Digital Workflow Portal for Collaboration Between the GP and Orthodontist: A Great Way to Create New Smiles

You're listening to the Phil Klein Dental Podcast Thanks for joining us. I'm Dr. Phil Klein. There is no question we are in a very exciting time in dentistry with all the new technologies and digital advancements. In fact, today we're going to be talking about technologies and software that can help simplify workflows between specialists in the areas of alignment and restorative dentistry. Today, we'll be learning how using a digital treatment software facilitates case collaboration between the orthodontist and the dentist to create a comprehensive treatment plan. Our guests are Dr. Lois Duerst and Dr. Donna Stenberg. Dr. Duerst is currently staff dentist for 3M Oral Care Solutions Division. She joined 3M after more than 30 years of general dentistry experience. Dr. Stenberg has over 30 years of private practice in orthodontics and served in organized dentistry in the ADA and AAO organizations. She is a visiting faculty member at Spear Education and has led a Spear Study Club for 10 years. Before we get started, I would like to mention that Dr. Duerst and Dr. Stenberg's webinar titled Digital Workflow and Interdisciplinary Collaboration, A Perfect Way to Create New Smiles, is now available as an on-demand webinar on VivaLearning.com. Simply type in the search field Durst, D-U-E-R-S-T, or Stenberg, S-T-E-N-B-E-R-G, and you'll see the webinar. If you're looking to learn more on how to use digital treatment software collaborating between the orthodontist and yourself, check this webinar out. It's definitely worth watching. Dr. Duerst, Dr. Stenberg, thanks so much for being on our show. Well, thanks, Phil. I really appreciate the invite and looking forward to chatting with you. I'm happy to be here as well. Thank you, Phil. So to begin, Dr. Stenberg, tell us what the 3M Oral Care Platform is and how it helps general dentists with their restorative work and also regarding orthodontic cases. how the GP can collaborate with the orthodontist using this platform? Certainly, Phil. The oral care portal, the 3M oral care portal, is a web-based platform. And it allows not only an orthodontist to be on it, but because of 3M's PhilTech Matrix digital platform, general dentists can be on it as well. And because of that, it offers us the opportunity to add that. to our way of communicating and collaborating. So what would you say the main objective of the portal is for the general dentist and the orthodontist? Well, the main objective is treatment planning, maybe some diagnosis and treatment planning. But once I do an orthodontic treatment plan and develop a... a result from the orthodontic plan, I can share that with Dr. Duerst. And in fact, she could share a result of her using the 3M matrix composite veneer system. And then I can have a better vision of what she needs as her final result restoratively. And those visual sharing really makes collaboration a lot easier. Let me ask Dr. Duerst this question. So you're representing the GP side of this collaborative effort. I am. Yes. Good, good. So from the GP side, what happens when the orthodontist thinks the patient is done, but the restorative dentist, which is you in this case, feels more tooth movement needs to happen? Well, ideally, there should be some discussion between the restorative dentist and the orthodontist prior to starting the treatment. regarding what the expectations are of the orthodontic treatment. And likewise, there should also be probably some level of communication throughout the orthodontic treatment to avoid the situation from happening. I think, Phil, many of our listeners who are general dentists probably have had the situation where they have referred a patient to the orthodontist. And then before you know it, that patient's back in your chair and the braces are off and you don't. There is not the result that you wanted or hoped for. And so this is a very undesirable and unfortunate situation. And it can lead to many hard feelings, both on the specialist and on the patient side. So really, the key to all of this is good communication throughout the process. And this platform facilitates that? The Oral Care Portal does, yes. what the results of the orthodontic treatment are going to be ahead of time so that then the general dentist can plan for any restorations that need to be done. So in that case, maybe before the orthodontics even start, I can... a team, we can get together and say to the patient, well, this is what ortho is going to accomplish. Then you're going to go to the restorative dentist, and this is what he or she's going to do, and the cost of all of that is going to be that. So it's kind of you can present it as a single treatment plan rather than having two distinct treatment plans, which the patient doesn't always follow through. Yeah, that seems extremely valuable to have both. general dentist and the orthodontist on the same page throughout the whole process. So post-ortho patients often need some aesthetic work. That's not atypical. What aesthetic situations does the 3M Filtek matrix work best for? Well, the 3M Filtek matrix is a newer matrix system from 3M that allows you to do composite veneers. more predictably. I think all of us know who are restorative dentists that it's really, really, really hard and time consuming to do composites, veneers. So whether that's closing spaces or adding length or maybe reshaping teeth, or maybe you have a wear case that you're just totally rebuilding the tooth, all those things are just very hard to do by hand with a straight matrix. So this system allows us to use a single shade composite in the matrix system. And it's very slick. It goes quick and easy. But whether it's a post-ortho case or whether you have a case where you're trying to avoid ortho in the first place, it's just a way to help dentists do these cases more predictably. And we're going to get to Dr. Stenberg in a second, but I still have some questions for the GP side of this collaboration. So when we talk about the 3M PhilTech matrix, How much direction does the general dentist need to give to create the treatment design for using this when they're using the oral care portal? Right. So the oral care portal is really the communication between the dentist and 3M who is creating this matrix, much like many of us have a relationship with a lab. And so we want the lab to create something. That oral care portal acts as a communication tool between dentists and 3M. And just like we might do a prescription, write out a prescription to send to a lab, we do the same thing on the portal. So there are specific questions on the portal that will prompt the dentist to get the result that they want. So it will be, what teeth are you restoring? Are you adding length? Are you closing space? What about the occlusal guidance? And they have a smile gallery, so you can choose a different type of smile style that you like. So obviously, this information along with photos and the scans. is no different from all the information we send to an outside lab to make a crown or porcelain veneers. The more information you can give 3M, the better the result and design, or what we call the digital wax-up, is going to be, and the quicker you can get to the results that you want. So let me ask you this. What if the patient wants to see the new smile design that was created? Well, now, Phil, many dentists are used to doing a wax up on a model, right? So we give that model to the patient to look at or we can show them and they can hold it in their hands and turn it. So the digital workflow is just a little bit different that way. We have a digital wax up instead, but we can still use a portal to turn it, to look at it from all the angles. The patient can also look at that with you. So you can either have a Zoom or Teams meeting where you share your screen and show them the wax up that you think you're going to approve. You can take a screenshot of it. You can take a picture of it and send it to the patient. So, you know, while this is kind of a new, the digital aspect of it is new, there are actually many advantages sometimes over having just a model that you hold in your hand. with a wax up in this case. Yeah. And how long has this portal been available to dentists to use? The portal's been used by orthodontists for quite a while to do clear tray liners. For dentists, for general dentists, this Filtek Matrix is the first avenue that we can use a portal in, and that's been out for about a year now. Dr. Stenberg, how does a general dentist find an orthodontist to collaborate with using this platform? Lois and I have the advantage that we have worked together for many years and we are in the same study club so we already know our philosophies match well in terms of treatment outcomes. I think if you are a general dentist looking for an orthodontist and maybe there's frustration because the orthodontist that you are working with is maybe not as amenable to collaboration for more complex cases. I would suggest that you talk with other colleagues that are working with an orthodontist that is amenable to collaborating together and pursuing those relationships. Also, your team in your own office would likely have conversations with patients, would maybe know an orthodontist that a lot of patients are very comfortable seeing they send their kids there the the community actually makes that referral in a sense and so um but i would all if there is an orthodontist that you'd like to work with as a general dentist presenting the case that this is not a situation where you're trying to tell people what to do, that it's a very win-win at both sides, the general dentist and the orthodontist, in collaborating, working together, it's so much better for the patient and the outcome and to initiate a relationship from that standpoint. Yeah, it seems that it would be. Everybody, like I mentioned earlier, is on the same page and they can kind of understand their expectations with the case. So talking about expectations, what if you as the orthodontist can't achieve what the general dentist wants and you're kind of afraid that the GP will look for another orthodontist? How do you handle that? Well, that's a tough situation to be in. And it can be real because all of us want to be considered a very quality practitioner and respected by our colleagues. But there are some things that we just can't defy biological principles. If a patient declines certain appliances or certain procedures to get the result, those are things that we just can't overcome. uh even as a specialist and this is where that partnership and collaboration comes into play i know that i can tell lois that i likely can't achieve what she is asking for or i will help her understand the consequences from my perspective even though we've worked together for many years there's still things that she may not grasp with orthodontics, just as I have to keep asking her about a number of things that I need to do to make sure I'm giving her what she needs for the best restorative outcome. It's really important to engage the patient as well, I think, when there are situations like that to make sure that the general dentist and the orthodontist and the patient all have the same goals in mind and then making sure that those are predictable and achievable. And if not, then what are the compromises that you could come up with that still give you the acceptable outcome? We have to be honest about what we can achieve. Yeah, without a doubt. So is this collaborative effort more popular among a certain patient demographic. When young children are visiting the orthodontist to get their teeth straightened, is this necessary to have this type of collaboration? The parents bring the patient to the orthodontist. They go through all the treatment. From there, they go back to their restorative dentist, obviously, for their regular re-care appointments. Or is this more suited to patients that are looking for a combination of some form of orthodontic treatment along with restorative dentistry? Question, Phil, in that so many patients do need some or potentially could benefit from some restorative care after ortho. For example, if I have a young patient that has a tooth size issue, there are certain teeth that are a little small and the option might be to either file down teeth, say they're two small teeth in the upper arch, if we file down teeth in the lower arch to kind of make that fit, is that really the right way to go? Or should I have a good collaborative relationship with a dentist and say, you know what, what do you think about doing a restorative procedure for these laterals at the end of treatment because there is a two-size issue here? And I can... beauty of the oral care portal is that i can actually set the teeth up in their proposed final alignment and show the dentist that this is where those spaces would exist and help them to visualize okay if they did a composite restoration on those teeth how are the aesthetics how are the tooth proportions is this really the right direction to go Or is it to leave the teeth as they are and do the reductive procedures in the lower arch? That's a great example, Dr. Stenberg, clinically, for sure, where that collaboration would be valuable. Dr. Duerst, to swing back to you, could you tell us what the most popular cases that fit into this portal, this collaborative communication between you and the orthodontist? Is there some, you know, the 80-20 rule? You know, most of your cases will be... Tell us about that. I think most of the cases that have worked best with Donna and I using the portal are cases that are complex. adult cases or their cases maybe where a patient's missing the laterals and we need to decide about space and what to do. Or there were cases, there are adult cases that just have restorative, lots of restorative options. So lots of the cases we've done have been those. But as Donna said, you know, sometimes it's just simple cases that you don't even really think that there's going to be a problem. And it's not until you actually run through the orthodontic setup that you realize that maybe we're going to have an uneven situation here. There's going to be a space that. We just can't close. So it's really easy. Yes, it's really great for those complex cases where you can just sit down and really think it out and decide how best to handle those cases. But there are often cases that seem like they should be very easy that we end up using this type of communication for. Let me ask you this question again, Dr. Duerst. Chime in, Dr. Stenberg, please. Adult crowding is very common. I have it myself. Lower anteriors, they just love to drift towards the midline. And in my case, which I think is pretty severe, I think an oral surgeon might even be necessary. Does the platform accommodate an oral surgeon to fit into this treatment plan where, in my case, I may need, for instance, tooth number 24 extracted in addition to having the orthodontic therapy? Well, I can start with the answer, sure. and this is where the portal is again a great option phil because i can set up a treatment plan for you and for instance let's start with the treatment plan that we know there's a lot of crowding let's align the teeth and see how much expansion that really comes out to can the bone that you have support that kind of expansion and if not do we want to consult a periodontist or possibly an oral surgeon to to help us make some of those decisions and i can export a video i can export of just a final here's the malocclusion here's the final setup that we're expecting and get those other specialists involved in the process At the same time, I can then do a second setup that takes out tooth number 24. And then we can reevaluate and say, oh, my goodness, if we do that, we are going to be left with more overjet than is really the norm. And is this going to work out functionally? Can we get a good functional result? So those are the really nice things. And all of that can, because it's done in the portal, we can communicate that with really anybody. We can send it to the patient and say, here's the two options that we're looking at. And if we do option one for you, Phil, then we may need to engage periodontists to help us understand how your tissues are going to respond to that. or we're going to take out a tooth and we'll need to ask if the general dentist doesn't want to do the extraction, we'd have the oral surgeon help us with that. So it's also really wonderful to use these tools to make sure a patient is well-informed, that we really have established a good informed consent before they actually make a decision to move forward. Anything to add to that, Dr. Duerst? I really want to emphasize the importance of the communication piece because, you know, it's really hard to collaborate with specialists, I think, these days. Everybody's busy. You know, sometimes you don't take lunches. You work late. Your day's off. You don't want to, you know, have to meet with somebody to discuss a case. And what's really nice about this is that Donna will often send me an email and she'll say, look, I know we talked about a certain plan at the end, but I want to show you an update on what's happening. What do you think? Are we on the right track? I can just in my office at my own time, look at it, take a peek and decide what what I think about it and send her an email back. So it allows a really convenient way of communicating that fits into our busy. schedules and our busy times. And that's what I think is really nice about this too, because it really is hard to collaborate. It's hard to communicate. There's just no time. Dr. Stenberg, what do you do if you don't get enough information from the referring dentist to actually move forward with a treatment plan? There can be many reasons why I may not get that information. I mean, as Lois has said, practices are busy days are busy the patient might go right from that office make an appointment and and show up in my office and there hasn't been time yet to consolidate thoughts and put together some photos to send to me that's the ideal and a luxury if i get all that information ahead of time but anytime i see a patient i do my normal orthodontic records which would include photos and in today's world we would do a scan at that first visit then my job is just as important to get information to the referring doctor and say here's what i'm seeing here's the the problem list that i've come up with and let's get aligned in the problem list because some of the problems i see you may not see as a problem and i will send over a powerpoint with photos in it and i'll give my initial thoughts if i don't know the dentist at all i will basically treat it as if i'm just sending you this information let's start some communication And whatever format works for you, whether it's email, whether you want to get on a phone call, if you actually want to see face to face, Zoom or a Teams meeting, any of those kinds of situations. And you just start building from there. So it's not just the general dentist's job to send information. It's very much a two way street. And it's helping each other look at the case from. different person's eyes to make sure we're seeing everything that we need to. For those complex cases where interim restorations are required, how does the 3M oral care platform handle that? The interim restorations are not meant to be a very perfect ideal type of restoration, certainly not like the matrix veneer system. It's giving the orthodontist back the relative proportion of a tooth in a severe wear case so that we can use our mechanics correctly to get the teeth where they need to be. If you just have a very small tooth to work with and it's going to need to be restored by several millimeters in length and width, I can't visualize that. length and width with my eyeball. And I may have lost my ability to use good mechanics in order to get that tooth to move in its proper position. So the interim restorations are really helpful in some of these very complex cases. So overall, both of you have provided some really great information about the 3M Oral Care Portal. What's the best way for an orthodontist and GP to get started? Well, from a GP standpoint, the best way is to reach out to your 3M sales rep or to call the 3M number, which of course I don't have with me right now. Of course, you can just search online. 3M oral care platform and the site should show up? The general dentist will use this platform to help them get set up to use the matrix and to order the matrix for different cases they have. So they, yes, they just go ahead and Google 3M and call the number and we'll get them all set up and get them signed on onto the portal. And in closing, Dr. Duerst, if you would comment on how valuable this experience has been for you as a GP using this oral care platform? Well, I would say right now, there are so many aesthetic cases that are untreated. because the patient perhaps can't afford porcelain veneers or porcelain crowns, or they don't want their teeth cut down. And frankly, a lot of general dentists just are avoiding doing composite veneers or such because it's so time consuming and so hard. It's hard to make those profitable. So I think what the Filtek Matrix does is that it levels the playing field as far as that goes. composite much more affordable and it makes it something in your hands that you can create really artistic restorations that the patient is just over the moon about. So it opens up the door for you to add another tool to your toolbox and offer more aesthetic treatment options for your patients. Thank you both for being here. It's been very enlightening about this portal. We appreciate your time, Dr. Duerst and Dr. Stenberg. We hope that you join us again and give us an update on some of the new things that you'll be integrating into this portal in the future. Thanks for having us. Yes, thank you, Phil. It's been a pleasure. If you're enjoying our 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.