Renee Knight is a freelance writer and editor who's been covering the dental industry for 15 years. 

Renee Knight

	When Dr. Kayvon Javid first invested in the Waterlase Express hard and soft tissue laser from BIOLASE two years ago, he planned to use the technology to perform minimally invasive gum surgeries. He wanted to keep more periodontal services in-house and to expand that portion of his general practice. 

	“I had several perio patients I would refer out of the practice,” Dr. Javid says. “I started thinking, there’s a source of income we’re not capitalizing on.” 

	Incorporating the Waterlase Express into his California-based practices has changed that, but it’s also brought many other benefits. He’s able to use the laser for a variety of restorative procedures as well, giving him the ability to offer patients a much more comfortable experience during their visit. 

	“I have three offices and have a Waterlase in every one,” he says. “We use it throughout the day for many procedures, whether it’s a small cavity or gum surgery. If I don’t have it for a day, I feel handicapped. It’s an integral part of my practice.”  

	Not only can Dr. Javid use the laser for a variety of procedures, such as crown lengthening and frenectomies, but it’s also portable, making it easy for him to move it between operatories and even from office to office. The high-quality hard and soft tissue laser is also one of the most affordable options on the market, so it was the no-brainer choice when he was looking to add a laser to his practice. 

	Waterlase Express is also a great marketing tool, Dr. Javid says. He can perform procedures he wasn’t able to before with minimal bleeding and minimal discomfort for his patients, which is a huge selling point for the practice. 

	“People like to see technology,” he says. “We can do fillings without numbing the patient. We can do small treatments like frenectomies without numbing the patient. It’s great to be able to tell our patients we have the latest technology and we don’t have to use any anesthetic for most procedures.” 

	With the Waterless Express, Dr. Javid can now perform procedures that were once very painful for patients in a more minimally invasive way. For example, there’s no longer a need to use a blade to remove excess tissue and then place sutures during gum surgery. 

	“Patients can’t eat or function for a week or two after traditional gum surgery,” Dr. Javid says. “With lasers, you can tell patients they can go back to normal immediately. There is no major discomfort or pain. They can go about brushing and flossing their teeth immediately after treatment.”

	The fact he can complete fillings without a handpiece is also a huge benefit, he says. A lot of patients don’t like the noise that comes from a handpiece, and some patients even fear it. While lasers make some noise, they are much quieter and more calming for nervous patients. 

	Overall, Dr. Javid’s patients love the technology and the fact he can perform more procedures in-house. Using the laser cuts the healing time in half for most procedures, and only causes patients minimal discomfort. 

	“People are amazed I’m cutting into their mouths and there’s no blood,” he says. 

	Dr. Javid can now offer services he wasn’t able to offer before, which has helped him grow his practices. Not only is he able to give his patients more treatment options, but he’s also able to provide them in the most conservative way possible. 

	“My patients come to me because they trust me, and I want to give them the best treatment possible,” Dr. Javid says. “And the best treatment is not always how it’s been done traditionally. If there’s a new technology that I have to invest in to give my patients the best outcome and the best experience, it’s not only the right thing to do, it’s a way of promoting my practice. Patients will walk out of my office and tell their friends and family about the experience they had, that they had a filling done and the dentist didn’t use a drill or any anesthetic.”

	Waterlase Express has the smallest footprint ever for an all-tissue laser, and it works well as a countertop unit. Moving the laser from operatory to operatory or even office to office can become a reality with optional carts and travel accessories. Waterlase Express is described as the only laser to feature in-depth, step-by-step, 4K HD animations for every clinical procedure on board. The Waterlase Express animation library is an informative training resource that will serve as a great foundation for you.

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Closer Look: More applications and more patient comfort

	Dr. Paul Kelley has a long history with Apex Dental Materials products. He started using the company’s first bonding system, Simplicity, in 2005 and was thrilled with the results-especially compared to other systems he’s used throughout his more than 30-year career. So when Apex introduced the Surpass self-etch bonding system , he just had to give it a try. 

	He still uses both systems, but said the biggest difference is the stronger bond strengths Surpass offers. It also comes as a three-part system (conditioner, primer and resin) instead of Simplicity’s two. The conditioner etches both the enamel and dentin in a unique way that prevents post-operative sensitivity. The primer then penetrates the dentinal tubules, while the bonding resin links the primed surface to all self-cure, dual-cure and light-cure restorative materials. 

	“With Surpass, if you follow the instructions you’re going to get a good bond,” he says. “You can’t screw it up. Other products I’ve used are much more technique sensitive, and if you don’t use them exactly right, it’s not going to work. That’s what drew me to Simplicity and then to Surpass.” 

	Most bonding agents require you to first etch the entire tooth, dry it and then re-wet it, Dr. Kelley says. If you don’t complete this step just right, the bond won’t last. The bond might work while patients are still in the chair, but it won’t give them the long-term results they’re after. That isn’t a worry with Surpass or Simplicity, as neither require re-wetting. 

	“This is critical to bond strength to the dentin and critical to the next step, which is when you put the bonding agent on so it actually adheres to the tooth structure,” Dr. Kelley says. “Surpass is a fail-safe system where you can’t dry it too much or wet it too much. With other products if you don’t do this exactly right the bond is going to fail.”

	Because Surpass eliminates the re-wetting of the tooth preparation, Dr. Kelley is able to give patients more predictable outcomes. He knows the bond will not only work that day, it won’t fall apart three or four years later.  It also provides no post-operative sensitivity for patients like other adhesive systems do. Because Surpass is a no-rinse system there is no need to dry between the etch and prime stage which can lead to sensitivity.

	“Patients get a restoration that is bonded to the tooth,” he says. “They get a better bonded filling that adheres to the tooth structure, which is what every dentist and every patient wants.”

	A one-bottle adhesive may be attractive to some dentists, Dr. Kelley says. He finds these solutions just don’t work as well, and while Surpass may require more brushes and perhaps more material, the results are worth it.

	“It doesn’t cost more and it might take 35 seconds to apply the bonding material,” Dr. Kelley says. “But you know you’re getting a good bond and the patient is getting a better restoration.”

	Surpass actually takes less time than most single bottle protocols, according to Apex. So not only does it save you time not having to redo the restoration, the initial protocol is only 35 seconds and can be less time than the initial protocol with some leading one-bottle systems.

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	Dr. Kelley often hears about young dentists having trouble with one-bottle bonding agents. Patients will call the day after the procedure because they’re in pain. The reason? The bond wasn’t completed correctly, which means the restoration must be re-done, costing more time and more money.

	“I haven’t had to re-do any composite restorations because of bond failure since 2005. It just doesn’t happen,” he says. “Dentists get in a hurry and want to complete bonding in five seconds and then move on. If you do that it will come back to haunt you later.”  

	Dr. Kelley likes the fact that the company behind Surpass is owned by a dentist who’s involved in product development. It’s a small business so he can talk to the chemist who developed the product or the dentist who started the company. 

	“I can call in and say I have this clinical situation and they can tell me exactly what to do,” he says. “You can’t get that from any other company. It’s just not possible. That’s another reason I like using this product. I really think it’s the best bonding system out there.” 

Delivering stronger bond strengths

	After using TheraCal LC calcium silicate pulp liner for a few years and having great success, Dr. Ted Croll wanted to know if it could work as a primary tooth pulpotomy filling material as well.

	A BISCO scientist told him that while it wasn’t indicated for that procedure, the company was developing a related material for exactly that purpose. That turned out to be TheraCal PT™.

	Dr. Croll eagerly anticipated the release of the “PT version” and has been using the biocompatible, dual-cured, resin-modified calcium silicate pulp filler for his pediatric patients for about six months. He’s had excellent results with the few dozen cases he’s completed, and that’s a trend he expects to continue.

	“TheraCal PT delivers calcium, which is very kind to the pulp,” Dr. Croll says. “BISCO has made delivery of the material extremely convenient. The hardened filler doesn’t break down because the resin component of the material stays solid and continues to deliver calcium. It’s unlike any other material I’ve ever used.”

Trending article: Why dentists should take a fresh look at new restorative innovations

	TheraCal PT makes pulpotomies much easier and quicker to complete than the zinc oxide/eugenol mixture, or the mineral trioxide aggregate (MTA) materials dentists have been using for years, Dr. Croll says. The fact that it’s light cured gives clinicians an immediate light-hardening of the material in addition to a chemical setting reaction. If the tooth is to receive full coronal coverage, such as with a preformed stainless steel or zirconia crown, there’s no need to place another material on top of the liner, which is a time saver.

	“A chief problem with this procedure has always been the timing of treatment,” Dr. Croll says. “Once this material is placed in the pulp chamber after hemostasis is achieved, hardening of the material is immediate as the light beam is applied. The opacity of the material might make practitioners question whether there’s hardening of the material deep within the chamber, but the chemical cure obviates that concern. In the same way a dual-cured resin-based composite makes for sure through-and-through material setting, TheraCal PT rapidly and conveniently ensures optimal pulp chamber fill.”

	All told, using TheraCal PT routinely cuts procedure time by five to 10 minutes, Dr. Croll says, sometimes more.

More from BISCO: Creating predictable restorations with Pro-V C&B

	The packaging also gives TheraCal PT an advantage over other pulpotomy filling options on the market, Dr. Croll says. The double-barreled delivery system and injection/mix- ing mechanism eliminates the need to squeeze the material out onto a pad, mix it together and then put it back in a syringe tip, which saves clinicians even more time.

	And because the procedure doesn’t take as long as it once did, Dr. Croll’s young patients are out of the chair faster-and that’s a benefit for the practice as well as the patients “Those little mouths get tired

	of opening and kids get wiggly,” Dr. Croll says. “TheraCal PT just makes the pulpotomy procedure easier, faster, and better for the patient, the dental assistant and the dentist.”

Product roundup: How to provide better results with bulk fill materials

	Even though TheraCal PT hasn’t been on the market that long, Dr. Croll knows BISCO has done the research necessary to ensure it will hold up over time. In fact, he says using this material to protect the dental pulpal complex could become the standard of care for primary molars.

	“The results over the first six months have been excellent, but of course clinicians want to know how their pulpotomies will perform three to five years down the road,” Dr. Croll says.

	“That’s a big concern. If you do a pulpotomy for a primary molar in a 3-year-old, it may even need to last seven or eight years, the usual exfoliation time. Primary second molars may need to last longer than that. BISCO scientists are attuned to that clinical challenge and their research is geared to ensure long term success of TheraCal PT pulpotomies. The TheraCal PT formula is based on the same chemistry as TheraCal LC, which has proven to be a most durable and reliable lining material. I believe there is enough clinical experience and science behind the new material to use it with confidence.”

The benefits TheraCal PT, a resin-modified calcium silicate material, has brought to one dentist’s practice. 

Efficiently getting calcium to the pulp

	Even when dentists decide they want to switch to a digital workflow, many are hesitant to purchase the technology necessary to make it happen. They’re worried the equipment they invest in today won’t be relevant tomorrow, so they continue to wait for just the right time and just the right piece of technology before making the move.

	While dental technology is constantly evolving, nothing you purchase for your practice is going to become obsolete any time soon, says Lee Culp, CDT, of Sculpture Studios. Sure, the scanner model that comes out a year or two from now might have a few more features than the one you bought last week, but your scanner will still be able to do the job you bought it to do. 

	“There will always be new technology with more bells and whistles, but that doesn’t stop your ROI,” Culp says. “The model three years from now may be 30 seconds faster, but that doesn’t make yours obsolete. It just means it’s older. It’s not obsolete until the manufacturer stops making and supporting it.”

More from the author: Building a digital workflow one step at a time

	Of course, you still want to make sure the technology you purchase can grow with your practice and help you to create the digital workflow you’ve envisioned. Futureproofing your digital investment will help to ensure that happens. Here’s how.

	Purchase the technology from a reputable company

	Whether you’re investing in a scanner, a mill, a 3D printer or other supporting equipment, it’s important to work with a company that has a proven track record, says Dr. John Flucke, chief development officer for Cellerant Consulting and chief dental editor and technology editor for Dental Products Report. You don’t want to end up with equipment that isn’t upgradeable because the company you bought it from no longer exists. Find a manufacturer you’re confident will be around five years down the road and will be able to provide you with the support you need to successfully integrate the equipment into your practice.

	You also should consider the company’s data plan, says Dr. Chad Duplantis of Fossil Creek Dental Partners. Find out how much the plan costs and if it includes support and hardware upgrades. Ask about warranties and how much down time you can expect if you ever have issues with the system.

	“Once you start using the technology, you won’t want to live without it,” Dr. Duplantis says. “Having to pay for service that can take weeks is really frustrating and a huge impediment in the efficiency of your office.”

	Make sure the technology you invest in is upgradeable and will work with any equipment you plan to add to the mix in the future, Dr. Duplantis says. You should be able to build upon the technologies. So, if you start with a scanner, get software that makes it possible to communicate with the other technologies that might become part of your practice in the future, such as cone beam CTs, mills and 3D printers.

	“If you’re not going to do in-house milling today but think you might want to in the next three to five years if all goes well, you have to plan for that when setting everything up,” Dr. Flucke says. “Look at what will interface with a mill and what software powers everything.”

Related reading: From digital to reality: The gear you need to complete your digital workflow

The right software is intrinsic to the process, Dr. Flucke says, so you should think about investing in software that not only works with all the different types of digital technology you plan to have in your practice someday but that’s also easy to use.

	“If the software is buggy or hard to figure out, it can be a point of failure in the whole process,” Dr. Flucke says. “If you get a system and the software is really complicated and one of your team members jumps in, gets the training and gets really good at it and then has to leave the practice, you have nobody else who knows how to do it. That’s a huge investment in resources you can’t use now. Having software that’s easy to use and easy to teach people how to use is really important.”

	Dr. Flucke suggests playing with different software solutions in your office before making a decision. That way, you’ll truly get a feel for how it will work in your practice.

	Purchasing technology isn’t a one-time deal; you’ll have to make upgrades at some point, Dr. Flucke says. That doesn’t necessarily mean buying an entire new piece of equipment. If you want your equipment to last, you need to make the appropriate upgrades as it ages. 

	“You have to keep the technology current and working properly,” Dr. Flucke says. “That might mean upgrading to the latest software release or the latest camera. If you upgrade a little at a time, it might add up to the same amount of money, but it doesn’t equal the same amount of pain. You spend a little here and a little there so you don’t have to do it all at once when things start breaking down.”

	Make a commitment to using the technology

	Any equipment you invest in won’t do you much good now or in the future if you don’t actually use it. There will be a learning curve, Culp says, but you can’t give up when things get difficult. You must be patient and understand this won’t be a perfect transition. When you run into problems (which you will), figure out what’s causing the issues and how you can work around them. That’s where customer support comes in; a good manufacturer will help you to problem solve so that you start reaping the benefits the technology offers as soon as possible.

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	“It’s a big commitment to change from analogue to digital,” Culp says. “There’s really no bad equipment or software. It’s just commitment and a cultural change.”

	If you want technology to change your practice for the better, you really need to have your team on board, Dr. Duplantis says.

	“Staff can make or break you,” he says. “If you choose technology that’s not properly presented to your staff and your staff never gets on board with it entirely, it could end up being a huge failure in your practice. It’s important your staff understands why you’re bringing the technology into the office. That comes from proper training.”

	Dr. Flucke agrees and says it’s important to get the team involved from the beginning. If your staff members think the investment is a good idea, they’ll be excited about the changes the technology brings rather than resistant to them. Even though it may be difficult at first, they’ll be more likely to stick with it. They’ll take ownership and actually want to use the technology, helping to drive its success.

	Before purchasing new technologies, take some time to research what’s available and decide what you want to offer in your practice. Talk to colleagues already using the equipment you’re interested in and find out what they like and don’t like about it. Ask them about their successes and failures and why they chose that specific product over another. Get as much information as you can and learn from their experience.

	Social media, tradeshows and dental journals are other places you can turn to learn about the different products available, Dr. Duplantis says. He also suggests trying out technologies in your practice before making a large purchase. You want the technology to last, so it’s important to get this purchase right. 

	“Don’t just settle on one,” he says. “Bring in a few different types of technologies and see how they work in your hands. What works for someone else might not work for you. You need to research the equipment’s capabilities and the type of results it’s producing.”

	Technology that grows with your practice

	Many dentists wait to invest in technologies that make a digital workflow possible because they’re afraid a newer, better version will come out as soon as they do. While there always will be newer models on the horizon whether you’re talking about scanners, mills, 3D printers or other various technologies, that shouldn’t keep you from reaping the many benefits a digital workflow provides. Think about the type of services you want to offer in the future, and then take the steps necessary to help get you there.

	“My best advice would be to have a vision and to plan for the long-term,” Dr. Flucke says. “Try to think about what would interest you down the road.”

How to ensure the technology you invest in grows with your practice. 


Futureproofing your digital investment

	Once you’ve decided to take your practice digital, the first step is to invest in a scanner. A mill and/or a printer may come next depending on the vision you have for your practice and the services you plan to offer your patients.

	A mill will give you the ability to provide same-day permanent restorations, while a 3D printer will make it possible to create products like clear aligners, models and surgical guides in-house. These are the big technologies everyone thinks of when talking about going digital, but the investments you’ll need to make don’t end there. You also have to think about what other products you’ll need to purchase to complete your digital workflow.

	Here’s a look at some of those products to get you thinking about all the pieces you’ll need to be successful.

	Good software is one of the most important elements of a digital workflow, says Dr. Chad Duplantis of Fossil Creek Dental Partners. You need to make sure the software you have is specific to the technology in your office. Let’s say you invested in a scanner and have plans to add a mill down the road. Both pieces of equipment likely come with their own software, but it’s important to make sure they’re compatible with each other.

	It’s also important that your scanner and 3D printer can communicate, Dr. Duplantis says. The 3D printer software needs to be able to interpret scans and turn them into a 3D printable format.

Related reading: How to invest in the right technology for your practice

	If the software that comes with the systems you choose isn’t compatible, you can invest in third-party software to bridge it all together, Dr. Duplantis explains.

	Having a mill in-house won’t do you much good if you don’t have enough materials in stock to mill the appropriate restorations for every patient you treat.

	“Make sure you have an inventory of the various materials your mill is capable of milling to provide good, long-lasting restorations to your patients,” Dr. Duplantis says. “This does require an additional cost in inventory that some dentists don’t take into account.”

If you want to go completely digital from start to finish, you’re going to need a porcelain oven, says Dr. John Flucke, chief development officer for Cellerant Consulting Group and chief dental editor and technology editor for Dental Products Report. That’s because after being milled, some materials must undergo an additional firing or crystallization process in a ceramic oven.

	“If dentists want to use ceramic and zirconia, they need a scanner, a mill, a sintering oven and a regular oven, and then appropriate stains to finish it out with,” says Lee Culp, CDT, of Sculpture Studios.

	You’ll want to invest in an oven that’s advanced enough to handle the materials you plan to mill, Dr. Duplantis says. He prefers a programmable oven that has the various preset firing times to ensure the restoration is crystalized to the extent required. 

	Mill manufacturers often sell ovens as part of a kit, Dr. Flucke adds.

	You’ll want to use stains and glazes after the milling cycle, Dr. Duplantis says, so that you can characterize the restoration.

	Before restorations are placed, they’ll need to be polished-meaning you’ll need to have the appropriate tools on hand, Dr. Duplantis says.

	“You want a really good all-around polishing and finishing kit,” he says.

	There are polishers available for every material, but Dr. Flucke recommends purchasing a kit that will polish everything.

	“I don’t see any reason to have a separate kit for zirconia and e.max,” he says. “Once you get in the trenches and your day goes crazy, you will forget what goes with what and polishers will end up in the wrong containers. It’s easier to get a system that does it all so you don’t have to worry about it.”

	The thought of glazing, staining and polishing might turn off some dentists, but Dr. Flucke says some of this work can be delegated to team members who enjoy the artistic part of dentistry if you don’t.

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	“The doctor doesn’t necessarily need to do all this stuff,” he says. “If you have good preps that create good cosmetic crowns that fit really well, you can turn over the finishing to a team member who can make the restorations look phenomenal. To some team members, being able to do that is the best thing in the world.”

	Many curing lights on the market only cure common materials, Dr. Flucke says. Some materials require a different wavelength, which is why he recommends investing in a broadband light that can cure everything.

	If you opt to purchase a 3D printer, you’ll need a washing station to clean off the resin from the printing plate, Dr. Duplantis says. Some printers come with a station, but if not, it’s something you’ll have to buy separately. 

	You’ll also need the appropriate resins for the products you’re going to fabricate with your printer and know how to mix them, Culp says. Some have to be mixed in a separate device, for example.

	While investing in the right products is important to a smooth transition to a digital workflow, so is making sure your office is ready to handle the new technology, Dr. Duplantis says. For example, some mills require additional air or water, which means you may need a plumber to come in and add lines to go through the mill.

	“You need to make sure your office is equipped to take on the technology,” he says. “It’s usually not a huge upfront cost, but you want to ask all the appropriate questions before incorporating a mill or a printer into your office.”

	Training is also important, Dr. Flucke says. Making sure both you and your team members are comfortable using these technologies and the products that support them is key to a seamless transition.

	Converting to a digital workflow is an exciting time for a dental practice. Technologies such as scanners, mills and 3D printers help to improve efficiencies, enhance the patient experience and give you the ability to offer same-day dentistry. But, you’ll need other products to truly complete your digital workflow, and knowing what you need to invest in will help make your move to the digital world a smooth one.

The equipment and instruments you should consider investing in beyond a mill and a printer. 

From digital to reality: The gear you need to complete your digital workflow

	Before investing in a scanner, it’s important for dentists to understand what they can actually produce with the technology and how. Some clinicians might opt to send the digital impressions to a lab so that a technician can create the restorations like before, just with more accurate information that yields better results. Others might prefer to keep the work in-house, which requires investing in more technology, such as a mill or a 3D printer, depending on what they want to fabricate.

	“Some dentists invest in scanners to make impression taking easier on their patients and to improve the quality of the restorations. If you don’t want to go beyond that, you don’t have to,” says 

, chief development officer for Cellerant Consulting and chief dental editor and technology editor for Dental Products Report. “But, if you’re a gadget lover, you might want to get into the same-day aspect of this. You can be a same-day single-unit crown office and send the more complicated cases to the lab. The nice thing about it is the flexibility. Once the impressions are digital, they’re just electrons. How you choose to use them is totally up to you.”

	Before investing in other digital technologies, Dr. Flucke suggests taking the time to become comfortable using the scanner and the new workflow it requires. It’s important to remember you don’t have to purchase everything at the same time; that will just overwhelm both you and your team members, not to mention strain your budget. He suggests continuing to send all your cases to your trusted lab technician-who should be able to produce just about any restoration with the files-until you get really good at using the scanner. Then, you can focus on adding other technologies to your practice.

	Once you decide it’s time to expand your digital workflow, how do you know if a mill or 3D printer is best for your practice (or both)? It comes down to understanding what you can produce with each machine.

Because they’re all open source now, any mill can read the STL files from a scanner, Dr. Flucke says. You just need to select a machine that best meets your needs. There are two types: wet mills and dry mills. Dry mills cut materials with dry tools, while wet mills use water. There are also machines that offer both wet and dry milling capabilities. If you want to offer same-day crown and bridges, the wet mill is the best option, Dr. Flucke says.

	When selecting a mill, it’s important to think about the type of materials you plan to use. Wet mills can mill just about any material, says Dr. Chad Duplantis of Fossil Creek Dental Partners, including lithium disilicate, glass ceramic and composite resin. Dry mills can fabricate dry materials like zirconia, making them well-suited for larger cases such as full-mouth restorations. Regardless of the mill you choose, you’ll also need to invest in an oven for crystallization and staining and glazing materials for after the milling cycle.

	If you add a mill to your practice, it’s important to keep up with the necessary ongoing maintenance, says Lee Culp, CDT, of Sculpture Studios. This is especially important for wet units, as the liquid can get gummy inside the mill and lead to problems. Look for systems that are easy to clean and then follow the directions for maintenance.

	3D printers continue to become more advanced and can now print a variety of materials from PMMA to zirconia, but their capabilities are different than mills when it comes to what they can produce, Dr. Duplantis says. If you want to fabricate multiple-unit indirect permanent restorations ,you need a mill (printers can produce temporaries but not permanent restorations yet). If you’re interested in producing clear aligners, custom trays, models, surgical guides, or occlusal guards, then a printer is what you’re looking for.

	There are three main types of 3D printers: Stereolithography (SLA), Digital Light Processing (DLP) and Fused Deposition Modeling (FDM). The biggest difference in these printers is the resolution they provide, with FDMs having the lowest and DLP the highest. Cost “is all over the board” for these printers, Dr. Duplantis says. When making your selection, it ultimately comes down to selecting a printer with the resolution you’re happy with from a reputable manufacturer you know you can trust.

	Before you purchase a printer, it’s important to understand how to use it, Culp says.

Related reading: 5 ways technology has changed the implant workflow

	“Doctors investing in printers often don’t know what they’re getting into,” Culp says. “They want to use the technology because it’s cool, but they don’t realize there’s a lot of work to do.”

	For example, you need to know what light source is required to properly cure the printed material, Culp says. Otherwise, you won’t be happy with the results and might start to regret your decision to purchase a printer. You’ll also need to know how to clean the printer and properly mix the resins as well as the type of ovens you’ll need for the material you’re planning to use. It’s also important to purchase the appropriate stains and glazes to finish the restorations.

	Because there are manufacturers that offer affordable options, more dental offices and labs are starting to invest in printers, Culp says. This increase in popularity has led to higher quality solutions that are fairly easy to incorporate and use. So, if you choose not to invest in a printer right away or ever, you’ll be able to find a dental lab that can do the printing for you.

	“Printing is big now in dentistry and everything is getting better. Things have changed dramatically just in the last year,” Culp says. “Everybody is really nailing down their systems so that they come with their own lights and cleaners. If you’re a lab getting into printing now, you’re getting a pretty good system. In the beginning, it was ‘here’s a printer, have fun.’”

	When you move your practice to a digital workflow, you have the ability to improve the patient experience and provide even better care. It starts with investing in a scanner, then, once you’re ready, adding other technologies based on your practice vision. That might mean investing in a mill to offer patients same-day crowns or a 3D printer to fabricate clear aligners in-house.

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	Whatever direction you choose, it’s important to understand what the technology can bring to the practice and how to best use it to meet your goals.

	“I know dentists who have a mill and like nothing better than to block off a morning or a day to complete six restorations for a patient, put the restorations in the oven ,and stain and glaze them and make them look phenomenal,” Dr. Flucke says. “They get satisfaction from knowing that patient will look incredible for the next 20 years. Some dentists don’t want to have to put color on porcelain and fire it in the oven. Those dentists do the cases outside the cosmetic zone and send the esthetic cases out to the lab. Once it’s digital, it becomes your choice on how you want to handle it.”
	 

 A look at how digital scans can be used whether you send them to the lab or use your own mill or printer in-house. 


How to invest in the right technology for your practice

	Investing in a scanner and moving to digital dentistry will change your workflow and the way you interact with your lab. Not only will you have the ability to send the lab more accurate impressions, but the technicians will be able to turn around cases faster and provide higher quality restorations that give your patients the predictable results they’re after.

	So, what exactly does this new workflow involve? The process is fairly simple, but it’s important to understand what the lab needs from you and what you’ll get back in return as well as the difference between tabletop and chairside scanners and which is best for your practice.

Related reading: 9 tips to increase workflow

	The new workflow starts with the fact you’ll no longer waste time with traditional impressions, says 

, chief development officer for Cellerant Consulting and chief dental editor and technology editor for Dental Products Report. That’s the main reason he decided to invest in an intraoral scanner in the first place.

	Dr. Flucke says he no longer has to wait for impression material to set, only to find out a second impression needs to be taken because the first one wasn’t good enough. Scans are much quicker to take and more accurate than traditional impressions, and patients don’t have to deal with the not-so-pleasant taste or the sheer discomfort that comes with having the material in their mouths. And if he does need to make a correction, the process is quick and easy. 

	“I made the switch to digital impressions for the workflow aspect,” he says. “I didn’t want patients to have to deal with impression material, and I wanted to free up my time to do something more productive than entertain someone with goop in their mouth.

	“What I found is the digital nature of these impressions is so much better than what you get from traditional impression material,” Dr. Flucke continues. “The fit is better, the occlusion is better and the contacts are better. It’s now uncommon for me to have to adjust a crown. A cement appointment now takes five to seven minutes, and that’s not an exaggeration.”

In most offices with intraoral scanners, the doctor completes the prep and then leaves to do something else while the assistant scans it, Dr. Flucke says. The doctor then comes back to check the scan to make sure it’s up to standards. If it is, it goes out to the lab and the assistant is instructed to make the temporary. This is a much better workflow for the doctor than with traditional impressions, and it reduces the amount of time patients need to be in the chair.

	The scans are typically converted to STL files once they leave the office, says Dr. Chad Duplantis of Fossil Creek Dental Partners. Depending on the manufacturer, scans may go to a cloud service to be analyzed by a team that marks the margins and then forwards the scan onto the lab. With other systems, the scans go directly to the lab. Once the lab receives the scans, it starts designing the restoration.

	“At that point in time, your restoration can be produced in a matter of hours and returned to your office,” Dr. Duplantis says. “It just depends on the lab and their capabilities.”

Read more from the author: Building a digital worfklow one step at a time

	One of the biggest mind shifts with digital dentistry is the fact that restorations are fabricated and manufactured virtually, Dr. Duplantis says. Because the restorations are digital, the physical models dentists are so used to are no longer necessary. That can be a difficult transition, but know you can still receive a physical model if that’s your preference.

	Dr. Flucke always asks his lab to send him a physical model because he likes to make sure everything is as it should be and to have the opportunity to tinker when necessary. To him, the model is like looking at a map and is an important part of his workflow. Some labs can even print models for you.

	Of course, you don’t have to send all of your cases to a lab. You also can fabricate crowns in-house if you have the technology, says Lee Culp, CDT, of Sculpture Studios. You just need to decide if that’s a service you want to offer your patients or if you’d rather continue to work with a lab for all of your cases. If you have a mill, you also can opt to send the files to a lab for design, then have the lab send it back to you so that you can mill the restoration in your office.

	While you don’t have to work with a lab that can handle digital files (they can always fabricate a model), Dr. Duplantis has found it’s more cost effective and time efficient if you do. If your lab already is digital, Dr. Duplantis suggests asking technicians what they think about the various scanning systems on the market before you purchase one. Ask them what they like and dislike about the different systems and which ones they prefer to receive scans from. Getting their input and following their advice will help to ensure a smooth transition when you switch to the new workflow.

	These days, most labs can handle digital files, Dr. Flucke says, so it shouldn’t be difficult to find a new lab if you currently work with a small facility that hasn’t gone digital yet. 

Trending article: Seeing the same dimensions as we operate

	What happens once the files arrive at the lab

	It’s fairly easy for dentists to get these scans to the lab of their choice, Culp says. They just need to go into the internal software, put in the lab’s email address and fill out a file that will be mailed directly to the lab. The email will contain everything technicians need to know about a case, including the tooth number, material shades and all the necessary scans. When it arrives, the lab receives a notification that they have an email, which the tech extracts and moves into his or her software.

	With this process, there’s no more worries about dentists not submitting enough information. Everything is right there, improving communication. 

	“The whole process is really easy compared to what it was 10 years ago,” Culp says. “The software had glitches that would cause problems and clinicians would have to start over. One of the cool things about intraoral scanners today is if you miss an area or there’s blood or saliva, you don’t have to take a new scan. You erase that spot on your screen, then scan only that area again, and it will be pinned back to your original scan. With a regular impression, you’d have to start over with packing cord and remixing the impression material.”

	If you’re placing an implant, an implant scan flag offers lab technicians imbedded data that tells them what kind of implant to use as well as the size and position of the implant to the bone. Techs can then make a crown right then and there and send it back to the doctor. If they also receive a CT scan that shows the skull and the bone, they can put all the data together to design a surgical guide and send that to you as well. 

	The difference between tabletop and chairside scanners

	Dentists who are thinking about entering into digital dentistry might be tempted to look into tabletop scanners. These scanners are less expensive than chairside versions, and some think they’ll make the transition to digital dentistry a little easier. With tabletop scanners, you digitally scan an analogue impression to create a model you can send to the lab, using the same workflow as a chairside scanner from there. Dr. Duplantis doesn’t really see the benefits of investing in one of these scanners first, and instead suggests starting with a chairside model that allows you to take digital scans directly from a patient’s mouth.

	“There are dentists who want the accuracy digital impressions provide and the faster turnaround time from the lab, but they don’t want to make the investment or pay for the data plan associated with an intraoral scanner, so they buy a tabletop system,” Dr. Duplantis says. “I’d be careful purchasing a tabletop scanner. Remember, the impressions you get are only as good as the analogue impressions you took.”

Related reading: 5 new workflows that are now possible

	Dr. Flucke says he sees these systems being more beneficial for labs that work with many different doctors who use many different materials. Like Dr. Duplantis, he doesn’t see any real benefit of these scanners for dentists. So, if you’re ready to make the move to digital dentistry, purchasing the right chairside scanner that takes impressions digitally straight from the mouth is best.

	Investing in a digital scanner will make your workflow more efficient and enable you to provide your patients with even better care. While it does require a change in your workflow, the process is pretty seamless. You can easily send your lab files, even after quickly making any necessary changes to your scans. Labs can even contact you right away if something is missing or off so that you can update the scans, a process that once required patients to come back in for a second appointment.

	Patients also no longer have to deal with goop in their mouths and the time they have to spend in the chair is reduced, resulting in a more pleasant experience while also giving them improved outcomes. 

	“It is so much better to do this digitally,” Dr. Flucke says. “It saves you a lot of time plus the quality of what you’re putting in your patients’ mouths is better than it’s ever been before.”

A look at the digital workflow, what happens when you send a scan to your lab, and the difference between chairside and tabletop scanners. 

Digital dental workflows: input options

	When scanners first hit the dental market in the early 2000s, many of the systems were closed. At the time, closed systems were touted as offering more predictability because they kept everything controlled, which made sense to the early adopters investing in this technology. But over the years, the benefits of open systems have emerged, and the idea of a closed system has really become a thing of the past.

	“In the beginning, we were not quite as advanced in software connectivity,” says Lee Culp, CDT, of Sculpture Studios. “Now, with the way companies are working together, opaen is better. It allows us to pick and choose what we use based on our needs.”

	At first, scanners were fairly limited in their capabilities, says Dr. Chad Duplantis of Fossil Creek Dental Partners, partly because the technology was young and partly because they were closed off from other systems. The first company to offer a truly open connection was 3M, and eventually other big names like Henry Schein and Sirona did the same. So for the last three or four years, open systems have become the norm.

	Today, scanners, which are the gateway into digital dentistry, offer seemingly endless capabilities. They provide high levels of accuracy and can integrate with mills and communicate with cone beam machines. This has led to higher adoption rates, with more dentists investing in technologies that allow them to offer enhanced patient care and optimal results.

Related reading: How the digital workflow will enhance communication and reliability

	One of the biggest reasons manufacturers started to open their systems is because customers demanded it, says Dr. John Flucke, chief development officer for Cellerant Consulting and chief dental editor and technology editor for Dental Products Report. They wanted to have choices, and closed systems didn’t allow for that.

	“These systems open the door for more dentists to become interested in the technology,” Dr. Duplantis says. “Dentists don’t want limitations, they want endless possibilities. They want choice in the marketplace and they want to be able to use what works best for their practice.”

	Once companies started opening their systems, those that didn’t follow suit likely saw sales start to decline, prompting them to open their systems as well, Dr. Flucke says. If they were going to compete, they’d have to make the jump.

	“When two huge industry leaders like Henry Schein and Sirona say open is the way to go, it’s really hard to resist,” Dr. Flucke says. “When they announced they were opening up their systems, it was like the Berlin Wall coming down.”                                                                        

	While giving dental professionals more options is a huge benefit, opening systems also puts more pressure on the manufacturers to deliver high-quality products, Dr. Flucke says. Customers are no longer locked into one platform, so manufacturers are more motivated to continue to improve their systems and stand out from the competition.

	Open systems also make it easier for dental professionals to upgrade their technology, whether it’s a scanner, 3D printer or digital impression system, Dr. Flucke says. Let’s say you buy a 3D printer because it’s the best one on the market, then a new one comes out six months later. You can keep using the one you have or sell it (which Dr. Flucke says is easy to do in today’s market) and upgrade to the newer model. The dentist buying the older system knows it will interface with other technologies, as will the one you’re going to incorporate into your practice.

	Because today’s systems are open, more dental professionals now feel comfortable investing in the technology, Dr. Duplantis says, which has helped spur adoption rates. Even though these systems have been around for the last 15 or 20 years, they’ve been slow to take off. That’s starting to change, with more dentists seeing the advantages digital dentistry can provide.

	“We’re in a huge phase of growth right now,” he says. “Every company is trying to come out with a scanner or buy a scanner from someone else.”

	If you’re among the dental professionals ready to invest in your first scanner, there’s a lot to consider before making the purchase. Knowing the systems are open makes it easier, but there are other factors you must weigh to determine what’s best for you and your practice.

	Before making your decision, Dr. Duplantis suggests talking to other dentists and lab technicians about what they’re using. Both can prove to be invaluable resources. Ask your lab technician what systems he prefers and why, and which systems have the most success. Talk with other dentists about what they like and don’t like about the systems they’ve invested in and what challenges they faced when they first got started.

	“Ask your colleagues how long it took to fully incorporate the system into their office and if the learning curve was excessive,” Dr. Duplantis says. “Find out if it was what they expected, if it was a painful experience and if they would do it again.”

	Clinicians should purchase systems that meet their needs, Dr. Flucke says. If you do a lot of cosmetic dentistry, for example, look for systems with features that will help you improve on what you already offer. The device you purchase should do what you need it to do and save you steps in your workflow. Avoid buying systems with features you know you’ll never use. While you want room to grow, you also don’t need to spend extra money on bells and whistles you’re never going to take advantage of.  

Related reading: How technology is changing the implant workflow

	It’s also important to consider the data plan, Dr. Duplantis says. If the scanner you’re looking at is more expensive because it comes with a data plan, be sure to determine what the data plan includes and what the support with it entails. Basically, make sure it’s worth the extra cost. If the scanner goes down and the company can’t get you a new one for four to six weeks, Dr. Duplantis suggests you keep looking. You need a company that continues to support you after selling you the technology, and can get you a new system right away if you’re ever in a bind.

	To Culp, company support is the most important thing to consider before investing in a system.

	“The equipment, the software, the scanner, whatever they do becomes secondary. If you have a problem you need somebody you can call who will fix it fast,” Culp says. “In our lab, we had a scanner go down and our support group, CORE3D, had a scanner to us the next day. We were only down half a day before we were good to go again. Support is No. 1, especially for people new to this technology.”

	Software is also an important consideration, but basically comes down to finding one you like, Culp says. Most of them do the same things, it’s just determining which one you interface with best.

	Speed, wand size, ease of use and patient comfort are also important to consider when investing in dental scanners.

	Open systems have certainly won the day, and scanners are now faster, more accurate and offer more capabilities than ever before. Take some time to determine how you plan to use the scanner in your digital workflow before deciding which option is right for you, then make the investment. After the initial learning curve, you’ll find you’re able to offer an improved patient experience and optimal patient care.

A look at why selectively open systems have won the day.

A winner in digital dentistry's open versus closed system debate

	If you’re ready to incorporate digital dentistry into your practice, you’re probably wondering how to get started. What do you need to buy first, and which technologies do you add from there?

	It can all seem a bit daunting, but with the right guidance, you can seamlessly integrate technologies such as scanners, mills, 3D printers and CBCT units into your workflow-making your practice more efficient and enabling you to offer additional services to your patients.

	“By digitizing, you streamline your practice and make dentistry more predictable,” says Dr. Chad Duplantis of Fossil Creek Dental Partners. “Every clinician who wants to improve the quality of the work they’re producing should look into going digital.”

	Despite what many dental professionals might think, making the move to a digital workflow doesn’t have to cost upwards of $100,000 all at once whether you’re a dental practice or a lab, says Lee Culp, CDT, of Sculpture Studios. As demand increases, costs associated with these technologies are coming down, making it easier to invest in them and to start reaping the many benefits they provide. 

How to know when to add various technologies to your office from scanners to mills to 3D printers. 