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Professional Courtesy: Plug Into the Future by Dr. Thomas Giacobbi

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Categories: Practice Management, HR and Accounting;
Professional Courtesy: Plug Into the Future


by Thomas Giacobbi, DDS, FAGD, editorial director

What’s the next big thing in dentistry? Is there something on your wish list that would make you more efficient, provide better outcomes or reduce your overhead?

We have entered an era where skilled team members are more difficult to find, yet we have access to technology with the potential to do some heavy lifting. This month, I’m going to introduce some concepts for your consideration, and I would love to read your feedback about them.


Designs for the future
The adoption of intraoral scanners for digital impressions has happened much more rapidly than the suite of same-day dentistry devices that paved the way in this category. That’s not much of a surprise, when you consider that to begin doing everything in-office and getting rid of your lab bill costs a ton of money and requires a fundamental change in patient flow. Only a small number of dentists have transformed their practices completely so far.

The reality of having skilled team members who can manage the design, milling, staining, firing and finishing of these restorations is intimidating—and difficult to sustain. Take a single scan and send it to five different digital labs, and I promise you won’t get five identical crowns back. Why? Machines can make great proposals, but humans will improve the design with more detailed anatomy and contours.

Design is such a critical element that I would argue more offices would consider milling or printing restorations if they could send their scans and receive a ready-to-manufacture design shortly thereafter. I mentioned this idea in a recent column discussing 3D-printed nightguards: Several remote services will design one to your specs and send you a design ready for printing. Yes, some dentists have installed the software in their practices to design their own nightguard and do it all, but I’d say most of us don’t want to take on that aspect of the treatment.


Getting—and sharing—the right information
Meanwhile, surgical guides for implant placement can provide a similar but more complicated opportunity for remote manufacture.

I restore implants but don’t place them. Like many general dentists in my situation, I’ve had to restore too many implants that would’ve had a better result if a surgical guide had been used. (In my book, two of these cases is “too many.”)

One of the technical challenges is correctly compiling the information: The surgeon has the CBCT image for planning but needs to get an intraoral scan from me that can be merged with the CBCT. Once the surgical guide has been designed, it then needs to be printed. Should this happen at the general dentist’s office or the surgeon’s office? Bottom line: You need a surgeon who is willing to make a change and use surgical guides on a routine basis so every implant, regardless of location, is designed with consideration for the best restorative outcome.

In the short term, many capable labs can bring these elements together to produce a surgical guide. Sometimes the lag time can be a factor. That’s why the ability to manufacture this in-house may be an attractive model in the future.

I often wonder if some of the larger labs would consider satellite milling and finishing, operating in a manner similar to Amazon distribution centers: As orders come into the central facility from all over the country, the designs could be sent to strategic locations in large cities around the country to be milled and finished. This model could reduce delivery times significantly. I imagine there would be cases where a group of dentists could share a space where together they would have enough volume of lab work to make a model like this fly.

The fact that we routinely share large volumes of patient-specific data every day is a modern miracle. We are starting to discover all the possibilities.

How would you like to practice in the future? Please share your comments on the digital version of this article below. You can also reach me via email at tom@dentaltown.com.


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