Digital Impressions for All: Why You Should Take Them For Every Patient

Digital impressions have converted many dental practices away from traditional impressions. We explore why you should capture a digital impression of every patient and what you can do with those records.

Rune Fisker, Senior Vice President of Product Strategy and Product Management for 3Shape, believes taking digital impressions for every patient will change dentistry and redefine patient care. For example, clinicians can juxtapose current and previous scans to detect changes in wear from bruxing, chipping, or gingival recession.

"We have numerous cases where dentists have described effects of a disease that weren't possible to see with the human eye," Fisker says.

Agatha Bis, DDS, agrees, adding that capturing a digital scan of a patient's teeth is a game-changer for the patient, too. She says most patients who experience a digital impression for the first time are blown away by its simplicity and how fast, precise, and detailed the scans are.

"When we take digital impressions in my office, we often show the patient their scan and manipulate it in multiple dimensions so they can see what their mouth looks like, often with more detail than can be seen with the naked eye," Dr Bis says.

"Having digital impressions as well as records and images helps us provide better care for our patients and allows our patients to understand their oral health and treatment options better," Dr Eric Mayuga agrees. "I believe digital impression capability is a near must-have for every dental practice today. It is a wonderful tool for patient education, comfort, convenience, and enhancing dental team productivity."

In addition, Fisker says clinicians can track orthodontic relapses or teeth shifting. Digital impressions take digital restorative care to the next level, especially for treatments like digital dentures and implants.

Fisker says the most progressive dental clinics already use digital-impression-for-all approaches. Also, dental service organizations (DSOs), like The Aspen Group and Heartland Dental, have systemized digital impressions for all patients in their supported practices. Fisker thinks more dental practices should follow their example.

"It's a rare opportunity to create a better world and treat diseases much earlier than ever before," Fisker says. "It will set a new dentistry standard and redefine how we use intraoral scanners."

"It gives you or the patient a portfolio of what's going on in their mouth over time," Alexander Wells, DDS, Program Manager, Customer Incentives for Dandy, agrees.

Dandy gives its dental practice partners an intraoral scanner, scanning software, a laptop and rolling cart for free so practices can implement a digital workflow. In addition, they provide complementary scanning and workflow training for the entire staff. Dr Wells says that scanning is fundamental to dental care because it is such a visual practice. He also says that one of the goals for scanning every patient should be patient education. Digital impressions allow staff or clinicians to show a complete 3D and rotated view of the patient's mouth while they explain the diagnosis. For example, if a patient can see the tooth's decay or deteriorating state, they understand why a crown is necessary.

"The other side of that coin is scanning every patient inherently adds to trust, which leads to treatment plan acceptance," Dr Wells says.

"Multiple times every week, patients come into the clinic, and dentists tell them they need treatment, but maybe they don't want to spend the money. Instead, they want to buy a new iPhone or go on holiday. The tooth is not the top of their mind," Fisker agrees. "This technology takes patient communication to a completely different level. It helps them understand when a serious problem needs fixing."

The lab benefits from getting digital impressions for every patient, too, especially since there are shortcomings to traditional impressions for the lab. Kenn Butler, Director of Lab Research & Development for Dandy, says cases lose critical details at each subsequent step after the initial impression in the traditional impression workflow.

"There are 3 of 4 levels of translation and, therefore, 3 of 4 levels of detail that will be inevitably lost," Butler explains. "In the intraoral scanning workflow, there is only 1 translation level. It's the patient’s existing dentition to scan, and whatever you see as the clinician is what your technician will be working off as well. So, there's no room for interpretation."

Plus using a digital-impression-for-all approach means clinicians will have an easier process getting an excellent impression.For example, when most of an impression is excellent, but 1 section isn't, a digital impression means the clinician only needs a partial rescan for the troublesome section. With an analog workflow that would mean a retake.

Butler also likes how digital impressions make capturing the emergence profile a lab needs for an implant case more straightforward for the clinician and patient. In a traditional workflow, that's 2 impressions; with a digital impression, it's an extra 10 seconds of scanning.

"Digital makes the gold standard of care much more approachable and accessible to the average dentist," Butler says.

"Dentistry is extremely invasive from the patient's perspective. That's why there's so much fear and anxiety around dentistry," Dr Wells says. "The digital scanner means you don't have to throw away your entire impression, nor do you have to stick more of that mold in a patient's mouth. So, it is a much more comfortable experience for that patient at the end of the day."

Incorporating Digital Impressions for Everyone Into the Workflow

Dr Mayuga says the learning curve for using an intraoral scanner is not steep, and all of his staff members have been able to take excellent digital impressions within minutes of first picking it up.

"A wireless scanner makes this process even easier and more convenient," Dr Mayuga explains.

Also, intraoral camera experience helps the learning curve, per Dr Mayuga. At his practice the team takes a full-mouth radiographic survey and multiple intraoral pictures with his cameras.

He says intraoral pictures are an excellent tool to help patients see for themselves what the clinicians see, and better understand any issues or potential problems. However, intraoral pictures are static. Clinicians cannot manipulate pictures other than changing colors and contrast.

They have recently started taking digital impressions at the first visit as a standard of care for adult patients and find that having these impressions benefits the patient and the office.

"A digital impression can show patients their dentition in 3D. We can manipulate the arches at any angle and show patients how their teeth interact. This functionality is important for helping patients understand potential issues like malocclusions and the detrimental effects of bruxism," Dr Mayuga says. "When indicated, these scans can be sent instantaneously to our lab for immediate fabrication of a splint or appliance. In addition, if the patient will be undergoing extensive dental work, these scans provide a baseline to refer to and compare as their treatment progresses."

Butler says it is vital to remember digital impressions still require attention to detail for preps and isolation.

"You have to use your hemostatic paste, and you can't rely on the PVS doing that last little bit of tissue compression with the digital scan," Butler explains.

"The beauty of this, like any other skill in dentistry, is the more you do it, the more you move from spending a lot of time getting comfortable with it into becoming extremely proficient," Dr Wells says.

Moreover, Fisker says the practicality of implementing digital impressions for all dictates it should not be the dentist but the assistant or hygienist that scans.

"No high-volume clinics have the dentist scanning patients," Fisker says.

If a dental practice cannot manage a digital impression for everyone, Fisker would advise clinicians to incorporate regular scanning with annual X-rays. However, the scanner you use will influence the practical application, too.

"The scanner needs to be super easy to use and fast," Fisker says.

Incorporating a digital workflow in your appointments has challenges, too, Dr Bis explains. The first is time. It takes a couple of minutes to take a digital impression, then review and present it to the patient, adding time to the appointment. Then there are resources, like staffing, to consider; someone must set up the scanner, take the scan, and disinfect the scanner after use.

However, with these challenges also come rewards. "In my practice, taking digital impressions has led to more comprehensive treatment acceptance," Dr Bis says, "and a greater level of confidence and understanding of patient treatment recommendations."

Elevating the Patient Care with Regular Scanning

Dr Bis says digital impressions provide a detailed multi-dimensional view of a patient's bite, gingival profile, margin line, etc., which enables a clinician to see how a new restoration or restorations would address a patient's particular functional and esthetic needs.

"Dentists have an intrinsic ability to see in three dimensions, but most patients do not. Most people don't know how to visualize the movement from mesial to lingual to distal, then over to occlusal and buccal, then back over to lingual. As you read that sentence, you knew exactly where I was in space at all times. But most people do not. And they do not intrinsically understand how something small in one area can be big in another and why you can't ‘just fill’ that area. That is something that needs to be seen in 3 dimensions while maintaining the flow of movement," Dr Bis says.

Dr Mayuga's office has 2 different scanners, each pairing with the Roland DGA DGSHAPE DWX-42W chairside milling solution and their older mill. With the mills' open architecture system, they have no problems sending scans from either scanner to the mills. Plus, providing same-day crowns, onlays, and inlays is a convenient and time-saving benefit for their patients and the practice. Patients do not have to return for a second appointment, and their days aren't filled with non-productive seating time.

For esthetic and more extensive cases, Dr Mayuga sends the digital impression to the lab, where providing a digital impression also reduces time.

"Our current lab can often turn these digitally submitted cases around in as little as 4 days, which is impressive," Dr Mayuga says. "The margin accuracy and fitment are outstanding whether we send digital impressions out to the lab or mill in the office with the DWX-42W."

Fisker appreciates that delivering outstanding patient care is the goal of most practitioners. Scanning technology has multiple applications, allowing practitioners to track disease development and oral health stages along with enhancing patient records and long-term comprehensive treatment planning. New scanner technology also can leverage the digital impression as a diagnostic tool, Fisker says.

For example, advanced scanners have a fluorescent scan mode, which discloses many things besides surface caries. With TRIOS Patient Monitoring, Fisker says different color maps delineate small, medium, and significant changes between present and previous scans.

Moreover, when regular digital impression scans are combined with X-rays, intraoral scans, photos, videos, and CBCT scans and stored in the practice management software, a dental practice has comprehensive patient imaging in the patient record. Fisker says 3Shape is currently in beta testing with a Dentrix integration.

In addition, a digital-impressions-for-all approach facilitates faster accident and trauma recovery, denture fabrication or replacement, or smile design applications. For example, Butler appreciates that if someone chips a tooth, the practice already has a pre-accident scan, making restorations faster and more accurate. Also, practices could do a case presentation for night guards or clear aligners based on the wear and movement they see in the consecutive scans.

"I don't see as many practices doing this, but the ones that do have crazy effectiveness with it," Butler says.

Fisker says with TRIOS Treatment Simulator, a dental team can show patients a before or after image with clear aligner treatment using a single click. They also have plans to leverage AI analysis with intraoral scans.

"Coming in the software in a couple of months, the TRIOS Treatment Simulator will have a whitening simulation, also. There is also a smart design software where you can take a 2D picture of the face and do whitening there, or even smile design using a 2D picture," Fisker says.

Dr Wells sees similar benefits in hygiene appointments. Showing patients what is happening because of their habits is an effective preventative care tool.

"The beauty of the oral scanner is that you can see things like recession, calculus and tartar buildup, and furcation visibility. We can show them on a big screen what's happening at the hygiene level because there is something not happening that should be," Dr Wells says.

Dr Bis' office uses digital impressions routinely for same-day dentistry alongside Roland DGA's DGSHAPE DWX-42W chairside milling solution. Most of the restorative dental treatment provided in her practice involves a digital impression sent to their DWX-42W mill. However, she does provisionalize more significant cases that require more milling time or more complex cases that she sends to her dental laboratory.

"On a typical day, my digital workflow is scan, design, chairside mill, and seat the restoration in the same visit. This means there is no need for a second appointment involving anesthetic or a temporary restoration," Dr Bis explains. "There are so many options when you get to the stage where you want to mill in-house, and it ultimately comes down to each individual and their desire to grow, expand, and take on new challenges."

What Dr Bis says she didn't know before investing in technology, like a digital scanner, CAD/CAM software, and a chairside milling system like the DGSHAPE DWX-42W, is what it can do for her dental practice, how patients see her, and who she can become as a result. She says these tools' intangible aspects and impact are beyond what she could have imagined.

"I am a vastly better dentist, a much more effective communicator, and much more able to make a compelling case when I feel there is an urgency to going ahead with treatment now rather than sometime in the future," Dr Bis says. "And the best part, at least for me, is that I am having way more fun."