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  • Dr. David Alfaro

Digital Impressions

Dr. Dave, Dr. David P. Alfaro, Dentist, Richmond Dentist, Prosthodontist, Vancouver Dentist, Beer, Wings, Dental Implants

So another nerdy dental blog....sorry guys.

Kristie and I have been putting together some quick videos in the office of our Trios 3 digital impression machine and to my surprise, they have actually been viewed quite a bit, so I figured that I would let you know about the system itself. It would be boring to put all this information in a video.

Let us talk about the Trios 3 scanner.

What are dental impressions?

Dr. Dave, Dr. David P. Alfaro, Dentist, Richmond Dentist, Prosthodontist, Vancouver Dentist, Beer, Wings, Dental Implants

I am sure that many of you have suffered through the traditional goopy pastes and bulky trays that are required of traditional dental impressions. Whenever we dentists need any dental labwork, we must send an accurate representation of the dentition to the lab tech, and that is still usually done with impression material. There are a whole bunch of different materials that we can pick from depending what we are trying to do, and each one has advantages and disadvantages.

Having traditional dental impressions made is not the most comfortable experience for patients, and it sometimes takes a couple of tries to get things just right.......especially if your dentist is picky about results.

What are digital dental impressions?

Dr. Dave, Dr. David P. Alfaro, Dentist, Richmond Dentist, Prosthodontist, Vancouver Dentist, Beer, Wings, Dental Implants

Dentists can now take impressions with the use of intraoral cameras, and no longer need to rely on these pastes!

This technology has been around since the late 80's, and has been primarily utilized in "crown in a day" applications. Today's scanners are much more versatile and can used for a whole bunch of dental treatments.

The scanners usually consist of a "wand" or "gun", which is the actual camera component that captures the images. There is a huge range of systems out there; some capture still images one at a time, others capture a rapid succession of still images, and some capture data in video format. All of the systems use some sort of algorithm to stitch the images together to create a 3D model of the teeth and gums.

I have done a lot of research on digital scanners as it was a major component of my masters thesis and I have worked with a bunch of these systems. As a prosthodontist, I am often completing dental treatments that are more complex than a single crown, or a single implant, so I was hesitant to get a scanner because historically they had limited applications.

But things have changed. The new scanners are versatile, fast, and easy to use.

Here is the Trios 3 in action:

Why did I pick the Trios 3?

Even with all of the scanners that are available on the market, when I decided that they had advanced enough to be used in a Prosthodontic office, I did not hesitate to pick the Trios 3 as my first choice, even with the hefty price tag. I looked into at least a half a dozen other machines before picking this one.

I love lists. Let's make a list of pros:

1. Full colour:

Dr. Dave, Dr. David P. Alfaro, Dentist, Richmond Dentist, Prosthodontist, Vancouver Dentist, Beer, Wings, Dental Implants

There is nothing better for patient education than to be able to show them a full colour, 3D image of their teeth, gums, and bite, in a manner of minutes. During our consultations, Kristie will scan the patient (5 minutes), and we can review the findings right away. It actually has a "wow" factor. Patients can really see what is going on and are amazed by the technology.

Previously, to complete a case presentation, a patient would have to return to the office at a later date because we had to get models poured and I had to crop and edit photographs. It is done now for me by Kristie in less time than it takes to make a couple of alginate impressions. This may not be a benefit that can be measured on a spreadsheet (for those crunching the numbers to see if a digital scanner will save you money), but it is truly an invaluable asset to have the technology.

Shade matching has been surprisingly accurate. The lab gets so much information and you can overlay HD images in seconds. I know there are skeptics of it, and I was one of them, but the results are pretty convincing.

2. No Powder:

Various machines on the market still require the use of a powder spray on the teeth before scanning. This is unacceptable because it really affects ones ability to predictably start and stop the impression. Once you powder the teeth, if the patient brushes off powder with their tongue or cheek or even if the dentist or assistant does so while scanning, the field has changed. Most reps say that this is negligible, but for me that is a major problem.

The Trios 3 has no powder at all so we can start and stop the scan whenever we want, which is great when you encounter people who have strong pharyngeal reflexes for example. In fact, we can even begin the scanning one day and complete it another. People often come in on an emergency basis with something broken. If we do not have time to see them that day, we can easily squeeze in a five minute scan and get whatever we need for the next appointment. Furthermore....that scan can then be the basis of our crown or bridge impression, so all we need to do at the next appointment is scan the abutment once it is prepared, which takes 15 seconds. It has done wonders for our workflow.

3. Bite Registration

This is where I was skeptical about any scanner. How accurate is the bite really going to be?

It takes this scanner under 20 seconds to "take a bite" and the results have been amazing. With the ability to send the lab a pre-preparation scan, the bite registration is made before any preps are made, and the original occlusion can be used as a model for the future crown. My insert appointments are much shorter and I often do not even have to do any adjusting. I have only had to send back a couple of cases all year; a much lower rate than with my traditional impressions.

Furthermore, it is so fast that there is no reason to not send full arch impressions every time. How many of you are still working off triple trays to save time and money? This is a much better option.

Take a look at how quick it is:

4. Virtual Articulation

Dr. Dave, Dr. David P. Alfaro, Dentist, Richmond Dentist, Prosthodontist, Vancouver Dentist, Beer, Wings, Dental Implants

Trios 3 is made by 3Shape, which is a major player in laboratory technology, and they make both hardware for lab scanning, and software for 3D design and milling/printing of all sorts of dental work. Being such a design based platform, 3Shape has virtual articulators for pretty much every brand on the market. If you use a Panadent, or SAM, or a good ole Hanau articulator, the lab can set up your case on a virtual articulator with the settings that you prefer. I honestly don't go that far for most cases, but the option is there if I need it.

Talk to your lab. What do they use for their CAD/CAM design? I bet it is why not send them a file that fits right in? Oh.....and it is not a closed system so it can go to many programs in case they are not using 3Shape.

5. Evolution

This is the hardest thing about keeping up with technology nowadays. You buy something, and before it is delivered to your office, there is something newer, hotter and better out. It is a tough pill to swallow when you are dropping mega cash on a specific technology.

3Shape is software driven. They have designed the scanning systems to be able to have the software upgraded so you can be running the latest versions on older versions of the scanners. For example, 3Shape recently released an update for Trios 3 scanners called "insane speed", which sped up the scan time to a truly unbelievable speed. This update was also available for the previous Trios model, so even though people are using an older scanner, they can reap the rewards of the software advances.

6. It is just easy and versatile

You just have it to try it to really understand. The software is quick and intuitive. It is really easy to fix mistakes if you have say, marked the wrong tooth prior to scanning, or decided that you want to do a crown instead of an onlay, or found an undercut or a spot on a margin that you want to fix. There are so many fancy features during scanning that it would take multiple articles to explain. Maintenance and infection control are very simple. And best of all, there is no "retaking" an impression, and you do not have to wait for the lab to pour something up for you to evaluate things.

And it is versatile. When I posted my first video, one of my colleagues piped up ,"well let me know when you can print a guide, place an implant, and then mill a temporary crown in the same day".

Um....I can.

Dr. Dave, Dr. David P. Alfaro, Dentist, Richmond Dentist, Prosthodontist, Vancouver Dentist, Beer, Wings, Dental Implants

I have used the scanner for crowns, onlays, bridges, implants, guides, nightguards, partial dentures, whitening trays, waxups and vacuforms......the list goes on and on. I am even using it for an immediate complete denture coming up. Trios will soon be able to send cases to Invisalign, which is great, because as we know, they are really picky about their PVS impressions but accept virtually 100% of digital ones. The only thing that I have not used it for is traditional complete dentures.

I do send things to the lab for manufacturing so I cannot do things "in a day", per se, but if I was interested in using up my valuable time with labwork in my office, I could send files to a broad array of mills and printers, instead of being locked in to one machine.

7. Portability

I have the "pod" version, which is a laptop and pod for the wand. I do work at two offices, so I can easily take this machine from location to location without any problems. It sets up in five minutes.

8. Support

Whenever I run into a "how do I do that again?" moment, I get instant support. This is essential when learning such a versatile machine with so many features and options.

Ok so there have to be some cons. I racked my brain to try to not look so biased, but I really could only come up with two.

1. Price

This is an expensive machine. But the more I use it, the more I see I made the correct choice.

2. Lack of milled models

Dr. Dave, Dr. David P. Alfaro, Dentist, Richmond Dentist, Prosthodontist, Vancouver Dentist, Beer, Wings, Dental Implants

Unfortunately, one manufacturer has the monopoly on milled models, which are more accurate than printed models, depending on the printer. This means that you have to actually speak to your lab and find out what they are doing to verify that their printed models are accurate. The lab I use scans the models after printing and then compares them to my original scan to make sure that there is no difference. This takes time and experience to have this level of quality control. And like I said, I have only had 2 cases come back ill fitting.

If you use a digital scanner, you need to use a lab that has a grasp on digital workflow.

Well, I know that this was a nerdy dental blog again and I bet only a handful of people are going to read this. If you have gotten this far and are in the Vancouver area and want to come check out the machine in action before diving in to the world of digital dentistry, please get in touch. We will be running very casual study club sessions starting in September, where we hope to get everyone to sit down in a clinical setting and check it out for themselves.

Digital impressions are here and should become the standard; I am worried that my impression material is going to expire and that stuff cost me a fortune.

Get in touch!

Thanks for reading.

Dr. Dave

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