Digital Dentistry – Removing the Barriers to Entry

by Steve Cowburn, BComm; George Cowburn, CAD/CAM Expert

It all started in the 1970’s when Prof Francois Duret gave the world a glimpse of the future of digital dentistry. When we look back now, we can see just how ahead of his time Prof. Duret was.
Today in North America, less than 10 percent of dentists utilize intra-oral scanning in their office. Digital Dentistry is in “The Chasm”.

The Technology Adoption Lifecycle has five main stages.

Digital dentistry has passed the innovation stage, the ‘bleeding edge’ populated by technology fanatics. If you have held out on going digital, you have made the right decision, because the technology simply was not ready for everyday use.

But digital dentistry has now matured to the point where early adopters can implement it in their clinics – if they can cross “The Chasm.”

Dental professionals are busy, especially clinic owners. It’s a balancing act between keeping patients and staff happy, making sure that chair time is optimised, marketing, book keeping and on it goes.

To even consider jumping across the technology chasm and implementing digital dentistry in your clinic, you should be satisfied that it meets three essential requirements:

Ease of use by current staff without extensive training,

Openness in working with a broad range of competing systems, and

Price is what you pay, value is what you get. What real value does it bring to your office today?

FIGURE 1. Carestream CS 3600
Cowburn Scanner CS3600

FIGURE 2. Carestream CS 3600 with stand
Cowburn Scanner on Holder CS3600

Ease of Use
In order for technology to make sense, it must save time and make money – now.

At the recent Mid-Winter Meeting in Chicago, Carestream released the CS3600. The latest scanners from Carestream and 3Shape are superb, mature products.

Technically speaking, these scanners’ color detail, speed and accuracy fully satisfy the requirements of digital dentistry.

Perhaps more importantly, the newest scanners’ user interface is modern and familiar.

The first generation scanners were as clumsy as texting on a 90’s flip phone, (where you would have to press the number seven button four times to get the letter “s”). The new user interfaces will be familiar to anyone who uses a computer.

As a result, the learning curve has been drastically reduced. Instead of taking days or weeks to become an efficient dental scanner, it now takes hours. If you accidently scan a cheek or tongue, you simply re-scan the area and the system’s algorithms are smart enough to automatically clean it up. Instead of new users taking 15-20 minutes to fill in all the holes in their first full arch scan, it is now being done in under a minute by the same users. Scan time is now less than the time it takes for impression material to set.

Not only do these scans have great value for creating highly accurate restorations, they provide an excellent tool for patient education. Be prepared to amaze patients. “Wow, I never knew my teeth looked like that, I see exactly what you’re saying”.

When patients see what you see, communicating the benefits of certain treatment plans will be that much easier. This simple improvement can drastically improve case acceptance and increase revenue.

With the most recently released scanners, ease of use is no longer a barrier to entry.

FIGURE 3. Carestream CS 3600 – Full arch scan with bite
Cowburn1 Intra-Oral Scan - Bite

FIGURE 4. Carestream CS 3600 – Quadrant scan
Cowburn2 Intra-oral Scan - partial arch

In an immature technology, vendors try to lock you into their proprietary system so you have to buy everything from them –even though their product line may have horrible holes and limitations.

Innovators on the bleeding edge waste much time and energy trying to break through these closed system walls to get the best of different vendors’ offerings.

In a mature technology like personal computers, there are open standards like Adobe’s PDF and Microsoft’s Word and Excel that every vendor can read from and write to. Similarly, digital dentistry is adopting the widely used STL (Stereo Lithography) format for transferring 3 dimensional shape information.

Open systems have more options. Dental professionals can’t be expected purchase a scanner for crown and bridge, and a different scanner for implants, ortho or removables. It’s just not feasible. Ideally you want one scanner that can scan a small restoration or an entire arch for anything from an inlay to a full arch restoration.

Open source systems also provide labs with the flexibility to produce the best possible product using the best software, machines and materials – which change almost daily – while your patient data and instructions remain unchanged.

No one company can produce the best intra-oral scanner, the best design software, the best milling machines and the best millpath software. And then there are completely new approaches to manufacturing such as the new CEREC speedfire line, which introduces chair side induction sintering furnaces. In this highly completive industry, change is the only constant.

When we look at the major scanners, the Carestream CS3500/CS3600 and the Planmeca Planscan are a fully open systems, from which you can quickly export files as an open source STL file.
The 3Shape and Sirona scanners can be open if you purchase additional modules, but colour information from the scan is lost when you export to STL.

Some companies continue with an outmoded protectionist strategy, but the triumph of open data transfer is not in doubt.


Price is usually the greatest obstacle, especially when it comes to digital dentistry.

Open and accurate intra-oral scanners today cost between $30-45K. If you finance/lease this over a 5 year term, you are looking at a monthly payment of $570 – $850. It is essential to consider the total cost of ownership, including any annual license fees.

Competition in the intra-oral scanning field is currently low, but several companies such as Dental Wings, MFI and GC currently have or are working on intra-oral scanners. Some of these scanners have been rumored to be priced below $20K.

What remains to be seen is how their accuracy, speed and colour will compare to the benchmark set by 3Shape and Carestream. If these low cost solutions deliver, you may be able to save up to $200/month, but how long these other solutions will take to come to market is uncertain.

If you have a multi-practitioner clinic, it might be reasonable to first purchase the newest model scanner to maximize productivity and minimize the learning curve, and consider buying older units once the technology is well established. Carestream for example is still selling the CS3500, but the sacrifice will be in the learning curve and speed of impressions, as discussed above. You need to assess how much you value these added benefits and whether they can both save you money and make you money.

How Can Digital Dentistry Save You Money?

Digital dentistry saves you money by reducing material and labour costs, and by improving clinic efficiency.

Currently in the USA, dental overhead is approaching 78 percent, with similar numbers expected in Canada. For the average dentist who owns their clinic, that represents $503K per year or $42K per month in overhead costs.

From a materials perspective, with digital dentistry, you no longer have to clean and sterilize impression trays or pay for disposable trays and triple trays. You no longer have to purchase expensive impression material.

The potential labour savings are much more significant. Taking high quality impressions takes both skill and time. A recent survey of dental labs in the USA, showed that 25 percent of impressions received are inadequate. Training and retaining assistants who are good at taking high quality impressions is crucial. What if junior staff member could take high quality impressions in a matter of minutes? The economic impact on the business could be significant.

With digital scanning, you can be 100 percent confident in your properly prepared impressions. Scanning errors, such as holes, are very easy to see and rectify while the patient is still in the chair.
When you have a problem with a conventional impression, it becomes a finger pointing exercise to determine why the restoration doesn’t fit in the patient’s mouth – and a complete remake is often required.

The reality is the costs of inefficiencies, like remakes, trickle down the entire organization and consume valuable chair-time.
It can be difficult to determine what digital dentistry can save you in materials, labour and remakes. But if you are able to reduce your overhead by just two percent, that represents the lease cost of most scanners.

How Can Digital Dentistry Make You More Money?

Highly skilled professionals are your clinic’s most valuable resource. The more efficiently chair time is used, the more patients a professional can see in a day.

Digital dentistry is now being taught to students in all dental related programs, creating a new generation of professionals who are already digitally literate. These potential employees are graduating with all of the necessary skills to assist in the digital transformation.

Digital dentistry can also lift you above the crowd, creating a new buzz with your patients, their technology-savvy friends — and their children. “Guess what I had done at the dental office today?” Your staff can easily load a USB flash drives with before and after treatment pictures, the treatment options, and 3D scans, all of which can be viewed in windows 10 at home or with freeware.

And finally, introducing digital processes to a mature clinic adds value. This is particularly important if you are a senior professional considering clinic sale. Young dentists will be looking to apply the new technologies that they have been trained in, and will be hungry for competitive advantage in a crowded profession.

If your staff are familiar with digital workflows, and have already seen how smooth and efficient they can be – then you will have crossed the chasm of early adoption. OH

Steve Cowburn BComm & George Cowburn CAD/CAM Expert began researching digital dental solutions in 2003. This passion for digital solutions was fully realized with the launch of Perfit Dental Solutions, a company dedicated to digital workflows and innovative solutions.

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