Terri Lively

	Spurred by the spirit of competition and pursuit of market share, scanning manufacturers  have raised the standards for their image quality, speed and accuracy. Dr. Chad Duplantis, DDS, a private practice dentist from Fort Worth, Texas, and frequent lecturer on digital dentistry, says all the scanners employ enhanced speed, accuracy, and ease of use for the dentist.    

	“I don’t know what the computer scientists are doing; I’d be lying if I tried to tell you that,” he says, laughing. “But over the past several years, every scanner software has improved to a certain extent.”

	Dr. John Flucke, DDS, a private practice dentist in Lee’s Summit, Missouri., is impressed with how the technology has evolved already.

More from the author: How the digital workflow will enhance communication and reliability 

	“The results with the scanners now are better than I thought they'd be,” he says. “The folks that design and create these devices have taken this technology to the point where it's just so doggone easy.”

	So, what are the ways that scanning software has improved? Here’s what our experts had to say.

Dr. Alex Kalmanovich, DDS, a private practice dentist from Laguna Beach, California, uses the CEREC Omnicam and before that, the CEREC Bluecam. He appreciates how the upgraded software streamlined the scanning process, from getting rid of powder to adding the ability to perform a continuous scan. “We couldn’t do a continuous scan. You had to click on each image and snap. That was more difficult. Now we just scan like we are shooting a video instead of clicking on images,” he says.

In addition to streamlining the scanning process, Dr. Kalmanovich likes the improved image quality. “It looks esthetically better. It looks more realistic, more accurate. From what I had before, my new scanner is so many times better in quality. Not only for the great image, but also for patient education. It looks so nice I could use them to show patients and use it as an intraoral camera almost,” Dr. Kalmanovich says.

The new software has simplified the scanning process and automates many aspects of the impression for you. Dr. Flucke, who was an early adopter of scanning software, remembers when he had three different windows that showed the x-, y- and z-axis, which required more calculation on his part. He also recalls spending more time trying to read the scan, looking for margins, and determining where and how tight the contact would be than he does now. “Now you just wave the camera over the working area. It almost finds the margin directly for you, does all the design for you. It's incredible how simple it's become as opposed to how complicated it used to be,” Dr. Flucke says.

Related reading: 17 technologies to embrace in 2017

Dr. Ford Gatgens, DDS, a private practice dentist from Dickson, Tennessee., just outside of Nashville, uses the 3M™ True Definition Scanner. He has seen many upgrades to the software and the scanning wand itself. “I saw an increase in my efficiency and improved image capture as the technology and the software gets better,” Dr. Gatgens says. Dr. Duplantis agrees that over the past several years, his 3M Scanner and all the other scanners have enhanced the speed of capture, reducing the time spent taking an impression on a patient. “The software has gotten to the point that as you are moving the wand, it’s capturing the image and you don’t have to hover as long over the teeth to capture that accuracy,” he says.

Per Dr. Duplantis, every scanner is racing to achieve the fastest scanning of the arch without affecting precision, and they are all “within hairs of one another.” Each of the scanners captures information differently, but accuracy is measured using the spatial relationship of the teeth as compared to a static object. “Compared to a predetermined spatial relationship with an object and using a standard deviation, researchers can determine how accurate a scan you get with the wand,” Dr. Duplantis explains. “Every single one of the intraoral scanners is more accurate than a traditional impression.”

	Up next: 5 more improvements to scanning software ...

Dr. Justin Chi, clinical research associate at Glidewell Laboratories, appreciates how his TRIOS

 3Shape camera can pick up and facilitate a close look at fine details. The scale and resolution of the images are such that he can pick out the burr marks on the tooth. Dr. Chi can zero in on a particular spot on his prep to analyze and see things he cannot see even with loupes or high-powered magnification. “The resolution and the details you can see on the screen are extremely accurate,” he says. “It ultimately makes people a better dentist.”

Requesting more information when needed: 

Dr. Flucke appreciates how scanning software is not only faster and more accurate but also more assertive when it needs additional data. After taking the scan, the software alerts the doctor to areas where there isn’t enough data to give a good model. Dr. Flucke likes how this automation prevents getting surprises from the lab. Moreover, after the area is retaken, the software automatically fills those indicated areas with the new scan. “Bing, bing, bing. It just knows where it is and fills those areas in,” Dr. Flucke explains. “It’s just incredible.”

Trending article: Is the future of dentures digital? 

 Some software added a feature that allows doctors to see the amount of space on their prep. The immediate feedback is great. “So instead of having to wait for your lab to tell you, ‘Hey, you didn’t reduce enough here,’ now you get that information right away,” Dr. Chi explains.

 Shade matching has many variables that affect accuracy when handled the traditional way, from the lighting of the room to the experience of the technician. However, the 3Shape produces a live view with an actual color image, eliminating some of the guesswork involved with the shade matching process. Dr. Chi likes how his 3Shape’s resolution of the scan is such that by clicking on the adjacent teeth, the software has an actual shade measurement function that gives you the shade right then.

Working together with open source technology: 

Dr. Flucke is a big fan of open source technology and manufacturers agreeing to cooperate. With open source, he can mix and match. If he wants to buy an open source mill, it will work with his iTero

 Element™ Intraoral Scanner. He says he likes not feeling limited in choices or pushed into the purchase of an individual brand.

	Dr. Gatgens is impressed with the improved features of scanning software from units that are powder-free to those that produce color scans, as well as units that shade match, all features that he sees as beneficial to a dental practice. When it comes to investing in technology, Dr. Gatgens has two questions he asks himself:

			Will it help with my patient outcomes?

			Will it make me more efficient in the office?

	“As the technologies continue to improve, the answers to these questions would both be yes,” Dr. Gatgens says. “Technology is how things are going in dentistry for the future and that means better outcomes for our patients. Ultimately, that’s how our decisions have to be made.”

More from the author: Why better adhesion means happier patients 

	Dr. Flucke is an advocate for scanning over traditional impressions. He believes it is not a technology that is “still working the bugs out.” He also will no longer accept the argument that someone can take a better traditional impression than what the scanner takes. He compares it to the arguments regarding moving to digital X-rays, when doctors said film was more accurate.

	“A picture the size of a postage stamp is never going to give me as much information as an image on a 24-inch widescreen monitor. That's not even open for discussion. It's the same way with scanning vs. traditional impressions,” Dr. Flucke says.

	As far as the reliability, speed and accuracy of scanning software, he thinks the technology is essential to today’s practicing dentist.

	“It's not hard to do. It's not hard to learn. It is so simple. And the results are so good,” Dr. Flucke says. “It's no longer an 'if' technology; it's a 'when' technology."

Articles

Scanning manufacturers are raising the standards for speed, image quality and accuracy.

10 improvements to your scanning software that can change the way you work

	Hygiene is a huge part of your patients’ overall oral health. When it comes to hygiene instruments, investing in a curette that will do the job well and stay sharp can make all the difference to your results - and hand fatigue.

	Since the 1940s, the Gracey Curette, invented by Dr. Clayton Gracey with the help of Hugo Friedman of Hu-Friedy, has been an integral part of many hygienists’ instrument inventories. Hu-Friedy touts their latest Gracey curette, the EverEdge 2.0 Gracey Curette, as unlike anything you have experienced before in a scaler.

Related reading: Hu-Friedy expands EverEdge 2.0 line with Gracey Curette designs

	We spoke to Registered Dental Hygienist (RDH) Tami Wanless about her experience with Hu-Friedy’s EverEdge 2.0 Gracey Curettes. Here’s what she had to say.  

	Last January, my first-level dental hygiene students from College of DuPage and I went to Hu-Friedy for a tour of the instrument manufacturing process in Chicago. During our visit, I was introduced to EverEdge 2.0 (EE 2.0). I took the new instrument back to my private practice and assumed it would be as sharp as the original EE. I was overwhelmed by how tremendously sharp it was on the first patient I scaled. I was completely impressed-and sad-that I didn’t have to sharpen as frequently due to the continual sharpness of EE 2.0.

	What do you like best about Hu-Friedy’s EverEdge 2.0 Gracey Curettes? How do they compare to others on the market?

	Being on top of my profession is a high priority for me as an educator. I am more effective with deposit removal using EE2.0 than any other instrument; it’s that sharp.

	Clinically, I use fewer strokes and lighter lateral pressure on the lower anterior areas because they are that strong. There is less hand fatigue at the end of the day, and I don’t need to sharpen nearly as often. I have never used any other instrument this sharp. Not only are EE 2.0 a pleasure to work with in private practice, it’s nice to introduce this sharpness option when working with my students.

	What have been the results and/or patient responses?  

	Multiple patients could hear a difference when the cutting edge removed the deposit. They inquired during their appointment, “Do I have more plaque because it sounds like you’re doing a lot more scraping?” Also, when I blow air on the tooth surface, there is a remarkable transformation in the outcome of fine chalky deposit removal.

Trending article: Hu-Friedy introduces most advanced hand scaling instrumentation 

	What benefits to your practice have you seen since using the EverEdge 2.0 instruments?

	Using EE2.0 has sparked multiple conversations between my patients and I about these new “purple” instruments.  Any time I can demonstrate to my patients that I am using the best available anything, I know I am providing a practice environment they can feel confident in and will talk about outside my operatory.

	Patients have also noticed a change in their hygiene visit the moment I started using EE 2.0. Using a sharper scaler benefits my patients by providing more comfort, and I know I am providing a healthier oral environment for them at the same time. Incorporating EE 2.0 into my practice was like integrating loupes -you don’t know what you’re overlooking until you witness the difference.

	Why would you recommend them to your colleagues?

	Sharing facts about EE 2.0 with fellow hygienists is easy-all they have to do is use EE 2.0 once and the sharpness speaks for itself. I had to take some time off from private practice recently, so I had a friend I teach with fill in for me. She was ecstatic to use EE 2.0 and felt the significant sharpness and value right away.  

	Hu-Friedy recently donated EE 2.0 instruments to a mission project I worked with. If you’ve ever had the pleasure of working a dental mission, you know two things: one, you’re going to work harder than any day in private practice; and two, the instruments probably won’t be very sharp or stay sharp. The groups of volunteer hygienists were all smiles when I told them they would be using brand-new Hu-Friedy Ever Edge 2.0 instruments to debride all day! We didn’t have to sharpen after treating nearly 500 difficult patients. By not taking the time to stop and sharpen, we were able to help more patients and not compromise on providing the best care possible.

	Saving the world one tooth at a time takes a village. I’m glad I live near Hu-Friedy town. It makes it a lot easier!

One practitioner explains how Hu-Friedy’s EverEdge 2.0 Gracey Curettes work hard and stay sharp.

A review of Hu-Friedy's EverEdge 2.0 Gracey Curettes

	Adhesive dentistry has many benefits to the patient, from preserving more tooth structure to less cutting for a dental filling and even in some cases to reinforcing the tooth structure. Dentists have more options to restore or repair teeth thanks to advances in adhesive dentistry. However, these options all rely on bond strength. Without it, your restoration will fail, and your patient could come unglued.

	“Adhesive dentistry is a significant improvement in dentistry, both cosmetically and restoratively,” says Dr. Richmond Chung, DMD, a private practice general dentist in Orange County, Calif. “But when the adhesive fails, the restoration will become displaced. Another big challenge with adhesive dentistry is post-op sensitivity, where the restoration is satisfactory, but maybe it wasn't isolated as nicely as you would like and there was some contamination, and now there’s some sensitivity.”

Related reading: How self-etch adhesives can help prevent sensititvity 

	Dr. Leah Capozzi, DDS, who practices in Buffalo, N.Y., explains that if a filling partially de-bonds, it can allow leakage, recurrent decay and exposed dentin. Unfortunately, the dentist and patient may not realize there is a problem with the bond in these cases until they replace the filling. On the other hand, a fully de-bonded filling can lodge in an uncomfortable position against the gum tissue and expose the tooth to the oral environment.

	“Either situation will cause patients to return to the office to have the treatment redone," she said, which can infringe on the patient's time and erode their confidence in the dentist. 

	For all of these reasons, excellent adhesion leads to happier patients.

	“Better adhesion can prevent de-bonding and leakage, saving both the patient and dentist from spending time on replacing fillings. Better adhesion can also reduce post-op sensitivity for patients,” Dr. Capozzi says.

	Dr. Ford Gatgens, DDS, who practices just outside Nashville in Dickson, Tenn., said patients want everything to function like it is supposed to and look natural as well. Most of all, they want to avoid postoperative problems after their dental visit.

	“Obviously, if the patient had work done and he or she says, ‘Man! When I left, I couldn’t even tell I had been at the office. Everything feels just like it belongs,’ I would say that’s a happy patient,” he said.

	Dr. Kalmanovich agrees that happy patients are those who feel comfortable in your chair and confident they are in good hands. He ensures he is doing the right steps, so his patients don’t have post-operative sensitivity.

	“They can see that you are doing things in a step-by-step strategic manner and not fumbling around not knowing what you are doing,” he says.

More from the author: 3 ways mishandling adhesives contributes to restorative failure 

	Dr. Kalmanovich, who usually etches and then applies Gluma to prevent sensitivity before using the adhesive, compared his bonding procedure with his dental assistant to watching an orchestra perform -- precise and systematic while working together to achieve a result.

	“We do the same thing every time. I get the etch. I get the Gluma. I get the primer. I get the bonding. She light cures it for the same time every time. I put in my liner and I put in my composite. Everything flows well. The patients appreciate that,” Dr. Kalmanovich explains.

	“Whenever they don’t have to come back after dental work has been done, they feel comfortable and confident, everything functions the way it is supposed to and they look good as well -- that’s a happy patient,” Dr. Gatgens says.

	Up next: Adhesives recommended by dentists ...

	Adhesive dentistry is a sticky subject. Most dentists compare adhesives based on bond strength. However, ease of use is another important criterion. Some dentists swear by total-etch adhesives while others prefer self-etching. Some use different adhesives for different cases while still others prefer universal adhesives. Many dentists have a drawer full of products that they use in various circumstances.

	Since 1955, there have been seven generations of adhesives with varying degrees of success in both areas. When Dr. Chad Duplantis, DDS, looks back over the history of adhesives, he notes the most successful were those with both a priming agent and a bonding agent in a total etch procedure. The downside with these adhesives was that when used inappropriately, they caused considerable postoperative sensitivity. The dental industry tried to improve these bond strengths while reducing sensitivity over time.

Trending article: Bonding 101: Everything you need to know to have satisfied patients 

	Dr. Duplantis admits he has switched adhesives 10 times in the 18 years he has been in private practice in Fort Worth, Texas. For a while he was using two adhesives: a total-etch and a self-etch. However, the self-etching adhesives weren't robust enough for his anterior composite restorations. He compensated for this by using a total-etch adhesive on his anterior restorations and a self-etch on his posterior restorations. But he was still challenged by de-bonds, chips or abrade on his anterior restorations.

	“I don’t feel that the self-etching adhesives are as strong as they say they are. I have never had good luck with a self-etching adhesive,” he says.

	Now, Dr. Duplantis uses a universal adhesive. One of the biggest reasons is that it works with everything he uses in his practice.

	“I chose the Scotchbond Universal [from 3M] for a number of reasons, but mostly because it fits all of my needs. It’s been a very good product for me,” he says. “Knock on wood, I have not had any sensitivity or de-bond issues since I have been using it.”

	Dr. Gatgens has been practicing for more than 10 years. He also chose a universal adhesive for his practice, Dentsply Sirona’s Prime and Bond Elect. When he switched to the universal, he said he didn’t have a lot of the problems he had experienced in the past.

	“Not only do I find the product works well in my hands, but I also know it’s gone through the rigors of all the testing against all the other possibilities. I feel comfortable using products like that to make sure I am getting my patients the best results possible,” Dr. Gatgens explains.

	Dr. Gatgens uses lasers with all of his procedures, a step he feels sterilizes the bonding surface for optimal strength.

	“When I use the lasers to open up the tubules to clean out any debris, I feel comfortable and confident with that process and use the universal,” he says.

	Dr. Capozzi wanted an adhesive that is straight-forward and easy to apply. “I use Ivoclar Adhese universal, which is a universal adhesive.  I have had great results with bond strength and decreased postoperative sensitivity for patients,” she said. 

	Dr. Kalmanovich prefers to use dual systems, not all-in-ones. Dr. Chung says he is happiest with his fourth-generation, multi-step bond adhesive because it is time-tested and proven.

	“I don't believe the hype just because it's the latest product and they claim all these great things,” Dr. Chung says. “You've got to feel comfortable with the one you use, as long as you are not having any problems with it in your practice and you're having real success with it, which, for the most part, we have been.”

	But no matter which adhesive you choose, the most important aspect for your patient is the efficacy of your bond. Otherwise, Dr. Duplantis says, the patient couldn’t care less which one you use.  

	“A patient is not going to care what generation you are using or what type of adhesive you are using. They care about two things: that the restoration is going to stay in their mouth and that they don’t have sensitivity afterward,” Dr. Duplantis says. “The patient trusts that the dentist has done their research so that those two things occur.”

Ensuring bond strength and avoiding post-op sensitivity are key for dentists.

Why better adhesion means happier patients

	Dr. Justin Chi, clinical research associate at Glidewell Laboratories, has firsthand experience with postoperative sensitivity with his restoration-as a patient. After his doctor placed his e.max crown on his #30 First Molar 10 years ago, he couldn’t eat on the right side of his mouth for over a year.

	“Every time I bit on it, it was so painful I thought I needed a root canal,” he says. The crown eventually came off (via a Jolly Rancher). When his doctor fixed the crown, she used a desensitizing agent on the tooth, scrubbing it in and following with the same cement. Once the crown went back on, he hasn’t had sensitivity since.

	It was an important lesson for Dr. Chi, who wasn’t a dentist at the time. His experience with misdiagnosing his crown adhesive postoperative sensitivity as a compromised tooth “stuck” with him.

	“Lots of endodontic procedures are performed every day for post-op sensitivity when in reality it is because of dentists not following the right protocol in adhesive dentistry,” Dr. Chi says.

Related article: 5 things you need to know about adhesives 

	Adhesive dentistry has revolutionized the dental practice. However, it requires a bond between the restorative material and the tooth underneath. Success and failure in adhesive dentistry has much to do with how you treat the tooth underneath. Here are three ways mishandling adhesives contributes to restorative failure. 

	Every adhesive has instructions, and they all have specific details to them. No matter which adhesive you use, following the directions is paramount to your success. Dr. Alex Kalmanovich, DDS, believes this is the most important aspect of any bonding technique. When dentists begin mixing in their ideas, they start experiencing failures. Dr. Kalmanovich thinks each adhesive’s instructions are essential to its success.

	“The companies have done the research. The companies have tested their products. They know what works-but based on their recipe. If you follow that you will be successful and get the results they get. If you start doing other things or forgetting to do certain steps, that’s when you have problems,” Dr. Kalmanovich says.

	“With adhesive dentistry, it is all about the technique,” Dr. Chi says. “In a busy practice, you are moving quickly and there are a lot of steps, so you have to be diligent about following them properly.”

	Dr. Ford Gatgens, DDS, says several problems can occur for your restoration if you don’t follow the manufacturer’s steps precisely, such as:

			Too little or too much of the adhesive where you don’t want it

			Problems with uniformity from lack of air drying the adhesive adequately

			Materials that preset because the vial wasn’t closed all the way or was exposed to light before it should have been

	Dr. Gatgens recognizes that there can be more potential for mistakes when there are more steps to follow. He looks for products with a decreased number of steps, even if that doesn’t result in less time spent on the bonding process.

	“If you don’t have three or four individual bottles of something that you have to do things with, you are going to decrease the risk of contamination or another problem,” he explains. 

	Up next: Why isolation is crucial for adhesive restoration ...

	Isolation is crucial for a successful adhesive restoration. However, it is also one of the most difficult aspects for any dentist in adhesive dentistry.

	“Isolation can be challenging,” says Dr. Leah Capozzi, DDS. “We work in a dark, wet environment with cheeks and tongues getting in the way.”

	“We don’t want to contaminate the area. We have to make sure the adhesive we put on the tooth is nice and clean. Things like saliva and blood and even certain chemicals like the ones we use to control the bleeding have to be cleaned off properly because if there are remnants left behind it could interfere with the bonded tooth,” Dr. Chi says.

	Isolation prevents those contaminants from getting into the working area. In dental school, students learn how to isolate with a dental dam for everything they do. However, once dentists begin their practice, time is money, and the dental dam can feel like an extra procedure that is going to slow them down.

Trending article: The latest in universal adhesives 

	“When you get into adhesive dentistry, one of the main things that is going to cause it to fail is any moisture or contamination, whether it’s saliva or sulcular fluid or any hemorrhage,” explains Dr. Gatgens. “It’s important to have an isolation system that’s going to work for you. It’s not necessarily saying that it always has to be a rubber dam scenario, but the whole process is predicated on a dry field, and any type of moisture contamination will cause problems long-term.”

	Adhesive dentistry success is somewhat of a balancing act between controlling the moisture in the area without drying it out too much. If the area is too wet from water, moisture or saliva, it can interfere with the bond. However, if it’s too dry (especially for bonding to the dentin), the patient could experience postoperative sensitivity.

	Dr. Chi says over-drying tends to occur when, during a total-etch process, the dentists check to see that they have a good etch on the tooth surface before bonding. Too much air can desiccate the dentin.

	Dr. Chung says he used to have problems with over-drying in the priming step, which led to some problems with post-op sensitivity.

	“It goes away,” Dr. Chung said, “but you’d rather it never happened.”

	Dr. Kalmanovich sums it up: “So, you want to air dry, but you don’t want to make it bone dry.”

	Up next: How to advoid common problems ...

	So, how do you avoid these problems? Dr.Capozzi has the following advice for her dental colleagues regarding adhesives:

. Every system has specific instructions that must be followed.

. All adhesive dentistry requires a clean, dry surface.

 Ask your assistants to review your systems at weekly or monthly meetings.  Products may change or you may be forgetting a step.

 If something goes wrong, stop and start over. 

	“We all want to be fast and efficient but not at the expense of the quality of work we provide,” Dr. Capozzi says.  

	Dr. Chung adds that you should pick a system that has a broad application that you’re familiar with and you know how to use to avoid confusion between the details of the process.

	“Sometimes the steps are a little different. One adhesive is cured for 15 seconds, the other is 20 seconds, or maybe longer. If it's a prime and bond, you must scrub it in and then air dry it and that sort of thing. It can be confusing,” he says.

More from the author: 6 challenges in adopting dental technology 

	Dr. Kalmanovich has a tip for dentists who struggle with isolation. He admits he rarely uses a dental dam, but he does use DryShield, which retracts the tongue, suctions, serves as a bite block and isolates the area.

	“It is one of the keys to success in adhesive dentistry,” Dr. Kalmanovich explains. “I use it for my CEREC imaging. I use it for my bonding. It is one of the tricks that is great if you are doing any kind of adhesive dentistry.”

	Both Dr. Kalmanovich and Dr. Chi recommend adding a desensitizing agent between etching and bonding to dentin. Dr. Chi is in a unique position to replace restorations that have resulted in post-op sensitivity. He finds that rehydrating the tooth can often resolve the issue.

	“Scrubbing it in well will not only rehydrate the tooth, but it also helps to seal off the dentin tubules. And it’s also an antibacterial agent,” Dr. Chi says.

	Dr. Gatgens believes that partnering with an excellent materials company will help you achieve success.

	“What I have chosen to do is to partner with an excellent company. When I am using their products, I know they are vetted and tested, and they have a high quality.”

Success and failure in adhesive dentistry has much to do with how dentists treat the tooth underneath.

3 ways mishandling adhesives contributes to restorative failure

	With innovations in technology for CAD/CAM dental solutions, the collaboration between the lab and the clinician is easier than ever. But how will these advances change the usual workflow between lab and clinician?

	We talk with DENTSPLY Sirona’s Kassandra Braun, Marketing Manager, Laboratory CAD/CAM and Prosthetics. She shares her insight on how productivity, communication and reliability improve with enhancements in digital dental solutions for both lab and doctor.  

	What were some of the challenges dental labs struggled with in the past and why?

: There are several major challenges to an analog solution for dental restorations. For one, analog restorations take longer to make. Over time, we’re seeing fewer dental laboratories nationwide. At the same time, patients require more restorations. This means that each laboratory needs to produce more restorations to meet the demand. There are great opportunities in this for labs that are looking to grow by increasing their productivity. Workforce specialization can be another challenge. It is becoming ever more difficult to hire trained waxers and ceramists. These two challenges combine to make it difficult for labs using only analog techniques to compete in the crown and bridge market.

Related article: How 3D printing streamlines your workflow

	How have dental digital solutions influenced lab workflow and relationships with practices?

: I would say that these solutions have had a major positive influence. Digital solutions have opened the door to faster turnarounds coupled with reliable quality. This, in turn, helps labs compete in a tough market. Designers can use the software to create restorations quickly, as well as use the tools to tailor the restorations to their style. Digital solutions can also allow laboratories to broaden their product offering by including restorations such as surgical guides and fixed hybrid dentures.
	The digital workflow opens communication between labs and dentists, and we have seen improvement in relationships.

	Up next: The impact of software on the workflow ...

	How do features of CEREC® and inLab® influence the workflow and these relationships?

: The Sirona Connect portal helps labs and doctors stay on the same page when viewing and discussing cases. The laboratory technician can look at a prep while the patient is in the chair. With the smart watch app, technicians can review cases from anywhere in real time. Using the chat function, technicians and doctors can screenshot cases and discuss them through the portal. Technicians can even provide a design service to doctors through the portal by designing the case and sending it for the doctor to produce on a CEREC milling unit.

	Our inLab software helps simplify the lab workflow and speed up turnaround. Recently, the DLOAC hosted a design competition that was open to dental lab technicians. The contest had three timed rounds to design different types of restorations. They were judged on speed, esthetics, occlusion and tooth shape. Zhen Yin, a student at the LA Community College, learned the inLab software that morning and won the $5,000 prize. As part of the competition, he designed an esthetic full-arch upper bridge in less than 10 minutes. With turnaround times like that, a lab can get more cases done faster.

	How will these technologies evolve, both short- and long-term?

 These technologies will continue to evolve to create more synergies. For example, cone beam technology currently integrates with CAD/CAM to allow dentists and labs to create restorations with live functional data. We will see more indications and simplified workflows.

	What advice do you have for today’s dental professionals, labs, clinicians, or otherwise regarding digital solutions in the dental practice?

: At an inLab Marketing Summit last fall, the keynote speaker was Michael Gerber, author of The E-Myth Revisited. He said that the most important thing a small business owner can do is work on their business and not in their business. The good thing about digital dentistry is that it allows lab owners to do that. If you have not already incorporated digital dentistry into your lab, make that change now, get your training and start getting more done.

Innovations in technology are changing the collaboration between the lab and the doctor.

How the digital workflow will enhance communication and reliability

	When you first invested in your practice management software, everyone shared an enthusiasm for learning a new system that would take your practice to new heights of productivity and efficiency. The atmosphere practically crackled with the electricity of new possibilities.

	Today your practice management software languishes, laden with untapped potential while doing a fraction of what it could for you.

	Sound familiar? You are not alone. Our experts reveal many dental practices have a similar story.

	“It’s amazing how underutilized practice management software is in almost every practice I have ever worked with,” says Genevieve Poppe from 

. “You would think that having all this data at their fingertips people would use it, but they just don’t.”

Related: The top things to consider when selecting new practice management software

	“Most people use maybe use five to 10 percent of what their software can do,” says Dr. Lorne Lavine, founder and owner of 

	“A colleague of mine once said practice management software is the least understood, most underutilized power tool in the dental practice,” says Dawn Christodoulou, president of the 

, a dental software solutions company. “It’s true.”

	Dr. Jason Watts, a general dentist in private practice in Cape Coral, Florida and dental blogger for 

, also feels too many clinicians don’t take advantage of all the insight their practice management software provides. “The best way for dentists to save money or focus on being more efficient in their office is by measuring the outcome of their success.  

	Tija Hunter, dental assistant and vice president of the 

, says that sometimes software gets pigeon-holed for an individual function. “So many times I go into an office and they say they have dental practice management software for the front desk. Well, if you have it for the front desk, then you already have it for the back,” says Hunter. “People have the technology; they just aren’t using it.”

	Lynette Brodie, Office Manager at a private practice in Los Angeles for the past 34 years, agrees. “Some people will use the appointment book and maybe a couple of other features, and then they will stop,” she said.

	Underutilization of practice management software is an area of opportunity for many practices. So how can you change that? What ways can you dive deeper into your system to benefit your patients and practice? And how will that effort pay off for your practice’s bottom line?

Related article: How technology is REALLY changing the dental workflow

	We talked to experts nationwide about 25 ways to take advantage of the features you already have on your practice management software. 

	1. Embrace the cloud and reduce maintenance and security expenses

	Cloud-based systems are becoming more mainstream. With so many built-in features that cover vital areas like security and IT support, Dr. Lavine thinks the decision about whether to go with a cloud-based system is important.

	“You’ve got programs like Curve, Dentrix Ascend, Umbie and tab32, to name a few. A cloud-based option takes away the need for services most practices needed in the past, like encryption, backup, disaster recovery, maintaining servers and licensing fees,” he says. “A lot of that goes away with a cloud-based option.”

	Dr. Jonny Brennan, a private practice dentist in Chandler, AZ, also points out the savings in tech support. “It also saves money on IT costs, like having someone come in and set the system up in a HIPAA-compliant way for remote access by configuring the ability to tunnel into your office securely. It’s all built into the cloud-based options.”	 

	2. Subscribe monthly and spend less with bundling features and services

	Many doctors resist cloud-based software because of the monthly subscription fee. However, per Dr. Brennan, an estimated $500 monthly subscription might save a practice money.

	“A lot of practices are paying for pay-per-click on the older, installed, I-run-my-own-servers model. With these newer software, you are paying a monthly subscription fee, but that covers all your services. That’s text messaging and email campaigns, and even insurance claims; they are all bundled and covered,” he explained. “A lot of practices might be going over the $500 marker just on insurance claims processing charges alone.” 

Related article: The cloud is here ... but some software vendors still refuse to change

	3. Gather the patient’s email addresses for efficient communication and marketing

	Almost all software systems acquire email addresses. Email addresses are not only essential for patient communication but also for direct marketing options that come with the software.

	“A lot of practices don’t capture email addresses as part of that new patient information, which is a big mistake. You absolutely want that information,” Dr. Lavine says. “You can then market things like a ‘Use it or lose it’ letter that is built into the software. A lot of people don’t even know that their software can do that.”

Related: 5 reasons to collect patient email addresses

	Practice management software can pinpoint ultra-specific groups with marketing promotions, including those with certain treatments pending.

	“If you just send a mass marketing piece to all patients that you saw for that one month, that’s a lot of money. Now, by being more selective, you are saving a lot of money,” Dr. Watts says.

	5. Remind patients of their remaining insurance benefits

	Providing relevant information improves the patient experience. Poppe encourages the team to pull the insurance utilization report to remind patients of what benefits they need to use by the end of the year, particularly if they have a treatment plan pending.

	 “It’s amazing what you can get booked and how strongly you can finish a year if you help people utilize their remaining benefits,” Poppe says. “Patients do not like to waste money that they consider free.”

Related: The myth that patients should know their benefits

	6. Exploit the benefits of third-party programs

 send out confirmations automatically, cutting down on no-shows. Also, some third-party programs work with your software to put patients’ online 

	“While this doesn’t save the practice money, it is going to make them a lot of money to keep track of these things and to increase the new cases coming in,” Dr. Lavine says.  

	Appointment texts and email reminders are intrinsic to many programs, while others integrate with third parties that provide them. Pair it with a portal on your system where patients can change or add an available appointment to the schedule online. Dr. Brennan’s practice sets automatic reminder campaigns and the appointment portal on their 

 for certain patients, like those on a three-month recare schedule.

	“It texts that patient when it hits the three-month mark and reminds them when they should come in. Patients can also confirm through those as well, which helps because patients can communicate with our office without us having to employ anyone,” he says. “It’s very automated, and saves us money and time to let them just pick a time that works for them.”

, many systems can contact a list of patients most likely to be available, cutting down on open appointments on the schedule.

	“Let’s say you get a cancellation on a Tuesday morning,” Dr. Lavine explains. “You can easily pull a list of all of the patients that said you could call them on Tuesday morning and they could be available to come in.”

 system for nearly 20 years likes this feature as well. “It eliminates the one-on-one calling that takes a lot of time,” she says.

	9. Organize patient conversations to enable systematic follow-up

	Dr. Watts also recommends creating a tracking code for the different conversations you have with patients, so you stay organized for follow-up calls. For example, if you talk about 

 treatment, enter the code for that conversation. At the end of the month, run a report to see who you need to contact to schedule the next appointment or follow up. “You can call them if you are having a special,” says Dr. Watts.

	Dr. Brennan, a self-described data nerd, also tinkers with custom reporting on treatments. It allows the doctors to follow up with patients that might need treatment but chose not to move forward. 

	“We find it very powerful to have the doctors take part in that and let the patients know, ‘I was reviewing your case. I noticed that ____ was going on. I would recommend we circle back with you and see if we can figure out a better way to approach that,’” he explains. 

We take a look at 25 ways your practice management software could be saving you money.