November 4, 2022
by Varisha H. Parikh, DMD
We wear many hats in our daily practice – doctor, artist, engineer and therapist to name a few. Under all those hats we are always thinking: how can I make this better? How can I make this faster? How can I make this more comfortable? To answer all of these questions and steer our patients towards their goal – that gorgeous confident smile – we utilize our resources. Technology is one of those resources that can make our paths more accurate, efficient and comfortable.
When it comes to accuracy, digital technology has given us the ability to have an exact replica of our patient’s mouth right at our fingertips. For the longest time we were bound by the capabilities of our impression materials, but now we can, with confidence, make digital scans that provide a solid foundation upon which to build our restorations. The three keys to success in ensuring an accurate scan capture are: scan path, scan coverage and vital structures.
The recommended scan paths for each scanner varies slightly, but the method by which I prescribe is to begin scanning at the terminal molar and scan the lingual surfaces, then rotate onto the occlusal surfaces and scan all the teeth, and lastly to rotate onto the facial surfaces and complete the scan. A consistent and predictable pattern allows the scan data to be stitched with minimal distortion. If your preferred scan path varies, that’s totally fine, but I recommend sticking to one prescribed path to make it easier to troubleshoot scanning issues if they arise.
Scan coverage relates to scanning the full arch, which is defined as every tooth in occlusion, or a partial arch, which is defined by scans that go up to the midline. If your restoration is located in the posterior sextants with adjacent teeth on either side, it’s acceptable to complete a partial scan. In anterior sextants, the accuracy falters only because anterior dentition does not have as many unique anatomical features that the scanner camera can pick up. Therefore, if your restoration is located in the anterior sextants, it’s recommended to complete a full arch scan.
Vital structures are dependent on the type of restoration that is being completed – i.e. crown, veneer or implant. Understanding what the laboratory will need to successfully make your restoration will help to determine which vital structures need to be captured in the scan. For instance, for a single implant crown in site #14, the lab will care most about the soft tissue around the implant site, the contacts on the adjacent teeth, and the occlusion. Digital technology is great because you can confirm immediately that you’ve gotten all the necessary information.
When it comes to efficiency, the best part of digital technologies is that they don’t require a doctor. Digital scanning, milling, and printing are all techniques that can be taught to and executed by your support team almost entirely. In a report published in the Journal of Prosthetic Dentistry in 2021,1 digital impression making was determined to take 11.2 minutes total which is roughly 4.5 minutes quicker than conventional impressions. During the digital impression making process, the doctor’s presence is only required for the few minutes it takes to scan the restoration area – i.e. the implant or the prepped tooth. Think about those extra five-plus minutes. Think about the fewer intra-oral complications such as getting an impression stuck in a patient’s mouth. Think about simply typing a quick text to your lab and pressing send like an email or text message. Think about the other treatment opportunities you could be participating in during that extra time. The report also goes on to detail that the delivery time is shorter for restorations made digitally.1
Having the team involved in digital efforts is also rewarding to them and helps them feel more invested in the patient’s treatment outcomes. Training your staff to ask leading questions to patients based on the visuals presented in the digital scans has been shown to increase treatment acceptance. In terms of sending cases into production and/or storage of case data, digital technology makes it easy and accountable. In this day and age, we’re used to having everything at our fingertips and thats what you get here with all of your patient cases. Gone are the days of searching through the shelving for casts and boxes. The entire process of working together not only increases productivity, but also enhances the flow of the practice, which makes the schedule more predictable and manageable.
As dental providers, patient comfort is always at the forefront of our practice philosophies. It comes as no surprise when 89 percent of patients state they prefer digital workflows to conventional.1 Patients may not understand the technicalities of dental treatments but what they do appreciate is finesse. They appreciate any and every thing that makes their treatment painless, quick and predictable. As we’ve already discussed, digital technologies provide all of those benefits in addition to one big one: a real-life, real-time visual. Because dentistry operates in an area patient’s cannot visualize and dental treatment occurs on teeth that are numbed, patients grapple with the lack of physical accountability and control over their treatment. This can increase anxiety and strain the patient-provider relationship. Digital technologies have aided in this effort because they provide the patient a direct and real-time visual on treatment that needs to be rendered or is being rendered. The transfer of data to patients and record keeping is also simplified by digital processes and this helps patients ensure that they are receiving exactly the care they need when they need it.
A lot of the questions swirling underneath the many hats we wear can be answered by technology. By using this key resource, you too can create a precise and efficient workflow and an amazing experience for your patients. It’s an investment but it is well worth the effort.
About the Author
Dr. Varisha H. Parikh, DMD, is a practicing prosthodontist in a multi-speciality group practice in Los Angeles. She completed her degree in dental medicine at the Arizona School of Dentistry and Oral Health and obtained her speciality training in Prosthodontics at the University of California, Los Angeles. She is also a lecturer at UCLA in the department of Advanced Prosthodontics. One of her primary focuses is utilizing digital technology for implant fixed and implant removable treatment plans. In her spare time, Dr. Parikh enjoys hiking and spending time at the beach.