Intraoral scanners and the primary scanner
In the digital age of dentistry, more and more practices are choosing to adopt intraoral scanners, replacing their time-consuming traditional impressions with a cutting-edge alternative. These technologies allow for quick and accurate impressions that fit into the modern workflow. They also allow for same-day communication and review with capable labs, and they produce quality, reliable restorations. Yet the adoption process can be daunting, and overcoming the initial speed bumps is a standard part of any new advancement.
Who is the primary scanner?
One of the major questions when it comes to adopting intraoral scanners is who should be taking the impression scans, i.e., be the “primary scanner” or user. Unlike traditional impressions, some intraoral scanners are capable of in-depth editing, allowing the patient to be scanned before the preparation—ideally while the anesthetic takes effect, a normally empty period in the workflow—and then again once the units have been prepped, changing and recapturing only the areas that were altered. This frees up the workflow and allows various team members to make use of the numbing period.
In an ideal world, every team member in a practice should be capable of taking an intraoral scan, ensuring that any workflow can be well managed and preventing sick days and vacations from causing chaos. Realistically, however, each practice should designate a primary scanner. In addition to the primary scanner being (ideally) the most tech savvy, there are pros and cons to each team member position taking on the role.
Pros: Dentists who perform their own intraoral scans can take full advantage of the digital workflow, particularly in the case of restorations. They can perform the primary scan while the patient is becoming numb, set the scanner aside to prep the teeth, and then edit and refill the scan once the preps are finished. Another positive to dentists performing the scans themselves is in the case of margin lines that may need adjustments; a dentist can identify unclear margins during scanning and adjust them accordingly.
Cons: In large practices with extremely tight schedules, it can be difficult for a dentist to devote the time to scanning in addition to hygiene checks and other responsibilities. It can also limit the workflow when multiple patients are scheduled simultaneously, occupying more of the dentist’s attention. In smaller practices, this is less of an issue, though it can still be difficult depending on the workflow and the number of operatories.
Pros: Assistants are generally the ideal choice for primary scanners, able to operate within various workflows to excellent effect. They can perform the scans while the dentist sees to other patients or handles other responsibilities. In addition to fitting well into restorative scan workflows, assistants are ideal for nonrestorative impressions such as study models, aligning systems, and mouthguards, when the dentist could be scheduled for other procedures. In large practices with numerous assistants, multiple primary scanners can be helpful, allowing the scanner to be passed between operatories and associates seamlessly.
Cons: There are few cons to assistants being primary scanners. The only limits are in their inability to prep, adjust margin lines, and place scan bodies, making a dentist’s intervention necessary in those workflows. However, those procedures would be handled by dentists in any event, and there are still benefits to then handing the scanner to an assistant who can follow up and complete the impression.
Pros: Though rare, hygienists who can perform intraoral scans can fit the procedure into the general hygiene workflow. This allows for study model and record scans to be taken directly after a prophy. These scans are also extremely useful for post-hygiene checks, where the hygienist and dentist can use the scan as an illustration tool for the patient, pointing out areas of interest with a fresh digital model. This can be valuable as an educational tool, for record keeping, and as a method to promote positive changes in oral health.
Cons: Due to their own schedules, hygienists are rarely free to perform scans on restorative cases or assist in other more mundane impressions. This makes them a niche, though important, option when adopting an intraoral scanner into a practice.
Though most practices will have the best results by choosing to designate an assistant as the primary scanner, much of the decision comes down to the size and workflow of the office. Digital dentistry provides alternative workflows that can optimize scheduled patients in ways that were impossible with traditional impressions, such as scanning during the anesthesia window. This allows dentists to guide the entire impression-taking process from beginning to end, incorporating it within their restorative workflow.
GARY KAYE, DDS, FAGD, is the founder of the New York Center for Digital Dentistry and has practiced comprehensive dentistry in New York City since 1993. He graduated from Columbia University College of Dental Medicine, where he received awards in endodontics, prosthodontics, and geriatric dentistry. Dr. Kaye provides consulting services to dentists and dental manufacturers. He lectures on topics including ceramics, occlusion, and digital dentistry. He is on the guest faculty of Planmeca University in Dallas, Texas.