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It's a new world of dentistry

July 28, 2014
It has been 50 years this June since I began my career in dentistry. It was an age of belt-driven handpieces, little use of local anesthesia for restorations, and foot pump-up chairs that were standard.

By Albert L. Ousborne Jr., DDS

It has been 50 years this June since I began my career in dentistry. It was an age of belt-driven handpieces, little use of local anesthesia for restorations, and foot pump-up chairs that were standard. The dentist worked alone, standing up. Treatment plans, for the most part, did not exist, and once treatment was completed, the dentist collected the money and bid a patient farewell until his or her next tooth caused trouble.

It's hard for me to believe how far and fast dentistry has evolved. Today's dentistry is so much easier and refined compared to many years ago. Yet I'm amazed how many dentists are unaware of the true value of what is now available to make dentistry easier, faster, and better.

Last week I attended a course on digital dentistry and realized how many of you are not aware of how much our dental world is changing and how many of you are not taking advantage of it. I asked how many in attendance were using digital imaging in their practice. Only two hands went up. Knowing what my experience has been, I found this astounding, as well as sad.

Are you providing for the changes in our profession to assure that your office is going with the flow into the future? Are you being competitive and congruent with this new dental world? Your patients are learning about the new and creative ideas being presented, especially through today's networking and social media. Digital radiography is now the norm and is accepted as the standard. Quiet, durable electric handpieces are now in dental schools. Digital impressions are rapidly replacing impression materials. You are behind the curve if you are not incorporating this new technology. You are also working much harder physically than your colleagues and with increased stress. In addition, your decreased efficiency is affecting your bottom line.

Six years ago, we decided to try the iTero. It was one of the best decisions we've ever made. It was awkward at first, but the learning curve proved to be extremely short. It made a believer out of me and my treatment room assistant in less than a month. In fact, my partners and I would wait for the unit if it was in use rather than take a standard impression. No more concern for rigid trays, that little tear in the impression material at the margin, the material shrinking, the stone expanding, patients gagging for several minutes, adequate clearance, and accuracy of the bite. How is that for reducing stress and increasing efficiency? Digital impressions taken by today's units are simply spectacular in the benefits they bring to our treatment.

Our practice consists of a general practitioner, a prosthodontist (my son), and me, and it is limited to prosthodontics. I estimate I've placed over 4,000 units of crown and bridgework in the last 50 years. Grinding on second molars in a small mouth can be extremely stressful, especially on a patient with a limited opening. Nothing frustrated me more than to be adjusting the occlusion on a gold second molar and trying to visualize where to adjust, especially when the patient's saliva or tongue kept washing off the articulating paper marks.

Suppose there was a way to almost totally eliminate that adjustment? Believe me, this is the norm with digital imaging. Suppose you could have your crowns just drop in place with the fit and contacts almost perfect every time? How much value do you place on just that? My experience proves that with a good lab working with you, all of this becomes the normal routine experience each and every day. These technical problems ended when this technology entered our office. Now our assistants can take the images in less than 15 minutes for us to evaluate, and if all is well, they are transported to the lab immediately with the prescription.

It should be mentioned that in the past, digital was unable to capture images without powder. That is no longer true. Previously, implant transfers had to be used with a pull impression. That is also no longer true. There are special fabricated transfers that can now be captured digitally for just about all implants. One implant system can even allow capture of all the information required from a code on the healing collar. Wow! That is so much easier than pulling transfers and hoping they all remain stable and in their proper position.

About three years ago one of my patients flew back from Europe just to have a crown made. She was back on the plane in three days since we decided not to make a model and construct it directly from the digital images. Since then, we have made this our routine. No longer do we have the lab make a model, and our costs are reduced accordingly.

Several of my colleagues have asked about downtime for repairs. Like any piece of equipment, it does occasionally have a problem, but fortunately that has happened very seldom. The local dealer and manufacturer have given us excellent support so that we have been back in business within two days. They know we hate to have to use impression material now that we've experienced digital imaging. In fact, we may reschedule a patient for another appointment if the equipment is down. This is especially true if the patient has experienced impression taking both ways and prefers digital.

About a year ago, my partners decided they wanted to step up to a full CAD/CAM system, and they chose the CEREC because of the Omnicam. We had been considering this for many years, but having the system in our office twice had not yet convinced us it was capable of excellence. It also seemed to require too much time by a dentist to produce a single unit. I had been doing large cases and I was busy. My partners had openings in their schedules. How could we make that open time productive?

We learned how the milling machine could give a good return on investment, especially for a general practitioner, if the schedule could be used to fabricate the lab work. Here was a way for a dentist to use that open time to fabricate the units and deliver them the same day. It was a win-win! Think about it. We have always been a full fee-for-service practice, and when the economy took a dive, it resulted in open appointment time. Rather than succumb to the lack of busyness, we decided to put the time to productive use.

My partner, Tom, and my son, Pat, decided to pursue this concept. Fortunately, they like working with fabricating the crowns. Personally, I've never liked lab work. My enjoyment of dentistry has always been spending time with patients. Sometimes my team has to remind me that I'm talking too much and getting behind schedule. Adapting digital impressions has reduced my necessary time for the procedures, but I've dedicated it to getting to know my patients better. That makes dentistry fun and gratifying for me. It also creates an environment of success for building our practice.

Meanwhile, my partners are learning to use the complete system to fabricate the completed units. The learning curve is much longer, but their schedules are now full and their patients are elated to get the work completed the same day. Initially they needed three hours to complete a crown, and now they're getting closer to two. With their latest training they have advanced to laminates and bridgework. The newest blocks of porcelain are multishaded, which allows for translucent incisal edges and darker cervicals than the body shades. Now the laminates can appear similar to those using the cut back technique with stacked porcelain. Now the new digital systems can closely resemble and match the artistry of those being created by hand.

I still limit myself to digital imaging, as I prefer not to tie up my schedule with fabrication time. Also, in my case, the time learning the fabrication is better put to use preparing additional units and having the lab technician perform what he does best.

Digital dentistry will allow you to see your preparations 40 times larger. That makes you a better dentist as you can modify your work for excellence. The patient wins, your team wins, and you win. So, why are you waiting? The systems are less costly than ever, and the return on investment is terrific! Try it and you'll be a believer in a month. I'll see you at the top!

Albert L. Ousborne Jr., DDS, is a practicing dentist in Towson, Md. He has served as president of the American Academy of Dental Practice Administration, and lectures on creating a successful practice with professionalism. You may contact him at (410) 828-1177.

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