Intraoral Scanning 101: Your First 3 Workflows

Introduction to Digital Dentistry

Speaker Introduction

• Shirley introduces Dr. Christopher Bayer, highlighting his educational background in molecular and cellular biology and dental expertise from the University of Arizona and Oregon Health and Sciences University.

• Dr. Bayer's commitment to excellence is noted, including a post-graduate residency in San Antonio, Texas, where he mastered various dental procedures.

Presentation Overview

• Dr. Bayer encourages audience interaction through questions in the side chat during the presentation on digital printing workflows.

• He shares his experience as a long-time digital dentist practicing in Lone Tree, Colorado since 2008, utilizing various digital technologies.

Digital Workflow Fundamentals

Learning Objectives

• Emphasizes the importance of understanding available technologies in dentistry to enhance patient experiences.

• Quotes Shan G about technology: "The experience you create with it is everything," stressing that knowledge of technology can differentiate practices.

Audience Engagement

• A quick survey is conducted to assess how many participants currently use an intraoral scanner; results show 60% do while 40% do not.

Traditional vs. Digital Workflows

Comparison of Methods

• Traditional workflow involves taking PVS impressions and sending them to labs for manual processing; this process can be lengthy and less efficient.

• In contrast, digital workflows start with a digital scan sent directly to the lab via the internet for quicker appliance design and delivery.

Benefits of Digital Workflows

• Digital scanning allows for expedited processes; labs may offer discounts due to reduced shipping costs when using digital files.

• Dr. Bayer discusses why practitioners should consider transitioning from traditional methods: increased ease, predictability, and reduced stress associated with digital scanning compared to PVS impressions.

Implementing Digital Technology

Equipment Options

• Recommendations include investing in an intraoral scanner or using benchtop scanners if one prefers not to transition fully yet.

Digital Workflow in Dentistry: Benefits and Considerations

Closed vs. Open Systems

• Closed systems restrict users from exporting native files to different labs, limiting flexibility in design and manipulation.

• Some closed systems require fees for file exports, which can add to overall costs for practices looking to utilize external services.

Scanner Options and Costs

• Practices can choose between standalone scanners or those bundled with milling systems; sometimes scanners are offered for free with a milling system purchase.

Advantages of Digital Workflows

• Digital workflows streamline processes, making them more enjoyable for both practitioners and patients; they significantly reduce discomfort during procedures.

• Patients prefer digital impressions over traditional methods due to the absence of uncomfortable materials, leading to increased referrals based on positive experiences.

Patient Interaction and Communication

• Patients can interact with digital models on screens, enhancing their understanding of dental conditions through visual aids.

• The ability to view scans in color allows patients to better appreciate their dental health, fostering informed discussions about treatment options.

Efficiency and Cost Savings

• Younger staff members adapt quickly to digital technologies, improving practice efficiency; the return on investment (ROI) is notable due to reduced material costs.

• Scanning times have drastically improved; full arch scans can be completed in under a minute compared to traditional methods that take much longer.

Reduced Material Needs and Treatment Options

• Digital scanning minimizes the need for various impression materials, reducing overhead costs associated with traditional methods.

Real-Time Patient Engagement in Dental Treatment

Enhancing Communication and Treatment Planning

• Real-time visualization of teeth on a large screen allows patients to actively participate in their treatment planning, identifying areas they wish to address.

• This method serves as a superior communication tool compared to traditional models, enhancing patient satisfaction and engagement.

Cost Efficiency in Digital Scanning

• Many labs offer discounts for digital scans due to reduced shipping costs, emphasizing the financial benefits of adopting digital technology.

• It's crucial for dental practices to communicate with labs regarding any potential digital fees associated with sending scans.

Environmental Considerations

• The use of digital impressions significantly reduces waste from traditional materials like impression trays and 3D printed models, aligning with eco-friendly practices.

• Digital scanning can lead to faster turnaround times for crowns and other dental work, streamlining office operations.

Training and Implementation Challenges

• Transitioning to digital scanning requires an initial investment in technology and training for the entire team, not just individual practitioners.

• Engaging staff through practice opportunities is essential; encouraging them to scan familiar patients helps build confidence with new technology.

Technical Limitations and Backup Plans

• Understanding the limitations of scanners is vital; if margins are not visible during scanning, the quality may suffer.

Digital Dentistry: Managing Equipment and Training

Challenges with Powder Guns and Scanner Maintenance

• Discusses the potential issues when a powder gun tip gets clogged, leading to an unexpected burst of powder on a tooth. Emphasizes the need for troubleshooting skills among team members.

• Highlights concerns regarding staff turnover in dental offices, particularly when key personnel leave, which can disrupt operations and training processes.

• Questions whether existing staff will be able to train new hires effectively, especially in small practices where one person may handle multiple roles.

• Raises scenarios where equipment malfunctions occur due to disconnections or power issues, stressing the importance of having backup plans for such situations.

Utilizing In-House Printing Capabilities

• Introduces the concept of printing diagnostic models in-house as a starting point for practices transitioning into digital dentistry.

• Suggests providing physical models to patients post-scan to enhance understanding and communication about their treatment options.

Scanning Process and Benefits

• Describes the speed and efficiency of Medit scanning technology, allowing quick acquisition of scans by assistants or hygienists.

• Explains how scanning can facilitate the fabrication of various dental products like clear aligners, whitening trays, temporary crowns, etc.

3D Printing Applications in Dentistry

• Discusses the advantages of 3D printing for creating educational models that help train auxiliary staff without incurring high costs from manufacturers.

• Mentions that printed models can showcase specific preparations or restorations effectively during patient consultations.

Digital Workflow: Additive vs. Subtractive Manufacturing

• Compares additive manufacturing (3D printing) with subtractive methods, emphasizing how digital designs streamline production processes in dental practices.

Understanding Subtractive vs. Additive Manufacturing in Dentistry

Overview of Manufacturing Techniques

• Subtractive Manufacturing: Involves carving away material from a solid block (e.g., emac) to create dental restorations like crowns.

• Additive Manufacturing: Builds objects layer by layer, such as crowns, using technologies like 3D printing.

Advantages of Subtractive and Additive Methods

• Precision and Surface Quality: Subtractive manufacturing offers high precision and excellent surface quality across various materials.

• Material Efficiency in Additive: Low material consumption since only necessary material is used, with additional support structures being minimal.

Speed and Limitations

• Speed Comparison: While some milling processes can be faster than 3D printing, certain crowns can be printed in under 30 minutes.

• Geometric Flexibility: Almost any geometry can be printed with additive methods; subtractive methods are limited by the number of axes on the milling machine.

Types of 3D Printing Technologies

• Common Methods: Various types include SLA (Stereolithography), DLP (Digital Light Processing), and LCD (Liquid Crystal Display), with SLA being widely used in dentistry.

The Process of 3D Printing

• Layer Curing Mechanism: A platform lowers into a liquid resin where a laser cures tiny dots to build up layers for the crown.

Resolution Considerations in Printing

• Resolution Variability: Different printers have varying resolutions; finer details require smaller layer thicknesses for better accuracy.

Importance of Digital Workflow

• Optimal Outcomes through Workflow: Emphasizes the importance of a digital workflow from scanning to design, printing, and delivering restorations.

Scanning Protocol Essentials

• Scanning Accuracy: Proper scanning protocols are crucial for creating accurate models; poor scans lead to fabrication issues.

Challenges During Scanning

• Color Recognition Issues: Advanced scanners can ignore specific colors (like glove color), improving scan quality by reducing extraneous data capture.

Data Integrity During Scanning

• Data Stacking Problems: Multiple scans over the same area may cause data stacking issues that compromise model integrity if not managed properly.

Factors Affecting Scan Quality

3D Printing in Dental Practices: Options and Considerations

Exploring In-House vs. Outsourcing Design

• Discusses the choice between handling 3D printing in-house or outsourcing to a lab, emphasizing the need for design software if done internally.

• Highlights that CAD design can be challenging due to steep learning curves and associated fees, which may deter adoption among dental teams.

Software Options for CAD Design

• Mentions popular CAD software options like Exocad and 3Shape, along with other services such as Blue Sky Bio and Evident.

• Shares personal experience with Evident, noting their supportive team that simplifies the design process.

Utilizing Medit Link Software

• Introduces Medit Link as a versatile tool for designing models, night guards, and smile simulations; it is free to use with or without a Medit scanner.

• Describes how outsourcing designs to Evident saves time during busy periods, allowing for efficient production of dental items like crowns and temporaries.

Material Selection for 3D Printing

• Emphasizes the importance of choosing appropriate materials based on whether they will contact tissue (e.g., night guards vs. dental models).

• Advises on ensuring biocompatibility by following manufacturer recommendations and avoiding cross-contamination during processing.

Accuracy and Print Orientation Considerations

• Discusses accuracy requirements based on application needs; suggests using lower resolutions (200 microns) for non-critical applications like patient demonstrations.

• Explains how print orientation affects outcomes; newer software versions can automatically orient models based on selected materials.

Practical Application of 3D Printing in Practice

3D Printing in Dental Practices: Software and Workflow Insights

Compatibility and Updates

• The software is designed to be compatible with various computer systems and operating systems used in dental practices, ensuring seamless integration.

• Users receive free updates, notified upon logging in, which helps avoid additional costs associated with software upgrades.

User-Friendly Interface

• The pre-form software is intuitive; new users can learn its functionalities quickly—one assistant mastered it in about 20 minutes.

• It supports exporting files in common formats (OBJ, STL), depending on the system's capabilities, facilitating easy file manipulation.

Printing Parameters and Features

• Users can set up printing parameters by selecting printer materials and layer heights; the interface includes a menu for different resin options.

• A notable feature is "Fast arches," allowing nearly four complete arches to be printed in under 10 minutes.

Remote Printing Capabilities

• The remote printing feature enables users to send print jobs from home, making it convenient for urgent requests outside office hours.

• This functionality allows assistants to manage reprints or urgent models efficiently while maintaining workflow continuity.

Model Scanning and Processing

• Preform allows direct conversion of 3D scan files into printable models without needing additional software, streamlining the process.

• The Meted Link Model Builder app offers a quick way to create physical models for traditional use alongside digital workflows.

Efficiency in Patient Care

• Rapid model production enhances patient care; hygienists can prepare retainers or whitening trays before patients leave the chair.

Post-processing Techniques

• Post-processing involves washing parts with isopropyl alcohol according to specific resin protocols followed by curing processes.

3D Printing in Dental Practice: Integration and Implementation

3D Printed Night Guard

• A simple demonstration of a 3D printed night guard designed using Meda software was shown, highlighting the ease of integration into practice without needing adjustments.

Team Buy-In for Digital Dentistry

• Successful integration of 3D printing and scanning requires team buy-in; it’s essential to engage the entire team in discussions about digital dentistry advancements.

• Identifying team members with relevant skills, such as past dental technicians or those adept at video games, can facilitate smoother adoption of new technologies.

• Quality training is crucial; teams should not be expected to learn complex software without proper guidance and support from leadership.

Practical Applications and Patient Engagement

• Utilizing digital scans instead of traditional pictures allows for better patient engagement by showcasing their dental conditions directly on screens during consultations.

Considerations for Equipment Compatibility

• Assessing compatibility between scanners and dental lab software is vital to avoid frustration; ensure that file formats are accepted by labs before purchasing equipment.

• Different labs may have preferences for specific scanners, which can affect workflow if not properly aligned with lab capabilities.

Workflow Optimization in In-House Settings

• Establishing a clear workflow is necessary when integrating 3D printing; consider starting with simpler applications to manage overhead costs effectively.

• It’s recommended to focus on one primary use case initially rather than trying to implement multiple applications simultaneously.

Daily Routine in a Modern Dental Practice

• The daily routine includes using intraoral scans, CBCT scans for implants, designing restorations in CAD software, and utilizing 3D printing or milling processes.

• An ideal setup involves having designated areas for scanning, printing, post-processing, and storage to streamline operations within the practice.

3D Printing in Dental Applications

Overview of 3D Printing Workflow

• The process involves mastering the printing, cleaning, and fabricating final appliances. Starting with simple applications is recommended for efficiency.

• Medit software can be utilized to design models from exported STL files without needing CAD skills, making it accessible for teams.

• Quick ROI is achievable with inexpensive model printing; workflows should be tested during less busy times while ensuring team members follow protocols correctly.

Team Engagement and Scaling Up

• Encouraging team members to create personal items like whitening trays or retainers fosters engagement and skill development.

• As proficiency grows, expand applications from basic models to more complex items such as surgical guides and dentures.

Post-processing Considerations

• Proper equipment is essential for post-processing different materials; having multiple printers can streamline operations by reducing resin changes.

• A case study illustrates the efficiency of scanning patients quickly without traditional impressions, allowing for easy adjustments if needed.

Software Utilization and AI Integration

• Medit Link software provides a user-friendly interface for managing scans and designing splints using AI technology that adapts based on feedback.

• Feedback on fit allows automatic adjustments in future designs, minimizing costs associated with remakes.

Design Customization Process

• Users can select specific arches for splint design, incorporating various jaw records into the process to enhance accuracy.

3D Printing Workflow for Dental Appliances

Overview of the Design Process

• The design process can be completed within an hour; if not, patient scans are sent to Evid for overnight design.

• Users can upload specifications for the desired appliance and select their 3D printer model, allowing for file nesting directly into the workspace.

• AI-assisted design services can return a file in about 10 minutes, with options to request redesigns at no extra cost.

Printing and Finishing Techniques

• After designing, files are printed horizontally; optimal angles (like 45 degrees) improve print quality.

• Material selection is crucial; incorrect resin choices lead to workflow issues. Proper materials ensure high-quality splints.

• Supports from printing have been minimized; many supports can now be removed easily without sectioning.

Polishing and Final Adjustments

• Various tools like Scotch-Brite puffs and carbide trimming points are used for polishing surfaces post-printing.

• The entire workflow includes designing (10 mins), printing (45 mins), washing (15 mins), curing (6 mins), and final adjustments (5 mins).

Delivery and Cost Efficiency

• Same-day delivery is possible but typically planned for next day unless urgent due to patient pain.

• STL files become permanent records in patient charts, facilitating future access or modifications as needed.

• The cost of materials is low; approximately $5 per splint when designed in-house using specific resins.

Applications of 3D Printing in Dentistry

• 3D printing is effective for temporary crowns or bridges, especially useful during implant procedures where costs need to be minimized.

• Design tasks can be delegated to assistants trained on Medit software or outsourced entirely to services like Evid.

Post-processing Steps

• Temporary restorations require washing in alcohol followed by air drying or compressed air drying before curing.

• Final touches include cutting supports, air abrasion polishing, and optional staining/glazing with specialized kits.

Cost-Effective Solutions in Dental Crowns and Provisional Restorations

Cost Savings with 3D Printing

• The cost of traditional bisil temporary material is approximately $357, highlighting significant savings when using alternative methods for routine procedures.

• A clinical case involved replacing mismatched ceramic crowns; the patient was dissatisfied with their appearance after only four months.

• The team proposed a more cost-effective solution by scanning and designing new temporary crowns using Meta Link software and printing them on a Form 3B Plus printer.

Efficient Production Process

• Post-processing included testing the fit of the printed shells to ensure proper proximal contacts before finalizing the design.

• The use of an optic glaze staining kit enhanced the aesthetic quality of the temporary crowns, making them appear more lifelike.

• Total costs for producing two crowns amounted to $1.82, excluding labor, demonstrating a highly economical approach compared to traditional methods.

Comparison of Techniques

• A breakdown of material costs showed that 3D printed motivational mockups were significantly cheaper than conventional bisil injection methods, costing less than $1.50 versus about $8 per mockup.

• For extensive cases involving multiple arches, utilizing 3D printing can drastically reduce expenses while maintaining quality in patient communication tools.

Advantages of 3D Printed Temporaries

• Custom stain and glaze applications were performed on permanent crown materials at minimal costs, resulting in satisfactory outcomes for patients who might otherwise struggle to afford treatment.

• Temporary restorations are defined by aesthetic demands; while they may not be suitable for all cases (e.g., opaque PFM matches), they offer better color stability over time compared to injectable materials.

Enhanced Fit and Functionality

• Direct-to-prep techniques eliminate common issues associated with air bubbles found in injectable temp materials, ensuring stronger marginal fits without trimming excess material.

3D Printing in Dentistry: Cost-Effective Solutions

Benefits of 3D Printed Temporary Veneers

• 3D printed temporary veneers are less costly than traditional injectable materials, often by a factor of five, making them an attractive option for pediatric patients.

• The process includes creating mockups using composite material to gauge patient satisfaction with aesthetics before proceeding with the final product.

• Digital software aids in selecting shades for different parts of the tooth, providing a good starting point for color matching without extensive preparation.

Efficient Delivery and Patient Experience

• The delivery process is quick (about 10 minutes), requiring no injections; only topical anesthetics are used, enhancing comfort for children.

• Scanning can be done directly to create retainers or send STL files to orthodontists with 3D printers, streamlining the workflow.

• Restorations can be printed while patients are not in the chair, allowing for efficient use of time and reducing multiple appointments.

Time and Cost Efficiency

• The entire process from scanning to seating takes less than an hour and costs approximately 32 cents worth of resin per restoration.

• This method is particularly beneficial for families managing multiple orthodontic treatments or temporary restorations until permanent solutions are available.

Versatility in Treatment Options

• 3D printing allows for designing various appliances like Maryland bridges efficiently, which can also promote further treatment discussions between parents and practitioners.

• A digital mockup helps visualize outcomes before bonding procedures, ensuring better alignment with patient expectations.

Case Studies: Real-Life Applications

• In urgent cases (e.g., senior pictures), rapid design and printing of bonded veneers were successfully executed within tight timelines.

• Provisional bridges created through this method proved stronger than traditional injectables, saving chair time and ensuring accurate occlusion upon placement.

3D Printing in Dentistry: Insights and Applications

Temporary vs. Final Restorations

• Discusses the option of creating temporary 3D printed restorations that can be easily translated into final ceramic restorations if the design is satisfactory.

• Outlines cost considerations for preoperative scans, with typical outsourcing costs ranging from $5 to $10 per tooth, and mentions that printing a temporary crown costs less than $5.

Material Choices and Considerations

• Highlights the choice between permanent and temporary resins for 3D printed crowns, noting limitations in available shades but emphasizing effective metal blocking by lab materials.

• Explains the process of designing directly onto abutments during implant surgeries, allowing for immediate temporaries based on scanned data.

Cost Efficiency and ROI

• Suggests using temporary materials as a cost-effective solution while monitoring questionable implants over time before committing to permanent solutions.

• Summarizes potential savings when transitioning from analog methods to digital workflows, estimating costs between $85 to $200 for traditional methods versus significantly lower costs for 3D printing.

Team Training and Implementation Strategies

• Emphasizes the importance of training staff in new technologies, encouraging delegation of tasks and ensuring team motivation through structured processes.

• Advises on mastering basic techniques first, following product guidelines closely, and investing in quality equipment to ensure long-term savings.

Common Questions and Challenges

• Opens up a Q&A session inviting audience questions about 3D printing applications in dentistry.

• Addresses frequent inquiries regarding transitioning from digital scanning to 3D printing, stressing the need for compatible equipment and gradual implementation strategies.

Troubleshooting Techniques

• Discusses troubleshooting common issues such as misprints or incomplete curing during the printing process, highlighting necessary adjustments based on model fit.

3D Printing in Dental Practice

Importance of Scanning Patients

• The workflow emphasizes scanning every patient, as these scans serve as effective communication tools for follow-up discussions.

• Quick turnaround times are highlighted; 3D printing models takes about 10 minutes, with additional time for creating whitening trays.

Preparation Requirements for Procedures

• Tooth preparation depends on the procedure: no prep is needed for temporary appliances, but it is necessary for permanent crowns.

• Various printers compatible with iTero scanners are mentioned, including Formlabs and NextDent printers.

Legal Considerations in Auxiliary Roles

• There are significant legal variations across states regarding auxiliary roles in dental practices; some skills like scanning were only recently approved in certain areas.

• The speaker stresses the importance of understanding local laws and regulations that govern what auxiliaries can do within their practice.

Enhancing Patient Experience Through Technology

• Utilizing technology such as same-day 3D printing improves patient experience by reducing return visits and wait times.

• Patients appreciate quick service, especially when they have urgent needs like night guards or pain relief solutions.

Building Relationships and Affordability

• Providing immediate solutions fosters trust and encourages patients to refer others based on their positive experiences.

3D Printing in Dental Practice: Cost-Effective Solutions

Benefits of 3D Printing in Dentistry

• 3D printing offers a cost-effective way to create dental restorations, allowing practitioners to learn and refine their processes without significant financial risk.

• If mistakes occur during the restoration process, such as chips or breaks, the ability to reprint at a low cost enables quick corrections and enhances learning experiences.

• The technology opens up various avenues for improving client service by providing flexible solutions tailored to individual needs.

Closing Remarks and Future Engagement

• Dr. Bayer's presentation highlighted interconnected possibilities within dental practices, emphasizing innovative approaches to client care.

• The webinar was recorded for future reference, with plans to distribute the recording via email within the week.