute to size up a dental office. Patients will look at the staff, technology and general office esthetic and use that information to judge the dentist’s clinical skills. They will decide in minutes whether to accept proposed treatment plans, come back for a hygiene appointment or make referrals, so it is critical to have up-to-date technology and decor. The entire office must convey quality.

	Practice management systems also allow for secure data backups, which means that any practice connected can be up and running after an emergency. With a major portion of the business side covered, focusing on patient care is easier.

	Dr. Yang uses DentiMax’s Practice Management Software to operate his dental practice on a daily basis.

	“It’s the heart and soul of how I run my busy office,” he says. “DentiMax has allowed me to see more patients and deliver better care.”

Related reading: 12 questions to ask before investing in new practice management software 

	Because the software helps Dr. Yang be efficient and productive, the effect on patients is that more are seen and they are receiving the best possible care from Dr. Yang. A comprehensive practice management system also influences patient education, a lack of which can lead to a fear of the dentist, substandard oral health habits and denial of treatment plans. Dentists know that dictating the importance of certain steps or procedures isn’t enough for many patients. That’s why it’s imperative to have high-quality digital images that the patient can view immediately after having them taken.

	Digital sensors are much more comfortable for patients. DentiMax Dream Sensors are built from the latest technology, offering high-quality digital X-ray images and compatibility with hardware and software. They come in two sizes to comfortably reach a broader patient range. View DentiMax digital X-rays from any practice management software, thanks to the open system, or capture images from virtually any digital panoramic X-ray machine, intraoral camera or flatbed scanner, and see the images right away within the DentiMax software.

	Having images so easily accessible is a major benefit in diagnosis and treatment planning, and it also aids in patient education. Finally, they can see what you see.

	Modern technology also offers patients the opportunity to access resources from their own homes. They can then learn more about their health and proposed treatment on their own time, ensuring that they have opportunities to make educated, confident decisions about their health.

	Increased patient education and comfort leads to happier, more trusting patients, and more trusting patients are more inclined to accept treatment plans.

More from the author: 4 simple systems to get your office in tip-top shape

	Although DentiMax Practice Management Software has several functionalities that other practice management systems don’t have, one of its benefits really stands above all the rest.

	“Everyone in my office likes how easy it is to use,” says Dr. Yang. “It has all the essential components of a dental management software but is not as confusing as the other brands. My staff can teach a new employee how to use DentiMax in less than a day.”

	It is easy for your team to learn the software as well, with onsite and online training. Just choose the option that works best for your practice.

	Technology is here to make life easier, not more complicated. As every aspect of the dental practice is affected, take advantage of the capabilities. Spend less time waiting and completing repetitive tasks and more time being face-to-face with your patients.

The DentiMax Practice Management Software is pushing dental practices forward.

Why practice management systems are crucial

	The drawbacks of traditional, analog dentures are well known: They take a long time to make and require multiple appointments, raising your overhead. They’re prone to errors in the fabrication process and they’re inconvenient to patients. On top of all of that, they’re not even profitable for general dentists.

	“In the U.S., it costs about $5 a minute to run a practice,” says Stephen Wagner, DDS, whose primary clinical investigative interests center around work simplification in removable and maxillofacial prosthodontics. “That’s an expensive overhead, and the 1950s denture technique accumulates a lot of chair time. Many dentists can’t afford to make dentures in their competitive market. The question on a lot of our minds was, “How do we shorten the denture-making technique but improve the final product?’”  

	A few innovative clinicians knew the technology of digital dentistry had to impact dentures sooner or later. Many began dreaming up a simpler solution.  

	Charles Goodacre, DDS, MSD, distinguished professor and previous dean at Loma Linda University School of Dentistry, imagined back in 1995 that digital files could be used in place of plaster molds to fabricate dentures. He developed an impression technique that would obtain the clinical data necessary for making a denture in just one appointment. Stephen M. Schmitt, DDS, milled early concept CAD/CAM dentures in accordance with Dr. Goodacre’s technique.

	It has taken a while for digital dentures to enter the market. After a few attempts by individuals and dental companies, digital dentures have finally become a reality-although they are still in their infancy.
	The digital workflow tackles the issues plaguing the traditional denture process by eliminating some of the back and forth between dental offices and laboratories. Adding digital steps to the traditional workflow alone drops the number of patient visits by about half.

	Since 2007, at least six different companies have applied CAD/CAM technology to denture fabrication. In 2007, Tae Hyung Kim, DDS, a chairman of removable prosthodontics in the Division of Restorative Science, Ostrow School of Dentistry, USC, joined six other dentists to come up with the concept behind DENTCA digital dentures. A patent was filed on the technology in 2009 and the dentures were on the market in 2012.

	The AvaDent Digital Denture was created in 2011 by Global Dental Science and became available for use in 2015. That spring, both the Wieland Digital Denture from Ivoclar Vivadent and the PALA Digital Denture System from Heraeus Kulzer entered the market. Canadian company Perfit Dental Solutions introduced their digital denture in 2017. And finally, Glidewell Labs has a “digital spin” on a traditional denture.

	Companies are also creating denture design modules as add-ons in their CAD software. At this point, the software offers the ability to print or mill digital dentures. Examples include 3Shape Dental System 2015 Denture Design and Dental Wings DWOS Full Dentures. Exocad is also launching a denture module for their DentalCAD software.
	DENTCA, Wieland and PALA all allow impressions and bite registries to be taken in one step with their proprietary impression trays. That information is then transferred to design software. AvaDent also offers their own impression techniques, though they can use the clinical data from any impression system, so long as these six key values are defined, including the vertical dimension and the incisal point.

	(It’s helpful to point out here that some-though not all-of the experts interviewed in this article have an affiliation with AvaDent. Therefore, many of the examples of the digital denture workflow will be based on that technology.)

	Impressions can then be scanned and turned into a digital file to send to the milling facility, or they can be physically mailed in. Once the digital files are created, a virtual 3D image of the denture is available to the dentist for tweaking. They can either print or mill a try-in, or they can go straight to the final prosthesis. The total number of appointments for digital dentures can be as few as two (or three with a try-in).

	Glidewell’s process looks more traditional, while Perfit’s looks a bit different than how it’s been done. That digital “spin” Glidewell references is the ability to scan a stone model into the design software. Compared to the other digital systems above, that requires an extra step beyond the traditional impression. It’s done by the laboratory once they’ve received the initial impression (as opposed to receiving a digital file). Perfit is unique in that it relies on a 3D intraoral scan for the clinical data.

	“Most of the digital dentures are traditional dentures with digital workflows,” says Dr. Wagner, who argues that the AvaDent denture is the only true digital denture available. “There are two components to the digital denture workflow: the final product and digitally augmented clinical steps.”

	“For the last three years, denture fabrication has become exclusively digital,” says Stephen F. Balshi, MBE, president of CM Prosthetics laboratory. “Prior to that, some were digital and some were traditional, depending on the patient circumstances.”

	Up next: Advantages of digital dentures ...

	Stephen Balshi started working with AvaDent shortly before the introduction of their digital denture. He was impressed with their work in dental implants and dental implant prostheses and now appreciates the shorter workflow and consistent quality esthetics.

	“The dentist makes the clinical records and fills out a prescription to me in the lab, and I digitize those records and submit them to AvaDent for digital design,” he says. “In the lab, I can modify the design. I send the link to the dentist for review, and once it’s approved, I authorize AvaDent to mill it on my behalf. Most of the time, the denture can be delivered in two visits.”

	“We no longer have to do the try-ins because we know what the arrangement can be on the computer,” says Thomas J. Balshi, DDS, PhD, FACP, co-author of “A Patient’s Guide to Dental Implants” and contributing author to “Dental Implants: The Art and Science (2nd ed.)” and “Zygomatic Implants: The Anatomy-Guided Approach.” (Stephen Balshi is Dr. Balshi’s son.)

	“The master impression can be made during the first visit. If they’re wearing a traditional denture and they need a new one, we can simply take a wash impression in the patient’s denture and scan it while they’re waiting. If you have to send something out, you can make a duplicate denture and take the master impression and the occlusal registration and send that off to the lab for scanning.”

	“It allows us to provide a denture to a person in two to three appointments instead of the typical five,” Dr. Goodacre says. “Besides the obvious convenience of it for patients, you can create more cost-effective dentures.”
	Digital dentures leave room for the traditional process as well. A dentist can go digital after the initial impression, or they can choose to keep the traditional workflow, adding in the digital aspect by designing and milling the final prosthesis from the digital software.

	“They want to make sure dentists were comfortable doing it either way,” Dr. Wagner says. “Maybe a dentist doesn’t want to use our technique: they’re comfortable with the old method and five appointments doesn’t bother them. They can still end up with a superior digital denture, but they could also avail themselves of these newer time-saving techniques.”

	A fully digital process would start with an intraoral scan of hard and soft tissue. However, because the perfect fit depends on accurately measuring the soft tissue of the mouth, that process would be ineffective.

	“Every time you put the wand inside someone’s mouth, you’re moving soft tissue and everything is changing,” Stephen Balshi says. “It would be nice to find a way to remove functional impressions, whether that’s with an MRI or some scan we don’t know about yet. But for now, it’s extremely accurate and we get tremendous results.”
	The technology isn’t available yet that would facilitate an entirely digital denture process. But things are progressing rapidly.

	Read more: Why companies are offering a digital try-in ...

	All of the digital denture companies offer a try-in, but whether that’s for the benefit of the patient or the dentist is uncertain. AvaDent claims that defining those six values is the “holy grail” that produces a perfect denture the first time, but many dentists still find a try-in reassuring, at least at the beginning.

	“Originally, most digital dentures were advertising themselves as a two-appointment technique,” Dr. Wagner says. “But there was a component missing: trying the teeth in to make sure everything is correct.”

	“There’s a learning curve for both practitioners and technicians,” Stephen Balshi says. “It’s natural for a first-time user of any technology to want to do a try-in. Being able to conceptualize virtually compared to what they see clinically is a big leap.”

	Foreseeing that difficulty, Dr. Goodacre created a prototype CAD program for dental students in 2009. The 3D Tooth Arrangement Program was used in 2010 at Loma Linda University School of Dentistry “to teach students how to arrange teeth virtually before performing the actual laboratory procedure.”

	“The only downside [to using digital dentures] is making a change and being able to visualize the final denture,” Dr. Goodacre says. “It’s certainly doable, and for the younger generation, it’s an easy step for them. Adaptable dentists might make two to three dentures and then be perfectly comfortable. It’s pretty easy to sort out, generally speaking.”
	After the first time, the number of dentists who choose to do a try-in for a new denture seems to decrease.

	“I would put the denture in the patient’s mouth and sit down with a handpiece getting ready to adjust the bite,” Dr. Balshi notes. “It took me a while to look in there and think, ‘Whoa, if I adjust this, I’m only going to make it worse because this is as good as it gets.’”

	But there are still plenty of situations in which a denture try-in is still essential.

	“Occasionally we do a try-in when we’re making a significant change or a first-time denture,” Dr. Balshi says. “Unlike a wax try-in that produces the esthetic appearance, these are functional try-ins. The patient could wear it home to test it out.”

	“Another type of try-in allows the practitioner to move the teeth around in a thermoplastic resin,” Stephen Balshi observes. “It’s a little more traditional in that teeth can be moved around because it’s temperature sensitive. It’s not a fully functional try-in; it’s more of an esthetic try-in.”

	Two or three appointments is the norm so far, but Dr. Wagner had been utilizing a faster approach long before he teamed up with AvaDent.

	“As a maxillofacial prosthodontist, I’d been doing a three-appointment denture in my practice for years,” he says. “I did that in two ways: one was to develop a new way of making impressions that eliminated that preliminary impression and custom tray. Then I developed techniques where I could pre-set most of the teeth prior to trying them in the patient’s mouth. When I saw that AvaDent was making a digital denture, I approached them and said the two-appointment technique wasn’t viable, because there were too many potential errors.”

	DENTCA, AvaDent, Wieland and PALA use CAD/CAM technology to mill final dentures, although the prototypes used for try-ins can be printed, since they’re not intended for long-term use. (Available printing materials aren’t yet strong enough for daily denture wear.) Ultimately, the final prostheses are milled before adding the denture teeth.

	The AvaDent denture is unique in this matter. It is milled from one piece of material, making it kind of a monolithic mystery.

	“I recently gave a talk and was trying to demonstrate the differences between two AvaDent dentures: one that was made with AvaDent’s traditional technique of milling from the same material, and one in which the teeth were milled separately,” Dr. Wagner says. “I couldn’t tell them apart, almost to my embarrassment.”

	The monolithic process is said to make it both more esthetically pleasing and hygienic.

	“Traditionally, denture resin is squeezed and compressed under a couple of hundred pounds,” Dr. Wagner explains. “AvaDent puts the resin under 40,000 pounds of pressure. It is denser and much less permeable to bacteria, making it more biocompatible.”

	While most companies use CAD/CAM, AvaDent offers computer-aided engineering (CAE) to produce dentures in a digital workflow. “Think of it as CAE being the brains to CAD/CAM’s brawn,” the company writes on their website.

	“The AvaDent line can also be used for final prostheses for implant patients,” Dr. Balshi notes. “You can have a fully milled titanium framework with a monolithic denture or an Accelerset Prosthesis: The first section is pink resin for the gingiva, the second is a block of titanium to fit on the implant and support the gingiva, and the third is a block of ceramic material for crowns, which will be milled onto the framework. All three are milled at the same time off the same file system for that individual patient.”

Exploring the ways that technology is changing one of the oldest dental workflows.