The NINJA empowerment in digital dentistry

June 15, 2016
Oftentimes, we read about the profitability that a well-run dental hygiene program can bring to a practice, but rarely do we read about the profitability that a dental assistant program can bring to the practice-until now.

Angela Severance, CDD, RDA

Oftentimes, we read about the profitability that a well-run dental hygiene program can bring to a practice, but rarely do we read about the profitability that a dental assistant program can bring to the practice-until now.

With the adoption of digital imaging and in-office milling units, CAD/CAM dentistry has triggered a paradigm shift for the dental assistant role. No longer is the dental assistant just there to suction, assist hygiene, and sterilize instruments; the digital era has opened up new opportunities and created a new wave of dental assistants, or "NINJAs" as I like to call them.

What is a NINJA?

"NINJA" is an acronym for "No, I'm Not Just Any Assistant," and we, with the advent of chairside CAD/CAM and digital imaging, can now turn suction into production like never before. That's right, doctors-at the end of the day, when hygiene production numbers are handed out, I want to see the NINJA production numbers too! How many restorations were scanned, designed, and milled today? How much overhead was saved in dental lab fabrication costs this month? How much increased production was achieved in additional restorative appointments rather than zero-production crown-seat appointments? Better yet, how much revenue was generated seeing additional restorative patients while the NINJA did the entire CAD/CAM process instead of the doctor? All of this is NINJA dentistry!

Integrating NINJAs

While it all sounds great, the big question is: How do you incorporate NINJA dentistry into your practice? The key to low-stress technology integration comes with initial training followed by continued advanced education. These two elements are imperative to success. Having the right team members educated and communicating expectations will allow CAD/CAM and digital imaging technology to thrive in your practice.

The assistant using the technology should show intrinsic motivation to continue to learn and improve. Then, over time, the doctor and assistant will establish mutual confidence in each other that will allow them to deliver quality care together. I like to think of my doctor as the pilot and me as the copilot. Once the confidence factor has been established between us, the sky is the limit.

Scheduling and productivity

Now let's visualize just what a morning schedule looks like when working with a NINJA. The first patient arrives at 8:00 a.m. for a same-visit restoration. After anesthesia is administered, the NINJA scans in the opposing dentition and captures the digital articulation scans. These steps replace the alginate and bite registration. The patient is now numb and the doctor returns to prep the tooth and assist with tissue management as required.

The time is now 8:30 a.m. and patient No. 2 arrives. The patient gets seated and topical is placed. The NINJA stays with patient No. 1 to complete the prep and bite scans. This replaces the final impression and bite registration, saving the doctor time and cost of impression material. Next, instead of creating a temporary crown, the assistant designs the restoration and sends it to the milling unit to be manufactured, all while the doctor has placed anesthesia for patient No. 2 and completed hygiene exams.

It is now 8:45 a.m. Patient No. 2 is numb and ready to begin the restorative procedure.

This is where things change up a bit, depending on how many operatories and assistants a doctor work with. Either a second assistant assists with patient No. 2 or the NINJA is available to assist while the restoration is milling.

At 9:00 a.m., instead of the patient leaving with a temporary crown, the final restoration is ready for try-in. Using two assistants or investing in an Isodry (Isolite) or Mr. Thirsty (Zirc) to keep patient No. 2's restorative care going, the NINJA quickly makes any necessary adjustments to the restoration for patient No. 1 to keep the workflow moving along.

A restoration can be simply hand-polished and seated at that time, or it can be characterized, glazed, and put into an oven for 10 to 20 minutes before getting seated in the patient's mouth. Either way, in 90 minutes or less, a permanent restoration has been seated, a second restorative procedure has been started, and a zero-production seat appointment has been avoided. The goals of patient convenience, added production, and professional fulfillment have all been met!

The NINJA shift

Advancements in technology and materials have allowed us to offer our patients convenience with no compromise to fit, form, or function. Every dental practice is run just a bit differently, but NINJA dentistry is an empowerment movement to CADapult the dental assistant into the future of digital dentistry.

Mandatory team education establishes a relationship based on confidence between the dentist and the assistant. This allows the doctor to delegate procedures to the assistant, creating an exciting paradigm shift in the role of the dental assistant and new opportunities for the practice.

Angela Severance, CDD, RDA, is a national speaker, educator, and author. She has over 15 years of clinical experience, specializing in digital dentistry and CAD/CAM technology integration into the modern practices. You can contact her at

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