Townie Survey: Tech Questions

Dentaltown asked, and hundreds of Townies replied. We tallied the responses when Townie Choice Awards voters weighed in on the areas of dentistry they had questions about, and the categories that received the most answers were:

• Dental lasers.
• Digital impressions and scanners.
• CBCT machines.

Next, we dug deeper, asking our Townies to get specific and discuss what exactly they hoped to learn about these developing devices and technologies. Over the next six pages, you’ll hear from your fellow dentists in their own words, about what they hope to incorporate into their future dentistry.

Dental Lasers

Dentaltown editorial director Dr. Tom Giacobbi says:
These aren’t the laser beams made famous by Austin Powers, but they do still conjure thoughts of science fiction. Whether you’re using a diode for minor soft-tissue procedures or considering a hard-tissue option, laser technology has long proven itself a winner. If you don’t have access to this technology in your practice, it’s time to get some training and learn more about the possibilities.

Townies are asking:

“My dentist friend just got into the Solea laser and loves it, but admits it has some limitations. I want to find out just how this new technology can be incorporated into the general practice flow, and if it is truly career-changing like my friend claims. The ROI is important to me, and I want to make sure this is a good thing for my patients as well as for me and my team.”
Dr. Scott L. Clough, Bellingham, Washington
“sclough”

“I’d like to know which laser would be best for the practice I have. I actually don’t know too much about it—I haven’t attended any laser seminars, for example, but I have read about lasers in dental magazines—and I’d be interested to learn which one would be a good choice to use for procedures like gingivectomy, cavity preparation and removal of mucoceles.”
Dr. Isza Aich, Chicago
“aich”

“What kinds of procedures does each brand of small desktop soft-tissue laser perform? What kind of tips does it use? How many classes do you need to take to do these procedures? Wattage? Costs? In the average general dental practice, what is the ROI? Is a laser really worth purchasing? As dentists, we can’t have every toy and gadget. And what is the number of actual procedures completed in one month in a general practice?”
Dr. James Karam, Warren, Michigan
“drjames”

“I use a dental laser in my practice and was initially drawn to the dental laser because of its versatility—perio, endo, snoring, cosmetic and more. The more I learned about the dental laser, the more I became fascinated by its ability to perform a variety of procedures, but there’s still a lot to learn about other tasks it can perform, including biostimulation therapy and treatments for TMD and orofacial pain. The world of laser dentistry is diverse, and I’ve only struck the surface!”
Dr. Yu Ting Wang, Frisco, Texas
“Smileup”

“Lasers always seem to be a hot topic. There is some exposure in dental school, but it can vary based on the technology used by the school. I took the laser certification course in residency and used a diode laser on a pig, but had mixed thoughts about its use in the pediatric dental office after the course. 
The biggest area that I could see for growth in my practice with the addition of a laser would be for infant frenectomies and frenotomies, to help with feeding and speech in infants and young children. Given the high investment in the technology, I’m interested in what product would be the most clinically effective and yield the most ROI for the pediatric dentist.
My questions: What type of laser is the best for cutting soft tissue quickly? Is a hard-tissue laser really worth the extra expense? What are the biggest limitations or shortfalls realized by practitioners who already utilize laser technology? And I’ve practiced without a laser for so long. Do I really need one?”
Dr. Jarod Johnson, Muscatine, Iowa
“jarod”

“I was exposed to little knowledge about lasers while in dental school, but I have noticed an increase in their use. I am mostly interested in using them for aesthetic crown lengthening and troughing for impressions/scans. I would like to also learn about the different types of lasers and their uses. Some specific questions I have include:
• What procedures are added when integrating laser technology into a general dentist practice?
• What are the advantages/disadvantages of diode lasers versus erbium lasers? I know erbium can do hard and soft tissue, but are there are other advantages?
• And are there any recommended CE courses to take for nonbiased laser education? (I’ve already taken Dentaltown’s Laser Dentistry basic CE.)”
Dr. Ben Lively, Portland, Oregon
“LivelyDDS”

Digital Impressions and Scanners

Dentaltown editorial director Dr. Tom Giacobbi says:
Digital impressions were still a small player in clinical dentistry when labs were busy converting their operations to a digital workflow. Now dentists are seeing the benefits of adding a digital impression to those existing workflows. The marketplace has many great options, and the dentists on Dentaltown.com can give you terrific stories of their experiences with this technology.

Townies are asking:

“I’m curious about how digital scanning can fit into our practice, from digital impressions for crown and bridge to impressions for Invisalign all the way to integrating a scan with our CBCT to create surgery guides. I still have the curiosity, but I just purchased a new scanner that should help us satisfy all the questions we’ve had.”
Dr. Guy Nash, Temecula, California
“guyrnash”

“I have an interest in digital impressions because I use them now. I use a 3M True Definition scanner and email my digital impressions to the lab. I am very happy with the advantages of the digital impressions. There are some minor problems and I’ve wondered if others have them also. I have had tremendous success with scanning natural teeth but have had some minor problems with scanning implants. Don’t know if others have had any issues.
Another unrelated issue: Why do most labs highly polish abutments? In most situations it does not make a difference. I know it should be polished at the tissue level, but why does the surface of the implant abutment (that is going to be touching cement) have to be polished? Shorter abutments I do use screw through one stage, but this is not always an option. A matte finish to bond would give better retention. Do we dentists want this highly polished cemented surface or do the labs think we want that surface?”
Dr. G. William Walker, Butler, Pennsylvania
“docgww”

“I’m definitely in the market for an intraoral scanning system; I recently viewed the latest systems at the Ontario Dental Association’s annual spring meeting in Toronto. I didn’t have enough time to fully examine each system due to a paucity of time, so I rely on magazines like Dentaltown to help me make an informed decision (for which I thank Dr. Farran and the entire Dentaltown team).
I need to know my ROI, the upfront costs of owning a complete scanner system and how long it would take to recoup my costs.
• Are there consumables to use, like plastic sheaths?
• Will the handpiece plastic crack if wiped regularly with a disinfecting wipe?
• How steep is the learning curve, because I’m certain my chairside assistant will need to take some courses, too?
• Will the machine will be obsolete in 3, 4, or 5 years?
• Can the software or firmware can be upgraded as technology progresses?
• Is the STL file open-ended, so I’m not married to one milling system?
• Can the scanner be used for every application for which I currently make intraoral impressions using gooey materials? Can I use it for crown/bridge/implant and other orthodontic scans?• Can I scan a pediatric patient for a space maintainer? How about complete and partial dentures?
• Can the scanner send files to my lab in California using my Wi-Fi at night, or do I have to stand over it and plug USB drives into my PC?
• Does it have auto-diagnostics? What are the running costs?
• Is a lease possible? What’s the warranty?
• And, of course, can it make me a perfect cup of coffee?”
Dr. Vipul G. Shukla, Mississauga, Ontario
“vipulgshukla”

“If a lab can scan a model and store it digitally (Glidewell) for only $10, why can’t a company make an inexpensive digital scanner a dentist could use to do the same in the mouth?”
Dr. Tommy Murph, Conway, South Carolina
“drtommymurph”

“I feel right now is the most exciting time to be in dentistry with the advances of technology. I am most curious about how the digital impression can be used for everyday workflow from single unit crowns to scanning full arches for nightguards, surgical guides, clear orthodontic aligners and implants. I would want to then know how to use a 3D printer in my office to fabricate them. I would also like to know how to do full-mouth rehabilitation cases and take accurate CR without using a facebow.”
Dr. Avi Malkis, Larchmont, New York
“Avim”

“I’ve heard a number of colleagues say that their digitally impressed, lab-made crowns are dropping in with better fit and less adjustment than PVS. My question is how much this has to do with a more efficient workflow and quicker turnaround time? If losing the steps of pouring, trimming, etc. is leading to less time in a temporary, the teeth have less time to shift and create difficulties adjusting the lab-made crown to a slightly different occlusal scheme. I’ve worked with Cerec before and I must say I prefer two quicker appointments than one longer appointment to go from imaging to fabrication in one day, but if digital imaging can create an easier crown seat date, I am very interested.”
Dr. Daniel Valicevic, Denver
“dsval”

“Digital impressions have many advantages over ‘material’ impressions. They do have a few drawbacks (software issues) that I am sure the manufacturers can work out in time.
1. The software must recognize when a finger, tongue, cheek or mirror obstructs the view and automatically remove them from the image. Cerec is supposed to do that but it does not happen reliably. In full-arch cases, this becomes more critical. 
2. Smallest tissue tag currently obstructs the view and creates an artifact. This is the major reason we prefer PVS impressions. The software must use the information from surrounding areas and extrapolate the obstructed spot so that the model can be made intact. 
I am looking forward for these issues to be resolved so that we can all put away the messy PVS stuff.”
Dr. Parsa T. Zadeh, Beverly Hills, California
“Parsa”

“I’m curious about how quickly the technology is being adopted by dentists of differing years in practice, what kind of return on investment others are finding whether through time savings or impression material costs and what kind of patient acceptance and positive responses offices are finding. I’m also wondering how easy dentists are finding the incorporation of the tech into their practices. Lastly, are there any standout digital impression platforms that most dentists are using (for instance, certain composites and companies comprise a majority of what dentists use), and is there finally one data standard that most of the digital impression providers are using so that they are universally accepted at dental labs?”
Dr. Kevin Ingham, Moncton, New Brunswick, Canada
“whizdent”

“What is the best product out in the market currently? Which one integrates best with Invisalign? How often are these products/systems upgraded? What are the maintenance costs and any additional fees owning one of these systems?
Are there newer models on the horizon?”
Dr. Christina Klein
“DrKlein79” 

CBCT and CAD/CAM

Dentaltown editorial director Dr. Tom Giacobbi says:
Having access to 3D images has completely changed our approach to many common procedures, including extractions and implant placement. There are fewer surprises and better planning before a procedure is done. As with digital impressions, our partners in dental labs have led the way with widespread adoption of computer design and manufacture of dental restorations. In many ways, this technology has helped labs deal with a shrinking labor pool.

Townies are asking:

• “What codes do we use for billing cone beam, including using the bite-wing feature?
• The bite-wing feature doesn’t have the clearest resolution when magnified. Is there a solution to this?
• Besides implants, sleep apnea, oral surgery and endodontics, what other applications can we use it for in dentistry?
• Please compare radiation levels to FMX and panoramic films, plus the patient’s lead apron type and the radiation beam area and distances plus information on the scatter radiation patterns.”
Dr. Vanessa Franks, San Francisco
“vanessafranks”

“I’ve been a Cerec user for 15 years now and so while it isn’t new technology for me, I have not utilized some aspects of the process, such as surgical guides for implants. I would also love to get into full-arch scanning and marry that with 3D printing for models, nightguards, etc. Let’s finally get rid of the plaster, stone and model trimmers once and for all!”
Dr. Scott L. Clough, Bellingham, Washington
“sclough”

“I’m most curious about how to currently get value in a CBCT if I don’t place implants. I think the technology is amazing in the placement of implants, pathology and in endodontics, but I’m having trouble finding a way to justify the current costs of the machine. I do believe as price comes down and uses go up then it will be a no-brainer to ditch my current pan. Until then, I’m in watch and see mode.”
Dr. Gary Holtzclaw, Simpsonville, South Carolina
“Gary1128” 

“I’m most curious about how to incorporate these technologies in my day-to-day work flow. I know how they can benefit me, but the integration part is where I am stalling out on. I would love to see basic hands-on and common-sense training on how to get immediate use and value out of the technologies. Dentists have a habit of buying a new toy and then it turns into a coat rack. I want to use the technologies daily and have them fit into my routine easily without completely changing my flow.”
Dr. Reid Marshall, Birmingham, Alabama
“talldent”