Digital Communication Continues to Evolve

Advanced devices help dentists and laboratories efficiently and accurately share important information

Keith Miolen, CDT

Communication between the dental practice and the laboratory has always been paramount to successful restorative case outcomes in our industry. Until recent years, communication pathways connecting the dentist and patient were limited to a written prescription, a series of phone calls, or a visit by the technician to the office for custom shade taking or assisting with an adjustment. Times have changed dramatically. Digital technologies have not only altered our means of consistently fabricating restorations and revolutionized the materials we use, but they have also dramatically changed how the dental team interacts and communicates with each other. These digital advances have opened the gateway to easily access and share patient and case information, which is changing the mindset of all involved in the restorative process. From digital photography, text messages, emails, intraoral scans, and digital shading to virtual implant planning, the rapid expansion of digitally enhanced communication tools has extended far beyond the simple analog written prescription or phone call. This article examines the various digital tools available to the dental team and demonstrate various ways that incorporating multiple digital methods can offer positive results for the dentist, technician, and most importantly the patient.

The upside to these new digital communication pathways is that they are free or relatively inexpensive. The downside for some is that the options are easy to use and diverse. Large and small laboratories alike will find that their client bases are extremely diversified in their preferred digital communication methods. Thus, it is imperative to offer a multitude of ways that clients can communicate based on the digital options they are most comfortable using. Many dentists send text messages, sometimes with photos, while others find emailing from their offices most convenient. Whether for a large or small laboratory, digital communication technologies have helped level the playing field for fabricating consistent and functionally accurate final products. However, it is vitally important that all parties are mindful to ensure that any digital communication pathway used is compliant with HIPAA laws.

Cameras/Digital Photography

One of the earliest methods of digital communication introduced to our industry was digital photography. Previously, analog prints that were sent with a case provided very little information or details. These images where most commonly used to relay profile information such as irregular teeth planes, a "cant" or asymmetrical smile, any preoperative midline issues, or simple pre-operative pictures to document the starting point of the restorative treatment. The images were often taken from several feet away, so properly capturing anterior and posterior teeth without blurring was difficult. Digital images, though, can be magnified and focused to provide enhanced detail without blurring. It is now common for clinicians to incorporate digital photography in order to properly evaluate cases, with the color of the natural dentition to help in selecting a shade, treatment planning, and capturing gingival contours, as well as documenting cases for marketing, publishing, and lecturing. Helpful features of today's cameras range from non-industry-specific capabilities such as easy framing and cropping, to specific modes for dental needs. Digital images can also be easily transmitted via web-based cloud portals set up to transfer data in conjunction with a clinical scan. There is typically no fee required and the laboratory can easily print the images. Smartphones and their ability to capture high-definition images are also contributing heavily to our industry's growth in the use of digital communication. That said, HIPAA compliance must always be a priority to ensure that a patient's personal information is protected.

Face Scanning

Several face scanning providers take digital photography to the next level. Once a patient is scanned, the file can be sent to the laboratory and integrated into design software. This protocol provides for an elevated mode of communication that the laboratory can use to diagnostically work up the end result of the case in a digital format, superimpose the patient's face on the case, and send the combined file back to the dentist. The dentist can make suggestions on esthetics, tooth placement, tooth alignment, and more, as well as share the image with the patient to solicit feedback and case acceptance. This can all be accomplished before a bur touches a tooth, so everyone is well informed and aligned with regard to case outcome expectations.

Intraoral scans are also significantly improving the level of accuracy and fit of restorations, as compared to traditional impressions. Many intraoral solution providers employ an HD camera feature to assist with establishing margins accurately and provide shade accuracy.

Smile Design and Augmented Reality

Several solution providers have incorporated smile design features in their CAD software, and some have introduced augmented reality features and apps. These are all designed to attain the greatest level of communication among the entire team, along with the patient. Utilizing smile design principles that are overlaid on the patient's existing dentition, or providing the patient with an augmented reality smile that virtually changes their teeth's appearance, provides for greater case acceptance and more desired outcomes.

Digital Shade Matching

A variety of software modules accept digital photos for matching the shades of existing dentition; the file is converted through an app or software, and a digital map of color and shade matching is output. The attributes of digital communication are bountiful, eliminating deficiencies of years past, such as visits to the operatory for custom shade taking and manually matching the color layout of existing dentition. A key factor in the success of these apps or software modules is regular calibration to zero in the color profiles of the software, instead of relying on the prefabricated shade guides. Digital shade matching applications often include a variety of shade guides, ranging from VITA classic and VITA 3D to Chromoscope and even some older Bioform shades. The images of the tooth can be printed with the mapped color layout, displaying multiple colors within the tooth and their locations. The cost of these programs is minimal, and in addition to grafting a custom shade, they can help with simple quality control for shades, whether the laboratory develops custom shades or uses standard ones.

Implants

Digital communication has progressed significantly within the implantology arena. Today's clinician can transfer important bone information through cone beam (DIACOM) and other information via intraoral (STL) scan files. DIACOM files provide detailed information on the patient's bone structure, nerve location, and sinus, making it possible to create a virtual cranium for planning and fabricating surgical guides to assist in implant placement during surgery and for treatment planning prior to the actual procedure. This method is much more accurate than manually placing an implant from a typical analog guide or a simple x-ray. Pilot or surgical guides can be digitally manufactured via milling or printing from an implant manufacturer or laboratories with those capabilities. An STL file is established when a scan body is placed on top of the implant platform and scanned either in the mouth or on a stone model. These file types are equally dependable after implant placement and osseointegration, thus opening avenues of communication between the dentist and laboratory.

Interactive Case and Production Software

Scanning models for case-specific implants, scanning a patient intraorally, scanning a tooth for shade mapping, and scanning a model for fabrication of a restoration are all important. Scanning of bar codes for scheduling, however, is an entirely different digital communication tool.

In years past, clients often called laboratories requesting updates on the status or progress of a particular case. Today, these questions can be handled much more easily via certain production software, without the need for the laboratory to spend time on the phone with the dentist's office.

Several of today's production software programs require scanning bar codes on prescriptions or laboratory production formats to track the workflow of cases. Some software is interactive, allowing the clinician and staff members to track their cases based on each of technical department scanning within the laboratory scanning a bar code. Even non-interactive versions of this type of software can help the laboratory's management track cases and production yields per employee. Advances in bar coding prescriptions and bill formats have contributed immensely to staff evaluation, workflow, and the actual placement of a case if an update is requested by the client.

HIPAA Considerations

Looming among all these communication technologies are HIPAA concerns. HIPAA—the Health Insurance Portability and Accountability Act—was passed to protect a patient's privacy, medical records, and other health information. In order to comply, laboratories and dentists must avoid including certain information when transmitting data via unsecured digital platforms: full names; geographic subdivisions smaller than a state; dates; phone or fax numbers; email addresses; Social Security and medical record numbers; URLs; and full-face photos. These issues can be avoided either by utilizing platforms that are HIPAA-compliant in their security, or by gaining the patient's consent to the distribution of data to other healthcare professionals. In the author's experience, most patients are agreeable to this. Documentation should be explained and a waiver signed in these cases.

For more information on HIPAA, go to insidedentaltech.com/idt1055.

Conclusion

Digital communication platforms continue to evolve as technology makes it easier to share more information among the entire dental team. As long as HIPAA compliance is a priority, these options can help both the dentist and the laboratory produce better results for the patient.

About the Author

Keith Miolen, CDT, is the Chief Operating Officer of Aurora Dental in Auburn, New York.