Why So Many Dentists Are Switching to Intraoral Scanners

You're listening to the Phil Klein Dental Podcast Thanks for joining us. I'm Dr. Phil Klein. Intraoral scanning is certainly catching on in the dental profession. Many of us who insisted only a few years ago that they had no intention of going digital are in fact picking up the proverbial magic wand to take their impressions. And in many cases, once they get started with their intraoral scanner, they wonder how they ever practiced without it. But there are a considerable number of dentists that just want to stay in their comfort zone. and continue with their favorite traditional impression materials. Others are reluctant to change because of some negative feedback they may have heard through the grapevine. So in today's podcast, we'll be addressing and debunking some of these myths and misconceptions about the intraoral scanner. In fact, we'll be revealing how it can actually be incredibly positive for the dental practice. Helping us put all this in perspective is our guest, Dr. Franklin Shull. Dr. Shull maintains a private practice focused on comprehensive care. and has extensive expertise in digital workflow. He shares his experiences through lectures and workshops throughout the U.S. and is visiting faculty at the Panky Institute. He's also part-time faculty at Spear Education, primarily teaching digital adoption. Before we get started, I'd like to mention that Dr. Shull’s webinar titled Clinical Workflow for Today's Aesthetics is now available as an on-demand webinar on vivalearning.com. Simply type in the search field Shull, S-H-U-L-L, and you'll see it. I recommend it highly for the entire dental team. Dr. Shull, it's a pleasure to have you on the show. Thanks, Phil. Glad to be here. So why is there a misconception based on the idea that using an intraoral scanner results in... loss of income, for example, or even reduced patient visits? Because that seems kind of crazy to me, considering that it's a digital tool that should increase efficiency and productivity rather than the reverse. Yeah, I mean, it is a misconception. I think, you know, any new technology you hear all sorts of things about, even though digital scanning obviously is not really new, internal scanning should do exactly the opposite. It's going to increase your patient comfort. it's going to your patients are going to love it you're going to get your roi that's the other thing that was a misconception is will this be worth the money i'm going to spend and now that scanning has been out there for quite a while now i can tell you without a doubt you will certainly be able to recoup your money and then make money instead of buying impression material from your retailer or wherever you buy it from yeah and just the whole concept of using impression material and patients getting that stuff put in their mouth. I mean, I know we've been doing it forever. I did it in dental school. You did. Honestly, it's not the greatest thing in the world for the patient to have goopy material floating down their throat. It does happen and there's gag reflexes. I've been talking to a lot of KOLs on this podcast program and some of these top guys and women who are dentists for many years. have resisted changing. And only recently, like the last, some of them are saying six months, some of them are saying a year. And I was really surprised to hear that. I thought many of these top KOLs who I respect, people like you who teach, and I know you teach at the Spear Institute. We're excited about having future podcasts on digital workflow with you. You'd think that those top -notch clinicians and teachers switched to digital scanning exclusively a long time ago, but actually that doesn't seem to be the case. But now they are, and they're seeing a major improvement in their workflow. I think the problem was that a lot of people from the inception of scanning, it came with milling in-house. And a lot of us didn't really want to mill in-house. And we saw the earlier generations of milling not be great. So it gave us kind of a bad taste. Well, we kind of discounted where the actual benefit was. And the benefit is in the ability to scan. Scanning, whether you mill or print or whatever you do, Scanning is the key. What you do with it after that is up to you. And that's another beauty is there's so many options now. Just because you buy a scanner doesn't mean you have to lock yourself into anything else. The other thing that a lot of us older guys resisted was, can I do bigger dentistry with it? Because I have been. I've taught at Panky. I teach at Spear now. I've done all of the big stuff. And yes, you can now. very predictably and even more accurately do it than we could before. So I think it's just maybe not having all the information. And I can't imagine any general practice not having a scanner now. Years past, maybe, because the cost was quite high. But now costs are coming down. The technology is so good right now. If you're not into scanning yet, it definitely is time. It's not like when the old days of when did you get a computer, right? You've got to have a computer. You've got to have a scanner. And that's kind of the trend that happens with new technologies. Adoption occurs quickly for those that love new gadgets and want to try everything new. There's some resistance, you know, a broad-based resistance overall. And then once it starts to catch on, the trend really gets momentum. Then it happens very quickly where the rest of us all come on. And I assume five years from now, I would guess most dentists will be scanning and those materials will be part of a legacy practice. I agree. And, you know, the numbers show us that in the U.S., we should be ahead of other markets. And we're actually behind a little bit. There's less than 50 percent adoption of scanning. And I think those numbers are a little bit skewed. But every year it grows in large numbers. Even dental labs, this means we're working with a lab. It doesn't mean we're cutting our lab out. Our labs, if we're not sending them a digital impression, 90% of the labs, they're converting our physical impressions into digital. So why not skip that step? That is a lot of inaccuracies built in that step. Why not take it directly from the patient's mouth instead of having... a second step that no lab wants to have to buy a tabletop scanner why not just send them the scan yeah that's a great point i agree with you the next five years i can't imagine it's kind of like digital radiographs You know, if you have a dip tank now, I think you're a little behind. Yeah. Yeah, for sure. Yeah. And it soon is going to be the exact same thing with the troll scanners. Yeah. I can't imagine not having on my scrubs the stain from the fixer as an endodontist. My wife worked with me and we would dip in that stuff and she handed me the film and it was dripping all over me while she handed me the film. So not great for the scrubs and not great for the marriage. Another main concern. Let's talk about the learning curve. You know, we hear. The misconception is that it's an ominously steep learning curve and there are so many things to overcome. What's your response to that? Yeah, and once again, I've been scanning since 2013 or 14. And back then, I would agree a little bit because scanners were slow. They had a big lag. You would have to designate where you were going to start your scan and end your scan. And if you ever got off track, it was cumbersome. It really was. Now we kind of make a joke about it because we'll hire new assistants or new auxiliaries in the office and we'll hand them the scanner. No instructions at all and say, go scan your partner, go scan the other assistants. And amazingly enough, they can. do it without instruction. It's very user-friendly now. And some scanners are more so than others. There's a lot of scanners on the market, and they're not all created equal. So I urge anyone that's thinking about diving in, two main things is going to be whether it works well in your hands, meaning ease of scan. And then I don't know if we'll talk about it later in the podcast, but what is your support like? When something goes wrong because it's a computer, How easy is it for you to get the support that you need to get up and running right then, not two days later? So honestly, that's the only things I care about anymore is going to be not can I scan, but how easy is it to scan? And then what kind of support do I have? Right. And sometimes it's tempting to buy a scanner that's a lot less expensive than other scanners that are out there. But then what comes with that is less support because you don't even know where that scanner is coming from. It's amazing. I think we all, as dentists, I don't know, we're cheap. I mean, for the most part, you know, we want to pitch a penny. And I get that. But this is one of those items. It's kind of like your handpiece. I'm not somebody that's going to buy the cheapest handpiece on the market because it is my tool that I do most everything with. It's the same thing with enteral scanner. I don't want to buy the most expensive thing on the market, but I'm also not going to buy the cheapest thing. Look in that middle ground. And right now, I don't know, throwing numbers out. Right now, that $20,000 mark is sort of where everything is settled. You can certainly buy things higher. You can certainly buy products from other countries that are much, much less expensive. But you've got to think about, you know, who is supporting you? And that's when I urge people, listen, go with a company, go with a group that... already used products from maybe, or has been around for a while, and you know that's going to be there to have your back. That's really what it comes down to. Yeah. And I think that's great advice. So should a dentist be concerned with the idea that using an intraoral scanner results in significant interference with workflows? And again, obviously it's counterintuitive, that question, but that's a misconception. What's your feeling on that? It is. And the term workflow has been so beat up in the last couple of years. What is a workflow? A workflow to me is something that I'm doing every day that gets me from point A to point B. If I change that workflow and make it a easier A to B, then I feel good, especially if it saves me money. And that's what the interval scanner does. It is so much quicker, so much more tolerated by patients, saves me money. It's a wow for your practice. Even today, I mean, scanning today every day and the patients always have the same thing to say this is incredible you know this is really cool I say the same thing even I've been using I've been using scanning technology for a long time but every time I use it I'm amazed by it I don't know it makes it makes my job you know it's enjoyable and you can visually see what you're doing so yeah I can't imagine it being a negative from a workflow standpoint. One of the things that we teach at Spear in our digital adoption is all the different workflows. There's not just one set workflow. And once again, kind of reverting back to what you and I were saying back in the early days, there was a defined workflow. You scanned, you milled, and that was a pretty cumbersome workflow, especially early on. Now you can choose whatever workflow you want. You can create anything you can imagine from that initial scan. Once again, it doesn't have to disrupt anything. All you're doing now is you're shortening the time that it takes to take the impression. Your patient's more comfortable. You no longer have to box up an impression that's going digitally at the end of the day within minutes. So all it does is really going to make a workflow, any workflow you choose, more efficient. That's really the main thing that you need to think about. Are dentists typically creating models from the scan using 3D printing? It depends on what they're doing. So if you're doing a crown and you're milling in-house, or these days we can print crowns in-house, which is a whole other podcast. Right. I don't think that most that are doing crowns in-house are actually printing models because you don't need to. Parameters are set. Your contacts are going to be dead on. Your occlusion is going to be pretty much dead on. Printing models really becomes something if you're doing aligner therapy, that you're creating your own aligners, or whether you just won't study models. I mean, you can print models for a variety of reasons. But it certainly doesn't require if you're doing in-house production to print models. When we talk about patient acceptance and comfort, I mean, that seems pretty obvious to me. Patients should be very excited about having a scanner wand in their mouth versus a tray and goop, obviously. Does it help with building a practice as far as using a digital scanner where that patient through word of mouth will say, hey, my doctor. I didn't even have an impression taking. I'm so used to, I knew I was going to have a crown or a three unit bridge. I was expecting to gag. He or she used this wand. Typically that would be a good thing. Don't you think? I really can't emphasize enough if you haven't used it, how much of an impact it has on that part of the practice. And the other thing to realize too, and I think you and I are from a little different generation than maybe some of the listeners, but they're teaching this in dental school now. My son's in dental school and they are learning digital impressioning. So I think that that shows everyone that if the new guys coming out, guys and gals coming out of school now are learning this as a technology that we're going to be using. It goes to show you that this is where we are. It's not something that is questionable anymore. digital adoption series, we talk about all of the literature that's out there, all the research that talks about accuracy. So there's no longer a question that patients almost, what I find is they kind of expect it. I have referrals from other practices simply because they can't get an impression on someone because of a gag reflex or maybe you think about taking an impression and you have an old fixed, you know, Bridge that if you take an impression, a PBS impression, you're going to extract that bridge. So many things to think about that you can do. Scanners like a lot of scanners now have different size tips. You have your conventional tip, but you also have almost a pediatric size tip for all of this possible scenarios. Ivoclar's VivaScan has a phenomenal little small tip that. Even if the patient's opening is very restricted, if you can get an impression tray in someone's mouth, I guarantee you, you can get a small impression, a scanner tip in their mouth. So all of the things that, you know, we worried about, I guess, in the early days, like you and I were saying, debunking some of the old ideas, they really have gone away. Yeah. How is Ivoclar's support program with the VivaScan? I use AvivaScan in my practice. I have multiple scanners and I can tell you that there are certain reasons to buy certain scanners. And you can spend a lot of money and you can spend a little bit of money. And once again, I talked about that sort of in-between zone. Find a company that has a good scanner that has great support. Support, no matter how great the scanner, is what you're going to need. The thing that sets the VivaScan apart from every other company I've ever worked with is their support. I have a person that if I have a problem, I know exactly who I'm talking to and they know who I am. The same group sets up every single doc that buys their scanner. It's not a system that is overseas. It's not someone that you're going to have trouble communicating with. It's someone that knows this scanner in and out. They can jump on your computer, help you with it. And I have not had a single... single problem that I couldn't have fixed within that patient's appointment, put it that way. That's huge. Yeah, that's so important. If it goes down in the middle of a big appointment and you can't get help with it, then nobody's happy. Yeah, I think that's what some of the dentists are afraid of. I agree. That's what Avoclar sells. And I've used Avoclar products all my career. And I've always known them as a tier one type of company. I mean, their R&D department and their support for every product they have. is phenomenal. So I didn't know their scanner at all, but I knew their company. So that's why I was drawn to seeing what their scanner was like. And I do urge people, don't buy just because it's the bottom dollar product. This is something you're going to use every day. And the more you use it, the more you're going to want to use it. So don't go cheap with questionable support. That's important advice. Let's wrap up this podcast fairly soon, but I just want to hit on the data security issue and privacy. That's a big thing now with HIPAA compliance. Are there any concerns at all with data security and privacy when using a digital file from a scan? I don't get asked that question much, but it is an important question. You and I were talking earlier, and I've had my emails hacked recently and all sorts of things. The more we use digital files, the more hackers are smiling. I'm not sure how much of a problem it would be or who wants a digital scan of someone's mouth. But I do know that with Avaclar's software, it is compliant and it's also very secure. So this one thing that you can be not to worry too much about is your patient scans. and the ability to get access to that scan in the future. It's something that we didn't talk about and I'll just touch on. The savings alone from the storage space of all the models that we used to have to keep, we now have those in digital files. And with the VivaScan, like we were saying, they're secure digital files. So you could more easily break into my attic and steal my models than you could break into my files from my VivaScan. The last thing I want to just touch on before we wrap it up is what does a dentist need to do as far as prep design when he's actually preparing the tooth with the burr and tissue management that's different, if anything, when doing a scan versus traditional impressioning? That's a great question. And there's studies that kind of back what I'll tell you. The basic bottom line is if you can see your margin, you can scan your margin. I think that... lot of us old school guys, you know, we envision squirting our impression material under the tissue and capturing that margin that we really can't see. Well, I mean, that's not the best idea anyway. So what you do with any scanner is you try to make it where you can see your margin. So tissue retraction, as you would with an impression, your double cord technique, if you want to use a laser, if you want to use retraction paste. whatever your technique, you still use. You can scan subgingibly. That's another thing that you have to be aware of. But at the same time, you have instant access to be able to see whether you captured your margin. With an impression, we're looking, trying to look with our loops and different lights, and it's very small. And you're like, yeah, I think I got that. Well, it gets to the lab and they say, doc, you didn't get this. Well, I immediately had the feedback of whether I've captured my margin while the patient's still in the chair. And if I need to rescan, I don't have to rescan the entire patient or the entire arch. I'm going to go back and rescan that one area. So to me, you know, it's validation that I have a good margin. I think that people get caught up in the squirting under the tissue issue. 90% of those, you're going to tear that impression anyway, either in the lab because they're going to scan it and they can't scan undercuts that are like tissue undercuts. So if you can see it, you can scan it. And I think that we need to get back to good retraction. It's no different other than we're not squirting under tissue. If anybody's interested, just to know that Dr. Shull is an instructor at the Spear Institute. And I'm sure he could talk a lot about that and what he does there. And that's going to be good stuff for another podcast. But if you're interested, I guess he could just go to Spear. Just look up Spear on Google, right? And find information about courses. Yeah, Spear education. And then look through their courses. And they have quite a few workshops. And the beauty of workshops is you're not just sitting there listening to somebody talk the whole time. You're getting your hands dirty. You're actually prepping models. You're seeing different types of cases. To me, it's the best way to learn for sure. Yeah, great facility. I was there in Scottsdale, Arizona a couple of years ago for an event. We actually did a live podcast there with some KOLs. Fantastic place. So that's Spear Education. Check it out on Google. And Dr. Shull is a very skilled professional teacher there. So learn from him and it'll save you tons of aggravation probably down the road. If you've been enjoying our podcast, we'd love to hear your thoughts and feedback by leaving a review on your favorite podcast platform, whether it's Spotify, Apple. Google, or any other podcast platform you listen on, leaving a review is a fantastic way to support us and help others discover our show. So we'd really appreciate you doing that. Thank you for your support. See you next time. Thank you very much, Dr. Shull. Really appreciate your time. Thanks for joining us on this podcast. Thanks, Phil. Enjoyed it. Appreciate it.