So, you’ve decided to invest in an intraoral scanner—now what? At least a dozen new, updated, or white-labeled intraoral scanners were introduced at the 2019 International Dental Show in March, giving doctors more options than ever. By now we are aware of the benefits of intraoral scanners and what we should be looking for when purchasing one: speed, accuracy, an open system, and flexible workflows. But what about the nuances of owning an intraoral scanner that never come up during a sales demo—the things you only realize in retrospect after owning a scanner for a while and wondering how you ever worked without it?
It’s so much more than scanning
The act of capturing the impression scan is only the first step in the digital workflow; it’s what happens after—in the software—that can make all the difference. When looking for a new scanner, I would encourage colleagues to make sure the outcome that is scanned looks as realistic on the monitor as possible, so patient education and treatment planning are as realistic as possible.
“Pretty” pictures for the nonclinical eye
My practice has found that the intraoral surface scans that our CS 3600 intraoral scanner (Carestream Dental) captures are an incredibly powerful tool to educate patients, especially in the codiscovery consultation process. Patients have a very positive reaction to seeing their mouths in the virtual world almost instantly, and the feedback is incredible. We have used the intraoral scans to help a patient realize a tooth has an old corroding amalgam that needs restorative/prosthodontic management; to demonstrate a worn dentition or a fracture; to demonstrate gingival recession and deficiencies in attached gingiva; to identify ridge deficiencies in cases that required guided bone regeneration; and for pathology documentation such as soft-tissue pigmented lesions that called for a biopsy. I have even used the scans as a way of showing patients plaque and helping them improve their self-performed hygiene habits. While we don’t consider the scanner a substitute for photography just yet, this appears to be the way things are trending and might be the way the technology continues to develop.
Integrated images for improved treatment planning
If you’ve taken the leap and invested in an intraoral scanner, you’ll want to ensure you’re getting the most for your money. Ensure your scanner can integrate with other technologies in your practice for a truly digital workflow from start to finish. For example, we can get digital diagnostic wax-ups, which are interfaced to the 3-D scans from our CS 9600 CBCT system, so that we firmly maintain our prosthetically directed implant surgery mantra. From these surface scans, we are also able to have printed models made and can make palatal stents for donor sites in soft-tissue grafting (connective tissue or free gingival graft surgery). We can also make simple vacuform conventional templates if an implant surgery is not planned to be guided or as a backup to ensure we have a plan B. We operate with a representation of tooth position in space, at least by means of a conventional template, to ensure prosthetically directed implant surgery is carried out in our practice. The superimposition of CBCT imaging data over the impression scan, facial scanning, and other emotion-based techniques are improving how we diagnose, treatment plan, and consult.
You’re not the only player
When investing in new technology, it’s always good practice to take your staff’s feedback into consideration. After all, they’ll most likely have their hands on it the most. But with an intraoral scanner, you need to think outside your office walls.
“Dial it in” with your digital lab partners
“Dialing it in” refers to how a digital impression is captured, the quality of the printed model, etc., and the workflow expectations of the restorative team. Before you choose a scanner, partner with one to two lab technicians who are willing to go digital with you. This is the most critical aspect of successful digital restorative dentistry. Making sure that you and the lab are in sync and that expectations, deliverables, and accountability from both sides are clear can help make digital dentistry fun, rewarding, profitable, and a great service for your patient. If you don’t spend the time dialing it in with your lab technician, you are destined for frustration, unfulfilled expectations, and buyer’s remorse.
Test your technology partner
Since most in the dental profession have no knowledge about how to engineer a practice for the digital era, we are often beholden to our IT partners. While the latest clinical technology is amazing and transforming what we do, making this happen on the business side of dentistry puts us in a rather vulnerable position. Therefore, when investing in new technology and choosing your IT vendor, be aware of hidden fees beyond the start-up process, such as repair and ongoing maintenance associated with being digital. However, as clinical technology continues to advance, equipment that is intelligent and intuitive will help doctors avoid a reliance on third-party IT vendors.
Regard your referrals
For my periodontist and oral surgery colleagues, I would caution against obtaining an intraoral scanner for the purposes of making restorative/prosthodontic colleagues more profitable with less effort. These marketing pushes undermine what collaborative accountability and teamwork are all about. In fact, these efforts, to some extent, marginalize the expertise needed from our restorative colleagues.
I often hear that I should be taking a digital impression for the implants at the time of placement or after osseointegration confirmation for my referral doctors. The appeal is that, if I do so, the restorative doctor can appoint the patient for a single seating appointment and deliver the crown, which should take 15 minutes. The message is that the process is very simple, makes implant prosthodontics highly profitable, and creates excitement for more implant dentistry that will ultimately be referred to us.
It is my position that everyone on the team should have skin in the game and be willing to contribute for the best outcome for the patient. Am I willing to scan an implant for my referring doctors? Absolutely, but this also means that they have to “dial it in” with their labs and be willing to carve out time in the digital planning phase so that there are no surprises. We, as a profession, need to be mindful of the complexities inherent in the health care that we provide. We need to avoid digital intoxication.
Buyer beware: You’ll want more than one
Having one scanner in each of my offices is fantastic and has been a breakthrough in how we collect initial examination data for new patients. We now have a complete digital diagnostic record. Because the impressions are virtual and 3-D, we can use these files as a part of a patient’s electronic record and document the patient’s clinical presentation at various points in time (initial, treatment outcome, etc.). Even if you have only one office, a light, portable scanner that’s not tethered to a trolley is ideal for transporting from chair to chair. That way, every new patient, not just those requiring advanced treatment, receives the same level of dedicated care.
When I first introduced an intraoral scanner to my practice, I didn’t know what I didn’t know. I didn’t know how a scanner would aid in case acceptance, change my relationship with business partners, and transform the way I approach information gathering, treatment planning, and patient care. These are ideas that are hinted at in sales brochures and mentioned in passing during demos, but only owning and using a scanner daily can truly make you aware of just how many benefits there really are.
GEORGE A. MANDELARIS, DDS, MS, FACD, FICD, attended dental school at the University of Michigan. He obtained a certificate in periodontology and a master’s degree in oral biology from the University of Louisville. He is an adjunct clinical assistant professor at the University of Illinois and the University of Michigan. Dr. Mandelaris is in private practice at Periodontal Medicine & Surgical Specialists LTD in Chicago, Park Ridge, and Oakbrook Terrace, Illinois. He limits his practice to periodontology, dental implant surgery, bone reconstruction, and tissue engineering surgery.
