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900: Digital Workflow in the Restorative Practice – Dr. Daren Becker

More than ever, labs and practices are going digital. In this episode of Clinical Edge Fridays, ACT shares one of their latest Master Classes with Dr. Daren Becker, visiting faculty member at the Pankey Institute. He shares some of the key aspects of a digital workflow that will make your dentistry more efficient, precise, and comfortable for patients. Embrace and master these workflows to elevate your practice! To learn how, listen to Episode 900 of The Best Practices Show!

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Main Takeaways:

  • Create a system for scanning every new patient.
  • Digital is a helpful tool in planning, patient education, and motivation.
  • Scanners are great digital tools, but you need to have a system for using them.
  • Everyone on your team should be trained to use the scanner. It is that important.
  • If your labs do digital, send them scans. If they do analog, send them impressions.
  • Don't forget your principles in doing digital. Do a complete and thorough diagnosis.

Quotes:

“Let's talk about digital dentistry for a second. It's routine. It's every day in my practice. We don't really do anything that's analog. We don't really take impressions anymore. We scan everything. Everything is digitally designed. We're printing models, surgical guides, occlusal splints, trial smiles, and provisionals. Pretty much everything is getting printed either here or at the lab. It can be used for diagnostics and archives. Archives are huge because we have limited space in our practices. Most of us do. If you're somebody like me, for years and years and years, you had thousands of models on patients that you had to store, and you’d run out of space. Well, in the digital world, I can archive every scan I've ever made of a patient. It doesn't take up any room at all and it's available forever. So, it's really cool. We can design and treatment plan in the digital world, which we do routinely, and we can design and fabricate definitive restorations. That is our mode of operation here.” (13:10—14:38) -Dr. Becker

“If you are doing analog impressions, elastomeric impressions for your final restorations, you should definitely check with your lab and find out how they're designing and creating those restorations for you. What I mean by that is, most of the time, today, modern labs are doing everything digital. So, if you send the lab an impression, the first thing they do is pour it up in stone. Then, they scan that stone. Then, they're going to design the restorations digitally on their computer, and they're going to have them printed or milled. So, what you're starting with is a copy of a copy, and you throw in an opportunity for error and dimensional changes. So, if your lab is doing digital design and fabrication, you should consider doing digital acquisition of the data — meaning, digital scanning of those preps. And the opposite is true. If you have a lab that's a hands-on analog lab and they're hand-waxing and pressing or hand-waxing and casting, those people are going to take digital scans and print or mill models. Every time you switch between one and the other, you throw in a risk of error. So, if the lab is doing digital, you should send them scans. If the lab is doing analog, you should send them impressions. That would be my best advice.” (14:44—16:16) -Dr. Becker

“Dr. Pete Dawson said this almost 20 years ago. Digital dentistry in the absence of sound occlusal, esthetic, and restorative principles will only allow a dentist to screw up mouths even faster.” (16:18—16:32) -Dr. Becker

“In the analog world, we would make an impression. When you have multiple units, let's say multiple preps, sometimes that's hard. You go around and you're injecting your light body on the margins. You do one tooth, you do the second tooth, and the third tooth. You get to the fourth tooth and, all of a sudden, there's a little bleeder. What do we do? We do the same thing. We go ahead, and we keep going, and we hope we get it. Sometimes, you pull that impression and there's a defect in the impression because it's got blood on it. In the digital world, you go around, and you start scanning. If there's a spot that doesn't look good, you stop, you clean it up, you put some Hemodent, whatever you do, you dry it off, and you go right back to scanning. If you end up with your scan and there's something you don't like, you can go trim it away and rescan it. It's brilliant technology for that, and I think it really can make a difference.” (18:30—19:30) -Dr. Becker

“You may have variation in accuracy if you're not using a custom tray in the analog world. You have different thicknesses of material. You're going to have distortion. These materials shrink and expand. You have to have the right timing, you have to disinfect it, and all these things that you have to do with it that can affect the accuracy of it. There is a potential for distortion, as we just said, and contamination. The biggest one is no facial references. When your lab is looking at models, even on an articulator, and they're designing restorations or designing a wax-up, they don't have the patient's face in there — that's a game changer for us — and no ability to see bone. So, with data stacking in the digital world, we can put the photo, we can put the scan of the models, and we can even put the CBCT on that and look at everything all in one thing.” (19:32—20:28) -Dr. Becker

“From a patient education standpoint, I think there's nothing better than using a scanner. But we need to have a system for using these tools. These are just tools. This is simply a tool. So, in our office, our system is quite simple. Every new patient gets a scan, period. Whether they’re coming in as a new patient through hygiene, whether they’re coming in as a new patient with me for a comprehensive exam, we do an initial scan on everybody. It’s the starting point. Again, patient education, diagnosing, treatment planning. Then, later, as we start moving to anything that we're going to be doing, I’ve already got them. I’ve already got their scans in the system, and I can do whatever I need to do.” (20:39—21:23) -Dr. Becker

“By the way, all scanners are great. There are pluses and minuses to each one. They've all come so far that there's not one that's the better one and the worst one and whatever. They're all really, really good at what they do. This happens to be an iTero specific thing. I think TimeLapse is what they call it. If you watch the thing on the left, what you're going to see is it's going to flash between 2021 and 2025 scans, and you can literally see the gum receding. The patient says, ‘No, my gums have always been like that.’ You say, ‘Well, let's look at that.’ And I don't even have to say anything. You just wheel the thing in front of them, and you put that on there . . . and it's like, ‘Man, you might be concerned about that. That's actually a change in less than four years. You are having pretty significant change.’ It's the same thing with gum recession like that, as it is with wear on teeth, migration or shifting of teeth, and crowding of teeth. We can show them those changes that we know when we tell a patient, they go, ‘No, it's always been like that.’ ‘Really? I don't think so.’ Here, they can see it. It's really powerful.” (22:13—23:27) -Dr. Becker

“Here is the mock-up, or as Christian Coachman calls it, the motivational mock-up or trial smile. So, no prep on these teeth. We've just simply got the wax-up or the digital design. We made that matrix, we filled it with Bis-acryl, put it on the teeth, and he can look at it and say, ‘Oh, that's exactly what I wanted,’ or, ‘Oh, that's not what I thought this was going to look like.’ You can get a lot of feedback, and you can play with those. That can become a really helpful tool in your planning and patient education on their case, whether they are or aren't sure what they want to do.” (34:38—35:14) -Dr. Becker

“By the way, who scans? Everyone. Everyone is trained to scan. It's that important. Hygienists scan during hygiene recare. Assistants scan when we're doing any kind of restorative work, or if we need anything like whitening, whatever it is. The assistants do that. I will scan, so I'm proficient with it. I probably couldn't take a really great impression with alginate anymore because I haven't done it in a hundred years. So, we all can scan. It’s the most important thing. One assistant, my associate, and myself are proficient at using the printer, and there are a couple reasons for that. One is, no one else wants to — and that's fine. I'm not going to force the issue on anybody. I think the more people who can use it, the better. Really, only one person can do it at a time anyway. We have one printer. So, it's sort of the sweet spot for us. But you can do it any way you want.” (39:09—40:16) -Dr. Becker

“Going from digital to analog, that's where the puzzle gets interesting because at some point we are working on human patients. So, if we could stay in the digital world all along, it'd be awesome. But at some point, you've got to go back to the patient, to the analog world, and either make something that's going to go in their mouth or do something in their mouth. So, it's an extremely important step doing analog models and equilibrating on models from a learning standpoint, and also from a standpoint of gaining confidence and knowledge about the patient. So, what I just showed you in the digital world is amazing, and it's a time saver. But it's simply diagnostic. You can't learn how to equilibrate somebody on that. So, we're still going back to the analog world, and mounting models on an articulator, and actually adjusting the models on the articulator, both from a learning curve standpoint and from confidence and knowledge.” (55:32—56:38) -Dr. Becker

“When you go from the analog world to the digital world, the amount of adjustments you're going to do in the mouth is next to nothing. It's amazing how accurate this is. So, everything we're adjusting in the mouth is going to be like rubber wheel adjustments, to lightly addressing a heavy contact or a heavy occlusal spot. But they're pretty much dialed in. It's amazing how accurate this stuff is.” (1:21:11—1:21:40) -Dr. Becker

“We all have our best days. Your best day might be the day that everybody, at the end of the day, you gather in the conference room or something, and we high-five because we knocked it out of the park, and everybody is feeling great. That's what we want every day, right? The best day might be the day you seated those amazing veneers on this really beautiful lady, and she was so happy, and you were so happy, and everything came together perfectly. It might be the day you made a ton of money. That might be your best day. I don't know. It might be the day that you got those Master's tickets that you got to use to take your friend Kirk Behrendt to the Master's from your patient who had access to that. It might be the day that you weren't in the office. You were at the Hinman Dental Meeting, and you took your team, and you guys had a ball, and you learned some stuff, and you heard Kirk lecture, and it was all great. But it might be the day that you change someone's life, and it affected you emotionally. Those are pretty magic days as well.” (1:22:33—1:23:42) -Dr. Becker

“By the way, how many splints can I make by hand at a time? One. How many splints can I print at a time? Well, I design them one at a time on the software, but I load up the build platform as many as I can fit. I can print 10 or 12 splints at one time. So, I come back to the office from being at home overnight, and the printer was printing all night because that might take a couple hours, and there are 12 splints ready to go. All I have to do is trim off the supports and get it ready to go. It's a very efficient workflow, so I love it. It's great.” (1:35:48—1:36:26) -Dr. Becker

Snippets:

0:00 Dr. Becker’s background.

5:17 How to get in touch with Dr. Becker.

6:16 Course objectives.

7:52 More about Dr. Becker.

11:20 Disclosure of conflict of interest.

13:10 Digital dentistry.

17:10 Using digital for diagnosis.

20:28 Have a system for using these digital tools.

37:44 Q&A: Do your auxiliary team members support these systems, or is it all you?

42:02 Q&A: What is your opinion on scan path for wand scanners?

43:33 Mounting the upper scan.

48:43 Mounting the lower scan.

50:06 Evaluating centric stops digitally.

55:28 Going from digital to analog.

1:02:25 Digital occlusal splint design.

1:13:22 What about implants in the digital world?

1:22:22 Your best day in the practice.

1:23:43 Reestablishing an occlusion.

1:29:53 Conclusion.

1:31:36 Q&A: What did you bond on that PMMA with?

1:32:31 Q&A: Offset and undercut preferences for bite splints.

1:36:32 Final thoughts.

Dr. Daren Becker Bio:

Dr. Daren Becker began private practice in Atlanta, Georgia, in 1998 with an emphasis on comprehensive, restorative, implant, and aesthetic dentistry. He is the owner and full-time dentist at Atlanta Dental Solutions and is in a full-time fee-for-service practice.

Dr. Becker began his advanced studies at the Pankey Institute in 1998 and was invited to be a guest facilitator in 2006. He has been on the visiting faculty since 2009. In addition, in 2006, he began spending time facilitating dental students from Medical College of Georgia College of Dentistry at the Ben Massell Clinic (treating indigent patients) as an adjunct clinical faculty member. In 2011, he was invited to be a part-time faculty member in the Graduate Prosthodontics Residency at the Center for Aesthetic and Implant Dentistry at Georgia Health Sciences University, now Georgia Regents University College of Dental Medicine (formerly Medical College of Georgia).

Dr. Becker has been involved in organized dentistry and has chaired and/or served on numerous state and local committees. Currently, he is a delegate to the Georgia Dental Association. He has lectured at the Academy of General Dentistry annual meeting, is a regular presenter at ITI study clubs, as well as numerous other study clubs. He is a regular contributor at Red Sky Dental Seminars.

In addition to his enthusiasm for sharing his knowledge, Dr. Becker's strengths are in meeting and special event planning and CE program development. He lives in the Dunwoody area of Atlanta, Georgia, with his wife Amanda and their daughters, Alicia and Addison. He is passionate about fly-fishing and enjoys traveling, golf, and outdoor photography.
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