Make a better impression on everyone

Dental Products ReportDental Products Report-2011-09-01
Issue 9

Dentistry has always been a profession that keeps us in fairly close proximity to our patients. We’re constantly working in their personal space, doing something the patient cannot see and working in a manner that doesn’t allow them to talk to us. I think that’s probably why many patients feel stressed about dentistry.

Dentistry has always been a profession that keeps us in fairly close proximity to our patients. We’re constantly working in their personal space, doing something the patient cannot see and working in a manner that doesn’t allow them to talk to us. I think that’s probably why many patients feel stressed about dentistry.

One of the amazing things about how technology is changing our profession is the rather interesting fact that some technologies actually allow us to touch our patients less or in ways that patients find less intimidating. Office efficiency is a wonderful thing. It can allow for increased productivity, less time for the doctor in the office, or (for me the most important thing) less time in the dental chair for the patient.

Over the years that I’ve been on this crazy technology journey, I’ve learned a thing or two about efficiency. The most important part is this: if a technology allows the doctor to provide equal or better clinical outcomes to what is currently provided, and the technology decreases the amount of time the patient is in the dental office, then it’s a technology worth considering.

Often these types of decisions can’t be measured in pure dollars and cents. Instead one should look at how much time is saved and how much easier it is to provide high quality care to the patient.
Impression made

One such technology that fits nicely into this category is digital impression systems. When one considers that dental impression materials have been around since beeswax was used in the late 1600s, it’s easy to see that the technique hasn’t really changed that much. I mean we have much more dimensionally stable materials today, but the overall process hasn’t changed much when it comes to using impression materials.

However, whether it’s in-house CAD/CAM systems like Sirona’s CEREC ( or D4D Technologies’ E4D ( or true “impression only” systems like Cadent’s iTero ( or 3M ESPE’s Lava C.O.S. (, digital impression systems have brought a change to the process that increases efficiency while decreasing chair times.

I’ll use my office as an example. We decided to bring a digital impression system (Cadent iTero) into the office in January of 2010. Our thought process was a simple one. While we were content with the fit and longevity of our fixed prosthetics, we were looking for a way to increase our clinical efficiency in the prepping phase and were trying to reduce adjustments during cementation.

We brought the system into the practice in late January and had training just a day or two after the installation by Goetze Dental. The staff and doctors easily took to the system after training and we began to integrate it into the practice almost immediately.

Word of mouth
Scanning with any of the digital systems on the market is quick, predictable and easy. Training is necessary, but that’s to learn the best way to use the systems. Even users with very little experience can create great scans because of the short learning curve with these devices.

We found our crown appointments became shorter and less stressful for all involved, including the patient.

What we found was an amazing increase, not only in efficiency, but in the internal marketing aspect of our practice. What we had failed to take into consideration was just how much patients dislike the whole process of taking the impression.

Our patients were excited when they learned that a series of pictures would be taken instead of filling their mouths full of “goop.” Even while we worked through the relatively short learning curve, patients were willing to let us take a bit longer than usual in return for the “no goop guarantee.”

As dental professionals, we are around impression materials all the time, but we truly don’t understand how much patients dislike this part of our profession. The word of mouth power of this technology cannot be overlooked. Our patients told friends, relatives, co-workers, you name it. Referrals weren’t something we anticipated when we moved to digital impressions, but we gratefully accepted them…and they continue to this day.

Models of accuracy
The other big payoff for us was in time saved during the seating appointment. Digitally capturing the data creates a much more accurate restoration. In my case, the iTero uses the data to create the model. This model is more accurate than traditional methods, and that includes the way the models are indexed. There’s much less “play” when the die is in the model, which means contacts and occlusion can be more accurately fabricated. The result is less time spent at the cementation appointment. Frequently the prosthesis is seated and requires no adjustments at all.

The same can be said of CAD/CAM systems that use data points from surrounding and opposing natural teeth to create amazingly accurate restorations in one visit.

As these technologies continue to gain traction in the market, we’ll see less and less of a dependence on analog acquisition (traditional impression techniques). While there are still some clinical situations that require impression material to be used, those situations will become fewer and fewer as the technologies continue to evolve.

When I started with the technology, I insisted that my favorite lab (Technical Crown & Bridge in Greenwood, Mo.) become part of the process. In short order, they were telling me they prefer the Cadent models to the traditional stone models they had been using for years.

Since January of 2010 we have taken fewer than 20 traditional impressions. Our workflow is more efficient, our clinical results are excellent, and our patients are much, much happier.
Can digital impression systems change your life for the better? The technology has certainly changed mine. Whether you are considering CAD/CAM with in-office milling, or like me, want to use the technology to fabricate models that are still used by humans in the lab, I strongly believe digital impressions can change your life…for the better.

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