30 INTERVIEW Dental Tribune Middle East & Africa Edition | 5/2021 The Digital Age with Dr Patel By Dentsply Sirona Dr Neal Patel, a dentist and a certified dental technician, opened Infinite Smiles in Powell, Ohio, in 2008. An authority on 3D diagnostic imag- ing with CBCT and same-day dental restorations with CAD/CAM, Patel travels the U.S., Canada and overseas to train doctors in the use of mod- ern dental technology in procedures such as computer-guided dental im- plant placement. He graduated from The Ohio State University, where he served as implant prosthodontic fel- low and helped establish techniques and protocols for digital implantol- ogy and prosthetics. The digital age When I opened my dental practice in 2008, I was awed by the transforma- tive power of technology. Through the years, I’ve stayed up to date with the latest dental technology trends to expand beyond private practice to teaching and research. Understand- ing the intricacies of new technology is hard work and takes a lot of time, but I believe it’s a requirement for successful modern dentistry. The lat- est digital tools—ranging from prac- tice management software and cone- beam imaging to intraoral scanning and chairside milling—have dra- matically streamlined processes and improved patient diagnosis and treatment in fewer visits. Digital den- tistry is quickly revolutionizing the practice of dental medicine, yet the concept still isn’t quite mainstream. Many practitioners are timid about investing in new and unproven digi- tal equipment, citing cost concerns and the time constraints of proper training. While there is a certain amount of risk involved, I believe in leveraging new technology to bet- ter treat complex cosmetic/beauty and restorative cases. Research has shown that integrated digital solu- tions can improve the clinical effi- cacy of dental implant restoration, compared with conventional analog dental implants.1 Our office’s digital platform is cen- tered around a highly accurate intraoral scanner, state-of-the-art cone-beam imaging, versatile prac- tice management software and the latest digital design and milling software and hardware. In our prac- tice, 3D CBCT is the cornerstone of care. The Axeos scanner (Fig. 1) from Dentsply Sirona is my imaging so- lution of choice because it offers a precise measurement of the teeth, soft tissues, nerve pathways and bone, and seamlessly connects with add-on technology. In addition, 3D diagnostic imaging offers patients a more interactive care experience, leading to increased case acceptance. CAD/CAM technology is a founda- tional element of our integrated digi- tal workflow for prosthetic implant placement and restoration. CAD/ CAM allows for imaging, design and chairside milling in one visit, making appointments more convenient for both clinicians and patients. These instruments, along with CEREC Primescan intraoral scanners, enable our practice to provide ex- ceptional oral health care to patients (Fig. 2). This entire suite of integrated solutions has transformed our prac- tice, allowing us to do more, better. For one, I use CBCT imaging data for implant placement (Fig. 3) in a range of other modalities, including sleep apnea, endodontics and orthodon- tics. With the newest addition to our digital arsenal, 3D printers, we’re able to scan, design, print and produce a range of applications, such as crown/ bridge models, surgical guides, in- direct bonding trays and gingival masks. Digital dentistry in practice In the traditional analog world of dentistry, several different varia- bles—the clinician’s experience and skill set, the lab technician’s skills and bandwidth, and the patient’s com- fort level—must all work in tandem; a single mistake can cause delays, worsen clinical outcomes, and pose a significant travel and cost burden for patients. The beauty of digital den- tistry is that it streamlines services across the gamut of dental care and comprehensive interdisciplinary procedures. In our practice, digi- tal technology has reduced clinical time for a comprehensive implant procedure by more than half—from eight visits to three visits from con- sultation to final fitting, as described below. Traditional analog dentistry: Visit one, the consult, requires obtaining a filmbased image for diagnostics and overall examination to determine if the patient is a candidate for dental implant therapy. At visit two, the clinician acquires diagnostic impres- sions for creation of a radiographic scanning appliance. At visit three, the patient is imaged with the scan- ning appliance with either 2D imag- ing or 3D imaging for evaluation of the future restorative plan relative to existing anatomy. If the patient is a candidate for implant, the clinician may prescribe additional grafting or creation of a surgical guide. On visit four, the patient is scheduled for implant placement. Visit five is traditionally a postoperative visit to ensure proper healing. Another appointment, visit six, may need to be scheduled to address soft-tissue Fig. 2 Fig. 3 Fig. 1 contouring or even uncovering the implant. At visit seven, the dentist obtains the final impression for the laboratory to create the abutment implant crown. Finally, on visit eight, the final implant prosthetic is seated. On occasion, additional appoint- ments may be required if the shade and contour from the previous visit were not appropriate. Keep in mind, extra time must also be built in for lab delays and additional cosmetic refinements if necessary. All of these factors can affect the patient because of time off from work and travel to and from appointments. Digital dentistry: At visit one, we are able to acquire digital intraoral scans of both hard and soft tissues using Primescan and merge that data with the Axeos CBCT image to design and place a virtual, custom- fit 3D prosthetic. The software allows us to provide patients with a visual representation of the implant and the procedure itself. From this data at the initial consultation, the den- tist and laboratory are able to create a surgical guide and even potentially an immediate implant provisional, using CAD/CAM with either mill- ing or printing technology. This re- moves all the analog methods of im- pressions and stone models, along with manual labor for fabrication of said surgical guide and provisional. On visit two, the clinician is able to place the implant fully guided with immediate prosthesis or even cus- tom healing abutment. Because of this minimally invasive procedure, additional follow-up visits may not be required. On visit three, we can provide the final implant restoration in a single visit with chairside CAD/ CAM prosthetics, which are fully cus- tomized and aesthetically matched to the patient’s smile. Empowering patients and build- ing trust We dentists expect our patients to trust what we stand for and what we have to offer. 3D diagnostic images help us build this trust because they help patients understand why they need a given procedure. Visual data and education help foster a mindset shift that increases case acceptance and patient satisfaction. A recent study has shown that dental patients are embracing the new era of ad- vanced digital technology and visual communications.2 My practice prides itself on being a front-runner in the latest technology and equipment. With CBCT as our “workhorse,” we are able to deliver highly personalized treatment with reduced chair time, fewer visits and more predictable outcomes— mak- ing for a better patient experience. When patients are more involved and engaged with their care, they are more likely to agree to our recom- mendations and interventions. Looking to the future Ultimately, dental professionals de- fine our practices by the experience our patients receive. Contemporary digital dentistry gives us an op- portunity to elevate our treatment modalities and results in the best dental care for our patients. Patients are more confident in our ability to manage their long-term oral health care, boosting the potential for long- term relationships and increased referrals. From a practice efficien- cy perspective, workflows can be streamlined and new service offer- ings can be uncovered, maximizing the potential of our practices. To cli- nicians who may still be hesitant to dive in: Now is the time to push for- ward! Of course, with anything new, there is a learning curve to adapt to the technology. The key to success and productivity is adequate train- ing and education for all of those involved in using the equipment. As you gain experience with today’s in- novative digital tools, you’ll be better prepared for the next generation of digital dentistry technology. It will be a win for the practice from a business and clinical perspective, a win for of- fice staff members who are working in a more modern, progressive at- mosphere and, most importantly, a win for your patients. References 1. Gedrimiene A, Adaskevicius R, Rutkunas V. Accuracy of digital and conventional dental implant im- pressions for fixed partial dentures: a comparative clinical study. J Adv Prosthodont. 2019;11:271-279. 2. Saponaro PC, Yilmaz B, Johnston W, et al. Evaluation of patient expe- rience and satisfaction with CAD- CAM-fabricated complete dentures: a retrospective survey study. J Pros- thet Dent. 2016;116:524-528.