Whether you know it or not, you’re using digital technology somewhere in your dentistry. It’s time to embrace it! To reveal how adopting digital dentistry will transform your practice, Kirk Behrendt brings back Dr. Daren Becker from the Pankey Institute to share three important steps to successfully modernize your workflow. If for no other reason, go digital for your patients! To learn about the advantages that digital can offer, listen to Episode 620 of The Best Practices Show!
Episode Resources:
Links Mentioned in This Episode:
Register for Dr. Becker and Dr. Cranham’s Digital Workflow course (June 13-15, 2024)
Main Takeaways:
Master the tried-and-true occlusal, restorative, and esthetic principles.
Figure out where digital technology fits into your practice.
Find a mentor or people that will support you.
Start by getting an intraoral scanner.
Go digital for your patients.
Quotes:
“Pete Dawson said in 2005, ‘Digital dentistry in the absence of sound, occlusal, esthetic, and restorative principles will only allow a dentist to screw up mouths even faster.’ To me, that’s everything because everybody is jumping on the digital thing. He’s right. The same way you could screw up a mouth if you didn’t pay attention to sound occlusal principles, or good biologic principles with your margin design, and good restorative principles with your prep design, and good esthetic principles — if you didn’t do that in the analog world, you’re going to screw things up.” (8:57—9:40)
“For most people, the start [to adopting digital] is an intraoral scanner. We’ve had conversations about this on the podcast before. There are lots of scanners out there. I’m not here to tell you which is the right one. I happen to use iTero. I love my iTero. I have two of them, actually, and we use them for everything. We do wellness scans in hygiene. Once a year, we scan every patient, kind of the opposite of having radiographs made. It’s a great way to monitor changes. It’s incredible because you put the screen up in front of a patient — I think it’s called TimeLapse. It’ll flash between the two years ago scan and the new scan. They can see the change. They can see the shifting of the teeth, or the wearing down of the teeth, or the gum recession. It’s right in their face. You don’t have to say anything. They’ll go, ‘Oh, what happened there?’ And then, you can have the conversation. So, it’s a brilliant tool. I’m sure other scanners have similar features. The point of it is replacing the gooey mold stuff with the digital scan.” (11:21—12:35)
“If you aren’t doing digital dentistry but you’re sending your restorative dentistry to the lab, you’re doing digital dentistry — you’re just not aware of it. Every lab, unless you have a little guy sitting in your office, is doing it digitally. If you send them an impression or a model, the first thing they do is scan it. So, you’re already at a disadvantage because now it’s a copy of a copy. You’ve introduced some errors because that impression material distorts. It shrinks, swells, or whatever it does. And then, the stone has a dimensional change as it sets, so it’s already a disadvantage there. And even though there are studies that show that the accuracy of the scan may not be quite as definitive as the accuracy of a reversible hydrocolloid impression — first of all, no one is taking reversible hydrocolloid impressions. No one is. And then, secondly, those distortion features, to me, when you introduce the distortion, it changes everything. Here’s what I know. When we started scanning, just routine crown and bridge, our time to deliver a restoration was cut in half without changing anything else. Same lab, same restorative material. That, to me, was huge. So, scanning is where you start. Lots of people are scanning now, and every company on the planet is making a scanner. And they’re all good. You’ve just got to find the one that works for you.” (12:46—14:16)
“Patients hate impressions. If there’s any other reason to go to digital scanners, patients hate gooey goop in their mouth. They just do. But you can’t just scan and get a whitening tray. There’s an intermediate step of making a model. Even that requires some design, some software, some way of taking that scan and turning it into a model that you can then either mill or print. Today, I would say it’s mostly printing. You can still get milled models, but 3D printing is pretty much taking over that world, especially in your office. In a big lab, or if you’re sending it to a commercial lab, they may still be using a mill for models. So, learning how to do that is not hard. It’s just you’ve got to learn the steps.” (15:10—16:07)
“Whatever it is we’re doing, the same way we would wax up on a set of models in the past in the analog world, we can do all that in the digital world. We can do it on a virtual articulator that mimics all the functionality that we would get from a regular articulator. But what’s really cool, because it’s digital — the one thing we couldn’t do on a regular articulator is you can’t put the patient’s face on the articulator. So, even if you have a facebow or a facial plane analyzer, you still don’t have their face on the articulator. Well, in the digital world, you can import their photograph. You can import a CBCT of their head and you can mount that model on that digital articulator, I think, maybe more accurately than we could with traditional facebows and DFAs in the analog world. It’s really crazy how well we can do that. And then, in terms of recording bites — we talked about occlusion. We make such a big deal about getting a proper mounting in a seated condylar position or centric relation position. How did we do that in the digital world? I think it’s actually easier to do that. So, using all the same tools, leaf gauges, anterior bite stops, and all the things that we’ve always used to help us get those bite records. That’s where we’re at. It’s pretty cool and it’s fun.” (16:32—18:07)
“The basic understanding — or, not even basic. The advanced understanding of occlusal principles, esthetic principles, restorative principles — that, you have to learn. You have to learn that. We get a taste of it in dental school. Most people say they got next to nothing in occlusion in dental school, depending on where you go to school. So, that’s where taking a course at Pankey, taking a course at Dawson, at Kois, at Spear — there are lots of places to go learn how to do this. I’m biased because I’m a Pankey faculty. I think we do the best job of that, not just in the technical piece of it, but how do I implement that in my practice, and how do I talk to my team about it, and how do I talk to my patients about it. We get into all that. That’s the baseline.” (18:46—19:35)
“One of the interesting things is we’ve been having this argument of, do you have to know how to do a trial equilibration on stone models before you can learn how to do it in the digital world? And we came to the observation that, yes — if you’re over the age of 40. If you’re under the age of 40, no, you don’t have to. In fact, you’ll learn it a lot faster on the computer.” (20:48—21:15)
“We can design a bite splint on the computer and then print that on our 3D printer. Best bite splints I’ve ever made. I’ve made them by hand with powder and liquid acrylic for 20-whatever years. The digital ones are so good, and they drop right in. They fit beautifully. They’re easy to adjust. You don’t reline them because they fit so well. To me, that’s the proof of the accuracy of digital, is we always relined. I relined every single bite splint I ever made when I made them by hand with acrylic. And now, there’s no distortion. It’s incredible.” (21:30—22:07)
“How do we not screw up people’s mouths? Make sure you have a great understanding of the occlusal, restorative, and esthetic principles that are tried and true. You can’t skip those. Then, figure out where digital works in your world. Again, I think scanning technology is first, working with a lab that’s already probably digital, working with them hand-in-hand. And then, maybe if you’re going to get into production in your office, a 3D printer is a great way to start. Today, you can get an excellent 3D printer for not a ton of money . . . And then, finding people to support you, finding people like John Cranham and Lee Culp that are doing consulting on this, or finding a mentor. I’ve stressed it so many times on podcasts, having a mentor that can help you get where you want to get. So, if this is something you want to do, reach out to folks that are already doing it that can help you.” (27:54—29:26)
Snippets:
0:00 Introduction.
1:14 Dr. Becker’s background.
6:38 About Pankey’s Masters’ Week.
8:44 Learn the important principles.
11:10 Start with scanners.
18:09 The three steps to get started.
23:18 Should you learn analog before digital?
27:31 Last thoughts.
29:30 Work enough days in your office.
32:17 Dr. Becker’s digital design course in 2024.
Dr. Daren Becker Bio:
Dr. Daren Becker earned his Bachelor of Science Degree in Computer Science from American International College, and Doctor of Dental Medicine from the University of Florida College of Dentistry. He began private practice in Atlanta, Georgia, in 1998 with an emphasis on comprehensive, restorative, implant, and aesthetic dentistry. He is the owner and full-time dentist at Atlanta Dental Solutions, and is in full-time, fee-for-service private practice.
Dr. Becker began his advanced studies at The Pankey Institute in 1998. He was invited to be a guest facilitator in 2006 and has been on the visiting faculty since 2009. In addition, in 2006, he began spending time facilitating dental students from Medical College of Georgia School of Dentistry at the Ben Massell Clinic (treating indigent patients) as an adjunct clinical faculty member. In 2011, he was invited to be a part-time faculty member in the Graduate Prosthodontics Residency at the Center for Aesthetic and Implant Dentistry at Georgia Health Sciences University, now Georgia Regents University College of Dental Medicine (formerly Medical College of Georgia).
Dr. Becker has been involved in organized dentistry and has chaired and/or served on numerous state and local committees. Currently, he is a delegate to the Georgia Dental Association. He has lectured at the Academy of General Dentistry annual meeting, is a regular presenter at ITI Study Club, as well as numerous other study clubs. He is a regular contributor at Red Sky Dental Seminars.
In addition to his enthusiasm for sharing his knowledge, Dr. Becker’s strengths are in meeting and special event planning, and CE program development. Dr. Becker lives in the Dunwoody area of Atlanta, Georgia, with his wife, Amanda, and their daughters Alicia and Addison. He is passionate about fly-fishing and enjoys traveling, golf, and outdoor photography.
