Thursday, November 29, 2012
Recently a top marketing person in the dental industry asked me to list the top 3 obstacles, issues, or concerns dentists convey to me in discussions about switching from traditional PVS to digital impressions. My reply was first the overall cost associated with the scanner and the fees, second the size of the scanning wands and the perceived difficulty of the systems, and third concern or doubt about the accuracy of a digital impression compared to a traditional PVS impression.
The way I see it, those concerns have little validity, and if you’ve been waiting to make the switch from traditional to digital impressions, the time now may be better than ever.
At Ziemek Laboratories we have managed approximately 30,000 digital impression files to date, from all of the major digital scanners on the market: the 3M ESPE Lava C.O.S. which was recently upgraded as the new 3M True Definition Scanner, the iTero from Cadent/Align, and the CEREC from Sirona. This means Ziemek Laboratories has received those scan files from dentists and either fabricated a restoration for them, fabricated some component of the restoration for their lab and sent that component and the model to their lab for restoration fabrication, or processed the scan file and routed the model to their lab to fabricate the restoration entirely. Each scanning system operates differently, but Ziemek’s track record of thousands of restorations we have created that originated from digital impressions that are in the mouth today is proof positive that this technology is no flash in the pan or a trend that will eventually go the way of the Beta movie player and the Laser Disc.
The reality is you can’t simply get lucky more than 30 thousand times. The truth of the matter is digital impressions can be incredibly accurate, the process is surprisingly easy for dentists and staff to transition into, and it streamlines the workflow of labs who are already working digitally. Additionally digital impressions allow any lab that isn’t working digitally to be involved in the restorative process, and to choose the level of financial commitment and involvement with their dentist’s digitally scanned cases.
Of those most common questions and concerns I mentioned earlier, the most frequently asked by dentists and their staff members is, “Are digital impressions as accurate as traditional PVS impressions?” My answer is yes, a properly taken digital impression is just as accurate as traditional PVS impression that is properly taken, if not better.
Fig. 1: The margins are marked on digital impression received at Ziemek Dental Lab.
Can you mess up a digital impression scan and provide the lab with inaccurate information just like a traditional impression? Sure, but it’s tougher to send a poor digital impression to the lab because the digital impression system provides the dentist with an onscreen magnified view of the scanned prep along with adjacent and opposing teeth chairside before the lab ever receives it and only catches an issue when it’s poured in stone. If the dentist sees something he or she doesn’t like, it’s simply deleted and rescanned. With a traditional PVS impression, once the temporary is on, the patient is gone, and a day or so later the lab has a stone model with buried distal margin back at the dentist office to trim. It’s not quite as easy and it’s already costing the dentist and the lab valuable time.
What about the cost? Early adopters of new technology almost always pay a premium to be among the first to own and operate said technology. I remember when my parents purchased our very first VHS VCR in the 80s. It was two pieces—the digital tuner for the TV was a separate unit from the player and only received 20 channels—and their combined weight was about 40 lbs. The cost of the system was around $1,300, and that is early 1980s currency and translates to several thousand in today’s dollars.
Fig. 2: The digitally designed e.max Press restorations are shown fitting on the SLA model created from the digital impression.
What’s my point with the time capsule back to 1983 in the Stover house? We all know technology gets better, faster, easier to use with improved features, physically smaller and lighter, and less expensive with time. Digital impression technology is no exception, and these systems will continue to improve and evolve like all technology, until in my opinion they replace traditional PVS impressions all together.
Just a few years ago you would have paid in the $25k- $35k neighborhood to purchase a digital impression scanner system. 3M ESPE’s new True Definition Digital Scanner is now priced around $12,000 - $13,000, a huge reduction in retail price which makes this technology instantly more accessible. 3M’s True Definition Scanner system also now provides an open architecture option, which is a complete paradigm shift for the company. The digital impression scan files can be plugged into virtually any CAD/CAM system by labs for model printing or milling in house instead of waiting while the model is produced elsewhere and shipped to the lab. This provides a savvy lab with many more options for fabricating restorations quickly and ultimately with more control over their workflow.
Fig. 3: The restorations created from the digital impression seated in the patient's mouth.
Another example of how this technology is evolving is the ability to digitally scan implants such as the connection between the iTero scanner and Straumann's implant systems. I’m really enjoying working on implant cases that are now scanned digitally, and we are creating custom abutments and crowns from all types of materials completely digitally. No stone models, no hand waxing and casting expensive UCLA style abutments, no hand waxing or casting any part of the final restorations at all, be it a PFM, full gold, e.max Press, Lava, or full zirconia crown. The parts and pieces of the restorations can all be digitally designed and milled or printed.
The dentist simply removes the healing cap and places a locator in the implant, scans the locator and the rest of the teeth, and sends the scan file off to the lab where we plug it into our custom abutment design software and have the custom abutment fabrication completed at around the same time as the model. Many restorations or their components also can be completely or mostly fabricated in this same time span which drastically improves our workflow, and shortens the amount of time the patient waits for the final implant restoration.
So we know that the digital impression systems on the market today are becoming less expensive, the technology is improving and evolving to allow more restorative choices, and we know digital impressions are very accurate and reliable, these facts can be proven. What about the concern regarding the difficulty of using a digital impression system vs. taking a traditional PVS impression? In my experience over years of working with many dental offices that have made the transition from traditional to digital impressions, this issue has always been about the process and level of commitment undertaken by the individual dental office and not about how difficult or easy the digital impression systems are to operate.
These systems are all surprisingly intuitive, and although they do have a learning curve, are not difficult to integrate into a practice. I’m sure many of you reading this article remember the very first PVS impression you took in dental, hygiene, or assisting school. Thinking back to those days, was it very easy to learn to perform the impression taking process correctly and consistently or did it seem a little daunting at first? Were there certain steps that had to be practiced and then performed with consistency each and every time to get a good result? With many years of practice things become second nature, and when a new process or technique is introduced it can feel foreign and uncomfortable until you become proficient with the new way.
The scanning process is no different in this regard, and my point is that these systems are all very user friendly and pretty darn easy to use. Another benefit in my opinion—an opinion shared by many digital offices with first hand experience—digital impressions are quite a bit easier for the patients. Holding still and not gagging for 5 minutes while you bite down on an impression tray is not a pleasant experience, especially for patients with an active gag reflex or heightened anxiety about dental appointments in general. A digital impression is less invasive and, once a user is proficient, a quicker process. One of the many benefits of switching to digital impressions is the ability to market the practice as a “state of the art, digital dentistry practice” and I have personally seen that marketing tool alone, or just the word of mouth, be enough to motivate a patient to switch dentists to one with a digital impression scanner.
In my opinion, the number one priority when considering going digital is to make sure the entire staff— from the dentists, hygienists, and assistants to the front office staff—all understand the benefits, are excited about the technology and it’s possibilities, and are 100% committed to making the transition from traditional to digital impressions. The offices I have seen struggle with digital impressions and not utilize the system to its fullest—or stop using it all together—all share one thing in common. At these offices the entire staff was not fully committed to making the switch.
I recommend that the dentist always become the “lead” scanner in the office at least for the initial integration and then select an assistant who is interested in the technology and not “technologically challenged” to begin scanning as much as possible. This way the office has options to function so the assistant can do the bulk of the scanning while the dentist is performing other procedures to improve efficiency, leaving just the preps for the dentist to scan. The law is different in each state, but most allow an assistant to scan the opposing and the adjacent teeth and the dentist to scan the prep. There are some dentists who are not comfortable with anyone else scanning and this also works. I think some of these dentists also realize how much fun this process can be, and simply really enjoy scanning.
I also recommend that dentists take their staff to a trade show that showcases the digital impression technology and all of the different systems available on the market to get a hands-on demo. This allows the staff to actually use the scanners, see how they operate, and do real world comparisons of the different systems to see which one is right for their office. Online forums are also a great place to get information and advice from actual users before you purchase as long as you are careful to look at the information exchanged very objectively.
Is the question now or never? No, but traditional impressions will eventually go the way of the VHS movie player and be replaced by an entirely digital process. It is inevitable in my opinion. Managing a lab that has processed 30,000+ digital impression cases and seeing first hand just how powerful and effective this technology is, I see it as the starting point of a string of digital information and tools that will create all of our restorations in the future.
With the prices of the digital impression systems coming way down, amazing accuracy, the technology improved and improving, open architecture systems available, thousands of restorations in the mouth originating from digital impressions, and thousands of dentists already taking digital impressions exclusively, the question is really if not now, why not?