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The Construction of the Same-Day Dental Practice


What it takes to get your office and your team ready for same-day dentistry.

Dentsply Sirona's CEREC Primemill.

Dentsply Sirona's CEREC Primemill.

Once you decide to add same-day dentistry to your practice, it can be both exciting and overwhelming. You’re well aware of the benefits these services can bring, from increased productivity and revenues to happier patients, but getting there doesn’t happen overnight. There are steps you must take to be successful.

From managing finances to choosing the best high-tech devices to getting your staff on board, there’s plenty to consider when integrating same-day dentistry into your office. You also must think about where you’re going to put the technologies that make same-day treatment possible and how your schedule may need to change to integrate the workflows.

Although it may seem like a lot, this can be a relatively smooth transition. Yes, it will take some effort, but with the right guidance, you’ll soon be reaping the many benefits same-day dentistry provides—and wondering why you didn’t offer it sooner.

“I’m finding more and more patients want same-day dentistry, and I always say I don’t want to lose a patient to the dentist across the street who offers a service I don’t provide,” says Fort Worth, Texas dentist Chad Duplantis, DDS, who uses the Glidewell fastmill.io™ for same-day single-unit restorations. “I can’t see ever living without being able to offer these services, and it keeps getting better and better. There are so many innovations. It’s just fantastic treatment to provide.”

Look at Your Budget
You’ll need to invest in high-tech devices to make same-day dentistry possible, including an intraoral scanner, a mill, and possibly a cone-beam computed tomography (CBCT) unit and a 3D printer. Although you don’t have to buy everything at once, you’re still looking at a significant investment over time.

Before purchasing that first piece of equipment, Lorne Lavine, DMD, founder and president of dental information technology (IT) company The Digital Dentist, recommends completing a return-on-investment (ROI) study. You’ll want to confirm you have the patient population to bring enough money into the practice to at least surpass your monthly equipment payments.

Dr Lavine says it’s also important to determine exactly what your costs will be. It’s not just how much the CAD/CAM system costs, but also how much you’ll need to spend on practice updates, and server storage. If you’re not sure what additional costs you might be looking at, talk to your sales rep about everything you need to get your practice ready for same-day dentistry.

“The bottom line is asking yourself if you’re making enough from the new services to justify the additional costs,” Dr Lavine says. “A dental accountant or practice management consultant can help you determine that, but it takes a deep dive into the numbers.”

Financial concerns often keep dentists from moving forward with implementing same-day dentistry. It can be difficult to justify a new monthly payment on top of other expenses, including the current lab bill, says Todd Ehrlich, DDS, who practices in Austin, Texas. When crunching the numbers, keep in mind your lab bill will drop significantly in the first 10 to 12 months. Remember, you’re keeping more cases in-house and increasing productivity.

Marketing is another cost you might not consider up front, Dr Lavine says, but be prepared to increase your budget to get word out about the new services you provide.

“Whether online, TV, or radio, most offices are going to want to market same-day dentistry as a unique selling proposition for their office that most other practices don’t have,” he says.

Decide What Equipment to Invest in
Think about what services you want to provide. If you’re interested in offering clear aligners in-house, for example, you’ll need to invest in a 3D printer. But if you only want to provide single-unit restorations, at least for now, an intraoral scanner and a mill will get you started.

No matter where you want to go with same-day dentistry, Lee’s Summit, Missouri, dentist John Flucke, DDS, suggests taking baby steps. Start with an intraoral scanner to improve your workflows and impressions, and then when you and your team master that, invest in a mill to produce restorations in-house. Give yourself and your team enough time to learn the new technology, and lean on each other throughout the process. That way, you won’t feel overwhelmed and end up quitting before you even really get started.

Investing in a laser such as the Solea® from Convergent Dental, Inc is a great way to enhance what technologies like intraoral scanners and mills can do, says Jeff Rohde, DDS, who practices in Santa Barbara, California. For example, he uses the laser for esthetic contouring for veneers and suggests investing in a laser before any other technology. Why? It can have the biggest impact on your practice—including improving the same-day dentistry experience and outcomes.

“There are very few preps that get scanned in my practice without some kind of laser-associated gum work,” Dr Rohde says. “When we got the Solea, the ROI of our CEREC improved because we were doing more units. We had more time because we were more efficient. And the draw of the technology brought more patients in. It really provides efficiency, satisfaction, and an increased ROI.”

Dr Ehrlich suggests investing in a CAD/CAM system like CEREC from Dentsply Sirona and then, once that is mastered, a CBCT system. A CT scanner expands your diagnosis and treatment planning capabilities, which can help with same-day services, such as implant placement.

The next level is a 3D printer, Dr Ehrlich says. Although not as far along as CAD/CAM yet, and not as straightforward, this leading-edge technology is where same-day dentistry is going.

“The fun part of printing is more and more resins are being developed so we can make bite guards and denture models,” he says. “It’s just infinite on what we can print. Eventually, we’ll even be able to print zirconia.”

Planmeca's Viso CBCT imaging solutions.

Planmeca's Viso CBCT imaging solutions.

When deciding what systems to invest in, work with a reputable company that can help guide you and give you a full list of requirements for the technology you’re buying, advises Dr Duplantis. For example, make sure the mill you buy integrates with your scanner. You don’t want to have any surprises when your systems are delivered.

Investing in open systems is also key, says Taylors, South Carolina, dentist Shea Tolbert, DMD, who uses the Planmeca Emerald™ S intraoral scanner. It’s important to purchase open systems that can expand with your needs and that play well with other technologies you already have or might want to invest in down the road.

“You can add CAD/CAM with 3D imaging and offer guided surgery and 3D printing with smile design. It’s a progression, but it’s limitless,” Dr Tolbert says. “To be successful with digital dentistry, it’s really important to have workflows that are simple and seamless. With Planmeca, it’s all tied in with Romexis®, which is the brains that brings all the different digital pathways together.”

Take a Look at Your Office
Before getting started, you must determine if your office has the physical space required to house these technologies, Dr Lavine says.

When deciding where to put the same-day systems, make sure they’re easily accessible, Dr Ehrlich says. Otherwise, team members might not use them.

It’s also a good idea to display the technologies so patients can see them, says Dr Rohde, who keeps his CEREC and SprintRay 3D printer in an all-glass room that patients must walk past and his laser in the operatory near the chair, in plain view. Before investing in the technologies, he thought about the best path for patients to see the milling machines to generate interest and spark conversations about same-day dentistry.

“We’re intentionally controlling the environment so patients see what we want them to see and not any of the scary dental stuff,” Dr Rohde says. “We’re highlighting the technology we have.”

If you’re investing in a printer, you not only need a dedicated space for the system, but also enough space nearby for processing, washing, curing, and removing parts, says Elisa Praderi, DDS, clinical protocols and KOL manager for Formlabs. This all can be set up in a separate room or in the operatory, again sparking patient curiosity and conversations.

The Infrastructure
When Dr Flucke initially designed his office, he realized that although he didn’t know what the future would bring, he wanted to be able to easily update his practice with new technologies—so he put outlets throughout the office and wired network connections. This foresight gave him plenty of options for placement when he invested in his Versamill 5X400 mill.

If you didn’t plan ahead like Dr Flucke it’s OK; just know you might have to make a few updates before bringing same-day technologies into your practice. The correct wiring is critical because these devices won’t work as well over WiFi, Dr Lavine says, so you’ll have to run network cabling. You’ll likely also need to invest in more powerful computers with better processors, more memory, and more hard drive space, along with additional server storage.

Another consideration? Cybersecurity. All patient information collected via these devices must be secure and compliant with the Health Insurance Portability and Accountability Act, known as HIPAA, the federal law restricting release of medical information, Dr Lavine says.

Not sure how to make all that happen? Dr Lavine says that working with a dental IT company or your sales rep can help ensure your office is ready to take on the technology required for same-day dentistry.

Get Your Team Excited
For any new technology to be successful, your team must be on board, Dr Flucke says. To make that happen, take the time to explain how offering same-day services and improving efficiencies will benefit both the practice and the patients.

What are some of those benefits for team members? With same-day dentistry, there’s no need to physically send anything to the lab, reducing the headaches that come with mailing models and communicating back and forth with techs about problems with impressions, Dr Lavine says. Their jobs become easier, and they’re providing patients with better care.

Implementing a bonus system is another way to get team members excited about providing same-day services, Dr Lavine says. They’ll be motivated to excel, and they’ll know the work they’re doing is helping the practice grow.

And once the technology is implemented, it’s critical to keep the team involved. Don’t take on all the cases yourself, Dr Ehrlich says. Remember, your team members are highly trained in making temporaries and take pride in the work they do. With same-day dentistry, there’s no need for temporaries, so they might feel like they’re not contributing as much. Empowering them to take scans and even design restorations will make their jobs more rewarding.

“We motivate the assistants by telling them they increase the value of the practice because they’re making the final restoration,” Dr Ehrlich says. “With the CEREC system, it’s so simple. If they know how to make a temporary, they know how to make a final restoration.”

In Dr Tolbert’s practice, he did 90% of the scans when he first started offering same-day dentistry. That eventually changed to a 50/50 split and is now a 90/10 split, with him completing the preps and his team taking on the scans. He’ll double-check the margins once a restoration is designed; the team will mill, stain, and glaze; and they’ll do the final seating together. Getting his team more involved keeps them engaged and frees up more time in his day, both of which fuel practice growth.

Know the Limitations

No matter which technologies you invest in, it’s important to understand each system’s limitations, Chad Duplantis, DDS, says. There will still be times you need restorations that require a lab technician’s skill—and that’s OK.

The Benefits of Brand Loyalty

There are companies that offer multiple technologies that work together to make same-day dentistry seamless. If you decide to go that route, make sure the company you partner with provides ongoing support and open systems that are easily integrated.

Shea Tolbert, DDS, found that with Planmeca. The company provided the support he needed throughout the process, and because all the technology is plug and play, it all tied together seamlessly.

Dhaval Patel, DDS, who uses all Dentsply Sirona products for same-day dentistry, had a similar experience.

“I wanted all my software to be able to integrate with each other and talk with each other, so it only made sense to stay in the same family of equipment,” he says. “I didn’t want to have to jump through hoops with a third-party software. Because everything is made by the same company, it all works seamlessly.”

Choosing a Mill

When you’re ready to buy a mill, do some research to determine which one will work best for your office and allow you to offer the treatment you envision, Chad Duplantis, DDS, says. Think about if you want to offer multiunit restorations at some point. Talk with your supplier and ask colleagues already providing same-day dentistry what they like and what they don’t like about the units they’re using.

Designing Restorations

Some treatment will require CAD/CAM design skills, explains Elisa Praderi, DDS, so you need to have someone with the skill to do this in-house, further involving your team. You can also hire an external design service or lab that guarantees to return the restoration quickly.

You can get started with simple applications that depend on model production—for example, thermoformed appliances such as retainers, bleaching trays, and aligners—and then transition into more complex applications.

The Workflow
Although the changes to your workflow should be minimal, you will have to make a few adjustments. The main one is scheduling.

You’re essentially combining a prep and a seat appointment into one visit, Dr Duplantis says, so you’ll need to allot yourself more time to complete these cases, at least at first.

Most dentists can complete a crown in approximately 90 minutes, but early on Dr Flucke suggests booking 2 hours. That way, if any problems pop up, you can address them without feeling rushed. Once you get into a groove, you can cut appointments back to 90 minutes.

“The person who handles the schedule has to understand they can’t schedule the same way,” Dr Ehrlich says. “They need to change the scheduling pattern.”

You’ll also need to learn to prep a little differently, says Dhaval Patel, DDS, a Mount Prospect, Illinois, dentist who uses technologies from Dentsply Sirona for same-day dentistry. A lot of times, the lab will correct mistakes in an impression. With digital scans, you can clearly see flaws on the preps and will realize you need to make improvements—and that forces you to become a better dentist.

Patient flow is the next consideration, Dr Praderi says. Patients won’t be in and out in an hour for restorative procedures; they’ll likely be there most of the day. Will patients stay in the chair as they wait, move to reception, or leave to finish errands while their restoration is created? You need to determine how patients will move through the office throughout the visit.

Carestream Dental's CS 8200 3D system.

Carestream Dental's CS 8200 3D system.

Developing communication systems also will help keep appointments running smoothly, Dr Lavine says. Everything must go from chairside to design to milling digitally, and the right communication and flow systems will help make this seamless.

Of course, the ultimate goal is for these technologies to easily integrate into your practice to enhance efficiencies and lead to excellent clinical outcomes, says Edward Shellard, DMD, chief dental officer of Carestream Dental, which provides digital imaging, software, and practice management solutions for dental practitioners. That might mean adding a surgical guide for implant placement or using 3D data sets to get a better view of the hard and soft tissue before designing a case, leading to a change in workflow.

Dr Shellard adds that the ability to partner with a variety of companies also helps minimize workflow disruptions, an advantage provided by open platforms like Carestream Dental’s systems.

The Right Training
You and your team should be comfortable using the technology, which is where training comes in. If your team members feel like they have to “fake” it, they won’t be confident in their work and they may inadvertently say something that scares patients away from accepting treatment, Dr Flucke says.

Most manufacturers offer hands-on training, Dr Rohde says, but you can always go beyond that with additional in-person continuing education or online resources, such as social media groups and webinars, for both yourself and your team.

Materials Matter

When you start offering same-day dentistry, you’ll have to learn more about materials, which is something you’ve likely relied on your lab for up until now, says Dhaval Patel, DDS. It will become important to know the physical properties of the various materials you use so you can determine what will work best for each case.

Get Input From Your Lab

Before you make a decision on an intraoral scanner, talk with your lab technician, advises Chad Duplantis, DDS. You’ll still need to send cases to your lab from time to time, so make sure they accept scans from the unit you’re considering. Also ask what systems they prefer to receive scans from.

Once you have a core team trained, it becomes easier to get new staff members up to speed, Dr Patel says. New team members are quick to adapt and learn from their colleagues. Training in his office is systematic and sequential, so once someone is comfortable designing a crown, they learn about the different materials they can offer patients, which includes the KATANA Zirconia STLM Bridge Blocks from Kuraray America Inc, and how to stain and glaze a crown.

Keep in mind these are sophisticated processes made simple, Dr Praderi says, and everyone involved must be working in step. Team members need to understand intraoral scanning best practices, for example, and if you invest in a 3D printer, they need to understand everything that comes with that—from postprocessing to manipulating the various parts.

Another element of training is constantly pushing doctors and staff to use the entire system, Dr Shellard says. A lot of these systems have advanced features that allow for more efficiencies. Knowing how to use these features will improve outcomes and offer additional ROI.

Investing in integrated solutions that are easy to use also helps make training painless, Dr Shellard says.

“One of the biggest questions we get is, ‘What software and hardware do I need and how does it fit together?’” he says. “We provide an end-to-end solution that incorporates all elements of hardware and software in an easy-to-follow, step-by-step workflow that gives doctors the ability to deliver the procedures they want to deliver.”

Moving Forward
Same-day dentistry will grow your practice, whether you opt to offer single-unit restorations or decide you’d like to take on more advanced same-day treatments, such as implant placement and aligner fabrication. Whichever way you go, it’s just a matter of deciding what technologies you need to invest in, choosing systems that work together to offer the services you envision, preparing your practice and your team, and communicating with your patients about the benefits of same-day treatment.

“This is a premium service empowered by technology,” Dr Praderi says. “It’s a sophisticated process and a very valuable offering for patients, as costs are reduced. Our patients’ time is precious, but clinical outcomes still need to be high quality. Same-day dentistry is powerful, and this is just the start.”

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