Where to Begin: The Technology You Need to Begin Your Digital Journey

You're listening to the Phil Klein Dental Podcast Transitioning into a digital dental practice and streamlining your digital workflow can be a bit overwhelming, at least in the beginning. There is certainly a lot to learn and many things to think about before purchasing your new technology equipment. So to help us get a better handle on this and hopefully avoid mistakes along the way is our guest, Dr. Anthony Mennito. He has been involved with digital workflow and the dental practice for almost 20 years. He is in private practice in South Carolina and is an adjunct faculty member at the Medical University of South Carolina. Dr. Menito also is part of an excellent in-person CE program in Charleston, South Carolina. You can find more info on this at impresscourses.com. That's spelled I-M-P-R-E-S, courses.com. Dr. Mennito will be joining us in a second, but first, if you're looking to raise the bar with your adhesive dental procedures, you should definitely be looking into Bisco. 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So to begin, what's the first step or what's the first piece of dental technology that a dentist should consider buying when they're new to digital dentistry? Well, I think there's two ways you can go with this. And I've spoken to a lot of my friends who are digital dentists about this very thing. And I think we always come down to one of two pieces of equipment. The first would be an intraoral scanner. And I think You know, most of us do crown and bridge. And when we think of digital dentistry, we think of getting rid of conventional impression materials. And obviously, in order to do that, you need an alternative. And the digital alternative for that is an intraoral scanner. The other piece of equipment, and this is a relatively popular choice as well, is a cone beam CT. And the reason for that, even though it's a higher cost item, is because once you get one, you just are able to diagnose more pathology. So when patients come in, for instance, and they are having an achy tooth in the upper right quadrant, for instance, and we take a 2D x-ray, there are times when the maxillary sinus can obscure any pathology in that area. Well, if you take a CBCT, you're able to see basically every... thing that's happening in that area. And there are studies out there that show that if there is pathology in the upper right, the upper left quadrant, a 2D x-ray can only really visualize that about 25% of the time, whereas CVCT can see it 100% of the time. So, you know, that's nice when patients come in and they're having a problem for you to actually be able to diagnose. I can't tell you how many times. A patient has come in and they have kind of a nondescript issue. And because I'm taking 2D radiology and can't really visualize any pathology, I don't really know which direction to go as far as treatment planning. So it's really nice to have that cone beam CT to really help nail down a definitive diagnosis and be able to send the patient to the proper specialist or to seek the proper treatment. So regarding diagnosis, CBCT is unparalleled, but regarding cost, priority, as far as productivity, if a dentist wants to get away from traditional impression taking, I assume that the initial investment would be in an intraoral scanner. Absolutely. I think the cost is a major issue. Obviously, we all have to consider cost into everything that we add into our practice. Maybe ease of adoption, the intraoral scanner is a relatively easy thing to adopt. I think there's enough information out there that is available to the public as far as YouTube channels and video trainings that the companies put out for new users to help kind of get new users over that. that learning curve and the scanners nowadays are very very user friendly versus when i started 10 years ago scanning i always tell the story that my first intraoral scan took about 35 minutes And obviously, nowadays, that learning curve is much shorter because the technology is much more user-friendly. So for me, that's the answer that I typically give. To begin really digitizing your workflows, an intraoral scanner makes a lot of sense. But I could also make the argument for that cone beam CT as well. Yeah. So this is a question that I'm sure you get a lot, Dr. Mennito. And the answer is dependent on the clinical expertise of the clinician in many ways. But generally speaking, Are intraoral scanners as accurate as the traditional PVS impressions? That is a very popular question. And in fact, I have done with my colleagues at the Medical University of South Carolina, probably around 10 studies on this very topic. And so I have a pretty good expertise and a pretty good grasp on the accuracy that intraoral scanners are able to reach. And nowadays I can... definitively say that yes, the accuracy of an intraoral scanner for most clinical applications is every bit as accurate, if not more accurate than a conventional impression. There's a couple of caveats to that statement, and those would be full arch or long span implant cases. denture fabrication. So when we have completely a denture-less patients and we don't have teeth or anatomic landmarks to help the scanner to accurately pick up those landmarks, then it becomes a little bit more difficult. And in fact, actually I would say it becomes a lot more difficult, if I'm honest. To scan in a denture-less patient is quite difficult. The two exceptions would be long span implant cases and completely edentulous patients. So you mentioned that when you first started using an intraoral scanner, it took you 35 minutes to do the first case. Was that a single crown? Yes, it was actually a single onlay. I remember it very well. Tooth number 21. And the patient was actually writing an article in a local newspaper about the technology. So man, was I sweating bullets during that procedure. We'll be getting right back to Dr. Menito, but first, we all know that to achieve healthy, beautiful smiles, we sometimes need to align the teeth. And to do so, aligner therapy is a great option. So why not set your practice apart with 3M Clarity Aligners Flex? Designed for comfort, Clarity Aligners Flex feature a thin, flexible design, yet they deliver excellent force persistence over a two-week period. Plus, they resist scratching and stains, and they're backed by a dedicated clinician team providing support every step of the way. With a variety of affordable case-type options, single or dual arch, Clarity Aligners Flex offer a great value to your patients and practice. To learn more, visit 3M.com slash clarity dash aligners dash flex. So what was the learning curve for you as far as time goes? How long did it take you to... it so you can zip through these scans? Well, we're really talking about apples and oranges because the cameras, the scanners were so different back then. It was like taking a single picture and then having to rely on the computer software to stitch everything together. And that's basically still the way it works, but we're able to capture so many more pictures. And the computer software, the processing power of the computers is so much better nowadays that, you know, the learning curve is much shorter. So I would say for me, it took me probably a good three to four months to feel really comfortable with those more archaic scanners. But as soon as we upgraded to the new, the next generation of intraoral scanner, which was the CEREC Omnicam. you noticed a quantum leap in the usability of the system. And the same holds true when we went from, and I'm using the CEREC system as an example, because a lot of people are familiar with that. But when we went from the... to the Prime scan, it was another giant leap forward. So currently using that generation of scanners and the learning curve, I think if you sit down and use it every day, you're looking at a one to two week learning curve as far as taking quadrant scans. So what you would normally take for a single unit crown or that type of restoration, say if it's two weeks for For getting the single crown intraoral scan nailed down, it's probably another week or two to get full arch scanning. But it's just a matter of sitting down with the scanner every day and making sure that you're utilizing it. It's just like anything else. The more you do it, the quicker you're going to get over that learning curve. So when we're doing digital scanning, talk about tissue retraction and prep design. Is there any difference at all between what a dentist was doing before with traditional versus taking impressions using a scanner? Not at all different. It's the exact same thing. If you use retraction cord for your physical impression, you would do the exact same thing for your digital scan. The scanner is not magic. I always say if it cannot visualize your margin. It's not going to be able to capture it, and your lab technician is going to really struggle. So the dentistry part of it is exactly the same. It's just how are you capturing the shape of your preparation and the adjacent teeth. That's the only thing that's really different. But doesn't a dentist need to keep in mind that if they're sub-G, they need to really make sure that that finish line is exposed? Because if you can't see it, you can't scan it. Whereas with traditional materials, you get the help of the goop being pushed under the sulcus when seeding the tray. That's true. That is true. So for those areas where you are subgingival, you may need to be a little bit more aggressive in your tissue retraction and maybe utilization of a laser to trough that area to help visualize that margin. But I think it's just a matter of really being able to scrutinize. clinical situation right before you take that scanner out to be realistic about whether you're going to be able to see that tooth and that finish line all the way around. And if not, then you may need to utilize something like a laser to be able to remove that excess tissue. Yeah, without a doubt. I would assume many dentists love their soft tissue laser for gingival troughing so that their margins are clearly visible for the digital scan. So let me... you a common question that's asked by many dentists who are first entering the world of digital dentistry. And the question is, what is the best kind of scanner to purchase? And that's a difficult question to answer because it really depends on what you're hoping to do with it. So if all you're hoping to do, at least initially, is to replace your conventional impression material in a crown and bridge workflow, then it really... Doesn't matter. You can shop around on price a little bit. There's some good lower cost options. The Medit's a good one. The Shining has a new intraoral scanner that is reportedly a very good product. And a lot of the other, I want to say, higher end scanners have come down in price significantly. It's a really great time to get into this market if you don't have an intraoral scanner because the cost is very, very reasonable. When we used to have scanners that were $40,000 scanners, those costs have come down $10,000, $15,000 now. So it's very much a buyer's market. But you really want to just, I think, have a chance to sit down and if you can actually hold them in your hand and just see how they feel, because the ergonomics can make a difference. Sometimes I've had some of my dental assistants do a lot of the scanning now in our practice, and they find it difficult to wield some of the scanners that are larger. They sometimes can require two hands for some of the larger wands. And so I would say you definitely want to hold them in your hand. You definitely want to see how it feels to scan with them. And you want to manipulate the software because the software for all these scanners is an important part as well. So you want to see, you know, make sure that the software isn't cluttered. Make sure it's user-friendly and easy to use. And then the other thing that I'd say is what is the setup? Is it a cart-based system? Or is it a laptop that you're going to have to, you know, figure out where you're going to put it while you're scanning? Because these sort of logistics within your dental practice can really make it a lot easier or a lot more difficult to want you to get that scanner out when the time comes to use it. I assume most dentists have a car with a laptop on it. Yeah, you want something that's going to be relatively mobile, right? Because if you only have one scanner, but you have three treatment rooms, you need to be able to move it to wherever it's needed. So I do love the cart-based system. The other thing that you would need to be able to figure out is will that cart and where will that cart fit within your operatories when the time comes to scan? So, you know, these are all really important things to think about when you're selecting a scanner. Now, that being said, the other thing that's important is the quality of the laptop. So you're purchasing the scanner and a lot of times the companies that are selling you the scanner or the dealers will recommend a laptop. And it's important that you buy a laptop that is powerful enough to run that scanner because these are incredibly needy pieces of technology and the specs of the laptop can really... hurt your workflow if they're not up to spec as far as the graphics card and the memory and things like that. So really important to follow that. I've heard and I've read a lot of horror stories on social media about dentists who have tried to skimp a little bit and spend a little less money on the laptop, and now they're having issues with the scanner. And it's not the scanner, it's the laptop that's causing those problems. Yeah, that's a great point. That's a really good point. I assume if you go with a gaming laptop, like my son uses, or he used to use, he says he doesn't game as much anymore, but gaming laptops have really excellent graphic cards. You got it. Yeah. NVIDIA is probably the most well-known, and that's something that you absolutely do need. I think the scanner that you were talking about, Dr. Menino, you mentioned Shining. I think it's called Shining 3D. Shining 3D. And I will say this also, Phil. you know, at the other end of the spectrum are, are like the, the CEREC prime scan. And we have one of those in our practice and it is extremely easy to use. I mean, it is, as far as all the scanners that have. used in my career the the three -shaped trios and the prime scan are the ones that can i think once again really shorten that learning curve so in many ways you know you get what you pay for as far as the usability but you know If you go to the other end with the Shining and the Medit and the lower end of the cost, those are very usable scanners and you're not really losing anything as far as accuracy with those. So let me ask you this. With all your experience teaching and working with digital equipment in the dental workplace, what are some of the common mistakes dentists make when using an intraoral scanner? I think that, and when I teach this, I always say that you need to have a plan when you go in. to scan an arch because if you just kind of go in and wave the wand around you're going to find it's going to be very difficult so there's a definitely a pattern and really each manufacturer will recommend a scan pattern for their scanner that is in order that you need to scan the teeth so if you're doing a quadrant what i always recommend is to scan the occlusal surfaces first so a lot of people want to start on the buckle for some reason but you absolutely want to start on the occlusal surfaces and then either going to the buckle or the lingual after that. And so it's just a matter of having that plan and following that plan of scan pattern. And once again, the manufacturers each recommend one for their scanner. So that's the first thing. And then I think the other thing is not really paying attention to moisture in the mouth because Just like with our physical impression materials, moisture does affect the performance of the scanning and you get additional... reflection off of the the teeth that the shininess is something that scanners can struggle with from time to time so really having a dry clean exposed arch to work with will make your job tremendously easier when it comes to scanning so those are the two things i think that i would recommend right off the bat is have a plan as far as what your scan pattern is going to be and do it the same every single time and then make sure that i think i personally think scanning is a two person job, one person to retract and keep everything dry and the other person to wield the scanner. So especially when you're just starting out, the drier that the teeth and tissues are, the easier it's going to be for you. When you first got a scanner, you use it yourself, the wand, I assume. And now you're delegating that to your staff. What was that process like? And how long did that take for you to say, okay, I've done this. I know how to do this. You trained your staff and now they're taking good digital impressions. Yes, absolutely. And now we use the intraoral scanner for a lot of different things. And we have multiple brands. We have it in hygiene. Our hygienists are scanning. We call them health scans. We're able to do time lapse. to compare one scan maybe to another scan that was taken a couple years ago and it's we're able to see the changes that are actually happening in the mouth and so in order to do this the dentist can't be the one doing it all the time so you absolutely have to train your team and we have in our office we have monthly meetings called four by fours and it's during these times that we really sit down and we fine-tune our policies and procedures. And so it was during these meetings that I would sit down with them, we'd practice scanning, we'd talk about things like scan pattern, and we really nailed it down. And then during the week, they were fearless and they would grab the scanner whenever they needed it, well, without hesitation. And of course, the dentists are always there to offer a bit of advice and things like that. But for the most part, Once again, the usability of these scanners now is incredible and how easy they are to use. Once you have the basics down and the fundamentals down, the learning curve for my team was relatively short. Now, we occasionally have patients who are more difficult than others. Obviously, you have patients with limited opening. There's patients with tongues and lips and cheeks that seem to fill the entire space. And so we do struggle with those. just like anything else from time to time. But for the most part, it's a pretty well-oiled machine in our office now. So it certainly looks like there's a major transformation going on in the dental office where we're transitioning to digital scanning and we're leaving our impression materials behind. There's still a place for them in the office for sure. But in a matter of years, I think it's all going to be digital and we'll be putting our impression materials in dental museums somewhere. Absolutely. I mean, I think especially as you get turnover, right, with the older dentists retiring and newer dentists coming out, the dental education currently, I think most of the universities have some exposure for the students to intraoral scanning. And so I think that obviously the students, the vast majority of students who are graduating now are what I would call digital natives, meaning they grew up with technology. And you'll find that they're able to pick up a scanner and have it, you know, mastered within a week in most cases, because they're just used to using new technology and just figuring it out as they go. So I absolutely think that within five years, we'll be pretty close to 100% adoption. Dr. Mennito, thank you very much for your time today. You certainly covered a lot of information about the digital scanner and getting into the digital workflow. And we look forward to having you on future podcasts. Thanks, Bill. Appreciate you having me. If you're enjoying this podcast, please leave a review or follow us on your favorite podcast platform. It's a great way to support our program and spread the word to others. Thanks so much for listening. See you in the next episode.