Michael Kelly, DMD and Edward Shellard, DDS
When most people think of 3-D imaging, cone beam computed tomography (CBCT) is the first thing that comes to their mind. However, 3-D intraoral scanners are making great strides in the industry - and no one knows this better than Dr. Michael Kelly. Since 2007, Dr. Kelly has been using intraoral scanners in his dental practice, Aesthetic Dentistry of Scottsdale. I recently had the opportunity to hear his thoughts on digital vs. conventional impressions.
What prompted your decision to switch from conventional impressions to 3-D digital impressions?
My lab contacted me and said they were obtaining improved results with digital impressions, so I decided to make the switch. I was worried about accuracy at first, but I've found digital impressions to be just as accurate as conventional ones. In fact, the marginal fit, occlusion, and contacts are even better with the intraoral scanner.
What were your criteria when selecting a scanner?
I had been using intraoral scanners for several years before I selected my most recent scanner, the CS 3500 from Carestream Dental. What frustrated me about my previous scanners was that I was locked into sending my files to specific labs. Essentially, I didn't "own" the data, even though I paid for the scanner. When I asked about getting more flexibility, I was told I would have to pay thousands per year on top of my initial purchase.
Because of these frustrations, I took a different approach when it was time to buy a new scanner. It was important for me to choose a scanner with an open system. In addition, I also wanted a scanner that could plug into any computer and was not tied to a specific workstation. Other factors that were important to me were ease of use and affordability. My current scanner and design software had a short learning curve and were not complicated with unnecessary features. As for affordability, my scanner has autoclavable tips, which saves more money than disposable options. There are no scanning fees, either.
What role does the intraoral scanner play in your patient care?
Patients today want instant results, so having the ability to make restorations immediately is a definite "wow" factor for many of them. I also find that many patients dread impressions, so they are happy to learn they don't have to get all that goop in their mouths.
One of my primary goals at my practice is to get patients excited about their oral health, and having an intraoral scanner helps me achieve this. Some patients want to see everything I'm doing, so I mirror what I'm doing on the iPad so they can watch along in real time. When I share my perspective with them, patients become more active in their care. I even take patients to the back so they can watch me design their crowns, see the block I use, and then watch the milling process.
My interaction with patients has earned many positive reviews and compliments on my practice's Facebook page, and I've also had an increase in word-of-mouth referrals. Many of my patients travel - which is one reason I incorporated this technology into my office to begin with - so if someone mentions they need a crown before going on a business trip, my patients often recommend me. They know I can complete the restoration in one appointment without sending their friend or family member off to China with a cracked tooth or temporary.
How do you measure ROI with this technology?
When it comes to my intraoral scanner, I have four categories that I use to measure ROI: time savings, cost savings, patient retention/referrals, and job satisfaction. In terms of ROI and time savings, it's a given - digital impressions are faster than conventional impressions, and the technology is more accurate, so there are fewer remakes. I heard one lab brought their remake rate down from 3% to .1% since encouraging doctors to switch to digital impressions. In addition, shorter seat times and faster patient turnaround also saves time. Plus, I don't have to set the operatory up for a second appointment.
As for cost savings, the scanner is inexpensive to use. Impression materials are expensive, but I don't think most doctors are aware of the cost since their staffs handle the orders. Typically, practices spend anywhere from $10 to $20 per impression - that really adds up when you consider that you typically take two to three impressions, plus bite registrations, per patient. With digital impressions, you not only eliminate the cost of temporary materials but, since there are no shipping expenses, doctors can also negotiate prices with the lab to save even more money.
As I mentioned earlier, taking digital impressions certainly helps with patient care. My patients are more satisfied and, in turn, more likely to refer me to other patients. As a result, my advertising costs are almost nothing these days, but I'm still able to keep the practice busy.
The last category, job satisfaction, is intangible, but I personally find that digital dentistry makes my job more fun. It keeps me enthusiastic, and my team is proud to be in an office that keeps up with the latest technology.
Do you have any interesting scanning cases to share?
There are actually a number of interesting cases that I can use to demonstrate the benefits of digital impressions. The first involved a patient who was interested in extensive cosmetic work, but couldn't tolerate reclining and had a bad gag reflex. She was a sweet lady, but one of the most challenging patients I have ever encountered. Fortunately, the scanner made it easy to take the impression. She even asked, "Are you kidding me?" after I took the scan, and I was able to easily place the work without making many adjustments. This saved my patient's time and made the experience better for her, and it allowed me to enjoy my work. What's more, because of the patient's intolerance to certain conditions, I don't think she would have moved forward without the digital scan. By giving her that option, I was able to keep a high-end case that I might have lost otherwise.
Many doctors think that digital scanning is only for one or two crowns. Quite to the contrary. It can be used in the most challenging cases with ease and reliability. In another case, the patient required a full-mouth neuromuscular restoration. As the victim of a past assault that involved trauma to the mouth, she was understandably nervous. She had to be sedated as a result. Due to the ease and predictability of scanning, we were able to complete her case in only three visits - a total of four and one half hours of chair time for 28 units, three being implants. With only four minutes of chair-side bite adjustments required, the case was a win-win for all.
Last, but not least, I had a case where a patient bit into a bone in her hamburger. She called me because she thought it damaged the crown we had just put in. She sent a picture and, sure enough, she was right. I went to my office and pulled up her file, then simply milled the tooth while she was on her way in, and upon her arrival, placed it immediately.
Michael Kelly, DMD, practices at Aesthetic Dentistry of Scottsdale in Arizona. He has earned Mastership with the AGD and ICOI. He is an accreditation candidate with the AACD and serves as senior clinical instructor for Aesthetic Vision Seminars. He is dedicated to sharing tips, techniques, and technology that will enhance dentistry. Contact him at [email protected].
