The Blueprint for a Successful Digital Workflow
When following an indirect restorative workflow, it’s important to map out a plan for success that allows the technology and the dental team to rise to their fullest potential
No dentist jumps into a procedure without a plan, whether it’s a simple filling, a single crown, or a complex implant placement. There are x-rays and impressions to be taken, esthetics to be considered, and patient expectations to be met. The same applies to investing in technology—or at least it should.
“The most important factor when implementing technology is to get clear about the reasons why you want a particular technology, and then come up with a plan for implementing it,” said Kaveh Ghaboussi, DMD, a practitioner and lecturer who has completed specialized training in dental technology. “Those steps often get skipped, which leads to the equipment sitting in a corner unused.”
Reaching Beyond ROI
One reason why this happens is that technology is frequently associated with return on investment, a correlation that Dr. Ghaboussi warns is a dangerous benchmark. “If ROI is the only criteria a dentist is using to evaluate a new technology, then they are missing out,” he said. That’s why any time he’s looking to add something new to his practice, he asks himself 3 questions: 1) Will it make me a better dentist? 2) Will it generate revenue? 3) Will it be fun? While some technology will fi t only one criterion—such as a loupe-and-headlight system that won’t necessarily increase profits or make dentistry more fun—other digital tools, such as a CAD/CAM system, will satisfy all three.
“CAD/CAM made me a better dentist because it forced me to analyze my work and look at it magnifi ed on a screen,” explained Dr. Ghaboussi. “It generated revenue because patients came to my office specifically for same-day crowns, and saved me money through its greater efficiency. Lastly, my team liked it because they thought it was fun to design, mill, and stain restorations.”
“CAD/CAM made me a better dentist because it forced me to analyze my work and look at it magnified on a screen.”
—Kaveh Ghaboussi, DMD
An essential piece of the CAD/CAM workflow, intraoral scanners have progressed by leaps and bounds over the past few years, as several new entries to the market ensure there is an excellent option for any office that wants to start scanning.
“Even dentists who still send crowns out to the lab can benefit from the much shorter turnaround time that digital scanning provides,” said Dr. Ghaboussi. “In my office, if we prep a tooth on a Monday, we usually get the crown back on a Wednesday or Thursday of that same week. The 3D face scans can be combined with intraoral and CT scans to plan esthetics for full-arch implant cases, or to help educate patients about their conditions and treatment options.”
A New Rising Star
While CAD/CAM has arguably been the star of same-day dentistry for the past few decades, there is another rising star in the growing galaxy of indirect restorative technology: 3D printing. Advances in 3D printers have made the technology more affordable and easier to learn—allowing dentists to satisfy more of their patient needs, gain greater control over their treatment outcomes, and improve their bottom line.
“There are so many opportunities opening up for dentistry due to 3D printing,” said Dr. Ghaboussi, who has been 3D printing in his office for the past 4 years. “Making wax-ups, models, mouthguards, clear aligners, dentures, even long-term temporary prosthetics and in-office crowns are all becoming a reality. Over the next few years, this will be one of the biggest areas of innovation in our industry.”
Many other components of the indirect restorative workflow have also gained momentum in recent years. Imaging systems, for example, have continued to advance both in terms of image quality and usability. Dental handpieces have become easier to hold and operate, incorporating smart features or infection control measures. And chairside mills have become more versatile with new options on the market, offering greater flexibility and faster, more precise fabrication.
Over the next few pages, we highlight many of the latest tools and technologies designed to improve your indirect restorative procedures.
3D PRINTERS
From manufacturing of models and splints to surgical guides and sleep apnea devices, 3D printing represents a cost-effective tool to expand the scope of treatment options in the practice.
Designed exclusively for dental professionals, the SprintRay Pro S is fast and versatile in the fabrication of dental parts for all kinds of treatments with wide materials compatibility and industry-leading speed. Developed to be easy to use and delegate, the Pro S combines smart sensors with workflow context to ensure the 3D printing workflow operates efficiently.
From FormLabs, the Form 3B+ and its patented Low Force Stereolithography technology deliver speed, reliability, quality, and ease of use, with validated workflows tested by dental experts across specialties and disciplines. High-performance models, appliances, and prosthetics are fabricated on a single printer with a wide range of rigorously tested 3D printing materials.
VOCO’s SolFlex 170 3D printer was custom engineered for the dental office and provides higher printing speeds, more accuracy, and the ability to print clear orthodontic appliances. An optional built-in laser sensor measures the peeling forces to optimize the building speed. Not only does this increase process effi ciency and reliability, but it also reduces print times by as much as 40%, along with material-consuming misprints.
With the VeriBuild LCD 3D Printer from Whip Mix, labs or dental practices can print extremely precise models and accurate surgical guides with slice thicknesses between 25 µm and 100 µm. This WiFi-enabled open-system printer can print 405-nm print resins using the proper fi le with its advanced software.
Dentsply Sirona’s Primeprint is a highly automated, end-to-end, medical-grade 3D printing system optimized for dental applications. The high level of automation helps reduce handling times and allows for delegation. Primeprint enables the user to print biocompatible applications with reproducible and accurate results.
DIGITAL RADIOGRAPHY
Whether it’s a single crown or a fullmouth reconstruction, every indirect restoration starts with an image— ideally one that’s sharp, accurate, and easy to capture.
Air Techniques’ ScanX family includes the ScanX Classic View, a digital imaging system that enables an intuitive, efficient, and time-saving digitization for both intraoral and extraoral formats. Powered by ScanX PSPs, which feature a 100% active capture area, its 4.3- inch high-resolution touchscreen can display 16.7 million colors for excellent image quality.
The SensorX from Air Techniques features rounded corners that allow it to be positioned closer to the tooth, helping to produce a sharper image. The sensor’s enhanced CsI CMOS technology ensures fast transmission of high-resolution images.
The Planmeca ProMax 2D S3 provides accurate 2D imaging for analysis, treatment planning, and follow-up imaging, offering
extraoral bitewings, pan segmentation, and a wide range of 2D imaging programs. Advanced features include Dynamic Exposure Control, which adjusts exposure values based on the patient’s anatomic structure.
With a true resolution of over 20 lp/ mm, the Planmeca ProSensor HD has a fiber-optic layer that captures sharp, low-noise, and high-contrast images. Three sensor sizes with rounded edges are available, while hermetically sealed housing ensures effective infection control.
Dentsply Sirona’s Schick AE sensor provides a theoretical resolution of 33 lp/ mm and a 15-µm pixel size. In combination with dedicated filters and an enhanced dynamic range that supports consistent image quality, dentists get superior x-rays to support their diagnoses. Reinforced silicon-coated replaceable cables are available in 3-, 6-, and 9-foot options.
The ORTHOPANTOMOGRAPH OP 2D panoramic x-ray unit by DEXIS features a stable 5-point patient positioning system to eliminate patient movement and 3 laser positioning lights to aid accurate positioning, reducing the need for retakes and movement artifacts. The V-shaped x-ray beam enables greater detail and a wider mandibular image layer to be obtained as well as more penetrating power for the thicker maxilla area.
The DEXIS Titanium sensor captures consistent, high-quality images with improved tissue contrast across a broader spectrum of radiation levels, especially at low doses. Its components were designed in a proprietary way to drastically reduce noise, clean data, safeguard image integrity, and balance and enhance performance. Additionally, practices can remotely diagnose the sensor and over time, sensor function and data analytics will occur in real time to alert users of sensor performance issues.
From SOTA Imaging, Clio Prime is designed for effortless positioning throughout a full-mouth series. Clipped corners and beveled edges are anatomically aligned to the oral cavity, simplifying x-ray orientation, while EveryShot technology features a fiberoptic design for low visual noise while eliminating over- and underexposure.
Offering CsI sensor technology and an easy-to-use interface, Dentsply Sirona’s ORTHOPHOS E provides a smooth entrance into the world of digital imaging—with motorized forehead and temple supports that fixate the patient’s head and prevent motion blurring. The 2D-CsI Plus sensor and reliable image quality aid in diagnosis.
Handheld Systems The NOMAD Pro 2 handheld x-ray system has a shielded, portable design that enables operators to stay in the room while taking x-rays, making the image acquisition process faster and more efficient. A unique, lead-impregnated acrylic shield protects the operator from direct and scatter radiation.
Producing significantly less radiation than wall-mount units, Denterprise’s portable and handheld MobileX allows x-rays to be taken at any point in the procedure. Lightweight at 4.7 pounds, it can capture 400 exposures on a single battery charge. A 1-year warranty protects against defects, while a no-cost 3-year out-of-warranty plan covers replacements.
IMPRESSION MATERIALS
The world of impression materials has exploded in recent years, offering formulations with varying viscosities, flavors, chemistries, and working and setting times that meet the needs of every impression technique.
Offering a variety of viscosities and 3 set times, Kettenbach’s Panasil family of final impression materials provides a custom combination for specific needs and technique preferences. The hydrophilic materials are available in a 50-mL cartridge and 380- mL jumbo cartridge for automix dispenser. Whether dentists are looking for high final hardness, comfortable working times, or a scannable material, Futar injectable, elastomeric bite registration materials offer a solution with 6 formulations designed to capture precise impressions in a variety of scenarios.
Henry Schein’s VP Mix HP is a super hydrophilic impression material with wetting agents that enhance hydrophilic properties during impression taking, allowing the material to displace moisture, which results in highly accurate impressions. Blu-Bite HP is a mousse-like, fluffy VPS used for bite registration, copying transfers, and primary impressions with bite trays; available in regular, fast, and super-fast set times.
VOCO’s V-Posil system offers up to 2 minutes of adjustable working time, giving dentists control over the pace of the procedure, while the abbreviated 2-minute thermoactivated set time improves patient comfort and limits procedural time. Available in multiple formulations, Heavy Soft Fast material offers an optimal viscosity to load the tray but remains soft enough after it sets for easy removal from the mouth.
Ultradent’s Thermo Clone VPS impression material begins setting when it is placed in the patient’s mouth for a faster working time that helps prevent distortion. The super-hydrophilic material adapts well to a wet environment, while its thixotropic properties allow it to easily flow into margins and capture every essential detail.
Available in a 30-second, 60-second, or 2-minute set time, Parkell’s Blu-Mousse stays stacked on the occlusal surface during placement with an optimal consistency that allows the patient to naturally close with no resistance. It resists break-age on removal and will not distort between the time the bite is taken and when the model is articulated.
Centrix’s Access BLUE bite registration material is fast setting, highly accurate, very stiff, and dimensionally stable. A mousse-like viscosity creates highly accurate impressions that set hard like lab plaster in just 30 seconds—making it possible to trim and cut the impression without crumbling. Available in various tray and wash viscosities, Dentsply Sirona’s Aquasil Ultra+ uses patented technology to create polyfunctional bonds for high intraoral tear strength, ensuring margins stay intact and material is not left in the sulcus.
3M Imprint 4 VPS impression material delivers precise impression results with a fast intraoral setting time and sufficient working time for a stressfree procedure. Super hydrophilicity ensures accurate detail reproduction. For use in the monophase technique, 3M Impregum polyether impression material flows smoothly under pressure with a snap-set for precise-fitting restorations.
Coltene’s AFFINIS PRECIOUS is a vinyl polysiloxane impression material that demonstrates an extremely low contact angle when applied to moist tooth structure, while superior flow properties allow it to easily capture all details of the prep.
Keystone’s Supergel is a premium blended alginate material that mixes readily to a smooth, creamy consistency. Its slow dehydration and low surface tension provide consistent, accurate, and bubble-free reproductions, while a pleasing sassafras flavor, controlled flow, and gag-reflex reduction provide greater patient comfort.
From EXACTA Dental, FRESH Bold Impression Material uses state-of-the-art silicone polymer formulas to create a forgiving impression material that is accurate in the most difficult oral environments. Clinicians can choose from 9 viscosities, most of which have 2 different set times—a regular set for more challenging cases or a fast set to make life easier.
The super-hydrophilic CHAIRSIDE VPS impression materials from Zest Dental Solutions provide a high-gloss surface and high tear strength. Ideal for full-arch or triple-tray impressions, the materials are available in 3 color-coded viscosities for easy differentiation and a variety of impression techniques.
CHAIRSIDE MILLING
The star of indirect restorative technology is CAD/CAM, with manufacturers offering both start-to-finish systems for scanning, designing, and milling, or the freedom to choose the tools that work best for your digital workflow Planmeca FIT Plus is a sophisticated same-day dentistry solution that gives clinicians the ability to perform more procedures in-house and elevate patient care. The system includes the Planmeca Emerald S intraoral scanner, Planmeca PlanCAD Premium design software, and the Planmeca PlanMill 50 S milling unit, which can be used to mill both wet and dry, discs and blocks, using a wide range of materials such as zirconia, composites, and glass/hybrid ceramics.
Axsys Dental Solutions’ Versamill 5X450 precision dental machining center is an open-source 5-axis mill designed to provide dentists with maximum flexibility and versatility. It can accept input from popular dental design programs and process virtually any dental milling material, including wax, zirconia, acrylic, composites, glass-ceramics, and more. Precisely mill zirconia and glass-ceramic crowns in less than 14 minutes without the need for laborious hand finishing.
A prime CAD/CAM system, Dentsply Sirona’s CEREC Primescan intraoral scanner and the CEREC Primemill milling unit work together with CEREC Software 5.2 to create same-day restorations with ease. Dentists can expect short milling and grinding times, including the ability to mill CEREC Zirconia+ restorations in about 5 minutes, along with outstanding restoration margins and surface details for extremely precise, esthetic results.
The glidewell.io In-Office Solution includes the fastdesign.io Software and fastmill.io In-Office Mill, the latter of which can deliver a same-day BruxZir crown in under 40 minutes. The 4-axis computer-controlled mill is smaller than a microwave oven yet capable of milling a full range of restorative materials for every indication, including full-contour restorations.
The fastdesign.io Software and Design Station auto-marks margins and auto-generates restoration designs using artificial intelligence, sifting through Glidewell’s extensive digital restoration database and selecting the ideal morphological components.
HANDPIECES
With over 2.3 million single crowns being placed every year, you’ll need a powerful, ergonomic, and reliable handpiece to tackle your preps.
In the electric camp, NSK’s Ti-Max Z95L 1:5 increasing handpiece has exceptional durability and power, a solid titanium body that’s 30% lighter than stainless steel, and a Clean Head System with an anti-suck-back mechanism. With a unique head angle and slim neck size for greater visibility and access, the Ti-Max Z900L delivers 26 watts of air-powered torque with speeds between 330,000 and 400,000 rpm.
Engineered as a cost-effective handpiece solution that doesn’t skimp on performance, Henry Schein’s Maxima PRO 2AR highspeed handpiece controls aerosols at the source without sacrificing performance, featuring 20 watts of power and a small but powerful head for superior visibility and accessibility. An active sealing system helps prevent suck-back of fluid and particles.
From Dentsply Sirona, the dynamic Midwest E Electric System motor weighs only 59 grams and measures just 1.25 inches in length, making it one of the smallest, lightest electric motors on the market. The power and flexibility provided by the Midwest E Plus and Midwest E Pro electric handpiece attachments allow clinicians to apply their skills to the fullest with confidence, accuracy, and efficiency.
Part of DENTALEZ’s Aeras Intelligence Platform, the Aeras 500 Elite offers 39 watts of power and similar cutting performance to an electric handpiece, but with the familiar light weight and tactile feel of an air-driven unit. Aeras handpieces support cloud-based, automated tracking and reporting that make it easy to provide hygienic and efficient care.
The Brasseler Mini high-speed handpiece has a super-miniature head size that offers maximum access and visibility. Recommended for use with Brasseler Mini burs, the handpiece is lightweight with ceramic ball bearings, push-button operation, a single-port water spray, and quick disconnect swivel.
Available in 2 head sizes, Lares’ ProStyle SF high-speed handpieces feature proprietary SilentForce technology, which includes a longlasting SteelGrip chucking system and DynamicPrecision balancing for whisperquiet operation.
Dentatus’ dynamic Profin Reciprocating System can be used with either contra-angles or flat Lamineer diamond tips that move in a reciprocating axial direction. Ideal for shaping, contouring, and polishing natural dentition and restorations, Profin also easily removes bulk, interproximal, and subgingival residual bonding materials in all parts of the dental arch.
BURS & POLISHERS
Single- or multi-patient-use, diamond or carbide, round or pointed? Burs are as unique as our patients, and the options are seemingly endless.
A powerhouse of single-patientuse burs and polishers, Microcopy offers the NeoDiamond Z-Class line of adjusters and cutters, designed to cut zirconia with minimal fracturing, even depth, and a smooth surface. NeoShine are mini single-patient-use polishers that use a color-coded ID system to organize composite, metal, and zirconia polishers by materials and steps. Satin polishers remove striations for a high shine in the posterior, while High-Gloss polishers create mirror-like luster.
A fast and smooth alternative to diamonds, the Great White Ultra crown and bridge prep kit from SS White allows dentists to cut through enamel and restorative materials using a single material, with minimal clogging and no drag or stalling. Right angle, latch-type Jazz Polishers are available in either 2- or 3-step systems for polishing porcelain and metal.
Ultradent’s Jiffy Natural Universal System of ceramic polishers consists of malleable spiral-shaped wheels designed to easily conform to tooth anatomy. Their pliable finger-like extensions easily reach where cups and points cannot and soften super-high-gloss finishes for a natural enamel-like result.
The 2-step 3M Sof-Lex Diamond Polishing System imparts a gorgeous diamond paste-like gloss in the convenience of a rubberized system. The flexible nature of the spiral adapts to all tooth surfaces—anterior and posterior, convex and concave—and can be used from any angle. They can be used to polish composites, RMGIs, precious and semi-precious metals, bis-acrylic temporary materials, and the Lava Ultimate CAD/CAM material.
Brasseler’s extensive bur portfolio includes DuraBraze Diamonds, which are ideal when scanning for CAD/CAM restorations like zirconia and lithium disilicate. A proprietary SpotBrazing manufacturing method leaves a smooth margin and a longer-lasting diamond. BrioShine Feather Lite polishers offer universal polishing of ceramics and composites. Single use and durable to last through multiple restorations, each polisher is color coded and features unique markings for easy identification and application.
Made from high-quality, fine-grade tungsten carbide, Henry Schein’s Maxima One-Piece Carbide Burs cut more effectively, with a greater blade contact on tooth surface and reduced risk of chipping or breakage. They ensure fast, smooth, vibrationfree performance, reducing patient discomfort as well as operating time.
Manufactured using the latest state-of-the-art, Swiss-made precision machine tools, EdgeEndo’s EdgeBurs is one of the strongest, sharpest, and most durable bur lines on the market.
With a bur for essentially every procedure and dental need, the product line includes carbides, diamonds, finishers, metal cutters, and polishers.
Distributed by Premier, Two Striper diamonds last longer and deliver faster, cooler cutting than electroplated multiuse brands, which means fewer burs used and less chair time. Made from a select grade of natural diamonds, they are developed with a proprietary P.B.S. brazing process to help the burs stay sharp and deliver predictable results.
Delivering high-performance, controlled efficiency to facilitate crown-preparation procedures, Komet’s Deep Purple diamonds are specially designed for fast, effective substance removal. These burs feature high-quality and uniformly sized, extracoarse diamond grains embedded at the optimal depth for rapid, reliable performance.
Coltene’s Alpen Speedster onepiece carbide burs are designed for rapid reduction of amalgam, porcelain, metal, enamel, and dentin. Highly concentric, these burs enable fast, smooth, and precise cutting, while operating freely and aggressively without stalling or clogging and with minimal chatter.
Technology Is a Team Effort
For Dr. Ghaboussi, technology works best not only when there is a plan in place for how to use it, but when the investment is approached as a team effort. “Too often, dentists will buy a product with only a vague idea about what it is, yet they expect the office to start using it without any real plan,” he said. For CAD/CAM to become an everyday part of his Madison, WI, practice, the staff had to work as a team to implement it. “If you go into a technology purchase with clear expectations and a plan for how to implement it, you won’t be disappointed, and your office will be able to rise to its potential.”
