Inside Dentistry
July 2018
Volume 14, Issue 7

What Criteria Should Guide the Selection of a Digital Scanner?

Robert Ritter, DMD, maintains a private practice with partners in Jupiter, Florida.

Paresh Shah, DMD, MS, maintains a private practice in Winnipeg, Manitoba, Canada.

Parag Kachalia, DDS, maintains a private practice in San Ramon, California.

Robert Ritter, DMD: As I continue to lecture, now 18 years into my career, one of the most asked questions is "which chairside digital scanner should I buy? Initially, it may seem as if it would be easy for me to make a recommendation, but it isn't that simple, and determining the answer to this question requires further questions that the dentist needs to have with his or her laboratory partner and potentially his or her team members as well. Be prepared to ask your ceramist questions. In fact, some of the questions that you would never think to ask can be germane to your decision. Remember that different offices have different needs. Some are focused on restoration only, whereas others perform orthodontics, implant placement, and other treatment modalities. Throughout the years, I have had five chairside scanners. Although my original scanner is now in moth balls awaiting its scuttling, the other four are still in use. Of the four remaining scanners, we use three on a daily basis. Although only one requires powder, all of them feature open STL architecture, which means that the scans are easily exported to labs, other acquisition units (eg, cone-beam computed tomography scanners), and to printers. Although this is not a big issue today, just a few years ago, it was. Interconnectivity is now one of the most important aspects of scanning technology.

Once an office has scanned a patient and saved the image data, some scanners allow the dentist to rescan the patient at a later date and overlay the images to identify any dimensional changes to the teeth. Other scanners offer dedicated applications for phones and portable devices that allow scan data to be entered, changed, and then communicated to a partner laboratory. Some also provide a dedicated milled model solution.

If your office provides model-less restorations, most chairside scanners will fit within your workflow. If your office is not providing model-less restorations yet, when you send your STL file to your lab, the laboratory must print a model. Printer technology is rapidly gaining speed and accuracy. The dentist should ask the laboratory what type of printer they are using in order to gain an understanding of the potential upsides and downsides of each system and how they affect scanner selection.

The last issue to address is the monthly cost associated with each chairside scanning system. Usually, the cost includes updates, unlimited scans, and a warranty. I have always believed that paying for technology with a robust support system is important for the times when the machines fail and let us down. Because the total cost of a scanner must be amortized during its lifetime, the return on investment should be calculated to see if it fits into ones operating budget. Remember: no matter what you do or how you do it-we all have a budget. I hope this general outline serves as a starting point for what will hopefully be one of the best purchases that you make for your practice.

Paresh Shah, DMD, MS: Many times during my lectures, I've been asked this very question, and the answer is not as simple as one might think. If there was a perfect answer to this question, we'd probably all have a scanner, but there are many key points to consider in this decision. Cost is always going to be an important factor, but I'm not about to get into a debate about how each individual chooses to spend his or her money. The bottom line is that there is an inherent cost to getting into established technology, and we simply have to pay that price to enter the playing field. Although I could probably list a dozen different things that can influence scanner purchasing decisions, I'd say there are three primary things to consider: ease of implementation, workflow versatility, and support.

I feel strongly that implementation of a scanner should involve your team. If your team isn't well trained and engaged in adopting the system, it's going to be a struggle. I'd suggest including key team members in testing several scanners and reach a consensus on the one that feels the most ergonomic and comfortable. My preference is towards a color scanner because it's visually more appealing to patients and preferred by lab technicians to help distinguish margins from cord and tissues. If you find one software application easier to use than another, then it's likely you will use it more often. Unfortunately, there isn't a "one-size-fits-all" option among the scanners. Regardless, all of the scanners in the latest generation are very easy to learn how to use when employing a laboratory workflow.

Considering the workflow is important as well. I'd contact an experienced digital laboratory and ask them if they are familiar with a variety of scanners and which scans they prefer to work with. You want to be sure that the scanner you select is versatile enough to work with the most common lab software applications. You also need to find out if there are any limitations regarding restorative and implant workflows. None of the scanners currently on the market are totally "open" to all implant companies, but some are very close. If using a scanner does not disrupt your daily workflow, you will find that it actually saves you time and improves your efficiency.

Finally, the value of customer support cannot be overstated. Each company has different support structures, and the work ethic of their regional representatives will vary. If all things are equal in terms of quality, price, and versatility, then I'm always going to choose the company that will provide me with unwavering support when needed. It's frustrating when you make a significant financial investment and your calls for help aren't answered. Ask the hard questions, lay out your expectations, and then make that purchase to get up-to-date. Digital scanning has been an amazing addition to my practice, and it can be for yours as well.

Parag Kachalia, DDS: Intraoral scanners are by no means a new technology. In fact, technology has been available to scan full arches for more than 10 years. In the early days of digital scanning, the choices were minimal, whereas today, the choices can be overwhelming. Unfortunately, there is not necessarily one scanner that is correct for every practice; however, by asking the correct questions, a clinician can find the scanner that is best suited for his or her individual office.

One of the first questions that needs to be asked is "how do you intend to use the scanner?" If the goal is simply to replace traditional impression materials in a crown and bridge workflow for primarily quadrant dentistry, then any scanner produced by a top tier manufacturer will meet your needs. On the other hand, if you find that you would like to capture full-arch impressions, then you may have a smaller cohort of choices. Another question that needs to be asked is "how important is color to you?" If you plan on using your intraoral scanner to present treatment options, a relatively true color output is important to help patients connect with the images they are viewing. You also need to think about any additional services that you would like to offer utilizing the data from your scanner. Do you plan on milling restorations in-office or offering specific brands of clear aligner therapy? If the answer is yes, then you may need to pick a scanner that has specifically opened up these workflows. Once you narrow down your choices to a few scanners that meet your needs, you will want to assess the total cost of ownership over 5 years and also gain a full understanding of the warranties, support systems, and software updates.  The reality is that as technology continues to improve, many clinicians will get an itch to upgrade around the 5-year mark.

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