Scanning the Horizon

Regarded by many as a significant player in 21st-century dentistry, digital impressioning continues to gain traction in dental practices across the country. And, as increasing numbers of new systems are introduced, this method of taking impressions is expected to enjoy rapid market growth. That’s not hard to believe when you consider all the benefits offered by digital methods over traditional ones.

First off, the most obvious advantage in using digital impression systems is that messy impression materials are no longer part of the equation. This translates to increased comfort for patients, who no longer have to struggle with the gag factor, often triggered by trays filled with material threatening to run down the backs of their throats. Because of this, digital impressioning is a patient pleaser. In fact, many patients are reportedly asking for it, preferring it, hands down, to the traditional impression-taking method. That means it is bound to have a positive impact on a practice’s bottom line.


POINT OF SALE | DIGITAL IMPRESSION SYSTEMS

  • Digital impression systems can help practices save time, space and, in the long run, money.
  • This method eliminates the costs related to impression materials and trays and shipping the impression to the laboratory.
  • They help eliminate “retakes” due to their accuracy and the fact that, unlike traditional physical impressions, they don’t tear or distort.
  • Patients will appreciate the enhanced comfort and see your client’s office as a cutting-edge practice.
  • Such systems serve as an aid to patient education and can enhance workflow.
  • This is considered “green technology,” as it eliminates waste from landfills.

In addition, by scanning impressions, rather than taking traditional ones, cleanup hassles, inherent in the use of materials such as alginate, polyether and polyvinylsiloxane are all but eliminated. Likewise, the potential for cross-contamination and the need for disinfecting analog impressions — and storing models — are also eliminated. And because digital systems are essentially software-based, file sharing — often instantaneous — between practices, labs and other third parties is facilitated. This can speed up the restorative process as a whole. Also, because they are stored digitally, patient files are less likely to get lost or misfiled, and office real estate is freed up.

When you consider that this is a technology that can make patients, staff, and lab technicians happy — and that many clinicians report a high return on investment, in less than a year for some — it could be the homerun your customers are looking for. But possibly most important of all is the fact that digital scanning for impressions boosts accuracy. And that makes everyone, literally, look good.

ACCURACY MATTERS

Digital impressions are reportedly more accurate than their analog counterparts for numerous reasons. A digital impression can be viewed on a large screen, making it easier for the clinician to ensure that no spots have been missed during capture. But if they have, it’s not a big deal to simply rescan the missed area in order to immediately correct the error. There is no need to rescan the whole thing. This is a stark difference from the analog protocol, which would require an entire gag-worthy retake — after being informed by the laboratory that the impression was insufficient.

But that’s not all. In traditional impressioning, there is always a risk of bubbles forming that can create voids. Impression materials may also be subject to tearing or distorting. Any of these issues would call for a time-consuming and sort of embarrassing need for a retake. There are no such risks with digital impressions.


LEXICON

Additive manufacturing: A product made through the addition of layers of material.
Closed system: For use only with corresponding software designed by the manufacturer.
Cone beam computed tomography: A three-dimensional (3D)
X-ray technology.
Open system: Can be used with any computer-aided design (CAD)/computer-aided manufacturing software.
Subtractive manufacturing: A product made through removal of material from a block.
STL File: Short for stereolithography, this is a file format native to CAD software; not to be confused with stereolithography, often abbreviated as SLA, used in 3D printing.


YOU CAN’T BEAT THE SYSTEM

Typically, digital impression systems are composed of a scanner, a laptop, tablet or tabletop computer, and software with various workflow options, which can help streamline scanning depending on intended application. Digital impression scanners are typically wand-like devices that render three-dimensional (3D) images of teeth and oral tissues to create digital impressions. As the clinician scans, the impressions are basically painted onto the computer screen in real time.

Intraoral scanners depend on a combination of light, which interacts with oral surfaces, and cameras to capture images. While some scanners are laser-based, others are optical scanners that use blue LED. Although the former are said to be exceedingly accurate, and, by some accounts, can be used to access obscure areas more easily, they may also be pricier than LED models. In the lab, they are often what are used to scan impressions and models. Laser systems acquire images through the measurement of tooth surface distances, while LED systems rely on reflectivity on tooth surfaces. The latter typically requires the use of reflective powder.

Scanners may be standalone units, used by clinicians who want to keep working with a lab through the electronic transfer of files. But to really take advantage of the efficiency offered by these systems, they may be used as part of a whole system that allows more work to be completed in the office, if not chairside. This, in fact, is the basis for what is often referred to as “same-day dentistry.”

Those who want to design and mill their own restorations in house using scanning systems in conjunction with computer-aided design/computer-aided manufacturing (CAD/CAM) units, and in some cases, with cone beam computed tomography (CBCT). Fully integrated systems from the same manufacturer can certainly enhance workflow, as well as streamline the training that is often supplied.

Still, some practitioners might prefer to build their own systems from disparate components. In response, manufacturers are increasingly offering open systems. Open systems, as opposed to closed systems, are those that can communicate with many brands of software other than just that which is proprietary. This can be especially helpful in that new technology can be used with existing units, for a cost-effective technology infusion.


SO WHAT ELSE IS NEW?

BAGWOLD/ISTOCK/GETTY IMAGES PLUS

It wouldn’t be a reach to say that digital impression innovations are on a roll, with advancements coming at near breakneck speed. With ergonomics in mind, as well as enhanced accessibility, today’s scanners are being engineered into increasingly compact designs to expedite their use in everyday practice. So instead of the Mack Truck-sized scanners of just a few years ago, today’s units are a little more along the lines of Mini Coopers.

And multi-tasking isn’t just for humans — newer scanners are increasingly available that integrate intraoral cameras, shade-matching technology and more.

Guided scanning is another design feature that’s recently become available on certain systems. With the help of features such as arrows, lights or voice prompts, this sort of technology walks clinicians through the scanning process, from start to finish. The intended result is a flawless impression with accurate bite registration and no missing information.

A late-breaking development, motion control technology allows the image on the monitor to be controlled by a hand gesture in mid-air, without touching anything. In this way, the image can be easily manipulated to show different angles. Like something you’d see on the Starship Enterprise.

One handy feature is high-speed, continual scanning, which not only reduces the time it takes to scan a full arch, but also counteracts any extraneous movement, either from shaky clinician hands or from fidgety patients. And with many of these systems, if any spots are inadvertently missed, the area can simply be rescanned, and the missing information will be filled without the need to redo the whole impression.

Other digital scanner innovations include the fact that they are increasingly wireless for enhanced mobility and ergonomics. Additionally, a variety of interchangeable tips enhance the clinician’s ability to access even the most obscure regions of the mouth. And many of these devices no longer require the use of a powdered scanning medium for image capture. There is even talk of the use of optical coherence tomography, which can be used to see through tissues without harmful radiation, being used in scanning.

With smaller, faster, more accurate, open architecture scanning systems, in addition to all the cutting-edge innovations, what’s not to like?


IN PRACTICE

In general, the whole digital scanning process is reported to be fairly straightforward. Once restorative prep work is completed, the practitioner scans the area, capturing images of adjacent teeth and tissues from every possible angle. The collected digital information is displayed as a 3D image on a computer screen. The software stitches images together, filling in any missing information. The clinician can also clean up the image and draw in preparation margins. Then, if he or she chooses to complete the restoration in house, CAD/CAM can be utilized to design and fabricate it via milling (subtractive manufacturing) or, in the case of temporary oral appliances such as retainers, mouthguards and provisional restorations, possibly via 3D printer (additive manufacturing). This allows same-day service for some restorative cases.

Alternatively, the clinician can simply send the digital impression, in the form of a stereolithography file, over to the lab electronically, along with all pertinent patient information. The lab can then design and fabricate the restoration. Just think, no more shipping costs and shipping time.

As with most technologies, prices are likely to drop with time. Still, it’s inevitable that many of the customers on a rep’s sales route continue with the tried and true traditional impression taking methods. But well-informed account executives may be able to convince them to at least check out the digital systems by sharing the myriad benefits offered by making the digital switch, and by allaying fears some may have of a steep learning curve, which, in actuality seems to be flattening by the day. By scanning the not too distant horizon, when most of their contemporaries will have made the digital leap, practitioners otherwise set in their ways may realize that the horizon is closer than they thought.

 

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Featured Image by VERNONWILEY/ISTOCK/GETTY IMAGES PLUS

From MENTOR. August 2017;8(8): 18-20,22.

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