Is Digital about Transforming What We Do or Replacing What We Do?

Todd Ehrlich, DDS, FAGD

Most clinicians have an “analog” dental education and experience. It is predictable, and it works. Unfortunately, changing over to a digital restorative workflow can be problematic. The problem is not inherent in the technology, but in the user, as practitioners can become set in their ways, and those ways become comfortable. Of course, the longer we live in that comfort zone, the harder it is to get out of it. It is absolutely part of human nature to want to stay in a comfort zone, even with the knowledge that there are better alternatives.

One phrase that I’ve heard dentists say many times is: “Well, it doesn’t work in my hands.” When I hear this, I absolutely believe them, but may disagree on WHY it doesn’t work. I believe that the hands can’t do what the brain won’t allow them to do, and if the brain wants to stay in a safe and certain realm, it won’t allow the new skills to develop.

Therefore, moving into a digital restorative practice style from what was originally learned can be very intimidating and scary for some. For others, it can be enlightening and energizing.

The mindset of the clinician will completely dictate whether or not the transition will be perceived as a positive one or a negative one. A dentist with a positive mindset allows the efficiencies of digital restorative dentistry to transform his or her practice and experiences the benefits that come with it. I’ve spoken to hundreds, if not thousands, of dentists who are contemplating moving into digital dentistry. The most common misconception is that it will completely replace what they have been doing for years. Yes, it very well could in some aspects, but it doesn’t change your morals, your ethics, or your restorative mindset. Clinicians can keep doing what they are comfortable doing, but transform the process to involve a digital scanner. You could say that it is replacing the impression material, but it is really just speeding up the process, and aren’t we always looking for a faster impression? Nothing is as fast as digital.

The fear of completely changing one’s successful restorative patterns is what makes digital so intimidating. A clinician who enters digital dentistry with an open mind, dedication to learning, and confidence in his or her choices for restoring teeth will have the best success with integration.

Joe Gaudio, DDS

Digital is about transforming what I do in my day-to-day practice, not about replacing what I do. I’ve embraced the accuracy that digital technology affords, but at this stage, I feel that the technologies available are not replacing what I do. Larger cases that involve proper work up with an occlusal or functional analysis still require that I’m hands-on in finding CR/CO relationships. And although the mounting on an articulator may be coming virtually, for now, I feel that I have much more control over these relationships that we have to establish before provisonals can go in the mouth. Ultimately, we must still work out the function by having the patient “test drive” these restorations before we finalize them, but the transformation to digital has given me the opportunity to treat patients that need same day dentistry and make them comfortable with the steps involved. My preference is to use lithium silicate restorations, which require crystallization before insertion, so sometimes it actually is more convenient to come in a day or two later, unless the patient is only in town for that day. In other words, for me, the transformation is about the options that digital dentistry provides for us, not the desire to “fire my lab.”

Gisele F. Neiva, DDS, MS, MS

There is no doubt that digital technologies are gradually becoming mainstream in many fields, including dentistry. However, what appears to be a natural evolution of “how we choose to do things” does not come without some controversy, especially if we take into consideration dentists who believe they are already quite successful and predictable using analog methods. The presence or absence of a deeply ingrained mentality to maintain the status quo and resist change is probably what determines if one sees digital innovations as a way to replace processes rather than an approach to transform workflows.

Given that it would not be practical for a practice to make a significant investment on digital technologies and then only use them sporadically, one’s level of commitment also likely colors their views on implementation. Some of the potential barriers include uncertainty if the team will be receptive to digital and engaged to make it work, doubt surrounding patients’ ability to accept change and adapt to the most common new methods, and concerns about how long it will take for the practice to get return on the investment.

Having the perception that digital can transform how we practice dentistry may require a change in mindset. It is important to understand that there is no need to change the dentistry. A dentist can and should continue to apply the same principles of cavity preparation, field isolation, and tissue retraction that are necessary for analog impressions when he or she chooses a digital approach. The change may appear intimidating and challenging at first; however, when there is an understanding that there is no need to replace what we do, but rather transform how we do it, the incorporation of new ideas, new processes, and new workflows is perceived as an enjoyable challenge. Ultimately, digitally transforming a practice requires a “champion”—someone who is committed to make it work and maximize the benefits of the paradigm shift.

Interested in learning more about CAD/CAM? Inside Dentistry has you covered:

Read our 2017 Tech Issue for charts comparing various products, peer-reviewed clinical articles on digital dentistry, and more at: insidedentistry.net/2017/07.