Standing at the Crossroads of the Digital Age

Take the first step toward faster, more profitable treatments with CAD/CAM

Bernie Stoltz | Dennis Marvel, AAMS, MTC

It arrived quietly, but the digital age is here. You are standing at a crossroad and need to decide which road to take. You look behind you and see that the bridge you crossed has been burned—there is no going back. You must decide.

Technology and dentistry have collided with patient desire. It’s no longer a decision of “if” to implement digital CAD/CAM dentistry. It’s not even a question of “when.” Your patients want treatment that is faster and more affordable. Can you achieve both? Absolutely.

The first step is deciding which system you will choose. When making your decision, consider the following actions:

• Test drive your preferred options and decide which produces the best clinical outcome.
• Determine which system is easiest to use and the best fit for the dentistry that you practice.
• Identify which system has the best support and most established community for its customers.

Remember, no dentist is an island. Find three colleagues who have implemented the platform you prefer and ask them for feedback. Once you’ve established your clinical preference, the business model is easier to define.

Now that you have made the choice, you will begin the “dance of implementation” that all dentists have to endure if they don’t want to be left at the crossroads. The number one challenge to overcome is fear. The fear of change can be worse than the change itself. Be an active force in the change and have a plan, a date to begin, and the flexibility to adjust course as you learn and your skill sets grow.

All new skills start with education, and this means training. Choose a system that has an integrated training program you can take before installation. I have heard personal accounts about sales representatives who offer to reduce the price if the doctor declines the training. Don’t do it! Finally, bring your assistants along for the training—even if it costs more. They are going to become your lab technicians, and they need the training to do the job well.

Once the training is completed and the installation is scheduled, it is time to create a plan. Implement a 12-week plan that allows you and your team time to develop the first steps toward mastery and build confidence. I believe it is helpful to approach this in three phases, which can be reduced if confidence is achieved faster than expected.

To minimize the impact on productivity, schedule the installation to occur on a day that your office is closed. For offices that are open 6 days per week, choose the last patient contact day in the week. After the installation is complete, use the two weeks that immediately follow as an experimentation phase. During the first week, have one of your assistants scan another team member each day. Scanning skill and speed will be critical to your overall success with CAD/CAM dentistry. They should also scan a diagnostic model with a molar crown prepped and design an actual crown for that tooth. It is important to note that, while the doctor needs to be mastering this technology too, the intent here is to create a team-driven process. Designing restorations in a computer-aided design system is like playing a video game, and making the restorations is like arts and crafts. While most dentists enjoy both activities, they are not always an effective use of your time or your skills. The doctor’s primary role is to make any final adjustments needed to the design before milling begins, so supervise and mentor—don’t take over the whole process. The final task in the first week is to identify four patients for participation in the last half of the experimentation phase.

In the last half of this phase, you want to arrange at least one crown preparation per day that is scheduled for 30 minutes longer than your usual blocked time. Before taking impressions, have the assistant complete a scan of the prepped tooth, then perform your impressions as usual. Next, randomly choose half of the scans to actually mill and cook. A few minutes should be blocked after hours each day for the team to collaborate on the design, milling, and glazing process. Once complete, you can compare these restorations to the ones done in the lab and get a feel for the fit of both restorations during the same appointment.

In phase two, your team is going to begin performing same day restorations. I have found that scheduling three hours for these first patients is sufficient, but you can add 30 minutes if it feels more comfortable. The first hour is for prepping, scanning, and designing, so the doctor should be present to supervise. Once the milling begins, you can move on to another patient. After the crown is tried in and a bitewing image is taken to verify the margins, you can supervise the final stain and characterization prior to the glazing cycle. At this time, you are free again to see other patients until the final try-in and cementation. Your goal is to produce a restoration that is equal to or better in quality than those produced by the lab.

Communication is a critical component in this part of the process. Inform your early CAD/CAM patients that you are using a new technology that will allow you to scan their tooth and mill their final crown. Emphasize that, because this is a new procedure, they may have to leave with a temporary and return another day to have it cemented, but should only need one visit and won’t need to have impressions taken. Lastly, be sure to offer third-party patient financing in your payment options and during financial conversations to help your patients move forward with the recommended dental treatment.

Phase three is all about efficiency. Put stopwatches next to your design computer and at your milling and glazing station. Time and record every single step of the process and try to reduce the time required by 25% per week. Your ultimate goal is to cut your appointment times in half within a month. Then you will be ready to start adding more complex restorations into the mix.

Don’t be intimidated by the digital age. Take the first step. Commit to implementing the technology that your patients are looking for, and you will look back on this crossroads from a new peak in your career.

About the Authors

Bernie Stoltz is CEO and Dennis Marvel is the Managing Partner of the Pacific Northwest for Fortune Management, one of the nation’s most recognized and sought after organizations on practice management.