Intra-oral Scanners: Rely on Your Team, Get Perfect Impressions and Reduce Your Chair Time

You're listening to the Phil Klein Dental Podcast. Today, we're diving into the realm of digital dental scanners, those sleek devices that are changing the way dentists capture impressions. If you're a dentist looking to step up your game with cutting-edge technology or simply curious about what these scanners can do, sit tight and enjoy today's episode. Our guest is Dr. Scott Benjamin, who is in private practice in rural upstate New York. He is an internationally recognized authority on dental lasers and advanced dental technologies. Dr. Benjamin has faculty appointments at several universities, is the chairman of the ADA Standards Committee Working Group on Dental Lasers, and is past president of the Academy of Laser Dentistry. He currently serves on the editorial board for several prestigious dental journals. Dr. Benjamin will be joining us in a second, but first... 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Dental's complete digital dental portfolio. To learn more, visit shining3ddental.com. Dr. Benjamin, nice to have you back on the show. As always, Phil, thank you for the invitation. I always enjoy the opportunity of hopefully sharing quality knowledge with my colleagues. Yeah, so we talked a while ago, and I joke with you about this every time I see you, which is not, I'd like to see you more often, but every couple of years when we get together, I always joke about this. We talked about what would happen to traditional impression materials, the goop that we're all mixing up and putting in trays and putting in people's mouths, they're gagging, and it's been working for, obviously. forever. But then, of course, 10 or 12 years ago, we had this discussion about digital scanners, and you said, Phil, in a couple of years, you'll never see that traditional material again. It's going to be replaced. Tell us what your thoughts are now about traditional impressions and where we are with the digital scanner. That was a very funny conversation that we had years ago that I predicted, again, about 10 years ago, that within five years, that traditional impression materials were going to be defunct. We're slowly moving in that direction. Now, again, in my practice, 95 or greater percent of my single unit crown and bridge, well, actually 100% of my crown and bridge work is done with a digital scanner. When it comes to soft tissue impressions for removable appliances, that's sort of presently where the digital scanning in office tends to fall apart, which is where we still use conventional. of impression materials. The thing that we get into a problem with is we use it so infrequently that I had to start buying it in smaller quantities because it was expiring before I could use it. We talked about your workflow, which you are kind of a little bit iconoclastic when it comes to how you delegate some of the responsibilities regarding doing your prosthodontics in your office. So enlighten us about how you actually use the scanner and what's the next step and who does what. Well, when I first got into, you know, digital impressions back again, got 15 years ago. My home time flies. 15 years ago, my initial training, I took two of my two licensed dental assistants with me down to the training. And as we sat there and did the training, I never touched the machine. I had them sitting in front of it. And I'm known as a computer geek in dentistry. questioned by the instructor saying, Scott, we've known you for years. We know how much you're into computers. You're spending basically $100,000 in this technology and you're not going to use it. My answer was I'm spending $100,000 so I don't have to use it. I train my assistants to use it from top to bottom. My assistants are much better at the digital impressions and designing the CAD CAM crowns better than I am because they're doing it. literally multiple times a day on a daily basis. All right, so I'm your patient, tooth number 19, broken down, large fillings. I sit in your chair. We're scheduled to do a full crown, and you've got chairside milling all set up in your office, one-day dentistry, one-visit dentistry. Tell me what the process is and who does what. The one-day dentistry was something that I thought initially was going to be completely bogus as far as does it really work and are patients that interested in it. The last patient I had today, as a matter of fact, made the comment he was so grateful that, you know, we could do this crown on his upper central incisors all in a single appointment. And, you know, so we developed the workflow that made the most logical sense. I anesthetized and I prepped the tooth according to the needs of that particular restoration. After I have done the preparation, I literally will hand the mirror to my chair-side assistant, who's licensed in the state of New York, and I ask her to inspect my prep. Very similar. to how a faculty member would inspect a prep in a dental school. And the question is, can you see everything you need? What do you think should be changed? And I've trained them to be a second pair of eyes for me. Can they visually see the margins? Do they like the emergence profile or do I need to possibly change the emergence profile of the soft tissue? I'm happy and content, and they're happy and content. I let them do the digital impression. Once the digital impression has been acquired, I'll quickly review it and say, yes, this is satisfactory. We can see what it is. And then they take over just like a lab technician would. and do the designing of the crown. If they run into anything as far as a question, gee, I'm not sure if we have enough reduction in this area. I don't like the contour of how this looks. We will then work together on how do we want to change it. They're actually doing the manipulation and I'm doing the anatomical coaching. They then mill the crown and then hand it back to me. And my entire time for doing a single unit of crown and bridge is significantly less than my time doing an MOD restoration. Because again, I'm doing the prep and the cementation and almost everything else is being handled by my clinical staff. So now that I'm able to do, you know, more dentistry in a shorter amount of time and getting the quality that I want out of it has really significantly improved the economics of the practice. The amount of time it takes for my staff to do a digital impression is literally probably less than half of the time it takes to have the impression materials set. to say nothing about mixing it, fitting the tray and everything else. So again, the entire appointment time of my time is cut down literally into minutes. Right. Now, a dentist will say, that sounds great, but if that person leaves the practice, now I'm really, my workflow has just been destroyed. Again, it comes down to two basic principles. One, make sure your staff is very happy and content as you train. Now, my present staff that I have have all been trained internally. They have been trained by my other dental assistants and myself on how to actually... sign crowns, and that's more what I'm involved in. And my other staff, my present clinical staff has been literally trained 100% by other staff members. So again, it's a matter of making sure that we have enough staff members. I had the misfortune back, I'm going to say 25 years ago, again, longer than that now that I'm thinking of it, because these kids are all now working, of having four staff members that were all pregnant at the same time. It taught me very quickly to make sure I have redundancy in my staff so that no one staff member is 100%, you know, responsible for any one task and that everybody is appropriately cross -trained. So if somebody goes off on vacation, et cetera, somebody's out with an illness, that my production can continue as normal. But for the doctor who has one assistant and who depends on that one assistant to do these procedures, all of his or her eggs are in one basket, right? Well, the idea, first you made a statement, never put all your eggs in one basket. That is a critical mistake all the way around. And that's just dental practice as a whole. Because you never can tell when a staff member is going to be, I had a staff member literally break her arm by getting hit by a metal door. Which again, was a situation, and I mentioned about having several staff members all expecting at the same time. So again, fortunately they were staggered. apart far enough that while one was out on maternity leave, you know, the others could follow through. But it was a matter of don't put all your eggs in one basket. One of the fears that many clinicians have, I'm going to spend all this time and effort training my staff to make their job skills now more valuable that they can go out and shop their skill set to other clinicians. You know, and in an urban area, that's a much more of a concern than it is in a rural area. But however, when you have a staff that, hey, I'm paying you to do this job and I'm appropriately compensating you for it. Grass always looks greener on the other side of the fence. And it only takes one person to actually find out that grass isn't greener. To actually have that come back and infect the rest of the staff of, I never realized how good I had it until after I left. Right. Let me ask you this question. Switch gears a little bit here. You talked about single crowns. We're talking about single crown restorations. You talked about the workflow. What about bridges? Dr. Benjamin will be answering that question in a second, but first, as an endodontist, I can tell you root canal preparation can be stressful, tedious, and exhausting. And part of the problem is that dentists typically use too many endodontic files, and they use them in somewhat of a haphazard sequence. This makes the procedure more complex, longer, and less predictable. That's exactly why Colten developed the HyFlex EDM file system. With only four endodontic files used in sequence, you can effortlessly clean and prepare the root canal system to working length case after case. Using a simple pecking motion with the opener, glider, shaper, and finisher, you'll quickly see how much faster your endo procedures will go and how efficient you'll become in achieving exceptional canal preparation. So if you're looking to speed up and simplify your root canal procedures consistently without compromise, check out the HyFlex EDM file system from Colteen. To learn more, visit colteen.dental. Traditionally, what we're doing now in our practice is that we're going in, we're doing the same workflow through the scanning phase. And then at the scanning phase, we're actually digitally sending the scan out to the lab to have the lab do the work there. So I'm working with Crown and Print Lab that has the ability to accept the digital scan. While the patient is still in the office, I'm actually able to communicate with them and saying, is this scan adequate for what you need to fabricate this prosthesis? Rather than, oh, you missed this margin, now bring the patient back. we're able at that same time to do a new scan and make the corrections at that time, something you can't do with conventional materials. So that works out very well. Plus, I'm a rural practice. Everything that I do in the lab, for the most part, has to be shipped in some form or the other. So I've now cut down. the amount of time a patient needs to be in temporization significantly because I've eliminated the shipping time going out. Now, we still have to get it shipped back to us, but a typical turnaround time for me doing a multi -unit bridge is still about a week in time because they know that the impression is appropriate before the patient leaves the office. So they're ready to go. literally the same day, to start fabricating it on their end. And then we have basically, I'm going to say, the two days after it's completed to get shipped back to our office. So we will schedule patients, tentatively schedule them a week and a half out, but also leave a space for them when we anticipate it coming back in the schedule that we will use for emergency time. As we get closer to it, we don't have the case back. So we know literally 24 hours in advance whether the case is back in time. And then we can open that case, that time up to handle, you know, an emergency or whatever needs to be done at that time. So it's significantly cut by digitally scanning. It is significantly cut down my time, both on internal cases that we're doing all in one day, but even more significantly. on the multi-unit bridges. Now, again, we know that digital scannings are more precise than our polyvinyls or polyethers that we're taking. And on top of that, we don't have to worry so much about temporization failure because the amount of time that the patient is temporized is significantly less. We don't have to worry about the long time of possibly having teeth move or drift slightly because of the lack of appropriate contact or whatever. And so it really has improved my efficiency and my need for remakes. My need for remakes has significantly dropped almost to zero because before the patient leaves, the lab has got all the information that is there rather than, well, make do with what you have. What do you say to dentists that they use the scanner to take their impression, they don't use the impression materials anymore, and that's it? They don't do any chair -side milling. Everything goes straight to the lab. They don't even do any design work. They don't have a staff that's trained on that, so they strictly cut the prep, use the scanner, send the file out to the lab, and that's where it stops. What's your feeling on that? If that's where their comfort zone is, and talking about the fear of a staff member. leaving that has been doing all these things, that the scanning, once you have the appropriate design and the appropriate tissue contouring, you can always do things that way. So even when you feel that, gee, I'm not confident with the rest of my staff designing this crown, you can basically follow the crowning. The same thing I do for a multi-unit prosthesis is being shipped out exactly the same way. So it's significantly less. Now, the amount of time that it takes... is literally, and I have my office set up, which is what was one of the prototypes where we actually have scanning stations that we scan the patient in an operatory, and then it's designed and milled on a separate computer in a remote area. So very commonly, well, I'm doing multiple procedures on the same patient. We will do the crown preparation and then maybe doing something else in another quadrant or even in the same quadrant, an occlusal restoration, something unrelated to the contacts on that patient during the same time so that the patient's time is being utilized efficiently as well as our time in the office. One thing that some doctors are saying, I'm not uncomfortable delegating any of this to my staff. Well, that's fine. Delegating what you feel comfortable delegating. That's how you step up the ladder appropriately to do more sophisticated delegation. Okay, I'm going to do the scanning. I'm going to be teaching my staff how to do the scanning as I do it. When we do all procedures, as one of the developers of the process with the Velscope, how we taught my staff, my hygienist staff, how to use it. Every time we have a patient coming back, because there's something we want to follow up on, I make sure that they're there to basically reassess that patient with me at the second appointment. And if we have to do some sort of soft tissue pathology, that same staff member. So they're learning how to use the technology that I'm using and why I'm using it that way as I'm learning the procedures myself and as they are. So let me ask you this. So you do the prep. They take the dental mirror like a dental instructor in a dental school. give their opinion, their feedback on your prep. And when you agree that the prep is approved by your assistant and yourself, they basically scan it with the scanner. You don't do the scan and you feel totally comfortable with your staff doing the digital scan. Oh, absolutely. And again, if they have a question on the scan, and usually I'll take a quick look at it, they'll say, I've got the scanning done, take a look at it. Is that satisfactory? very similar to what it would be if I send it off to a dental lab for a multi-unit case. Having me approve it, and then in the case of the multi-unit, I'm now being the dental lab saying, yes, that's an acceptable impression. Very similar if you had your staff doing crown and bridge impressions in a conventional way. Is that impression adequate? Yes or no. And if it isn't, why isn't it? And how do we make it correct? Is it a matter of a piece of tissue got in the way, there was excessive bleeding, or just the anglization was wrong and you missed the margin? And again, one of the reasons my staff is with me forever and a day is I empower them to take responsibility. They leave at the end of the day, they're as proud of our outcomes as I am, because they have ownership of how that procedure worked. This is where staff development and training becomes very important. If your staff is treated as a co-therapist, as you're doing a procedure, their respect for the practice, their respect for the patient is significantly higher than if they're strictly a subordinate of doing things of, I'm going to tell you what to do and do it my way. When it comes to developing the workflow, they're involved with developing the workflow to their own level of comfort. Let me ask you this about regulations, state regulations about... digital scanners by staff it varies very much from state to state in the state of new york a licensed dental assistant which is now referred to as a registered dental assistant that has had of you know formalized and in office training can do all procedures that are reversible and obviously a digital scan is reversible fabricating a crown you know whether it's done on a CAD-CAM basis or done by a lab technician as a reversible procedure because it doesn't involve doing anything to the patient at all that is going to be potentially harmful. So when it comes to intraoral scanners, the objective, obviously, is to capture as much detail and anatomic accuracy as possible, and the research is showing that digital scanners are more accurate than traditional impression-taking techniques. Now the question is, how does one select the right scanner because there are different price targets? and manufacturers all claim to have the best one. So what advice can you give our listeners when it comes to purchasing a scanner that would work best for them? It first comes back to what do you want to do with it. And again, which is a theme that I have all the way through technology in my presentations, is if you want to do dentistry in one day, you need to make sure that the scanner that you're incorporating into your practice will enable you to do that. And there's several that are on the market today that have the ability to do, you know, a single appointment crown and bridge work. So if that is one of your goals today, you need to make sure that that's a qualification. Is it a company that is dependable and will be around? As we invest in technology, one of the most overlooked aspects is how secure and how stable is the company that you're dealing with? Do you have confidence they're still going to be around in a year, two years, three years to support you? And that's a question that you need to be looking at. Just because it's less expensive doesn't mean it's poor quality. Just because it's more expensive doesn't mean it's higher quality. But does it have the resolution that you want? Talking to other people that are using it and deciphering the fact that I bought it, so it's got to be good. And the most important question with all technology when you're asking a colleague that uses it, what don't you like about it? What about this product don't you like? And being aware of that. before you make the same pathway. And if you're doing things like orthodontics with aligners, does the aligner company that you're dealing with, do they have a scanner that they would recommend that works with their product? Are they only able to accept scans from certain products? Being aware of all that. Again, what do you want to use it for? And will it do the goals of what you want it to do? Some of the aligner companies today will say, you must use scanner X, Y, and Z. So you want to make sure you're buying Scanner X, Y, and Z if that's the company you want to be dealing with. I think your point about having the company be around is really important because you need the support. If you buy a scanner for whatever it costs and then the company's not in business or no one answers the phone or they just don't get back to you, you have a technical issue, then you're really handicapped. Your office is in big trouble. Because your workflow has just gone to hell, to say the least. I'm laughing at one of the statements you just said, because one of the recommendations with support is when you're thinking about somebody, ask the sales rep for their tech support number. Before you buy the device, call the tech support and see what you get. Right, that's a very good point. Well, I mean, your office, it's the lifeblood of your office. When you're doing crown and bridge and if you're doing a lot of single crowns and patients are scheduled and they're lined up and this thing is not working, and it could be something very simple to adjust or you're just not getting the results that you need, you need to be able to call someone and someone's got to be around to help you. That's just how it works. And that's important with not only scanners but all the technology we have in the office, whether it's a CBCT unit. whether it is a digital imaging system, whether it's a laser, whether it's your computer system for your practice management, that when something goes wrong, you want to make sure there's a place to turn to to actually have that problem taken care of. All right. Well, Dr. Benjamin, thank you so much. And we'll see you on the next podcast. Thank you for the opportunity, Phil. It's always great discussing things with you. 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