Marcos White explains why he’s put his digital scanner central to everything in his practice and offers his top tips for maximising digital dentistry.
If you’re still thinking that digital intraoral scanning is just about eliminating the need for impressions, you are behind the times.
In this article on getting the most out of digital, I’ll describe the 10 game-changing ways a commitment to digital will transform the way we do dentistry.
When we received our first Itero scanner, we had already been using digital in restorative dentistry for three years with other industry brands. What was instantly different with the Itero was that the screen was larger. The user interface was patient- and dentist-friendly, making it the central point of communication.
This changed the way we considered its use and began using it for all consultations. When patients saw their problems on screen in colour, there was no hiding from it. Moreover, they bought into the solutions we presented to address these problems because they trusted what they saw on screen.
This was a game-changer – and not what intraoral scanners were brought to the market to do.
We saw 33% revenue growth in 12 months as a result of using the Itero in this way. This is why I make it my first top tip!
Digital consent is the process of showing a patient an image of what can be achieved through their treatment. This enables them to make an informed decision as to whether it is the right choice for them.
Invisalign was the pioneer of digital consent with its Clincheck software. This allows clinician input into the design of an Invisalign orthodontic case. This is then reviewed by the patient and ultimately forms a contract of understanding as to the direction and agreed outcome of treatment.
The Itero makes this concept even more instant and accessible with the Invisalign Outcome Simulator, which delivers an ideal outcome on screen in 90 seconds.
This is digital consent. The same principles hold for restorative and implant treatment and begin the same way; with an Itero scan. Followed by digital design.
The Courtyard has an on-site digital lab. This means any one of three digital designers can take the scan and design an ideal functional and aesthetic outcome on screen. The fact that one of our designers has now moved back to Poland has not changed or slowed this process – that’s the beauty of the digital world.
We call this a ‘digitally designed outcome’ and differs from what is commonly known as Digital Smile Design. This is because it isn’t just an image but the actual 3D outcome that can be used to create a 3D model and stents or indices to guide the delivery of the treatment, whether that be injection moulded composite bonding or minimal intervention porcelain veneers.
The Itero scan is the doorway to this way of planning, consenting and delivering dentistry.
Digital record keeping
Whenever you carry out a process digitally, you leave a digital footprint. Write an email, take a photo on your phone, they’re all date and time stamped and typically saved in the cloud forever. In dentistry, this is always a good thing. Any tool or technique that enables you to take better and more profound records of the way you treat patients protects you from litigation.
We take a scan at the initial consultation. Then, we scan at every Invisalign review, at our restorative patients at preparation. We scan our implant patients. Colour digital scans mean we are effectively filming every key step of the dental process. Finally, we scan our patients at completion to record the results we have delivered inclusive of occlusion, gingival health, aesthetics and function.
This level of record keeping leaves those without these tools in the past. In the same way that the advent of computerised notes left those with handwritten record cards subject to the scrutiny of professional bodies and increased dental claims from patients. We move on or we get left behind.
Digital case communication
Every scan taken with the Itero is immediately saved to the cloud under the specific login details of the account holder.
If the practice runs a singular account, as we do at our practice, then this creates an interconnected landscape where any patient scan can be retrieved from any scanner at the touch of a button.
The level of inter-team communication is unprecedented and transformational.
During the COVID-19 lockdown in the summer of 2020, we brainstormed how to increase the efficiency of what we did at the practice further still, in the knowledge that time and surgery space would be at a premium when we reopened. We were not wrong.
We felt that if we could ‘upload’ our patient base onto the Itero cloud we would have a better chance at triaging their problems over the phone in the event of a second or third lockdown. So, we reinvented the check-up and committed to taking a scan of every one of our 1,500 patients. That process is now almost complete.
Myitero.com is a desktop access point to every scan you’ve ever taken. The user interface looks exactly like you’re in front of your scanner, but you’re not. You’re at home reviewing your preps. You’re on Zoom discussing a case with a colleague.
You are a receptionist at your desk taking a call from a patient. They tell you they’ve broken the third tooth from the back. You bring their scan up on screen and advise them it has an amalgam filling and it’s likely that it’s just a fractured cusp. You schedule an appointment with the appropriate clinician after confirming the proposed appointment with the practice clinical lead. That is digital efficiency. That is digital triage.
At our practice, every new patient schedules in for a preliminary consultation with one of our treatment coordinators to take pre-clinical scans and discuss treatment options. We call this the ‘pre-clinical consultation’, or PCC.
If patients are keen on the options discussed and comfortable with the costs, they are scheduled with me to carry out the clinical and radiographic parts of the examination and continue the consultation process.
In advance of their attendance, I review the notes remotely from home via Teamviewer and review the scans on myitero.com. I then carry out digital charting to save yet further time in clinic by examining the dentition and transferring the dental chart to the dental record keeping software.
The scans magnify larger than anything deliverable with my eyes or loupes. This is an augmentation of my standard examination process and elevates my diagnostic and planning skills by allowing me to give thinking time to a case before I ever meet the patient.
Upskilling and skill blending
My team of four treatment coordinators carries out a pre-clinical scan of all new patients. The power of this efficiency and data capture is instantly evident. This upskills my team. This places team members in a key role in the growth of our practice, while also having the responsibility of adding an invaluable step in our robust consent process.
The fact that my treatment coordinators see every new patient before I do shows the commitment I place in them, and in our digital processes. I entrust every penny of our revenue in the hands of my team and the digital tools each team member deploys.
We also scan every registered patient at their check-up; we call this the ‘dental health assessment’ (DHA). Central to this process is a digital scan.
I find it a challenge to decide what level of skillset and experience should be tasked with carrying out the DHAs at our practice. Some patients are very stable and low maintenance. Others have had full mouth rehabilitation and full arch implants. How is a three-year qualified associate meant to assess, diagnose and advise on some of the questions and issues that may arise? They’re not. They are meant to start with a scan. They follow practice protocol and radiographic review criteria and take the necessary radiographic views to allow, where needed, others to assess, diagnose and advise.
The process is as follows: data acquisition. Involvement of skill specific clinicians to offer insight, training and treatment planning for the needs of the patient. That is skill blending.
The digital generation
I have been around long enough to hear it claimed time and again. There has never been a more exciting time to be a dentist. That this material/technique would change the way we work forever.
I remember the amalgam generation. The composite generation. The composite generation. The implant generation. All defined by an advent that improved how they could deliver dentistry. I now put digital central to everything I do in dentistry – whether it is:
- Diagnosis in an examination
- Improved communication with my patients in consults
- The way we digitally design and execute our orthodontics through Invisalign
- How we digitally design and execute our restorative dentistry through digitally designed outcomes and more accurate restorations.
I know that digital enhances what I do. I have demonstrated how digital can change how you perform dentistry, and how digital makes you better. It’s your turn to be part of the digital generation.
Start with a scan
None of these game-changing, profession-elevating effects can happen until you invest in a scanner. Then follow the principles outlined. Remember the golden rule. Whatever the situation, whoever the patient, whoever the clinician, start with a scan. That way you, the patient and your practice will end up in a better place. Trust me, I’m there already.
This article first appeared in Clinical Dentistry magazine. You can read the latest issue here.