A Fully Digital Dental Workflow by Dr. Michael Kelly

A doc lays out the case for why making the jump to digital is a no-brainer

by Dr. Michael Kelly

Technological advances are enabling a more efficient digital workflow in dentistry. Digital dentistry, which has become an essential component of my practice, improves clinical outcomes, reduces the time and expense of restorations and implants, and improves patient comfort. To keep up with modern dentistry and meet patient expectations, growing your practice with a digital element—or four—will help you practice on the leading edge.

What makes a digital workflow?
Digital dentistry can be as simple or as complex as you’re willing to commit to. The keys to a digital workflow are integrated systems and open platforms that allow every piece of technology to “talk” to others. My digital workflow for restorations and implants includes a Carestream Dental CS 3600 intraoral scanner, a T-Scan digital bite analysis, a Carestream Dental CS 9300 CBCT system, an Amann Girrbach milling machine with Exocad design software and a SprintRay 3D printer.

What are the benefits?
Saving time and expense. Think back to when we used film for photography. It took a lot of time and work. With digital photos we can be faster and take more photos quickly, deleting what we don’t like.

The savings in time and expense are the same with digital implants and restorations, contributing to increased speed, accuracy and convenience. First, the design process is so streamlined that it typically takes three to five minutes to design a restoration. The rest of the process is simple to delegate, so I don’t have to spend much of my time to achieve amazing results. Then, without the need to mail in impressions and models, a lab can begin working on my cases instantly. Also aiding in faster turnaround is enhanced communication; if modifications need to be made, the lab lets me know and the digital impression is modified (rather than remade) instantly. I used to have to wait for three weeks to get an implant surgical guide. That can be now accomplished by the next day, which means patients can wait less time for their final restorations. (We turn large cases over typically in one week or less. Single units can be completed the same day or the next day depending on the materials chosen.)

The other factor I want to stress with dental implant cases is the drastic reduction in cost of the restorations. Without the need for so many parts and pieces to achieve the ideal final result, material and lab costs are considerably less. I can allow for more cases to be ideally designed and placed, while also reducing cost to the patient. Not to mention, material costs have also plummeted since switching to the digital processes. Digital mock-ups for cosmetic cases allow me to reduce the number of wax-ups required, which reduces my lab bill and time delay that came with that procedure.

Increased patient satisfaction. Patients love the digital workflow. They no longer have to put up with the gagging and taste of conventional impression materials. Many fearful patients will accept treatment when they know they can avoid the parts that they hate. I’ve had patients come for a second opinion and, once they found out we offered a fully digital workflow, they accepted treatment at my practice. The awareness of same-day crowns is growing, but as technology advances, the consumer demand for more and more services with drastically reduced wait times will grow.

How do I introduce digital technology in my practice?
For dentists who are just dipping their toes in the digital realm, a good place to start is with the addition of a digital intraoral scanner. Look for a scanner that’s fast, accurate, simple to use and, most importantly, has an open platform. That means doctors can choose what they do with the files and can work with any digital lab of their choosing.

If doctors are still uncertain about introducing an intraoral scanner, it may put them at ease to know they don’t have to design restorations in-house. Instead, a third party may design the cases for them. This is especially nice when working on difficult or large cases. These services are fast and quite inexpensive.

Additionally, consider using digital bite analysis to take the guesswork out of the occlusion and reduce chair time. The biggest factor that was missing in my workflow before was the timing of the contacts. Paper only shows that the surfaces touched, but the T-Scan shows me when they touch, how hard and for how long. Interferences are easily detected and eliminated.

Perhaps a doctor is looking to dive even deeper into the digital depths and expand what services they can offer patients, say with virtual implant planning. A CBCT system is a must, especially a system with imaging software that’s simple yet robust and allows doctors to complete every phase of treatment without the need to export into other software.

I use the Carestream Dental CS 9300, along with a prosthetic-driven implant planning module that merges the data from the intraoral scanner and the CBCT scan. This allows me to finalize the ideal placement, consider the perfect restoration and work backward from there.

In addition to their benefit to diagnosis and to treatment-plan, these merged 3D and impressions scans are ideal for patient communication. I can show a patient their case with an implant mocked up, which is especially important when there is too little bone available. (It’s easy to make a case for bone grafting when the implant is protruding into the sinus cavity.) With the virtual implant planned, a digital surgical guide can be ordered from a lab or printed on-site, depending on the doctor’s desire.

Finally, for the “early adopter” seeking a fully in-house digital workflow, consider adding a milling machine or 3D printer. The printing option is still early in adoption but will drastically change dentistry in the coming years. Procedures like clear aligner therapy, surgical guides, provisional dentures and crowns, splints, etc., all can be printed at reduced cost to the practice and reduced case and chair time.

In the next few years, we will see more and more use of digital printers in the dental workflow. They are inexpensive, accurate and fast. This addition will make dentistry more affordable for both the patient and the dental provider.

Doctors who combine intraoral scanning, CBCT, virtual implant planning, and in-house milling and surgical guide printing may find themselves completing more cases than before, with increased confidence of what structures there are and how they will be managed in advance.

Dentists can provide a better patient experience and better clinical outcomes with digital technology. The speed, accuracy and convenience are not only a boon to doctors but to patients as well. Whether starting with the basics, like introducing an intraoral scanner to your workflow, or fully embracing the future of digital dentistry with a 3D printer, now is the time to grow your practice with an advanced digital technology.