Dr. Sunny Verdi shares the benefits of incorporating digital technologies into your dental practice, particularly for composite veneers. He highlights the improved patient experience and streamlined workflow, noting a reduction in appointment times and increased efficiency.
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Dr. Luisa Schuldt (LS): Hi, everyone. Welcome to Brush Up, presented by Oral Health Group, the dental podcast where we speak to industry experts to discuss a variety of topics such as technology, finance and practice management. This episode is sponsored by Solventum. I’m your host, Dr. Luisa Schuldt, prosthodontist and periodontist based out of Fonthill, Ontario. Today we are joined by Sunny Virdi. Dr. Virdi was born and raised in Winnipeg, Manitoba, and graduated from the University of Manitoba in 2016. He maintains a full time ownership role in a group private practice in Winnipeg. Dr Virdi received postgraduate training in the latest techniques regarding isolation, adhesion, material science and esthetic dentistry. He is a member of the Canadian Dental Association and the Manitoba Dental Association. Welcome Dr. Virdi. This is a real pleasure. Thank you for joining us.
Dr. Sunny Virdi (SV): Thank you, guys, so much for having me here. I’m very excited.
LS: I know a lot of our listeners are very interested in incorporating digital technologies, streamlining their care. I would love to hear more about how it is you started on this journey, what interested you in it, if you don’t mind sharing that?
SV: Yeah. So, it comes from a patient experience standpoint, and we all know taking like algin impressions and PVS impressions and things like that. I mean, it wasn’t the best experience. And you know, when we had issues with the impression or distortion, it became a big issue bringing people back, and our workflow gets, you know, it’s not as streamlined as it could be, and it can be inconvenient for people. So, we really wanted to adopt digital technology from a patient experience standpoint. What we’ve seen from that is that it’s totally changed our workflow in terms of being able to communicate with patients. And that’s been a huge practice, like, builder for us, because now that we’re able to use a digital technology to show people what’s going on, co diagnose, really look at what’s going on in a way that I think patients are familiar with… Like everybody’s familiar with, looking at things in high definition on a screen, and being able to manipulate models around and, you know, touch screen, zooming in and out. It presents things in a manner that they’re very comfortable with, which I find really helps us to explain things. And there’s not a lot of, like, that feeling like left in the dark. They really feel like they’re involved in the discussions. So the way I’ve seen people accept treatment and the way they understand their oral health better, the outcomes that we’re getting have been improved greatly by using a digital workflow. And I think it just keeps improving from here the more and more we adopt digital technology. So I really encourage people to start entering that world, if there’s been some hesitation still.
LS: Yeah, from what I’m understanding, it really helps you better understand the patient’s expectations and either meet them, or you know, in that communication with your patient, adjust what that expectation could potentially be, and you end up with happier, happier patients.
SV: One hundred percent. It’s a huge communication tool in that respect.
LS: From what I understand, this digital journey is a large part of what you do currently for composite veneers.
SV: Yeah, I’ve been using, like, you know, I’ve been doing composite veneers for a while now, and we used to just do them all, like, was all me. You build up everything step by step, you know, hand layer composite veneers. But now using digital technology to help boost the results that we’re getting, it’s been a game changer for my practice.
LS: You were mentioning that this makes it a lot more streamlined. And how can you, do you see patients for less appointments? Is it more predictable appointments?
SV: Yeah, I find it’s more predictable in terms of, you know, there’s a huge component still where we need to put the human touch. You need to, you know, polish them up. I spend a lot of time finishing and polishing but I’m finding why using this digital design, and I’m using a lot of the the Filtek Matrix system by Solventum. There’s a few different other systems out there in the market, but the one I’ve been having the best success with is using the Filtek Matrix by Solventum. And what I find is it gets me about 80 something percent of the way there in terms of the result I want to get. Getting all the teeth length set up, all the incisal edges set up, in terms of having everything balanced on a horizontal plane, and getting all like the composite material physically on the teeth. It gets me like, 80 something percent the way there, in maybe, like, a 15–20-minute window, which is incredible when you’re doing like, you know, eight teeth or 10 teeth. In the past, this would have taken me maybe, like, a few hours just to really get, like, into the appointment and get the material going and start to see where we’re headed, you know, the material placed on the teeth. But with the Matrix, it’s like, yeah, it cuts my time down significantly. So I can spend so much more time customizing them and really dialing in the finished result for the patient in less time and less appointments.
LS: You’ve already described multiple really clear differences with making this you know, the analog, old school, traditional veneer build up fabrication and doing it now with digital technologies. Are there any other big differences that jump to mind? Sorry, in terms of what? Can you clarify? In terms of what you need to prepare, in terms of training for yourself or your team.
SV: I mean, that’s probably the one of the nicest things, is that it really streamlines into your workflow. You don’t need to make a ton of differences in terms of, like, my record gathering, it’s the same stuff. Like, I always have a digital scan. I’m always taking photos, because we need to plan out, like, how long are we going to make the teeth, what shapes are we going to be using? The record taking doesn’t change, which is fantastic, because you take those same records, and you plug it into their online platform. They have, like that oral care portal. Go in there, you have the opportunity to design things, customize them, have the designs come back to you, where you can kind of refine that further and then come up with a result that you’re happy with. And I’ll say like, my initial thoughts were like, ah this is going to be…I don’t know what we’re going to expect here, and who knows what the design is, because I don’t know who the designer is on the other side currently. So, I wouldn’t say I was like all in right away, but after doing now a number of cases, I’ve seen the designs come back like, you know, four out of five times I’m super happy with the design. And the one time I do, it’s just a little refinement. It’s good to go. So, the design team has been fantastic. The results are getting are fantastic. It’s been nice. I haven’t had to change my workflow a lot, and it’s also given me the opportunity to see what things look like. I could show the patient. We can discuss, like, here’s what’s going on, and like you said earlier, sometimes discussing the limitations of things and saying, Look, based on where we are at right now, this is where we’re going to be. So, it’s nice to be able to have that discussion with the patient, if there’s any concerns, before we actually do the treatment. So, it’s been fantastic from that standpoint. But yeah, it’s something that’s super easy to work into your practice. You need a little bit of training, because there are some nuances that you should know about before you just go about placing this and they offer a fantastic course. There’s a small fee, I think, to sign up for, but you get it back in materials anyway. So, to me, I think it’s a bit of a wash, but it’s a fantastic thing to do with your patients.
LS: From what you’re mentioning at what’s something that really caught my attention is that you mentioned that some of the work, the design work, is done remotely. For people who are just, you know, entering the world of digital and really aren’t familiar with printing and how this can be done remotely, could you take us just very simplified, step by step process of how these veneers are created digitally?
SV: For sure. So, like I said, you have your record taking appointment, and if you go through the website. And if you’re not super familiar with doing this yourself outside of the portal, it’s fantastic, because it tells you exactly what records you need to submit in what order and what type of pictures you should be taking. So that’s very helpful. So, you get your records, you got to plan on what you want to do in terms of, are we increasing lengths? How many teeth are we doing? What is the goal? And there’s a form that you follow. I will say it’s very similar to, you know, maybe you’re familiar with doing clear liners through Invisalign maybe. It’s very similar to that. Or if you’re using clear aligners through their clarity program already, it really walks you through step by step. So, it does guide you quite a bit. So, once you have all that information in there that you send off, and then they send you a design in a pretty reasonable time. So maybe I usually see within a couple of days, business days, the designs back. We go, we edit it, take a look at it, make some modifications, if need be, which they come back with really quick. And then you’re good to go. And then you order that case up, and they prepare everything, because the design printing this matrix is actually quite complicated, but they do a fantastic job of sending it to you. I don’t think you’d be able to print it in your own office, but the beauty of having this system is that, like beforehand, it would be me talking to my lab tech, who may not be familiar with what I’m trying to achieve, or how to design composite veneers. They’re familiar with digital design, but I think there’s nuances with composite veneers in terms of how thick you want things to be and how to plan it out. So, it’s fantastic to have this resource that you know you don’t necessarily need to know the lab tech ahead of time. And for those of us who work with a lot of labs, you know that one of the biggest things is loud communication, and it’s tough, right? We’re always trying to have these goals and things that we want to do, but if the lab technicians are on the same page, but they also can’t know everything. So, the beauty of the digital world is being able to open this up to this platform and have these results no matter where you live. You could live, you know, in the most remote location, have access to this fantastic service, have it sent back to you, and still be delivering the best care for your patients, regardless of where you are or which lab technician you use.
LS: Sounds like this system is, at the same time, simple and thorough and, grateful for the user, quite intuitive. It’ll let you know exactly what information is required, and kind of walks you through the steps. How would you compare this system with, you know, manual, traditional, built-up veneers, or with ceramic veneers as well, for that, for that matter? How long do they last? How’s the esthetic outcome?
SV: For sure, so to kind of describe the process a little bit, is that… So, we’ve talked about the design process, and they send you back a matrix. It’s a 3D-printed guide that will help you establish the incisal lengths and the overall buccal-lingual thickness of the material, which is an amazing thing to have. When you’re doing them traditionally, I mean, maybe you’re using a matrix, maybe using the Unica Matrix, or, you know, whatever, or a mylar strip, where you’re just doing them freehand. It can be difficult to get all the lengths established manually. It’s a very time-consuming thing, and I’ve done it for a long time, and the amount of like corrections I need to go back and make, and I’m continuously looking and, you know, readjusting things. It’s possible, but it takes a lot of patience and a lot of time. So, I think we all have experience doing a free hand. Where this comes in, like I said, when you place the matrix on, there’s a lingual portion and then there’s a buccal portion that clicks on top of that. But it gets me all my lengths. It gets me all the insides of the buccal-lingual thickness ready to go. And you place it all at once, just little connectors in between the teeth, so nothing’s bonded together. So, you’re able to do, you know, initially, six teeth in literally, a matter of, like, five minutes. You know, we’ll have everything etch and bonded. You place, I place a little bit of flowable inside there, just to help the material, you know, run inside. Then I’m using Filtek Supreme heated and placed that all in all six teeth at once. There are these little windows that close down, that help you control the buccal-lingual thickness, but also the separators go in between, so the material doesn’t all bond together. You close all the little windows. And this sounds kind of like, you know, you’d have to see the product, and it makes a lot of sense. So, encourage it. I mean, come, if you check out my Instagram, DMDsunny, you’ll see a bunch of cases like that, but, but just go and google it, it’ll make sense. So, you do that, and then you cure everything all at once, so it’s super efficient. And then you can spend time finishing and polishing, because problems with veneers, regardless of the technique you use, require a lot of finishing and polishing and just getting to that step sooner. In terms of, like, what it does in bringing better quality, I think, to patients everywhere, is that it is an art, and it takes a lot of patience. And not everybody enjoys that, like, sitting there for hours and hours and hours and recreating each tooth individually. Some people do, and it is an amazing thing to be able to do on your own. But I think this brings an amazing result to the general population and to the general dentist that’s like, I want to bring the service to my practice, and I do so many other things, like, I can’t invest years and go to many courses to go and learn how to perfect this, you know, technique, doing it freehand. This brings the system to practice and gives their patients an incredible result in such a short time period. So, I think it’s an amazing thing they brought to the market.
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LS: It looks like it still gives you the freedom or the opportunity to show off your skill when you’re managing, let’s see, different effects on the incisal edge, combining other composites to do some finishing touches. You still have that opportunity with this matrix?
SV: Exactly. So, for me, getting everything all set up, like my personal technique is now to have it all done, where we have the lengths and the thickness all established, and the overall esthetics, the form and the shape is there. Then we can cut back the incisal edge, and that’s the beauty of composite, right? Is we can keep adding, we can repair, we can modify. I’ll cut back the incisal edge and go layer if I need to. You have the freedom to whatever you need to. Or if perhaps this is like just some transitional bonding before an ortho case, you’re like, you know, I just need to get the shapes done. We can go, we find things later. It gets you that really quickly. It totally depends on what the patient’s expectations are. You can do something in a really simple, quick way that helps somebody out, or you can spend, you know, as much time as you want and cut things back and give them, like, just the most beautifully layered, handcrafted composite veneers. So, I do a bit of like, a combination that way. But that’s what I love. It just, it’s you have the freedom to it whichever technique you like.
LS: And yeah, how can you ensure that the patient’s going to be satisfied with, you know, the shade, the shape, the contours of those? Can mockups be done with this?
SV: I haven’t found yet the ability to print the model before you have the matrix made. I haven’t had that service available yet, and then go and do a mockup from there. What I’ll usually do is, if somebody’s really worried about how it might look, because I’ll do my own mockup so that that is something that still isn’t, you know, well streamlined in. I don’t think that it necessarily needs to be either, because I think that with composite veneers there’s an understanding that, you know, at least we’re not doing, when I do it, especially, because I’m not ever preparing the teeth when I’m typically prescribing this. So, it’s still in some ways reversible. I can go and change things or whatever, so I don’t get too hung up on the mockup as maybe we would with doing some of the porcelain. We’re, you know, cutting the enamel a little bit preparing. So, I find it different that way. Of course, like I said, that is designed, but I’ve gotten to a point where I do so many that I think people see the work and they’re like, Okay, yeah. Like, I just want that. I trust you. So, it’s been, you know, the more you do, I think that that step will go away. But in the beginning, you know, I do think that you could show them the design. I don’t think the design necessarily looks beautiful to a patient. They’ll kind of be like, Okay. It’s hard for patients to imagine, until they see it in their face and design or see it in person, so that maybe is something that’s lacking compared to traditional workflows. But I think once you do a couple cases, you have some photos, people are going to see the results, and they’re like, yeah, that’s what I want.
LS: And is there the opportunity to have, like a digital mock up versus one in their mouth? Can you do a digital to some extent?
SV: The digital, the extent of it is just like on the model, like you just see the teeth. They don’t have, like a smile design per se, and showing that part. That we don’t have right now, perhaps in the works. And then that would be a fantastic idea if they could. But I don’t think that where this falls in our like, you know, as a tool in our toolbox, I don’t think it needs to be everything. If that, you know, like, of course, we can keep adding features and doing that, but I don’t think it’s trying to replace. I don’t think it’s trying to replace doing those workflows of personal veneers. It has a different place to try to simplify your workflow if you’re trying to do, you know, composite veneers, or bonding for your patients. So I don’t see it as a bad thing. I don’t think we need it either, but you’d have to find a different way to work through that.
LS: One of the big advantages from what I’m understanding, though, is that it is minimally invasive. You don’t need to do preparations. You conserve that natural tooth structure. That seems like a big plus.
SV: It’s huge, because we have people coming into practice all the time wanting to make esthetic changes. And I see a lot of young patients. It’s just my patient demographic. And you know, some of them are like, you know, late high school, or they just started university. So, finances can be an issue, but they want to make esthetic changes. And there are times where it’s like, hey, you know, maybe we need to plan some orthodontics or some interdisciplinary treatment. But they’re like, I really want something right now. So, it helps them have something, motivates them without doing things irreversible, and then we can make further plans. Or also that they’re so young that, like, sometimes the thought of doing preparation of the enamel, even though we do a lot of porcelain veneers, we’re super minimally invasive, like we know that we are, you know, respecting the biology of the teeth. That being said, still having the whole process done of having, you know, perhaps done having temps on for a while, trying in the finals. It can be a lot, especially for a young patient. So I’m finding this so useful in getting them to where they want to be in a way that fits within their, you know, a lot of these people, young people, so if it’s within their budget. And mindset wise, it’s easy for them to get started, because we’re not preparing the teeth or anything. And it makes them feel really good about that and so, and it makes me feel great. We’re getting such good results about having to do that. So I’ve been a big fan.
LS: It seems like the timeline is also quite short. You were mentioning that the design gets done remotely. You can see it within a few days. How long is it from your first interaction with the patient to when they can leave the office with their modified and prettier or more attractive smile?
SV: Yeah, I would say that realistically, within my practice and the way I’ve been doing it, probably within a month. Because by the time you’ve submitted the design and made the changes that you want to and that’s printed, I mean, it being a candidate has to come through from their processing plant. So wherever their manufacturing is, takes a little bit of time to get to us. So I find that within a month, I usually find that from when the, you know, I approve the design, I would say, within two weeks, I received the product. And then we go and place that so. Hasn’t been an issue. You know, they’ve been fantastic in terms of, I’m like, because these appointments, I’ll book, you know, a good of time frame. And so, I’ll, if something’s getting up close, I’ve been able to message like, hey, can we get this back at this time? And the team’s just been fantastic.
LS: So, you don’t have to readjust your schedule, or your patient’s schedule.
SV: That incredible tool, the team there, has been amazing. I have nothing but good things to say really.
LS: And for any dentist who is interested in starting to, you know, venture into these digital designs, what would be the first step you would recommend to them?
SV: I think photography is a big piece here. We talked a lot about the digital world, but I really believe in photography and the power of photography. So, if you’re starting to do more esthetic dentistry and you really want to get into that or make it a part of your practice, I think learn photography. I love DSLR photography. I think it’s awesome. Start with the smartphone if you want something simple. Like, there’s so many tools now, those little lights, I have, the MVP light from Curion, which has been incredible to have with the cell phone. That gets you started. But then you want to take it to the next level. You know, get a DSLR camera, learn photography. It’s going to change your world. Once you start seeing what your work looks like in that and you start diagnosing with that as a tool in part of your exam, it changes your practice, as you’ve probably seen as well. Like, photography is incredible. I really think that you need to incorporate that. And then, of course, getting a scanner so that you’re able to enter the digital world. It opens up all these workflows for you. There are so many tools out there. Like I said, this isn’t the only way. I’ve been doing it this way, in terms of digitally designing these veneers. But people make layer designs where they have like, you can place one matrix on and it layers a dentin for you, and you place a second matrix on it and layers your enamel for you. They’re incredible tools. So, photography, get a scanner, enter the digital world. It will give you the best results for your patients, regardless of where you are, which I think is the most incredible part.
LS: That’s true. Just entering the digital world will open so many different possible avenues that you can incorporate into your practice. It’s really a game changer. As far as patient care and maintenance is concerned, is there anything you tell your patients they can or can’t do? Is there any special care you recommend for them with these digitally created composite veneers?
SV: Nothing that’s outside the normal maintenance. But I’m more than happy to share my tips. I do a lot of this, and maintenance is a big part of this for me, because patients always ask for like, how long are these going to last? And of course, we don’t know. There’s some literature to suggest that maybe a period of five to 10 years they could expect. But of course, a lot of it depends on the patient, on the diet and how they take care of it, and also the maintenance protocol we use in our practices. So, in terms of resin itself, like, I’ll always tell people, that will be a big part. So, if they’re having, like, you know, a lot of coffee every day and it’s black, and especially if it’s hot, like, heat will affect the outcome of this, right? So, you know, you may expect less time with these and a little bit more staining. If they drink a lot of red wine, if they smoke, things like that. And I kind of go through that beforehand to see like, are you good candidate for this in the first place? So, I try to be selective with who we do this on. So that’s a big part. I like to see patients at least once a year to polish them. We all see composite over time. Some people will have different materials that may retain polish longer than others. But regardless, once a year, I like to see the patient to polish. I find that, as we see it over time, the higher we keep the polish, the longer we’re having patients happy with the results, and less we’re seeing staining and things like that build up. So, I’m a big fan of that. And also, I’ll find little quarter sometimes that like, hey, look this maybe quarter chip, per se, but there’s some wear here, or, you know, we need to do a little bit of maintenance. So, I like to catch things early, like that.
LS: Sounds like they’re also easy to repair. If there is a little chip, a little something, like margin that’s opened up.
SV: It’s composite. So, it’s so easy, like having an air abrasion unit is incredible for that. You do a little bit of air abrasion, rough up the surface, add some silane back and bond, you’re good to go. Which is something that patients love, because things do happen, right? And it’s incredible to have that feature, to be able to easily repair them and touch them up over time. And then, in terms of longevity, functionally, having this digital design is so nice, because what I used to do is I used to hand layer them, but if I might even size, that’s too thin, for example, because I had to, you know, totally control the thickness of all of them. If I missed something, sometimes I had a little fracture because I had made an area too thin, or functionally, it wasn’t where it should be. So, the digital design helps so much with that. You get the right thickness, and I’m seeing how much stronger these have been in function, because it’s helping me control that. It’s been a huge aid for me in terms of that.
LS: It’s been a real pleasure to talk to you about this and just see how effective and really easy a technique it can be, how much it can offer both our patients and the clinicians who are using this technique. And you were mentioning that annual polish sounds like something that can easily be worked into the routine hygiene visit. You just add your extra minutes, say, with the dentist. And you know, it’s not a big, cumbersome thing to have the patient come back for either.
SV: Exactly right, and it keeps them in a in a regular maintenance. So, because they’re so motivated to keep those looking good and keep their smile, I think it’s just an extra push to be like, come for your regular cleanings, you know, on your six-month intervals, or four month whatever, you know is required for that patient. It’s nice that way. And then you polish everything up, and they’re so happy. Keeping those composite polish is a huge thing to having success over time. And I think it’s something that we overlook, like we place the material and a lot of times we’re used to that just being the way it is, especially in the posterior. Like, are we going and polishing these things all the time or not? But when you do it in the anterior, you will see, you’ll see the effects long term for your patients. It’s an incredible tool.
LS: Well, thank you so much, Dr. Sunny. Thank you so much to our audience as well. Thank you for joining us and listening. Be sure to sign up for Brush Up podcast alerts and to subscribe on Spotify and YouTube to be notified every time we have a new episode. Thank you again and keep brushing up!