Outline a phased treatment approach for full-mouth rehabilitation.

Initial assessment and temporomandibular disorder workup, treatment planning, and execution using various dental technologies and VOCO products.

 Improved functionality, patient satisfaction, and esthetic results.

A phased approach can help clinicians verify the patient’s vertical dimension of occlusion and functional occlusion as well as meet the patient’s immediate and long-term goals of a more esthetically pleasing smile.

 By addressing both functional and esthetic concerns in dental practices, we not only create long-lasting restorations but also correct early temporomandibular disorder dysfunction.

 Loss of posterior occlusion and its impact on patient’s oral health, health outcomes, and advanced premature aging.

The article aims to present a viable treatment planning and execution method that accommodates the patient’s temporal and financial constraints.

This approach can transform patient outcomes by allowing flexibility in treatment planning.

Patients present to our practices with different goals. It could be to relieve jaw pain, fix chipped teeth, chew better, have a brighter smile, or feel more confident. Many times, a patient’s chewing function is what leads them to the desire for improvement. If a patient has a chewing pattern or occlusal alignment that makes it difficult to fit their posterior teeth together, the resulting chipping or wear on the front teeth drives them to us for help. This was the case in this situation.

Our patient presented with loss of her posterior teeth, which forced her to move toward chewing on her anterior teeth. Front teeth are supposed to behave like scissors and not potato mashers, and when flipped, they begin to have excessive breakdown. This premature and excessive wear can lead to further loss of tooth structure as it becomes thin, brittle, and possibly sensitive. To address that anterior breakdown, we first needed to recreate a posterior stop and build occlusion. Is it easier to do everything all at once? Absolutely. Is that always possible? Absolutely not. For patients who may need to break treatment into sections, we as clinicians need a way to offer a solution so that treatment can be planned comprehensively yet phased to achieve the desired outcome at the pace the patient desires.

For this specific case, our patient needed to restore proper occlusion, as she had lost most of her posterior occlusion earlier in life. To determine where the posterior teeth would go, we first needed to design the anterior teeth in our patient’s mouth. Ideally, she would have had her canine edge position set to zero (the cuspid tips placed right behind her lip line) followed by her centrals having 1 to 2 mm of display in the repose position as well (

). Our patient presented with moderate tissue display in her Duchenne smile, which we also incorporated into our design (

). Once we established the incisal edge position, we could then design her tissue architecture balanced with the width of her incisors. From there, we built the mock-up for her upper posterior teeth horizontally using the Kois glasses to level her plane of occlusion.

When phasing treatment such as this, we design from front to back but build from back to front. If we had performed her anterior restorative dentistry using her current occlusion, she would ultimately break any composite or ceramic off. Maximum intercuspation for her posterior lower teeth were directed by using a Kois Deprogrammer because she had lost her ability to find a repeatable bite. After wearing the deprogrammer for 2 weeks, she had a repeatable stop on the deprogrammer platform and demonstrated relief of her temporomandibular disorder symptoms (

). For this patient, we placed implants on both sides of her upper arch (using Neodent by Straumann) and allowed the implants to integrate while aligning her lower anterior teeth. Once her ClearCorrect® (Straumann) aligners were completed, she had an appropriate arch form for our upper anterior restorations. She was then ready for permanent posterior temporaries. This can be done using Grandio® blocs by VOCO if your patient is planning to have a temporary occlusion for a few years; however, in this case, we only wanted the temporaries to last until we were able to verify her new occlusion was comfortable and stable. This is more economical with Structur® CAD, which is a milled temporary material available in blocks or discs, and injectable material. When we used a hybrid of milled temporaries along with the mock-up, this allowed us to build an injected Structur 2 temporary crown on her remaining posterior tooth (

Once all posterior milled Stuctur CAD implant crowns were seated or prepared and temporized, we could move to the upper anterior teeth. We created a posterior stop along with an anterior open bite that would provide space for restorations that increased length and reestablished a facially generated incisal edge position. The patient was ready for injection composites using GrandioSO flow in shade BL on the anterior teeth (

Now we have a patient who has a full set of teeth using milled Structur CAD restorations in the posterior and injected GrandioSO flowable composites in the anterior to create a beautiful full-mouth rehabilitation. This gives us the freedom to advance her to ceramic restorations in any order. We could even phase her right side and left side in the posterior dentition.

This patient felt great with her new vertical dimension of occlusion and functional occlusion, meaning no jaw or masseter symptoms. Speech sounds were ideal, with no lisping, and she loved her new smile. She could stay in these restorations, and we have the ability to do a section each year for the next 3 years.

As you can see, the process can be simplified and systematized to create an outcome and pathway that work for a patient of any financial background and any treatment plan. When you have only a hammer, everything looks like a nail, and when you have a full armamentarium, you can treat the patient and the disease.

Articles

Using a variety of products, including Structur CAD from VOCO, we can craft restorative solutions that can address esthetics, functionality, and even temporomandibular disorders. 

A Step-by-Step Approach to Phased Treatment for Full-Mouth Rehabilitation

Most innovative technologies take time to find their way into a majority of dental practices, as dental professionals want to see what will truly work, and what is nothing but marketing buzz and bluster. Find out which dental technologies are winning over the industry and which are seen as over-hyped as we present the results of the 2024 

In general, how would you describe yourself in terms of incorporating new technologies into your practice?

The results here are on par with previous years, but fans of assuring a return on their technology investments grew at the expense of the dreamers and the impulse shoppers. In fact, while the researchers have remained in the majority through every Technology Census, this is the lowest total we’ve recorded for either the dreamers or the impulse shoppers.

Technologies in Practices and in Future Plans

Rate the following technologies based on the options listed below.

The movement toward digital dentistry being the norm is apparent in these numbers, especially when it comes to 3D imaging solutions. The number of practices using their own CBCT systems and intraoral scanners continues to grow year over year. While chairside mills seem to have lost some of their appeal, 3D printers saw growing adoption and interest. Artificial intelligence (AI) solutions also saw a rapid adoption. The number of practices using these automated computing solutions almost doubled year over year, and stands out with more than one-third of practices planning to add the technology in the next 12 months. All-tissue lasers and operating microscopes continue to occupy a similar niche, and the only technology losing space in practices seems to be the aerosol mitigation solutions that saw quick adoption during and after the COVID-19 pandemic.

The Technology Shaping the Future of Dentistry

What technology has the biggest potential to impact dentistry’s future?

The almost even 3-way spilt of these results shows that there is no consensus about the technology that will drive dentistry in the future. While development in 3D printing, regenerative materials, and AI is moving rapidly, all 3 technologies are likely to make a big impact on what dentists can do to care for their patients in the future.

In this case there is a clear frontrunner. Dental practices are certainly adopting AI technologies, and dental professionals see the potential in these technologies, but they also see plenty of bluster. Both in dentistry and in the wider world, AI seems to be everywhere these days, and maybe that’s a little too much AI for everyone to handle.

Rate the following technologies on their potential to provide a strong return on investment for your practice. 

(1 = least return on investment, 5 = most return on investment)

When it comes to a technology being worth the price paid for the tech, the most commonly used devices were rated as having the highest return on the investment. Loupes, curing lights, and digital x-ray systems topped the rankings, with intraoral cameras and intraoral scanners close behind. Other digital imaging and practice management solutions also provide value to a practice. The ROI on AI solutions was in the lower end of the rankings, while digital shade matching solutions and all-tissue lasers were seen as providing the least value to a practice’s bottom line.

Rate the following technologies on how much you believe your patients expect its use in your practice. 

(1 = patients do not care, 5 = patients expect this technology)

While many practices put their technology investments front and center for patients to see, most clinicians do not feel patients have high technology expectations when they come in for dental care. Once again digital x-rays proved to be the technology at the top of the rankings, with other digital technologies following closely behind. While clinicians believe some patients expect to see loupes on their dentist and hygienist, few believe they expect clinicians to work under a microscope.

Every year Dental Products Report surveys our audience to see what technologies are making the biggest impact on the way dental practices operate and the care they provide to patients.

High Tech Takeover: The 2024 Dental Products Report® Technology Census reveals the start of the industry’s true shift to digital solutions

, we get to highlight new products or technologies by taking them for a test-drive. It’s a chance to give you insights that break through any marketing hype and determine how best to use that product in your practice. As I sat down to write this newest Test Drive, there was a realization that a simple “unboxing with first impressions” was not going to work for a product that takes months, if not years, to develop. So in an exciting way, this Test Drive for SureSmile® Clear Aligners has been years in the making.

I started my journey with clear aligners more than 20 years ago. Using the leading system at the time, we started to change our mindset about the role of orthodontics in restorative practice. For example, we would have a patient with crowded teeth asking for veneers. But rather than amputating healthy enamel to make room for porcelain, we were able to move those healthy teeth into a better position using clear aligners. Even if we were going to place veneers due to unsightly old restorations, there was a benefit to improving root position and occlusion for a more predictable result. It also added another dimension that broadened our treatment planning for a multidisciplinary mindset. We were able to move our dentistry from single-tooth reactive treatment (“There’s a hole; let’s fix it!”) to looking at full-mouth health with an active, anticipatory approach.

The problem we ran into with that first system is that we often had a hard time finding our way back out of the case. We would get stuck in endless refinements, and it was only a matter of time before the patient blamed us rather than their own poor adherence. We also got tired of taking impressions and waiting for weeks, only to find out our impression was rejected. But we still saw the potential. We ended up trying other systems, but nothing gave us predictability or matched with the style and workflow of our practice.

Approximately 5 years ago, we switched over to SureSmile and have had a much different experience. One of the first things that makes a difference to me as a business owner is that it maximizes the investment we already have with our equipment. SureSmile will accept scans from any digital impression system available. Although the former clear aligner provider we worked with eventually had their own scanner, we had already invested in digital impression with CEREC. Rather than our equipment sitting around between crown preparations, those machines are being used all day.

The second thing that makes a difference is the ability to use various trimlines on the trays. Although we are used to a scalloped trimline that follows the gumline, SureSmile offers a straight trimline that could be at the gumline or just above it. What this does is create a stiffness to the trays for more balanced pressure on the tooth. It also helps to hold the shape of the aligner during the time in the tray when the patient is constantly taking the tray in and out.

This results in a reduction in the number of attachments needed. More complex cases are coming back with fewer attachments because the tray has better adaptation on each tooth. Basically, it grabs the tooth better than a scalloped edge that will flare out over weeks of wear. It also allows for more constant pressure on the tooth, resulting in more predictable movement. For us, this dramatically reduces the number of refinements necessary for our cases. SureSmile itself also has an analysis where they looked at more than 150,000 cases globally completed between January 2021 and June 2023. Seventy-five percent of those cases required no refinements.

 This is quite a change from what we were experiencing before.

Another factor to consider is the educational aspect. I had not exactly received a robust orthodontic education when I was in dental school. By the time I started into clear aligners, I realized I had to go back to school in a way. At the time, this resulted in an expensive start-up class followed by the occasional class when I could find them. Although online education has grown across the spectrum from the advent of webinars and streaming lectures, SureSmile has an extremely robust online presence for education. DS Academy and SureSmileU have resources for you and your team that start with how SureSmile moves teeth, to analyzing a case for problems, to setting up your digital prescription. I also know I can call the digital laboratory directly and talk to the person designing my case directly. My personal experience with my local SureSmile team has been valuable as we are using an entirely new system for us. On the most basic level, you can find the information you need in one way or another.

Regarding the financial aspect, as soon as I got home from my introductory class with our first system, we had expensive laboratory bills to pay for each case. Depending on which tier of treatment we chose, we would be on the hook for higher cost if we needed to do refinements. With SureSmile, I have a single fee for the laboratory case that covers any number of trays and any number of refinements for 3 years. This is for any size case, so I am not penalized financially for doing a larger case. The SureSmile fee also includes tooth whitening for the patient as well as the SureSmile VPro, which uses high-frequency vibrations to help facilitate minor anterior tooth movement and helps reduce discomfort to the patient when switching trays. Depending on tooth movements prescribed, we have been able to move patients to 1-week protocols to move through treatment fast. But in an age where everything is more expensive, it is nice to be able to cut costs for our business without any sacrifice in clinical results.

Looking back on this extended Test Drive, we have had a chance to get to know this product. Clear aligner therapy has become an essential part of our practice in diagnosis, treatment planning, and providing uncompromised care to our patients. SureSmile has been good for us, as the system has proven itself to show predictable results, making our practice more efficient and patients happier with the results.

Based on an internal analysis by Dentsply Sirona in excess of 150,000 global SureSmile aligner cases conducted between January 2021 to June 2023. Data on file with Dentsply Sirona.

“With SureSmile, I have a single fee for the laboratory case that covers any number of trays and any number of refinements for 3 years.”

SureSmile Clear Aligners Offer Predictable, Positive Outcomes 

Over the past 20 to 30 years we have seen tremendous improvements and advantages in increasing our ability to visually educate our patients. Intraoral cameras meant that for the first time, patients could see their oral health conditions and better understand our explanations of our diagnoses as well as the solutions we offered.

Better information leads to better decisions and better outcomes in dentistry. It’s important that doctors gather and maintain as much information as possible.

That’s why I’m so excited to be able to tell you about a new device from KaVo that not only increases our visual communication, but also provides critical diagnostic information that previously has been difficult to share with patients. The device is called the KaVo DIAGNOcam™ Vision Full HD, and it is impressive.

The KaVo DIAGNOcam Vision Full HD allows the dental team to capture intraoral photos, transillumination photos, and caries fluorescence photos all with a single device. Up to this point, these images were challenging to acquire. It required different devices with separate computer inputs capturing each image separately. Acquiring all of those images required a serious amount of time, if the office even had all 3 imaging capabilities in the first place.

Into this realm comes the KaVo DIAGNOcam Vision Full HD, which can acquire 3 diagnostic images with 1 device. You can place the device over a tooth and, with the push of a single button, acquire an intraoral photo, a transillumination photo, and a caries fluorescence photo within a second or 2. The entire mouth can be captured and recorded in 2 to 3 minutes by an experienced user.

We all know the value of a good, clear intraoral photo for communication with patients as well as for diagnosis and recordkeeping. Most offices use an intraoral camera multiple times a day.

Despite their usefulness, intraoral cameras can suffer from some problems and limitations. Most have a set focal length, which means it might be easy to capture a single tooth, but images from farther away or outside the mouth are blurry or have a fisheye effect that distorts the images.

KaVo built in a constant autofocus that instantly brings things into focus and renders them without distortion. You can easily take a photo of a second molar and then take a full-face extraoral photo a moment later, and both images are rendered perfectly with no distortion. Simply point the camera at the target, and it is instantly in focus and ready to capture. Whether it’s a single tooth, a quadrant, a smile, or full face, this device does it all.

The KaVo DIAGNOcam Vision Full HD captures precise and clear high definition images. These crisp images allow both the professional and the patient to see amazing amounts of detail.

Most offices using transillumination are doing so with small bright lights utilizing visible white light. They are like tiny flashlights that can be placed to illuminate the interproximal area. The problem with this approach is that because they are bright by design, the light pollution often makes things hard for the doctor to visualize clearly.

The second problem is simply sharing what the doctor sees. Because a flashlight doesn’t take pictures, the doctor has to share their findings verbally, and that brings us back to the fact that only 10% of our perception comes through the ears.

The DIAGNOcam Vision Full HD uses near-infrared (NIR) illumination instead of white light for this process. In the product photos, you can see what appears to be 2 small arms on the device. These arms go over the tooth to embrace it from the buccal and lingual aspects, and they contain fiberoptics that deliver this NIR from both sides of the target tooth. NIR harmlessly penetrates the tooth more effectively than white light and with no light pollution. These images are just as clear as the intraoral ones, and they can be shared with the patient to explain the findings.

Transillumination is a great tool for finding lesions too small to be found on x-rays. It’s a tremendous tool for early diagnosis, pediatrics, and pregnant patients. It is also a tremendous tool for monitoring remineralization therapy.

Transillumination is also a useful tool for locating cracks in teeth and decay under sealants and restorations. Conservative doctors will find this device a wonderful adjunct for their patients.

The third function the device delivers is fluorescence imaging. The bacteria that cause decay create a metabolic byproduct that glows (fluoresces) under certain wavelengths of light. The DIAGNOcam Vision Full HD has LEDs that emit these wavelengths.

The image created by this wavelength causes healthy enamel to have a light-green color, similar to the skin of a green apple. Areas of active caries glow with a red color, allowing for quick identification of their presence.

Simply put, if there are no metabolic byproducts, there are no active cariogenic bacteria. This also allows doctors to find and treat caries at their earliest stages as well as allowing for active monitoring for doctors using remineralization therapy. Comparing images taken over time can give a much better indication if lesions are progressing or shrinking.

If lesions are found when small, restorations can be small and potentially done with no anesthetic while preserving tooth structure. Being able to find active caries early also helps prevent the placing of a sealant over an area of active caries.

The device can also be used during restorative procedures to ensure all active caries are removed before placing the final restoration.

The KaVo DIAGNOcam Vision Full HD is an amazing device. Not only does it provide high-quality images in all modalities, but it also streamlines treatment. The efficiency of gaining all this information in a short amount of time means that offices can obtain more diagnostic information than ever before and still maintain the efficiency of a digital workflow.

I’ve found it to be a valuable addition to my office, and I highly recommend giving it a look. For offices looking to improve their diagnostic accuracy while maintaining efficiency, this is a device that should be considered. KaVo has a long history of delivering high-quality equipment and devices for the profession, and the DIAGNOcam Vision Full HD is a great addition to their product line. I’m confident you’ll be as impressed with it as I am.

This three-in-one intraoral imaging solution is designed for efficient diagnostics and documentation.

See It All With the New KaVo DIAGNOcam Vision Full HD								

In the increasingly digital landscape of health care, protecting sensitive patient data and ensuring the integrity of clinical operations are paramount. Cybersecurity threats, such as ransomware and malware, pose significant risks to dental practices, potentially compromising patient care and data privacy. One effective measure to mitigate these risks is application whitelisting. This security approach can play a critical role in safeguarding your practice management software data and maintaining regulatory compliance.

Application whitelisting is a cybersecurity practice that allows only preapproved applications to run on a system. Unlike traditional antivirus solutions that blacklist known malicious software, whitelisting takes a proactive stance by permitting only trusted applications. Any software not on the whitelist is blocked from executing, thus preventing unauthorized or potentially harmful programs from compromising the system.

Below are a few reasons why this is important.

Dental practices handle vast amounts of sensitive data, including personal health information and electronic health records. A data breach can lead to severe consequences, including identity theft, financial loss, and damage to the practice’s reputation. Application whitelisting helps ensure that only verified applications access and manage these data, significantly reducing the risk of unauthorized access and data breaches.

Ransomware attacks are a growing threat to dental practices. These attacks can encrypt critical data, rendering it inaccessible until a ransom is paid. Application whitelisting prevents unknown and unauthorized applications, including ransomware, from executing within the system. By limiting the software that can run, you can effectively block ransomware from infiltrating your networks.

Dental offices must comply with various regulations and standards, such as the Health Insurance Portability and Accountability Act (HIPAA). HIPAA mandates stringent measures to protect patient data and ensure data confidentiality, integrity, and availability. Application whitelisting supports compliance efforts by providing a robust mechanism to control and monitor the applications that interact with patient data, thus meeting regulatory requirements for protection.

Maintain System Integrity and Availability

The availability of patient data systems is crucial for patient care. Downtime due to cyber attacks or system failures can have dire consequences, including delayed treatments and compromised patient safety. Application whitelisting helps maintain system integrity by preventing unauthorized modifications to critical software and systems. This ensures essential health care services remain available and operational.

Identify and Approve Trusted Applications

The first step is to identify all the applications necessary for day-to-day operations. This involves collaborating with information technology (IT), clinical staff, and administrative personnel to compile a comprehensive list of trusted software. Each application should be thoroughly vetted to ensure it is secure and necessary for office functions.

Once the list of trusted applications is established, health care organizations can deploy whitelisting technology. Various solutions range from built-in operating system features to third-party security software. The chosen technology should be compatible with the existing IT infrastructure and capable of managing the whitelist efficiently.

Application whitelisting is not a one-time setup; it requires continuous monitoring and updating. Practices must regularly review and update the whitelist to accommodate new applications and software updates. Continuous monitoring ensures any unauthorized attempts to run applications not on the whitelist are detected and blocked promptly.

Although application whitelisting offers significant benefits, it also presents challenges. Managing and maintaining an up-to-date whitelist can be resource intensive, requiring ongoing effort from IT staff; it really is something that dentists and their staff should not be doing. Additionally, whitelisting may inadvertently block legitimate software updates or new applications, potentially disrupting operations.

By creating an application whitelist system, you can keep your operations running smoothly while reducing threats from malicious software such as ransomware.

Application Whitelisting in Dentistry: Enhancing Security and Compliance

As digital imaging and digital workflows empower clinicians to better streamline their dental care, the accessibility of technologies becomes key. In the past, there may have been a high barrier of entry to solutions and systems that could provide a variety of benefits for dental patients. These barriers often included high costs, complex implementation processes, and a steep learning curve for dental professionals.

According to Eric Relyea, vice president of marketing at Glidewell, dental practices are often faced with 3 main concerns when it comes to implementing digital dentistry and new technologies: affordability, disruption to the workflow, and concerns around ongoing support and training.

The initial investment required for purchasing advanced digital equipment and software can be substantial, making it challenging for some practices to justify the cost. Additionally, there are ongoing expenses associated with maintenance and updates that can add to the financial burden. Meanwhile, disruption to the workflow is another critical issue. Integrating new technologies often requires changes to established procedures and practices, which can initially slow down operations and reduce efficiency. Dental teams must adapt to new systems, which can take time and may temporarily affect patient scheduling and overall productivity. This transition period can be a source of stress for both staff and patients.

Finally, dental professionals need adequate training to effectively use new technologies, and they require continuous support to troubleshoot issues and maximize the benefits of these tools. Without reliable support and comprehensive training programs, the adoption of new technologies can lead to frustration and underutilization of the equipment. Ensuring that staff members are confident and proficient with new systems is crucial for a smooth transition and long-term success.

Glidewell’s fastscan.io, integrated with the glidewell.io™ In-Office Solution, aims to reduce the stresses of these 3 core concerns through its advanced features.

The fastscan.io harnesses the power of Medit® i900® hardware to ensure not only fast scanning, but also the precision required for same-day restorations. This technology is designed to capture highly detailed digital impressions of a patient’s teeth and oral structures quickly and accurately, at a speed that allows dental practitioners to reduce chair time and enhance the overall patient experience.

According to Relyea, the i900 was a perfect match for the workflow Glidewell wanted to provide for clinicians.

“We saw Medit as an ideal partner, as they are very much moving forward on the technology side,” he says. “We are providing a system that has no fees and no extra subscriptions associated with it, which is something very positive to the doctors.”

Also key to this decision was Medit’s frequency of updates, per Relyea.

“It’s a very powerful tool. They’re constantly updating it through new apps in their ecosystem,” he says. “And they were very open to integrating with both our in-office solution and our lab.”

Included with the scanner are a rolling cart, a laptop, a monitor and a backup battery—all at no additional cost to the practice. These features are complemented by the i900’s design, hosting a variety of optimal qualities for clinicians. Some of these features include the scanner’s lightweight wand, its 10.9 µm ± 0.98 accuracy, a 360º touch band, and a 3rd-generation optical lens.

“Glidewell is very much about helping make dentistry more accessible and more affordable,” Relyea says. “Medit has done that on the scanning side. So, there’s a nice synergy there.”

Accessibility Through Artificial Intelligence

The fastscan.io software harnesses the power of artificial intelligence (AI) by using the company’s existing database of successful cases to create crown proposals. These machine-learning software components, known as CrownAI™ and MarginAI™, will auto-generate a design for the clinician. Doctors can then approve that design or make adjustments if needed. Once it’s ready, it can go straight to the mill.

“We let AI do the work,” Relyea says. “We benefit from the fact that we run millions of cases to the lab on a regular basis. There are tons of data that allow us to create proposals that, by and large, are ready to be printed or milled with very minimal adjustments. So, that makes it very accessible to the doctor.”

Glidewell’s fastscan.io is indicated for 3D printing as well, providing clinicians with the ability to fabricate their own appliances and nightguards, according to Relyea.

“On the 3D printing side, we’ve really focused on making nightguard creation very simple by using the same one-click AI design system that doctors use for crowns,” he says. “Doctors can then accept and send to print, or make adjustments as needed. The same workflow used to design crowns applies to making nightguards. So, both of those pieces link together and make them make a very complementary package for clinicians.”

And clinicians can take confidence in Glidewell’s AI and production systems, per Relyea.

“The AI systems have been in use here at the lab since before 2018. It’s something that we’ve really pioneered,” he says. “It’s more than a lab. We also have a full materials [research and development] and engineering division, so that we are truly integrated and able to do things like create the software for these systems and create the mill itself. We make it right here on campus. Our support team is here as well. The materials were all created here too. So, it’s really a purpose-built system or set of systems.”

Purpose-Built Support With Savings Potential

Key to glidewell.io as well as the fastscan.io is its support services. Installation and in-office training are provided, as well as a fully staffed technical support team that’s available any time.

“We have field service reps that are available to them at any time at Glidewell. We don’t contract any of this out,” Relyea says. “It’s all internal people, all internal training. It’s a very easy situation for clinicians to get started and to be confident in what they’re doing.”

Clinicians can also take confidence in the lab support provided by Glidewell, which can assist and support in cases where the system is unavailable. The seamless connection to the lab includes a 3-day turnaround and $20 savings or more per unit on model-free cases. The more the scanner is used to send cases to Glidewell, the more doctors can save. Because the scanner is designed as an open system, doctors also have the choice to send scans to another lab of choice.

By offering a cost-effective solution that does not compromise on quality, fastscan.io aims to make advanced digital dentistry accessible to a broader range of dental practices.

Glidewell aims to make digital dentistry, including chairside milling and 3D printing, more accessible and affordable for dental clinicians with this integrated scanning solution.

Deep Dive: Expanding Accessibility With Glidewell’s fastscan.io Solution

I’ve seen a lot in my years in this profession. I was lucky to have entered dentistry at the time I did. I love change, and I have been fortunate enough to see a lot of them in my career. There are always better ways to do things. Those processes are out there just waiting to be discovered or uncovered. Like valuable minerals trapped inside a mountain, they just take a spark of motivation and a lot of digging to get to the gold.

Younger doctors will probably laugh when they read this, but in my first couple of years in practice, I charted with a red and blue pencil on a paper chart. We used film and a chemical processor to take radiographs, and when they were dry, we would put them in a small coin envelope and write the date on the outside of it. My procedural chart notes were written by hand, and I was sure to use ink so there was no way they could be edited. I had to print when I wrote up notes, because my cursive is so abysmal that sometimes even I can’t read it. I didn’t have time to write up those notes during the day, so at the end of the workday, I would spend approximately 30 minutes at my desk doing my notes.

Those days were long, and looking back, they seem so tedious. Of course, at the time, they didn’t seem that way. Simply put, I didn’t know any better. That’s just the way it was, and I slogged along blissfully unaware of how great the future would be. So this month, because the focus of this issue of 

 is our Tech Census, let’s take a look at 4 things you should be using at this point along the dental timeline.

The things I’m mentioning here are what I think you should be using at minimum. I understand that acquiring and integrating technology requires an investment in capital and time, so my recommendations here are for things that have been available for a while, are easy to use, and won’t put a huge dent in your operating revenues while enhancing productivity and giving you better clinical outcomes.

I’m sensing some eye rolls here, so please bear with me. I was peer review chair for the state of Missouri for approximately 25 years, and I also do expert witness work in the malpractice space. Because of my work in these areas, I’ve seen a lot of dental records in my career. I was constantly amazed by how many doctors were still using paper in their recordkeeping. Something to keep in mind if you ever end up in litigation: Perception by a jury is tremendously important. If your records look sloppy and unorganized, people may be inclined to assume the doctor is sloppy and unorganized, whether that’s true or not. I’ve also read records where the handwriting was worse than mine, and that is saying something. If your records cannot be understood, are sloppy, or are minimal, they could come back to haunt you.

Keeping all your clinical notes and charts digital is a tremendous time saver. Nothing is illegible, it’s hard to lose things, everything is in sequential order, and clicking a mouse is inordinately easier than coloring with that red and blue pencil. Knowing that charting, periodontal probing, and notes are instantly available and easy to use makes your day easier and less stressful.

American Dental Association statistics state that 90% of doctors are currently using digital radiography. That’s great news to me. My question is, why are there around 10% who are still holding out?

For those doctors, I have one thing to say. The 1990s just called, and they want their film back.

In all seriousness, in all my years talking with my peers, I’ve never had one person tell me that they got rid of their sensors and went back to film. Once you go digital, you’ll wonder why you waited so long.

Add to that the explosion the industry has seen with artificial intelligence (AI) in radiographic analysis. The number of users increases every month, and the more radiographs these systems see, the smarter and better they become. Of course, digital radiographs are necessary to use AI, so that’s one more reason to make the change from film. For those of you who are already on board with digital, you should be considering which AI system you want to implement.

For those of you who read this column regularly, you know how passionate I am about communicating visually with patients. It’s much easier for patients to comprehend their problems and understand treatment recommendations if they can see what those problems are.

The great news in this area is that the prices of intraoral cameras have fallen significantly in the past 5 to10 years. This allows the office looking to provide an image to use as a focus of communication with patients to purchase a camera for a few hundred dollars.

Two examples of very affordable intraoral cameras are the MouthWatch and the Shofu EyeCam. Both connect to a computer via a standard USB cord and are incredibly portable. However, the prices of these devices are low enough that buying a camera for every operatory can be accomplished without breaking the budget. The last time I checked, these 2 cameras were both under $300.

For offices that perform a lot of cosmetic or full-mouth reconstruction treatment, there are several cameras that provide stunning images in the higher price range. Every doctor has different wants or needs. The takeaway is that you should have an intraoral camera and use it regularly.

This is another product category that has seen amazing progress coupled with astounding price drops since the product first came to market. It’s incredible to me that when I was a kid, lasers were things only superheroes used, and now I pick one up every day. When I bought my first laser, it cost approximately $35,000 and was approximately the size of a 2-drawer filing cabinet. Today, a laser with similar power and settings can be purchased in the same form factor as a powered toothbrush for less than $5000.

Lasers can make everyday operative and surgical tasks easier and faster. One of the best things about them is that laser wounds heal incredibly fast and with minimal, if any, postoperative pain. They also rarely require sutures, even for large areas. A diode laser has an affinity for hemoglobin, which creates immediate hemostasis. This allows the doctor to work in a practically bloodless field. Being able to see the field while reducing the need for chemical hemostatic agents and sutures means more clinical efficiency, fewer postoperative visits, and fewer postoperative calls from patients.

Although retraction cord is still an option, I rarely use it anymore. I can create clear, clean views of my margins in approximately 1 minute using a diode laser and sometimes by adding VOCO Retraction Paste into the mix.

Diode lasers are a critical part of my clinical armamentarium. A day rarely goes by when I don’t pick one up for a procedure. When you consider the tremendous benefits, ease of use, and low price tag for many of these units, it’s hard to find a reason not to own one.

Let’s take a quick look at some technologies with either less time on the market or a higher price tag. If you already have the 4 things I discussed previously, this is where I’d direct your interest.

I won’t cover this in-depth because I’ve written on this subject recently. Let me just state that this is a technology that is now ready for prime time. Users are finding AI critical to help increase diagnostic accuracy and productivity. Having an objective “second opinion” always available to point out areas of interest is a game changer for the profession. As more features are added by the vendors and the products mature, they will continue to be game changers for doctors who embrace them.

This is another product category that has seen amazing progress in both features and lower prices. At this point, there is a scanner for every budget. Many offices, mine included, cannot imagine being without it.

Add to this the fact that an intraoral scanner is the entryway to a truly digital workflow. If you have not yet purchased a scanner and are looking to improve both your workflows and your clinical outcomes, this should be on your short list of technologies to invest in.

The devices can be used for fixed and removable prosthetics, orthodontics, diagnosis, and even hygiene, making them universal must-haves for practices. This is a technology that has a model with the right features for any office, no matter the budget. They save time and improve clinical results, and patients are fascinated by the technology.

Whether you are interested in same-day dentistry, improving results, or controlling costs, in-office milling has something to offer you. Today’s mills can create results previously thought to only come from a skilled laboratory technician with years of experience. We installed the DGSHAPE DWX-42W in our office more than 2 years ago, and I am still amazed at the results it creates.

When you combine the results with the lineup of materials you can select for your patients, in-office milling has tons to offer. The materials have a proven track record of success. That means that things you mill today have the longevity you expect from something created in a laboratory. There is also the fact that many laboratories are now milling most of their restorations. That translates to having the quality of materials you can purchase for your office match that of the same materials being used by dental laboratories around the world.

Milling in our office has improved efficiency, which our patients love, and given us the results we demand as clinicians.

Behold the next wave in the world of dental technology. The next 18 months are going to see in-office 3D printing take the industry by storm. For the past 3 to 4 months, I’ve been up to my elbows in the world of 3D printing, and I can tell you that from what I’ve seen behind the curtains, you are going to be thrilled.

Workflows are going to be changed for the better as we eliminate steps in our processes that are rapidly becoming unnecessary or redundant. Cloud-based design systems that use AI to help create all kinds of dental devices are on the horizon. Imagine diagnosing the need for an implant on Monday morning and performing the placement on Tuesday morning with precision and confidence and with a guide printed to your specifications right in your office. Then imagine placing a transitional removable partial with the pontic custom-designed to create the tissue contours exactly as you, the doctor, want them—also printed in your office.

Plaster and stone will rapidly become “remember when” materials as we move to virtual design using models that exist only in the design software. Occlusal guards, bleaching trays, interim partials, full dentures, and more will be delivered, sometimes within hours, to happy patients.

Our profession has become a moving sidewalk of progress. It seems that the only way to make sure you stay current is by constantly moving forward. Of course, I appreciate the fact that offices are always walking the tightrope of investment in technology vs maintaining profitability. However, in my career, I’ve seen doctors wait too long to pull the trigger. By not embracing the future, doctors are often overwhelmed by how much it will cost to invest in several new things at once. The best way to avoid this is to implement a policy of a technology budget. This allows you to set aside a specific amount of money every month knowing that at some point, those savings will be used to bring in new technology or to replace legacy systems.

The good news is that technology can decrease stress, streamline workflows, and give you amazing clinical outcomes. If you have not yet implemented the 4 must-haves I listed here, I highly advise you to do so. Then implement a technology budget and begin the process of saving to invest in even more cutting-edge products.

I’ve been lucky enough to have lived through this tremendous time of advancements in dentistry, and my perspective tells me that things are only going to get better. Even though I’m closer to the end of my career than I am to the beginning, I believe I was born right on time. See you next month.

Doing the same thing the same way will never move your dental practice forward.

The Dangers of Status Quo

My perspective on shielding patients during x-rays changed when I met Steve Maiman, founder and CEO of OCU-GUARD, and was introduced to his novel, cost-effective, intricately designed eye shield tailored for both adults and children. Although I previously hadn’t considered eye protection for radiation exposure, Maiman showed me a wealth of compelling scientific evidence underscoring the imperative of safeguarding the eyes against even minimal doses of radiation.

Coincidentally, during a recent dental visit where I underwent a comprehensive series of images, I took careful note of the proximity of the x-ray unit to my eyes, particularly during anterior imaging. Although opinions about radiation protection during dental radiographs have recently been modified, the eyes were not addressed by the American Dental Association.

Lou Shuman (LS): Why did you create OCU-GUARD?

 I was getting dental x-rays at a routine appointment, and the assistant put a protective lead apron on [me] that covered my body and my neck. After the x-rays, I asked my dentist if they ever considered covering the eyes. He said no but did not have a definitive answer on why not. I decided to pursue the question further and asked my brother, a practicing radiologist, whether ionizing x-rays are harmful to the eye, particularly the lens tissue. This led me to both further research and to the creation of OCU-GUARD.

LS: Can x-rays harm lens tissue of the eyes?

 The lens tissue of the human eye is very sensitive. And the sensitivity is exponentially increased in children because they are still developing physically and their cells are multiplying quickly. They are far more sensitive than adults to radiation. Even more importantly, radiation is cumulative—once irradiated, the damage stays with you. When kids start their early dentistry and orthodontic treatment and they keep getting x-rays, radiation exposure keeps adding up, from youth to old age.

LS: So why does that matter, if modern x-rays emit lower amounts of radiation?

 As we get older, we [are] more susceptible to cataracts regardless of whether we’ve gone to the dentist or not. But having x-rays to the eyes over a lifetime can contribute to an early onset of cataracts. So that can be part of the problem.

LS: Is there any research to back up the need for this product?

There are now [findings from] over 30 published studies demonstrating that x-rays cause tissue changes and damage to the lens tissue. The unique cells of the eyes are extremely radiosensitive, and unlike most cells in the human body, once irradiated, [they] will not regenerate.

At a session of the FDI General Assembly called “Radiation Safety in Dentistry,” the speaker said, “Exposure to ionizing radiation carries the risk of harm. The effect on the eye may be caused by lower doses than previously considered. All reasonable means should be used to reduce radiation exposure, without compromising diagnosis, when radiographs are taken.”2

Roy Rubinfeld, MD, MA, agrees, saying, “As a clinical professor of ophthalmology and practicing eye surgeon, [I can say] it is known that dental x-rays, even in low dosages, can increase the risk of earlier cataract development, especially in younger people. To help safeguard against this, eye shields should be an integral part of every dentist’s safety protocol.”

LS: What can dentists do to help prevent this potential problem?

 The solution is an eye shield. The flexible OCU-GUARD is composed of finely divided, specially graded, pure lead particles, fully encapsulated within a durable vinyl matrix. The lead content offers radiation attenuation greater than 93%. It is contained within the vinyl structure to prevent absorption from the product to the skin.

It is extremely durable [and] comfortable and can be cleaned with standard disinfectant wipes. Each shield is guaranteed to last a minimum of 500 complete examinations, making the cost per examination under 10 cents. The OCU-GUARD core leaded material passes the 3 most universally recognized testing procedures for radiation products: ASTM [American Society for Testing and Materials], [the] US standard; IEC [International Electrotechnical Commission] 61331-1, widely used throughout the world; and DIN [Deutsches Institut für Normung (German Institute for Standardization)] 6857-1, [the] German standard and considered to be the strictest in the world.

 Whether you are a parent or a patient yourself, once you realize that ionizing radiation is harmful to the eyes, you will be relieved to know that your dentist is doing something to prevent possible damage. Also, every practice has patients who refuse x-rays or who are very reluctant to allow x-rays to be taken because they are radiation averse. This is very helpful to show those types of patients that you’re taking every step you can, including protecting the eyes.

LS: Why should dentists add an eye shield to their protocols?

Dentists know they have always done their best with ALARA [as low as reasonably achievable] radiation initiatives. But now that we know a bit more than we used to, there is a need to be more protective, especially with children. We need to do what is best for the patient, even if it is not mandated, because it is the right thing to do. For more information, visit 

1. Benavides E, Krecioch JR, Connolly RT, et al. Optimizing radiation safety in dentistry: clinical recommendations and regulatory considerations. 

. 2024;155(4):280-293.e4. doi:10.1016/j.adaj.2023.12.002

2. FDI World Dental Federation. FDI policy statement on radiation safety in dentistry: adopted by the FDI General Assembly: 13 September 2014, New Delhi, India. 

. 2014;64(6):289-290. doi:10.1111/idj.12148

Radiation sensitivity shows a need for eye shielding during dental x-rays.

The Eyes Have It

In 2023, Synchrony, on behalf of CareCredit, conducted the Dental Lifetime of Care study (dentallifetimeofcare.com) to understand people’s perceptions of the cost of dentistry and to gain insights on how that perception may shape their dental health care decisions. A few of the study’s key findings suggest that patients may be confused about their insurance benefits and the cost of dental care. In fact, only 30% of survey respondents found understanding dental health expenses easy and only 50% with dental benefits knew their annual maximum.

When patients are confused about cost or are not aware of how their benefits may offset that cost, they may accept partial treatment, delay care, or choose not to accept treatment at all. The 2023 Dental Lifetime of Care study findings also found that because of cost, 17% of patients surveyed ignored a recommended procedure, 29% delayed treatment, and 13% chose a less costly treatment. Combined, that’s 59% of patients who did not move forward with recommended and needed dentistry. So what does that mean for dentists? Results from the Dental Economics/Levin Group Annual Practice Survey found that the average dentist’s personal production was $733,000 (excluding hygiene production).

 So even if 10% of patients are not moving forward with treatment, it’s not only patients walking out the door without needed care but also potentially $73,000 in production lost for the practice.

The dental team can play a pivotal role in informing patients so that they have clarity on the value of care but also on costs and how to pay for it. Here are 4 best practices to consider:

Proactively review patient insurance benefits and how they work prior to the examination so that patients know what their benefits will cover.

Put patients at ease by letting them know you have payment options, including the CareCredit credit card, should there be a gap in the cost of care and their benefit contribution. Make sure to reinforce that they thoroughly review the terms and conditions while considering payment options.

Use visual aids when presenting cost, and tie the cost to the value of the dentistry being recommended—specifically how it will benefit the patient or solve a problem. CareCredit has resources, such as a payment options form, available to enrolled practices at 

Let patients know whether there are any potential consequences for delaying, declining, or compromising care.

Most Americans have been faced at one time or another with an expense that they did not plan or save for, and that can cause financial stress. The study results found few patients proactively save for dental care. In fact, almost 75% of study respondents said they don’t save for dental care and of those who do, the average is only $648.

Confusion about the cost of dentistry and insurance benefits may also affect patients’ decisions to make an appointment in the first place. In the Dental Lifetime of Care study findings, of the people surveyed, only 73% went to see their general dentist in the past 12 months. Of those who did not, 54% cited expense as the reason.

Ongoing patient communications can encourage those who hesitate to schedule an appointment by increasing awareness of the average cost of care, how benefits work, and ways to manage out-of-pocket costs. Proactively educating patients about cost and insurance benefits can help patients have clarity and make care decisions to improve their oral health.

1. Levin R. The 2024 DE/Levin Group Annual Practice Survey: a period of higher production and long-awaited stability. 

. Published online May 8, 2024. https://www.dentaleconomics.com/practice/article/55016675/higher-production-and-much-needed-stability-the-2024-de-levin-group-annual-practice-survey

This content is subject to change without notice and offered for informational use only. You are urged to consult with your individual advisers with respect to any information presented. Synchrony and any of its affiliates, including CareCredit (collectively, “Synchrony”), make no representations or warranties regarding this content and accept no liability for any loss or harm arising from the use of the information provided. Your receipt of this material constitutes your acceptance of these terms and conditions.

CareCredit research indicates that many patients are unclear about their insurance benefits and the costs of dental treatments.

Dental Products Report July/August 2024