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Inside Dentistry
July 2015
Volume 11, Issue 7

Entering the Digital Workflow

For our annual Tech Issue, Inside Dentistry decided to take a close look at digital workflow: what it is, what it means, and why you should get on board. We chose two technology experts, Dr. Lou Shuman and Dr. Marty Jablow, to define digital workflow in principle and in practice.

We also developed a special Product Resource Guide designed to assist our readers in making purchasing decisions. A snapshot of the current marketplace for digital workflow technologies, it contains informative charts highlighting the specifications of many currently available products.

Whether you are new to the digital workflow or are considering an upgrade of your system, Inside Dentistry is here to keep you current on everything you need to practice efficient, exceptional dentistry.

PART 1 | Defining Digital Workflow in 2015

Lou Shuman, DMD, CAGS

As an executive consultant for numerous companies in dentistry, I sometimes have the opportunity to interact with the top executives in the dental industry. This small, core group of individuals plays a huge role in shaping and directing our field. Their companies in one way or another touch every dental office in North America and beyond. Ultimately, they have enormous influence on what products we use and how we actually practice, be it the ergonomic chairs we and our patients sit in, the tools we use to diagnose caries, or the software we use to design restorations. Dental company executives play as much a role in the ultimate goal of improving the patient’s quality of life as we do.

Over the past few years, a catchphrase has emerged—seemingly without boundaries—that seems to have become a foundation goal of great importance to corporate leadership as a whole, including Kavo Kerr Group, Henry Schein, Sirona, Planmeca, Patterson, Benco, and others. It is discussed in boardrooms, at executive retreats, IT meetings, sales meetings, even at conferences where numerous companies are represented.

That catchphrase is “digital workflow.”

When Inside Dentistry approached me about writing an article with Dr. Marty Jablow on digital workflow, I expressed a concern. While at the corporate and manufacturing level this concept had become a critical component and directive, had the practicing dental community been fully brought up to speed on what digital workflow actually meant? We looked at each other and said, “No!” To help demystify this important concept, my section of this two-part article will provide Inside Dentistry’s readers a clear definition of digital workflow as explained by those who will lead the charge.

The Digital Movement

One of the key leaders in developing digital workflow is Michael Augins, president of Sirona Dental, Inc. and executive vice president of Sirona Dental Systems, Inc. His vision started 8 years ago with what he termed the “digital waterfall.” The waterfall metaphor perfectly illustrates his goal regarding introducing digital technology into the dental practice: “Everyone goes down the digital path the same way.”

Before dental practices can fully take advantage of “going down the digital path,” certain requirements need to be met. First, the office must be computerized, choose a practice management system, and digitize their records. This sets the stage. Next, they must choose a digital imaging solution that is right for their office’s needs, and actively use it to both diagnose and plan treatment. Adding CAD/CAM and digital impressions completes the digital path, with software and hardware upgrades giving the option to offer additional services now or down the road (eg, orthodontics and using cone beam for implants).

The digital waterfall is an important concept because it creates real insight to follow a path. Sirona’s success, Augins believes, stems from the fact that today 98% of all Sirona clients follow the same path and are fully supported along the way.

Clearing Up the Confusion

Henk van Duijnhoven, senior vice president of the KaVo Kerr Group, provided another invaluable perspective on the development of digital workflow. I have had the privilege to work with Henk in the past, and the dental community as a whole is very fortunate to have a leader of such vision and capability. He agreed that there is some confusion regarding what digital workflow means both at the industry and practicing levels. He points out that the inclusion of digital technology in practice is providing better clinical outcomes both for the patient and for the practitioner. When applied properly, one can expect higher productivity and greater efficiencies. In fact, “digital workflow” could be more aptly named “digitally enabled workflow,” because the patient ultimately needs a treatment outcome that is not digital.

The foundation of any digital workflow is proper imaging, which depends on the case and the patient. For most cases, dentists start with a comprehensive diagnostic assessment that may include digital x-ray and potentially a caries detection device. The dramatic capabilities and clinical significance of 3D imaging, coupled with the lowering of radiation dosage in cone-beam computed tomography (CBCT) units across the industry, has made this a technology that many are choosing to include in their diagnostic protocol. Next, an intraoral scanner can be used to create diagnostic files for enhanced planning of the patient’s ultimate outcome, with the ability to create an individualized, more accurate treatment plan.

“We’re in the final stages of development for this phase, wherein you prep the tooth and use an intraoral scanner to create the diagnostic file,” van Duijnhoven says. “From there, you can design a crown in just a few clicks, or let a dental technician design one for you. Then you can mill a crown, inlay, onlay, or bridge, or have your digitally enabled lab provide that service.” The process concludes with seating the final product in the patient’s mouth.

“The opportunities to create individualized treatment plans that are also highly efficient and high quality will only continue to develop,” van Duijnhoven concludes. “Digitally enabled workflow is offering dentists the chance to see their canvas and their craft in new ways, but is also providing a more sophisticated, strategic approach to treatment planning that puts the patient experience and outcome front and center.”

Providing Better Care

Next up was meeting the founders of E4D Technologies, Mark and Henley Quadling, to get their perspective on the past, present, and future of digital workflow in dentistry.

The Quadlings note that the goal of replacing a conventional workflow with a digital workflow is to provide enhanced, more efficient care and/or better diagnostics and treatment—always without compromising the quality and precision of the final outcome.

When we considered development of technology for dentistry that began nearly 2 decades ago, we were intrigued by the evolution of the digital dental workflow. In its original iteration, digital workflow primarily meant the digital restorative process of scanning, designing, and milling—as opposed to the conventional methods of making physical impressions, sending them off, having them poured up in stone, and then using the lost wax technique to cast and layer ceramic.

Today, the digital workflow has the same basic elements, but now we can take information from various sources and professionals (eg, 3D imaging, specialists, technicians) and put the full picture together to diagnose, create a treatment plan, and provide comprehensive care.

“Scanning, designing, and milling technologies have been combined with 2D and 3D capabilities, so diagnosis, treatment planning, and treatment beyond crown and bridge based on a digital platform have all become a reality,” says Henley Quadling.

Software can combine all “images” into a virtual digital patient. Specialized design and planning modules allow for a comprehensive view of the patient and also provide information about the utilization of technology/equipment in the dental office. Communicating and tracking between specialists, laboratories, or digital services are now simplified through HIPAA-compliant portals, allowing for immediate communication and awareness, all of which lead to better dentistry and the possibility of more comprehensive solutions for the patient.

“The future will be combining these technologies with Internet and cloud-based tools for more preventive and diagnostic care and additional treatment modalities,” Mark Quadling notes.

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