Clinical dental technician Dean Ward shares why you should embrace digital dentistry, not fear it.
Digital: one word I hoped I could avoid! I could see in the past how much digital software had revolutionised dental technology in crown and bridge workflows and how dentists had started to adapt to it in their practices.
I honestly thought it wouldn’t impact dentures during my career, but I soon heard on the grapevine that there was a new milling machine that could mill dentures – I discredited it as ‘not possible’.
Rather than looking into it, I walked away because fear had kicked in! Then Ivoclar and 3shape’s software came about and I thought: ‘No way this is real!’ I buried my head in the sand and told myself it’s not ever going to happen.
Eating my words
We then had reps from various companies visiting and showing me how successful it could be. ‘A load of rubbish’, I thought, and I went back to my wax knife.
The moment soon arrived when I had to eat my own words. On a biofunctional prosthetic system (BPS) course taught by Chris Egan, he showed us the usual analogue workflows, then followed by the digital copy set. I was blown away! They looked average at best, but the patient was absolutely over the moon – this was the moment I considered myself sold.
I asked myself what I was scared of, and the answer was simple: I didn’t want to be replaced by a machine. Little did I know at the time it wasn’t going to work out like that.
The pivotal moment
During the COVID-19 pandemic, I had some time to look into software and 3D printing. I decided to buy a setup that worked for my lab. Why? I was scared of being left behind.
Will dentists send scans or even try digital dentures? The answer was simple: no, not the ones I was currently working with.
Once I had advertised that we were offering digital services, I soon got messages from like-minded clinicians that wanted to join us on the learning journey – this was the most pivotal moment in my journey into digital because my hand was forced into coming up with solutions. You will see people smiling and showing pictures of nice digital cases, but we have all lost our cool with an error code or two.
That’s enough of my back story, but I think it will build common ground and reassure those starting on their digital journey.
A complete flip of our workflow
We now print around 60-70% of our daily work, as some cases need an analogue impression. Dentures are not a one-size-fits-all workflow – they need good understanding from the clinician and technician to modify workflows to suit each case.
With each case, I ask myself three questions: Is it better? Is it more efficient? Or is it both? If these are answered by ‘yes’, then I choose digital. If it’s just to save time, I revert to analogue or a hybrid flow.
Digital advantages
Here are some of the advantages I have found as a technician:
- Chrome partial dentures: this is a game changer. I print the model and design a verification jig for the design at the same time, allowing the dentist to see if the scan is accurate. I have a 100% success rate working like thi
- Broken/lost teeth: this was my biggest annoyance, but it doesn’t happen anymore. If it did happen, it’s as simple as pressing reprint
- Patient satisfaction: this is the one I had to see with my own eyes. I’ve done more than 10 cases that are analogue versus digital, and digital has won every time
- Health: printing has its own risks, of course, but as a lab owner, they are so much easier to manage
- Reduced chair time and appointment numbers: this isn’t to save money, it’s to save time and be more efficient
- Quality of work: I like to think I can make a nice, comfortable, well-functioning denture that’s successful. The digital cases I now provide are more comfortable and accurate. They need more work aesthetically, but now in my clinical dental technician (CDT) work I’ve learned that patients usually put aesthetics at the bottom of their lists of requirements
- Scanning: I now scan all of my clinical cases before fit. I then have the denture, bites and models on file. I’ve used this several times to remake cases or modify later down the line. This means less clinical and lab time/costs
- Impression accuracy from intraoral scanners: I’ve had more than one chrome case where they have not fit. These have been from dentists who I trust to deliver the best impressions – when scanned and printed, they are perfect.
Top tips for a digital set-up
- Do your research: don’t follow the crowds – get what suits your lab
- Go on courses: try a few to play with software and printers before committing. Reps and companies are happy to help and let you have a play before committing
- Be open minded: I won’t lie and say it’s easy, but once you’re producing successfully, you will see huge benefits
- Speak with your clinicians: I have found that some dentists are happy with analogue workflows and some are itching to move into digital. Building relationships with like-minded clinicians allows you both to grow and get feedback from the other person’s experience
- 3shape or Exocad? Get what works for you and your laboratory at the best price you can.
Evidence?
It’s easy to say that I’m having great success from digital dentures, but I don’t want it to be sprinkled in fairy dust. Pretty cases on Instagram aren’t evidence enough for me. I want to prove that real cases have been successful and that patients prefer the digital cases we have provided for them.
On the Impressionclub digital dentures course, myself, Rupert Monkhouse and Ricardo Soares discuss everything we have done so far with success – and the odd failure. We have tried everything and found out what works for us, what doesn’t and then taken patient feedback. Some of the dentists that have come on our digital course have been convinced of its advantages.
One notable dentist was Dr Mike Gregory, self admittedly a digital sceptic and very experienced and skilled in analogue dentistry. Mike left the course having changed his opinion in some areas, but still to be convinced in others. That was a big one. Clinicians that are changing their opinions aren’t doing it based on our thoughts, they need evidence.
Printed or milled?
One of my bugbears in dentistry is people telling me how something has to be done – it should depend on your situation. My personal preference is milled. They are more expensive, but I find them more accurate. I use printed for try-ins and this can be taken away by the patient and verified after a week or two of being worn. This is a huge advantage to dentists as patients can change their mind. Working in this way helps to manage expectations and proposed outcomes.
Printed are more difficult to adjust chairside at the try-in appointment, but you can trim them and redesign. Printed also have lower aesthetics in my opinion, but if it’s your thing, you can go to town on either and make them look good. The truth is that patients barely notice aesthetics, based on my experience. The quality of manufacture, fit and function always seem to be their biggest requirements.
Printed cases are ideal for NHS scan-to-fit cases. Whether you believe that’s ethical or not, it’s happening – and successfully.
Patient communication
Sending a patient away with a printed try-in is a game changer. I have done this with several clinical cases, and some have asked for changes while some have not. From a clinical perspective, this is huge as all patients are different, and some will want the opinion of family. Doing an analogue try-in only gives the patient that appointment to make a decision.
When some people return at fit day, they have sometimes changed their mind and requirements, meaning we then don’t meet the patient’s expectations. Digital try-ins allow the patient’s family/spouse/friends to reassure the patient and it makes for a more transparent process.
Efficiency
I love watching the printers working away while I go home. I love the fact that a denture is milled, and I did not have to use plaster to process it, knowing nothing will go wrong during processing.
I love that I can offer patients and dentists a copy with either the printed try-in or a replica milled version. We have all these things on file, so if the patient loses or fractures a denture, we don’t have to start over again.
Clinically, I use a Trios 5 and it is a game changer. I will not take a partially dentate primary impression again. This takes great skill, and I admire that, but I can scan the same thing in less than two minutes. As a technician, I know where I need to scan to build my special tray. The Trios 5 also takes the shade for me in all areas of the teeth, giving me another tool to show patients.
What’s next?
The million-dollar question! It’s moving so rapidly that, for the first time, I can see analogue being dominated by digital. I never thought I would say it, but it’s my preference – I just need the evidence to be convinced. I also believe facial scanning will be a common feature in the near future as the equipment is affordable and offers so much information.
Printing will improve too, with the likes of Stratasys allowing us to print in exact colour templates. As a result, this will remove the time-consuming need to customise digital dentures.
Summary
I hope this article has made sense of the journey into digital from my perspective. There are people doing great things in digital dentistry who I am aspiring to. These people, both clinically and technically, are paving the way to something really exciting.
I think the key word in this article for me is ‘fear’. I was scared of being replaced, being put on the dental scrap heap by younger, more computer savvy technicians, but this is definitely not the case. And with the new breed of technicians coming through the ranks, nowadays sharing tips and helping each other out is much more accessible.
I see fear in older technicians like myself, but that wealth of analogue knowledge can’t ever be replaced by a machine. If both can work together in a symbiotic relationship, then the outcomes are unbeatable.
Overall advantages
- Accuracy
- Comfort
- Patient function
- Time-saving
- Cost effective
- Environmentally friendly
- Able to produce second set
- Patient communication
- Expectation management of patient
- Cleaner environment for technicians
- Can open doors with new clients on the same journey.
Potential pitfalls
- Expensive to set up
- Frustrating for both beginners and the more experienced
- Time-consuming early on
- Scary! At least for me it was
- Limits people you can work with – clinicians and technicians need to be on the same page.
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