Digital Intraoral Scanning’s Impact on Laboratories

The benefits of digital impression technology are numerous. The improved level of accuracy and consistency for laboratory restoration production is the factor most appreciated by the laboratory community.

Ongoing debates compare analog and digital accuracy. But in the author’s opinion, the professionals involved represent perhaps the top 5% of clinicians. The greater impact of these technologies occurs at the average skill level with the assistance clinicians receive in dramatically improving their preparation skills, much like the results seen when dentists trim their own dies.

Digital capture allows the clinician to see the completed preparation live at 100-plus times the size of the actual tooth. This provides a clinical quality-control opportunity that happens only after master cast development in the analog world—that is, after the patient has left the operatory, making reimpressing expensive and inconvenient for all.

The laboratory community routinely produces crowns, bridges, implant abutments, occlusal splints, and removable partial dentures from these files with great success. In the near future, the digital complete denture segment will quickly come into play because numerous industry-leading manufacturers are launching systems.

Use of digital impressioning technology significantly decreases time spent performing chairside adjustments and reduces the number of remakes, creating the best possible customer satisfaction for the clinician and patient. The author’s experience with this technology has resulted in reduced remake percentages of less than 0.5%, compared with an industry benchmark goal of less than 5%. Therefore, the cost of digital model production, where indicated, was far outweighed by the improved efficiency and increased customer retention.

Many laboratories report as much as 90% of their fixed restorations are digitally produced daily. The dramatically improved adaptation of the resulting fixed restoration to the master cast is significant, but it is not as clinically predictable when performed using a model as with a digital intraoral capture.

The acceptance of modeless monolithic single-unit restorations is on the rise. As clinicians move into the digital-capture era and experience consistently good results with model-supported restorations, the increased confidence in the digital workflow allows them to adapt to the more efficient modeless approach. For a majority of the less complex cases handled daily by clinicians, the need for a physical model is an emotional issue borne of the historical analog processes to which many of the more mature clinicians and technicians are accustomed.

Clinical scanning options are diversifying rapidly with several new developments in this area. Numerous new providers of scanning technology are impacting the associated cost and capability factors.

In the past year, manufacturers have continued to develop smaller, lighter handpieces that are more user-friendly for dentists. Evolving in popularity is the slimmer pen-grip design, which is similar in size and shape to the common handpiece with which clinicians are familiar.

Some impression scanners are now accurate to within 5 microns, and many produce a digital file immediately upon completion of the scan. Indeed, some of the latest technologies enable the user to have a completed scan in less than a minute. In addition, several scanning manufacturers have been able to eliminate the need for reflective powder, which further simplifies the process.

Improved developments in the accompanying chairside software modules for file management have made the digital data easier for dentists to view and manipulate. Many manufacturers have developed software that is more intuitive and more compatible with the CAD software used by the laboratory. Most digital impression scanners on the market now can transfer digital data files either via WiFi or by being plugged into a USB port.

All laboratories are looking for a competitive edge in the market. Many major laboratories actively operate campaigns that offer clients a rebated monthly lease payment for their intraoral capture system with minimum levels of activity each month. It is effectively a performance-based discount applied directly to the technology. The results are such that the cost of doing business with these customers is reduced due to the minimization of remakes. Customer retention is improved due to increased satisfaction and the financial tie with the laboratory.

This type of program surfaced in the early 1990s with the introduction of intraoral scanners. Unfortunately, many technicians purchased scanners for their best customers, only to have no realized increase in the volume of cases.

We should, however, expect this type of business model to increase in popularity due to the simple fact that with each use of these capture-only systems, a billable case will follow.

The clinical community’s adoption of digital impressioning technology is still in its infancy. However, many believe that as the technology becomes more user-friendly and the cost of integrating the technology is reduced, the digital impression will become the standard of care. The laboratory community is ready and waiting for the clinical community to further join the digital workflow revolution. Utilizing the new technology to produce the best possible product is a team effort. By maintaining a thorough knowledge of the digital intraoral scanner market and putting the best equipment in the hands of its dentist-clients, a laboratory can give itself an advantage in an increasingly competitive market.

David Avery, CDT, AAS, is a consultant in Charleston, SC.

By Andrew Koenigsberg, DDS

The paramount advantage of digital scanning is the ability to deliver better dentistry on a consistent basis. Although both impression material and optical scanning are theoretically capable of producing accurate models, the clinical reality is often different. This is not related to the accuracy of the impression material but rather to the challenge of impression making in a wet environment, the difficulties of working with a moving patient, and the difficulty in evaluating the impression chairside. Optical impressions are easy to evaluate immediately as the dentist can view an enlarged 3D virtual model. With many systems, space for restorative material and occlusal clearance can also be assessed while the patient is in the chair. Making corrections to the preparation and impression is free, and often just part of the optical scan needs to be retaken. Financially, eliminating expensive impression material, saving chair time, and reduced laboratory fees make optical impressions an economic plus for the office.