The Digital Center
Intraoral scanning and treatment planning software dramatically enhance capabilities
Digital tools have been developed or are being developed for nearly every aspect of dentistry. The shop-and-compare charts on the pages that follow this article cover some of the most widely used and impactful types of technology. Although these technologies perform a wide array of functions, which range from diagnostics to production, many seem to tie back to one common thread: the use of intraoral impression scanners. Whether it is combining intraoral scans with cone-beam computed tomography (CBCT) scans to create a more comprehensive virtual patient, utilizing the STL files to design products for milling or 3D printing, or leveraging diagnostic functions such as caries detection that are integrated into today's newest scanners, intraoral scanners are at the center of modern dentistry.
The Smartphone of Dentistry
"I like to refer to intraoral scanners as multifunctional technology, like smartphones," says Chad Duplantis, DDS, a private practitioner in Fort Worth, Texas. "The cell phone was once a very limited technology, but as it has evolved, it has become something that we cannot live without because there are so many uses for it. Scanners are becoming exactly like that. Dentistry is a bunch of culminating platforms: diagnostics, restorative, implants, orthodontics, sleep, and more. Scanners can play a part in all of those platforms."
According to Duplantis, although the speed, accuracy, and price of intraoral scanners continue to improve, and the systems are becoming more open, the hottest trends in scanner technology currently involve diagnostics and orthodontics. Multiple scanner manufacturers have integrated transillumination capabilities into their scanners to allow them to capture interproximal and smooth surface caries on teeth without the use of ionizing radiation. Several also include tools for tracking changes in the dentition over time.
Meanwhile, although any scanner can technically be utilized for orthodontic purposes, some of the newer ones make capturing a full-arch scan significantly more efficient. "Clear aligner therapy starts with comprehensive scans of both arches, including the bite," Duplantis says. "That can become much easier based on the size of the wand and the speed of captures."
Some newer intraoral scanners even advertise the ability to capture the edentulous arch; however, Duplantis recommends taking a cautious approach. "Only a few scanners are truly there, and it can still be rather cumbersome to do correctly," he says. "I would suggest consulting with colleagues who are doing it successfully before attempting it yourself."
Some dentists who prefer to acquire analog impressions for edentulous arches still end up scanning those impressions extraorally to facilitate the digital fabrication of prostheses. "Due to the dynamics of the tissue being captured, I feel that traditional analog impression taking is the best option for edentulous arches at this time," Duplantis says, "but my impressions are eventually digitized in the laboratory, and when I start 3D printing dentures in my office in the future, I likely will use my intraoral scanner for that."
Manufacturers will undoubtedly continue to improve upon the accuracy of intraoral scanners as well as add functions. For example, Duplantis believes that more of them will soon incorporate shade matching features. He also envisions the creation of extensions to make real-time patient education and co-diagnosis even easier. "Scanners have the potential to replace typical transillumination devices, intraoral cameras, impression materials, and more," he says. "In my opinion, the scanner has evolved from being a tool that many practices want into something that they truly need; I really feel strongly about that. However, the caveat is that you need to use it. Just as you will never get fit if you do not use a gym membership, you will never see ROI if you do not use the scanner. Years ago, the question was, ‘What can this scanner do for me?' Now, it is, ‘What can't this scanner do for me?' It is one of the most beneficial pieces of technology that we could ever have in our practices."
Turning Data Into Results
Of course, sets of scan data are only as good as the software used to turn them into treatment plans. Fortunately, treatment planning software has advanced at a rapid rate in recent years as well. Software modules are available to help dentists plan not only standard restorative treatment but also orthodontic aligner therapy, implant placement, and other procedures. The advantages of these modules range from successful co-diagnosis and case acceptance in the early stages with patients to the efficient, highly predictable completion of cases.
Lori Trost, DMD, a cosmetic dentist with a private practice in Red Bud, Illinois, says occlusal mapping is perhaps the most significant function of today's CAD/CAM software. "We are now able to explain and help patients understand why teeth fracture or chip, why incisal edges are worn, what an abfraction is, etc," Trost says. "We can show comparative data over the course of several visits to demonstrate exactly what is happening. It makes such a difference with patients. We can be transparent with our care so that patients can own their mouths, own their treatment, and own their care."
From there, the dentist can plan the treatment digitally, which Trost says is both more efficient and more effective. "I can plan everything methodically, tooth by tooth, surface by surface, and from various angles and views," she says. "I can do much better dentistry because I can analyze the case so intimately."
The benefits of planning software extend beyond restorative treatment as well. For example, orthodontic clear aligners can be planned more predictably than ever, eliminating the guesswork that was sometimes involved in anticipating tooth movements and timelines.
"The impact is astronomical," Trost says. "So much predictability lies in the before-and-after images of orthodontic software. The power of showing patients simulations of their outcomes is enormous. I expect even more tools to enter into that equation in the future."
Implant placement can also be planned very precisely, making all phases of the implant process smoother, from the placement itself to the seating of implant crowns, which can be better fabricated because of ideal implant positioning.
"The digital workflow makes treatments so much kinder, easier, and better for the patient," Trost says. "Time is money, of course. Perhaps just as importantly, however, patients notice how much time that you spend fine-tuning. I place crowns and hardly need to do anything because they are so perfect. The same goes for partials and dentures because everything is so systematic. It's like a checklist has been executed for you, and everything is so precise. You are delivering pristine restorations."
Plenty of other digital tools are available to help dentists enhance their treatments. The shop-and-compare charts on the following pages include chairside mills, intraoral sensors, practice management software applications, and more. Despite the transformative benefits of technology, many dentists have been slow to take advantage of it. A 2020 Inside Dentistry survey found that only 37% of the responding dentists used a digital impression system.
"Only a small fraction of people are buying into digital dentistry right now," Trost says. "There is ‘blue ocean' out there."
For anyone seeking to implement new technology into his or her practice, Trost recommends finding a digital mentor. "You need to crawl, walk, and then run to master the steps," she says. "You need to find people who can help you realize how efficient and, more importantly, how cost-effective this technology can be, especially with the additional PPE costs now factored in due to COVID-19. When you do that and when you start receiving restorations from the laboratory that are so perfect that you do not need to touch them, it is mind-boggling."
Oftentimes, laboratories can serve as those digital mentors. Many have been utilizing digital scanning and designing for several years. "Dentists need to partner with their laboratories and find out how they can be better, and that will lead to better outcomes for patients," Trost says.
Regardless, Trost agrees with Duplantis that dentists who are not capitalizing on digital technology are missing out. "This all makes us better dentists," she says.