Digital Dentistry and Beyond Is Now!

The digital age is upon us. Long gone are the days when postal mail was the standard. In fact, FedEx is now too slow, and faxes are useful but do not have the clarity necessary for an accurate review of images. The Internet is continuing to thrive with the revitalization that “techies” have termed Web 2.0. The pace set by the electronic revolution is only accelerating, and the dental profession is not far behind.
Perhaps you have experienced the frustration of thumbing through physical records for x-rays, charts, or prior laboratory forms? Or maybe you have become inundated with endless pieces of paper such as sign-in lists, daily schedules, treatment cards, charges, and payments? Many times you are probably wondering how you can keep it all straight and easy to find. There is no doubt that computerization can greatly simplify a practice. How well this is accomplished is up to you. Technology creates opportunity; implementation creates results.

Figure 1. Before LUMIsmile Custom imaging.

Figure 2. After LUMIsmile Custom imaging.

Figure 3. Before LUMIsmile Library imaging.

Figure 4. After LUMIsmile Library imaging.

SIMPLICITY AND SUCCESS

The foundation of any successful practice is efficient and effective practice management. When you need to find information it should be easily accessible. Hard copy files are quickly becoming an archaic method for record maintenance. Why would you want to continue to work in the 20th century? The reality is that digital records can be created in less time and with less effort than standard patient charts. You can diagnose patients with greater accuracy and ease by referring to images (both radiographic and intraoral) rather than drawings in a chart. Can you even recall the last time you referred back to an old, handwritten chart? In addition, images can also record the progression of conditions such as recession, alignment, soft-tissue lesions, tooth wear, and whitening relapse.
Digital records also harmonize the treatment and business sides of a dental practice. Digital images, which provide indisputable evidence of a patient’s initial condition and the treatment administered, are invaluable legal documents. These records can also be sent directly to the lab electronically, thereby improving not only the speed but also the quality of the clinical care you offer. Drawings, study models, and verbal description cannot always adequately portray the condition and shade of the teeth in question.
With digital records, you can file insurance claims electronically, which translates into faster payments for you. Electronic collaborative consultation becomes a reality. You have the opportunity to share your records and recommendations with specialists and colleagues anywhere in the world. They can provide you with their assessments and recommendations. Using a Webcam, you can even demonstrate specific ideas in real time. Multidisciplinary care is now common, requiring multiple providers to evaluate patients. On the Internet it’s a snap!

TECHSTHETICS: THE TECHNOLOGY-AESTHETIC CONNECTION

Digital technology and computerization are especially important for today’s cosmetically centered practice. All cosmetic procedures are rooted in patients’ desires for a visual change. They want to look better and want to know how you plan to change their smile. How can you adequately explain the possibilities of cosmetic dentistry if you are unable to show the patient an idea of what the final result would look like? While methods such as drawings, diagnostic wax-ups, and study models are fairly representative, these are not self-evident to our patients and frequently require additional explanations. Too often, some practitioners tend to speak in dental, not patient, terms.
When a patient views an intraoral mock-up using composite resin, you may feel the need to point out that the actual dentistry will be polished, glazed, and with the color illuminating from underneath. Patients, however, cannot visualize how the final result will differ from what they are seeing in the mirror. Digital imaging is the “power communication” tool that allows us to speak the language of the patient.
Just as important as the medium is the method. Generic before-and-after photographs illustrate only what a procedure essentially is. Personalized digital imaging relates the procedure directly to the patient. The patient can co-diagnose for treatment decisions. Consider which would impact you more: seeing 2 photographs of a stranger or seeing a picture of yourself looking better than ever before. Through the magic of digital processing and alteration, this personalization helps create realistic expectations.

EMBRACING THE CHANGE

Incorporating digital imaging into your practice is not as overwhelming as it may seem. In most cases the cameras today are relatively easy to use. Moreover, you can see the quality of the picture immediately—no more waiting for 1-hour processing or even weeks before you complete a roll of film. If you are not happy with the result, you can retake the photo.
How do you get started once you have the camera? Your first step is to take a great “before” photo. This is by no means a glamour shot, but a few guidelines should be followed. First, try to have a monochromatic background. I buy a $2 gray fiber board for this purpose. I simply place this behind the patient’s head. This portable tool hides the treatment room from the photo and can easily turn each operatory into a photo studio.
Next, lower the chair and remove the patient napkin. I stand at the foot of the chair,  while the patient looks up at me. That makes the patient look younger by eliminating the folds in the neck. The gray fiber board is behind the patient’s head. Then, have the patient look up, and frame the midline in the center of the shot. Ask the patient to smile, and immediately snap the camera to capture a new, natural smile. In addition to the smile p hotograph, take one with lip retractors to fully capture the appearance of the teeth. If you are too far away, then you can crop the photo with an easy-to-use photo-paint program that comes with the camera.
You now have the “before” picture. Once you have the image, download it into the patient’s electronic record. If you do not have an electronic file, then create a folder with that patient’s name on it, which you can place the digital image into. This photo, and any other photos you may deem important, can serve as invaluable reinforcement for the patient’s purchase decision during follow-up appointments. Nothing beats the patient being reminded why he or she came to see you for treatment. It is amazing how quickly such things can be forgotten.
Even though you can choose to create the digital imaging of how you will change that patient’s smile yourself, you can also have the “after” digital mock-up created for you. For me it is an easy decision. I leave it to the LUMIsmile professionals at Den-Mat Corporation. The artists are professionally trained to understand your comments and directions to achieve the result you want to demonstrate to patients. LUMIsmile is a Den-Mat service that offers professional imaging for LUMINEERS BY CERINATE noninvasive veneer cases. This service is also useful for more traditional veneer, crown, or bridge cases when the situation requires a more invasive approach. These images are created by artists to produce realistic and achievable results. Two LUMIsmile options are available: the LUMIsmile Custom and the LUMIsmile Library. On a LUMIsmile Custom image, the artist renders each tooth individually according to your prescription. The natural dentition (Figure 1) is also taken into consideration. If the artist notices that a few more units may better improve a smile, then you will receive an additional LUMIsmile depicting this option at no extra charge. The LUMIsmile Custom image (Figure 2) offers the greatest diagnostic value.
The LUMIsmile Library images (Figure 3) are created using aesthetic renditions of teeth from the LUMINEERS Library to simulate the improved smile. Although LUMI-smile Library is less costly than the Custom image, I have found that you lose some of the personalization that makes imaging so effective. In addition, the LUMI-smile Library image illustrates a full-arch improvement. It is recommended that these images be used only for patients with no complicating issues. The LUMIsmile Custom will generally resemble the final result more closely than the LUMIsmile Library. (Figure 4) Regardless of the option you choose, simply send the “before” images to This e-mail address is being protected from spambots. You need JavaScript enabled to view it , and the completed image file will be e-mailed back to you within a few business days. Once you have the LUMIsmile, the next step of the consultation is to demonstrate what LUMINEERS or other treatment options can do for the patient.
Perhaps the greatest challenge to using a digitally enhanced image is to let go of how you have always prepared for and presented your consultations. I learned this very quickly with my first digital imaging case. Once the digital images were ready, we called the patient to have her come in. As I ventured into this new digital age, my first response was to fall right back into the old pattern. The patient requested that the images be e-mailed to her. What a novel idea! Once she had the images in front of her, she immediately e-mailed me and asked, “WOW…how much?” I no longer had to discuss the benefits of the procedure when she could see them so clearly herself. I was thrilled with my newfound success, but then I did not hear from her. I had no idea what had happened. A year later, she called and made an appointment. The price did not deter her, but rather she was so motivated that in that year she had saved for the procedure. She printed the images and actually framed them as motivation. I wished I had known, as we would have offered her the option of CareCredit! She wanted her new smile more than ever. This patient taught me a new way to consult, and also the importance of addressing objections upfront. While needs and wants may vary, price and pain remain the 2 universal objections.

Figure 5. The patient preoperatively.

Figure 6. Digital imaging shows the patient what she could look like.

Figure 7. The completed dentistry.

THE ROAD TO ACCEPTANCE

Don’t be afraid to offer luxury. Patients are willing to pay for what they want. Cosmetic dentistry is not about price, it is about personal transformation. For a habitual grinder, being able to show a beautiful, full smile in his wedding photographs is invaluable. Digital imaging dispels the financial objection in several ways. First, it provides a preview of the purchase. Second, the patient can show the imaging, the impossible made possible, to friends and family to enlist their opinions on the purchase. Finally, the digital LUMIsmile image enables patients to evaluate the purchase on an emotional as well as financial level.
Of course, most patients will have some financial constraints no matter how greatly they value the procedure. Confront the financial questions upfront. Let patients know about financing options such as CareCredit. Do not assume that a brochure in the reception area is enough.
Addressing the discomfort (spelled p-a-i-n) of a dental procedure is a bit more complicated. The average person associates the dentist with drills, shots, and pain. For some patients, this perceived pain far outweighs any benefits that may be gained from cosmetic dentistry. Although pain is an inevitable byproduct of many dental procedures, it is not for all. Composite restorations, whitening, and noninvasive veneers frequently do not require local anesthetic or result in postoperative sensitivity. These viable options should be presented to patients. Also, you may find that once you eradicate the fear, the strength of the financial objection lessens.
Pain and tooth reduction can be a hindrance from the dentist’s perspective as well. For years I hesitated to place veneers or crowns on a patient with multiple diastemas (Figure 5). Cosmetic composite restorations were placed as an alternative. Although the bonding repeatedly needed to be polished and reshaped, it was more desirable than reduction of such healthy tooth structure. However, at a recent appointment I was able to offer her a new alternative: LUMINEERS BY CERINATE. To illustrate the dramatic change that could now be accomplished with a procedure no more invasive than the composite restorations already in place, a LUMIsmile was created (Figure 6). She was thrilled at the prospect, and I was finally able to give her a lasting and aesthetic smile (Figure 7) while preserving the integrity of her teeth.

CONCLUSION

Change is the one constant. In today’s digital age, change is occurring at an even more rapid rate than ever before. Technology has dramatically altered the way we operate in our personal lives, yet many of us persist with an outdated business model. If nothing else, I hope I have enlightened you to the possibilities technology can offer your practice. Whether you fully integrate your practice or simply introduce digital imaging case presentations, the choice is yours. The world of tomorrow is here. How will you use it?


Dr. Freydberg, a full-time practitioner, is a 1968 graduate of the University of Illinois College of Dentistry, receiving its Most Distinguished Alumni Award in 2004. He is a fellow of the AGD, the International College of Dentists, the American College of Dentists, and the International Academy for Dental-Facial Esthetics. He has lectured and published on the subject of computerization of the clinical and management aspects of the dental practice. He is also a consultant to the ADA Council on Dental Practice. Dr. Freydberg is an active member of the Chicago Dental Society and can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or by visiting the Web site hitech2thdoc.com.

Disclosure: Dr. Freydberg lectures for Den-Mat, which provides educational funds for meetings.