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Many of the world’s greatest literary achievements were created with a pen or typewriter. And then, along came computers and word processing software such as Microsoft Word and Apple Pages. Did anyone notice an improvement in storytelling? Maybe it got faster, but digital tools did not expand anyone’s imagination, or did they?
Computers help people spell better and write in a more grammatically correct manner. Using computers, people may not have become any more creative, but they certainly have become more efficient. Has this freed them up to be more expressive and inventive with their writing? Dentistry is at a similar crossroads. Digital dentistry techniques will not necessarily make you a better dentist or more creative overnight, but in my experience, they will improve your technique, and make your dentistry more predictable and efficient, just like the word processor did for writers.
I have heard many dentists complain that digital technology cannot make you a better dentist. In my opinion, that is not the case. I know because I am proof. I am just an average clinical dentist, but because of digital pathways, I can do things in dentistry that I could never imagine doing, and I can do the basic tasks effortlessly.
It should not be a question of one over the other
When it comes to dentures, implants and full-mouth reconstructions, digital pathways have made my work more predictable and time efficient, but I am not ignoring analogue techniques because I employ more digital ones now. Ever since adopting intra-oral scanning almost ten years ago, I have only made a small handful of physical impressions for routine crown and bridge cases, but I still use analogue workflows for larger cases.
Analogue and digital workflows are like good friends, especially for complete dentures and implant workflows. They just work together. When dentists ignore digital pathways because they believe it can only be one or the other, they are mistaken.
I am a better digital dentist because of my analogue mindset. In my mind, the digital pathways that I take are no different from the analogue workflows, except that I eliminate the polyvinylsiloxane. In addition, digital technology enables me to leverage the data I collect for design and production or, at the very least, share it more easily with a treatment partner.
In a denture workflow, for example, you can choose the analogue workflow, taking a traditional custom tray impression using polyvinylsiloxane, or the digital one, using an intra-oral scanner. You scan the identical arch, do a fully digital design, but ultimately, you get to that same point as you would with a physical impression.
Our inclination is to separate digital and analogue workflows, to treat them as if they are competing, but I argue that there is no such thing as a 100% digital dentist, just like there is no longer a need for a 100% analogue mindset. Our clinical reality is that we should be thinking about how analogue and digital can live together.
Studies have clearly documented that digital pathways for any number of indications are at least as accurate as analogue. I am not sure that anyone would argue about which one is faster or more comfortable for the patient. But again, I am not saying you need to choose one over the other. I think we should be taking advantage of both digital and analogue techniques to provide the optimal treatment for our patients.
Making the case for digital and analogue hybrid workflows
On my instructional website, learndentistry.com, you will notice that nearly every one of the cases that I demonstrate utilises both analogue and digital pathways. This is especially true for denture workflows when the maxillomandibular relationship must be accurately documented. You simply need to use an analogue technique to do this, for example a conventional wax recording technique. The studies I have reviewed have not concluded that this can be done both accurately enough and simply using a digital pathway—for now. Once you determine the relationship, the occlusal rims can be scanned and then you return to a digital workflow for design and production.
Likewise, beginning your denture workflow with an intraoral scanner has tremendous advantages too. Intra-oral scanners capture oral tissue in a passive state. You create a mucostatic impression that can result in a much better fitting denture, especially when your patient presents with thin, flat, sharp or flabby residual ridges. If you are still one of those wondering whether you can accurately scan edentulous patients, the literature supports that it can be done, and I know because I do it regularly in my clinical practice.
I encourage you to go to my website or the 3Shape case study page to review cases. There you will find real-world examples of how the two pathways work together to provide terrific treatments.
If you are not using an intra-oral scanner at this point, I suggest you consider it. You can get started with simple crown and bridge workflows, send the cases to your laboratory partner and, when you are comfortable, expand your repertoire.
Going digital is not about learning new techniques; it is about doing what you have always done, digitally. I will say, however, that being digital means that you will need to improve your tooth preparations, but that is a skill any dentist could use, even if he or she decides to throw out the scanner the next day and go back to conventional workflows. To tell you the truth: once you get used to intra-oral scanning, you will never go back to goo.
This article was published in digital—international magazine of digital dentistry vol. 3, issue 3/2022.