Digital dental workflows: input options

July 1, 2019

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

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

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

The new workflow starts with the fact you’ll no longer waste time with traditional impressions, says Dr. John Flucke, chief development officer for Cellerant Consulting and chief dental editor and technology editor for Dental Products Report. That’s the main reason he decided to invest in an intraoral scanner in the first place.

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

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

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

The new workflow

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

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

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

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

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

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

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Finding the right lab

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

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

What happens once the files arrive at the lab

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

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

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

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

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The difference between tabletop and chairside scanners

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

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

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

Why it’s time to go digital

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

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

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