PAGD Keystone Explorer Winter 2020

Let it be known, I hereby proclaim my adoration for digital dental impressions. For everyday dentistry, there has been no single piece of technology that I enjoy using more than my intraoral digital impression scanner, Trios 3. I often have conversations with colleagues about getting into digital dentistry, in particular digital impressions. While there are some legitimate obstacles to buying in, once you do, you certainly won’t regret it. Today’s market is flooded with digital impression scanners. 3Shape Trios, Medit, Caresteam, Sirona, and iTero are all excellent machines I can think of offhand. Each scanner has strengths and weaknesses. For years, many considered 3Shape Trios the field leader, but that gap has closed considerably, if not completely. Ultimately, when deciding on a new piece of equipment, it is important to consider what you will be using it for to make the right choice for your office. For instance, in my office, we do not do any orthodontics, including Invisalign. Due to legal battles, Trios impressions cannot currently be sent to Invisalign directly. Therefore, Trios users need to send using an alternative method or simply use a different aligner service, like Clear Correct, or fabricate their own in-office aligners. My everyday use of Trios 3 involves scanning impressions for crown and bridge cases, nightguards and clear retainers, surgical guides, removable partial dentures, including flippers, and immediate denture cases. The wide array of procedural uses makes investing in an intraoral scanner a “no brainer.” Many dentists ask “will intraoral scanning make me a better dentist?” The answer is yes… it can. Of course, it’s not going to improve your hand-eye coordination, but the ability to see your crown preparations up close will allow you to make the necessary modifications to get a better end result. Inadequate occlusal clearance is a common mistake seen in every dental lab. The capability of measuring occlusal clearance with the intraoral scanner makes sending your lab a proper crown preparation much easier—thus making you a better dentist! One underappreciated use for intraoral scanning is with removable prosthodontics. Especially in cases of mobile teeth, scanning your impression for a flipper or immediate denture can greatly reduce stress for both the patient and dentist. Of course, partnering with a digitally proficient lab will be important to the user’s success with digital removable impressions. While my love for intraoral scanning runs deep, there are some negatives to discuss. One concern is the financial cost, both upfront and ongoing for certain systems. In my case, the cost is well worth it for the comfort it brings my patients and the professional satisfaction it brings me daily. The other main drawback is that it can sometimes be more difficult to get a clear crown impression with intraoral scanning as opposed to PVS impressions. Specifically, gingival retraction becomes even more important when you need the tissue to remain displaced while the machine is scanning your margins. If you’re curious about intraoral scanning, talk to a colleague who uses one regularly. Go to their office and see the machine in use. Talk to the product reps and demo each machine. And most importantly, talk to your dental lab. Ask them which machine gives consistently great scans and easy workflow. Good luck and happy scanning. David  love letters From David Scardella, DMD 16 www.pagd.org