A Practice Transformed with Integrated Technology

Dr. Melonie MacDonald jokes that she was “the longest-living associate dentist” until about five years ago when she opened her own practice—Citadel Dental in St. Albert, Alberta. What started as a modest 4-operatory clinic has grown to 9 ops and a team of 16. In this interview, Dr. MacDonald shares her vision for going fully digital and how that decision continues to drive her practice’s growth and efficiency.

What went into your decision to build a fully digital practice?

The practice where I previously worked as an associate was almost entirely analog—we still used paper charts at the time. When I decided to open my own office, my vision was clear: I wanted to embrace everything digital. And that’s exactly what I did. I started with a CEREC system and an intraoral scanner. About 6 months in, I added a 3D printer, and a year later, I brought in a CBCT unit. I went all in.

I could see where dentistry was heading, and I was excited to be part of that evolution. My former practice wasn’t all that interested in advancing, and I was opening just a few miles away, so I wanted to offer something that would encourage my patients to follow me. My staff came along, too—they believed in the vision I was creating.

What has been your experience with intraoral scanners since making the digital leap?

We didn’t love our first scanner and it only lasted about 3 months. It was a good entry-level scanner and good for just getting to know what scanning was, but as soon as I saw Dentsply Sirona’s Primescan, I was all in. In just a few months, I got the Primescan, the Primemill, and the SpeedFire sintering furnace.

I now have two Primescan 2 scanners and a Primescan. I was lucky enough to beta test the Primescan 2, which turned out to be an interesting journey. My hygienist and assistants scan every new patient as well as every patient at their annual recall, so there's a lot of scanning going on, and that's why I was very excited about beta testing the Primescan 2. I assumed the team members would naturally gravitate to the original Primescan because they were familiar with it. And when you beta test something, you're basically there to work out the bugs—the idea being that we’re here to help develop it so it's better for everyone when it’s launched. But the exact opposite happened—they instantly gravitated to the Primescan 2 and that's their go-to scanner now.

What made them gravitate to the Primescan 2?

They can just launch it in a browser and easily enter patient information, and we have 3 monitors in every room so they can pick whichever monitor works for them to show the patient their scan. They just really enjoy that it's that easy, and the fact that it’s wireless and they can carry it around.

How has the Primescan 2 performed overall?

We not only scan every new patient and take wellness scans at recalls, but we also use it restoratively. We’ve evolved to the point where the original Primescan is used as a workstation and for scanning if all the Primescan 2 scanners are being used at the time. The Primescan 2 is just everyone's favorite. I think just the ease of setup makes it a faster scanner. And because the scan data is in the DS Core cloud platform, anyone can open up a scan right away wherever they are, and that scan is available to send to the mill or send to the printer, or for whatever they need to do with it after the fact. It's all very easy to do.

How has the DS CORE platform impacted your workflow?

For any given patient, we'll use DS Core multiple times in a day. So if they're in hygiene and getting a recall, my hygienist will take a scan and show the patient the heat map of their occlusion to point out any problems or show them any abfractions. We also run a SureSmile simulator for those people in case they're interested in seeing what their teeth would look like after we correct the alignment. My admin team uses it to send off information to third parties—if we've taken a CBCT scan, DS Core provides an easy way to send that file to a specialist. Or if we want to do a pre-authorization for a crown, they'll send the x-ray, the pre-authorization photo, and annotations to insurance companies to get coverage for patients. So, multiple people are using the same information at the same time, because it's all in DS Core and they can all access it at the same time.

DS Core allows for better communication all around. If we take a SureSmile simulation and the patient seems interested, we'll share that simulation directly with the patient from DS Core. If they need a crown or we've noticed that there's caries with the caries detection software, we'll put that in the Communication Canvas and share that with the patient.

How are you using your Primeprint Solution?

I mainly use it to make occlusal guards, night guards, or models. We are also printing retainers, which is a great service to offer patients—it's much more economical to print a retainer than to print a model and do a suck-down and all the steps that go into that. I also use Primeprint for some temporary restorations or to test-drive a bite while I'm doing a full-mouth rehabilitation. So, we use our printer in different ways than we use our mill, and I couldn't live without either one of them.

Are you using your CEREC Primemill to provide single-visit restorations?

Yes, and my lab invoices have gone down probably 90% from when I was sending everything to the lab. We are milling almost every restoration. An exception may be certain veneer cases that I will send to the lab, but if the circumstances allow, I'll send that design off to a digital designer and then they send me back the DXD file and I mill them, usually within a couple days, and then insert them. One of my associates performs a lot of implant surgery and uses the platform for everything—from planning and printing the surgical guide to designing the restoration, ordering the abutment from Atlantis, and milling and placing the final restoration. Everyone in my practice uses all of the technology. 

It sounds like the printer and the mill really complement each other. Do you see that relationship evolving?

3D printing is definitely getting better and better, and I think as materials continue to evolve and things get quicker, printing will be used more for more applications. But with the vast array of materials that you can use for milling, I don't see that going by the wayside either. I think it's going to be a marriage between the two. And that's what I love about the Primeprint and the Primemill and the whole ecosystem of Dentsply Sirona—everything talks to each other.

What are the biggest advantages to having an integrated digital workflow?

I would say to provide same-day dentistry for patients. I often get patients coming to me from other doctors who told them that they need a crown, but they don't want a 2-visit crown—they want it the same day. And to do that digitally, it's amazing—it's easier for my team, there's less waste overall, and there's less back and forth with labs. When you're taking an analog impression and sending it off to a lab, it needs to be couriered there. Who knows how long that impression sits in a car, which is especially an issue in Canada where it can either be as hot as the sun or as cold as the Arctic. When it's all sent digitally, there's no waste, it is not rolling around in a car, and you're not paying for sundries like impression material and trays that you're just throwing away or storing. It's just so much more efficient and I think better for the environment.