Pick Up the Pieces

Paul Feuerstein, DMD


As we strive to create new-age, high-tech offices, the permutations of the equipment are getting more and more confusing. We are being pushed to get the latest digital x-ray sensors (the “new and improved” models, of course), implying that the ones we have been using the past 10 years are no good. And let’s get rid of impression material and get the latest and greatest intraoral scanning systems. The older models were good for their time, but the new ones are much better.

In this past August’s CLINICIAN’S REPORT (cliniciansreport.org), Dr. Christensen offered this observation, based on the evaluators’ reviews: “Digital impression scanning and in-office milling provide alternative treatment options not possible with conventional techniques. The newest scanner models and upgrades are faster and easier to use. The greatest advantage of in-office milling is elimination of the second appointment. Use of digital impressions will increase, while in-office milling will continue to grow slowly.

“Major limitations continue to be cost and complexity of integrating new technology and digital workflow into clinical practice. The majority of users and patients are satisfied with performance.”

So what are we to do now? Ditch the old technology and get the new one? Pay an upgrade (usually a trade-in) of $10,000 or more? With the current models in the marketplace, they are all accurate; differences are in design, software, speed of acquisition, color, and more. But how important is it to have the fastest, slickest unit if the endpoint/accuracy is the same? We are now trying to build our “system” in the same manner we would build a stereo system or buy a new car while comparing features that may or may not make any difference in the end. And who can you turn to for help with these “what do I buy” decisions? Surely my reviews and those of my colleagues will give you some guidance, but my needs and visions may not match yours.

Let’s confuse this even further with the addition of cone beam units. We are being told that we cannot practice without these units. And looking at some of the manufacturers’ models, we are faced with choosing one of the 8 or so models they are showing! In fact, we are being told that we need both the intraoral scanner and the cone beam together. Sure! Why not spend $75,000 to $250,000 to get up to speed. Of course, the “experts” show us how this “modest” investment will provide a return far beyond the initial costs. But is it believable? If you read Dentistry Today’s clinical articles or go to seminars, it actually seems to make sense. Dr. Michael Tischler, Dentistry Today’s implant editor, presents cases and situations monthly in the magazine that seem to validate this upward move. But still, this question lingers: How do you make such a decision?

There are 2 strong forces now in our industry that are actually trying to be helpful. Their ultimate motive, of course, is to sell equipment—or in these cases, systems—to practitioners. I am talking about Dentsply Sirona and Henry Schein. CEREC is almost a household name now. When I talked with Michael Augins, Dentsply Sirona’s senior vice president and regional commercial officer, I said that there are many new scanners that are faster and perhaps slicker than the current Omnicam. Michael said that Dentsply Sirona knows this but is more focused on the entire system and workflow. It is teaching a system that includes cone beam integration that is a turnkey operation; you can purchase and install these newer, faster “components,” but there is no thought about how to make the parts talk to each other and create the restorations for the patients. Its system enables the practitioner to decide what he or she is looking to do clinically, then let Dentsply Sirona guide him or her to that path. Because all of the components are from the same source, it has total control over integration and solutions.

Not standing idly by, Henry Schein has launched ConnectDental. Unlike Dentsply Sirona, it has an enormous array of products and manufacturers. In addition to intraoral scanners, cone beams, and digital x-ray sensors, there are also several other products that can be integrated into the workflow. Schein representatives help practitioners determine what path they are taking, then mix and match the components and integrate them, taking that headache away from the office. Again, the practice establishes a goal. What Schein is doing is taking away the responsibility and tedious comparative research from the practitioner and choosing/integrating the components that will best get to that end. Additionally, it is coordinated under one supplier/installer, so there are not multiple calls to individual manufacturers for any troubleshooting. Benco, Burkhart, and others are also assembling packages of components in the intraoral scanning/design and milling arena. By the way, Carestream has just launched an integrated system with its CS 3600 scanner and cone beam systems that is called PDIP (prosthetic-driven implant planning). I will be getting more information on this shortly.

Another issue is post-installation training. Patterson Dental (cereconline.com) and Henry Schein (planmecauniversity.com) include the basics and also offer advanced training, either live or virtual. There are also courses being offered in the branches as well as at dental meetings for honing this craft. Additionally, there are several excellent practition-ers and websites that offer advanced training, with or without the blessings of the motherships. Among them are Mark Morin (drmarkmorin.com), Samir Puri (cerecdoctors.com), Tarun Argurwal (3d-dentists.com and asktbone.com), Todd Erlich (digitalenamel.com), Armen Mizaryun (cad-ray.com), James Klim (cadstar.com), and the website located at learndigitaldentistry.com.

The bottom line is this: if you’re comfortable putting together a system and setting things up, go right ahead. Others may want to spend time with patients and won’t want to deal with how these things work. Just head in with your eyes open.

Also by Dr. Paul Feuerstein

“Let It Grow”

The Shape of Things to Come

Somebody’s Watching Me