Digital Workflow: Staff Roles in a Digital Practice

Digital workflows change many aspects about your practice, including staff roles. Each member of the team should know what their role will become when adding digital services to your practice.

It begins with understanding the “why.” International speaker Mark Hyman, DDS, MAGD, an Adjunct Full Professor and Special Assistant to the Office of the Dean at UNC Adams School of Dentistry, says team onboardings should include why your practice went digital. As the second user of the CEREC 2 in North Carolina where he practiced for over 30 years, Dr Hyman purchased four different CAD/CAM units over his career, starting in 1997. He says the team’s support made the digital workflow successful.

“In most cases, you're going digital because the quality of the work skyrockets, whether you mill in your office or through a lab,” Dr Hyman says. “The patient experience is superior.”

According to Dr Hyman, after the staff learns to use the system, verbal skills training is essential to communicate with patients. He wanted his staff to understand the value and benefit of the treatment so they can support his treatment recommendations after he left the room.

“With digital technology, you train for the skill of using it, plus the verbal skills of building the value of it when talking to patients,” Dr Hyman says.

Getting the Team Involved in Scanning

Getting the staff buy-in on the system is essential, and John Flucke, DDS, and Technology Editor for Dental Products Report^® agrees. He recommends starting with the scanner for the workflow and having your reps bring you one to test out before you buy. That affords you a chance to “test drive” your investment before you commit, and it gives the staff some time to play with it, too.

“I am a huge believer in buy-in. Your staff and clinical team need to be on board, too. If they aren’t onboard, and you do not have buy-in, the implementation could be a disaster,” Dr Flucke says. “If you get them excited and they’re fired up about it, no matter what it is, you get everybody going in the same direction.”

There is an additional benefit of having the team play with the equipment. The team will provide you authentic feedback about the technology that you wouldn’t get from patients.

“If you use a scanner on a patient, a lot of people won’t say stuff like, ‘well, that thing that you stuck in my mouth was really big and I had a hard time because it was choking me,’” Dr Flucke explains. “But if you use it on each other, the team will tell you.”

Once you choose a scanner, the team should continue to apply the system. J. Wayne Leonard, DMD, FICOI practices in Jacksonville, FL, and serves as a regional doctor mentor for Heartland Dental. He presents extensively on digital workflow. He says every clinical member of the team should be able to scan a patient in under 5 minutes.

“The value of a scanner comes in the diagnostic world,” Dr Leonard says. “If an office were to use the scanner for nothing besides diagnostics, it would probably pay for itself 5 times over.”

Team involvement in the digital workflow is a value of Heartland Dental’s training. Educational modules always include a scanning component, from their esthetics courses to implant and crown and bridge continuums.

“Even at our annual meeting in our winter conference, there’s always a scanning breakout so people can receive that training,” Dr Leonard says.

Once treatment planning begins, Dr Leonard’s office takes a different track. Depending on interest and skills set, he has various team members take on different types of scans. For example, some team members are excellent at removable dentistry while others are better at working on scans for complex restorative cases. Dr Leonard trusts his team to deliver imaging that will facilitate the treatment, then reviews the scans before proceeding.

“The scan is as critical as the prep work, the temporaries, or the implant placement,” Dr Leonard says. “You have to make a leadership decision on who your best scanners are and who has enough training to handle complex scanning.”

An Excellent Enhancement to Your Team’s Work Environment

Employee retention is a critical issue for many dentists in practice today, especially after the COVID-19 pandemic. Dr Flucke and Dr Hyman agree that having the team engage in the digital workflow process enhances the employee experience. Dr Hyman’s team stuck with him for decades, and he credits that in part to their engagement with a digital workflow.

“Instead of sitting there sucking spit, a chairside assistant gets to play with a $100,000 CAD/CAM machine,” Dr Hyman says.

Dr Flucke’s dental assistants have also been indispensable with in-office milling. As the navigators of the digital workflow, his assistants were excited to help from the beginning, training on how to use the exocad software and system together.

Their excitement translates into friendly competition, seeing who can design the crown the fastest. Dr Flucke walked by and saw an assistant hard at work at a workstation in the conference room while the other held a stopwatch, calling out the seconds and trash talking. Dr Flucke appreciates the excitement and how their efforts have decreased the doctor time involved in the digital workflow process.

“Many doctors don’t want to be a lab technician, and I don’t either. Sure, it’s fun every once in a while, but I wouldn’t want to do all that stuff every time I place a crown,” Dr Flucke says. “And I don’t have to. The assistants rock-paper-scissors each other to see who gets to do it.”

Dr Hyman’s dental assistant also handled much of the digital workflow for him. In one situation, Dr Hyman numbed a patient with buffered anesthesia and handled the preparation and buildup. Then, his assistant would pack the chord as needed, scan it, design the CAD/CAM restoration, mill it, try it in, stain and glaze it as needed, take a pre-cementation radiography, etch the restoration and tooth, put in the bonding agent, and call him back. Dr Hyman set the restoration and cured it, then checked the bite.

“Then, I’m out the door while the assistant finished polishing,” Dr Hyman says. “So, in a well-run, restorative dental practice, my total doctor time with a CAD/CAM restoration was 30 minutes.”

Dr Flucke has a similar workflow at his practice. Dr Flucke kicks off appointments by preparing the tooth. Then, the dental assistant scans it with the iTero. After Dr Flucke checks the scan, the assistants design it, which takes around 10 minutes. The mill takes another 20 to 30 minutes. With expanded function in Missouri, where Dr Flucke practices, the assistants can try it in and adjust if it needs it. Once it is ready, Dr Flucke double checks the bitewing on his screen, and then the crown’s fit, the contacts and the bite, and the margins with the mirror, the same way he would with a lab case.

“Then if everything looks good, and the patient is happy, I get up and I say, ‘Okay, Amanda’s going to put you back together, and I leave,” Dr Flucke says, adding that when she’s done, he checks it again before dismissing the patients.

Delegating some of the digital workflow to the team has a few benefits to Dr Leonard’s practice. First, fresh eyes make sure that the practice is delivering quality dentistry. If one person was doing every aspect of scanning , it would be exhausting to the individual. Dr Leonard says that dentists should only be doing the required scanning specific for their state.

“But the dentists need to be available for the high-impact moment, which is reviewing the scan to ensure it is done well and will get excellent results from the laboratory,” Dr Leonard explains.

Dr Leonard says his team thinks scanning is fun. Also, the team feels more involved in the patients’ care when they can identify potential patient concerns from the scan they took.

“That’s a great thing to see,” Dr Leonard says, adding that he doesn’t want to take that away from his team. “Our team does a lot of unrewarding tasks, like scrubbing instruments, cleaning rooms, taking out the trash. They have to have some things in the office that for them are high value and empowers them to feel like they are participating in their patients’ care.”