Digital Dentistry Workflow

Based on the increasing digital workflow among dental professionals and the need for support, we have employed Johanne Olofsson to cover our dental customer support service. With more than fifteen years of experience working as a dental technician herself, she knows exactly what dentists and technicians struggle with on a daily basis and what support and help they need to maintain a seamless workflow.

Hi, Johanne! Tell me about your background as a dental technician?

Yes, I have fifteen years of experience working as a dental technician in different labs in Scandinavia. I attended the three-year Dental Laboratory Technology Program at the Institute of Odontology at the University of Gothenburg in Sweden. After graduating in 2001, I started working at a dental lab in Oslo, Norway. Then I went to a larger dental lab in Alingsås, Sweden, and after that, I started working at SML dental lab in Gothenburg.

What has happened in the dental industry since you first started out?

A lot has happened in the dental industry over the past couple of decades. When I first started working as a dental technician, most dental professionals had a conventional workflow using conventional techniques. Today, the majority has digitalized their workflow and use digital techniques such as lab scanners and CAD (computer-aided design) to design prosthetic restorations directly in computer software, and CAM (computer-aided-manufacturing) to manufacture the prosthetic restoration. Also, 3D-printing has become huge in the dental industry over the years.

And now you work with Elos Medtech’s dental customer support?

Yes, that is right. I work with Elos Medtech’s dental customer support and my role is to always put the customers first by answering their questions, taking orders, helping them via phone, email or TeamViewer, and providing my expertise, knowledge and advice. I also support and help our distributors when needed. Another part of my job is to visit our customers’ dental labs to help them with installations and make sure everything runs like clockwork. I also visit educational programmes to share knowledge about Elos Medtech and our dental components and keep a close dialogue with the teachers. A while ago, two of my colleagues and I visited the Institute of Odontology at the University of Gothenburg to install our Elos Accurate® Dental Libraries in their computer software.

What is your largest asset when working with dental customer support?

I think my vast experience and knowledge is something that our customers very much appreciate. They can feel confident with the fact that I have once been in their shoes. I truly understand their needs and know exactly what they struggle with on a daily basis. It is like the customers and I speak the same language! This is extremely helpful in providing them with the right service and support at all times.

What questions do the dental professionals have when contacting you?

I get a lot of questions about our comprehensive digital dentistry solution Elos Accurate® . Many of our present, as well as new customers, are curious about our dental components and instruments as they are fairly new on the market. I also get a lot of questions about our Elos Accurate® Dental Libraries which can be uploaded to the CAD software 3Shape, Dental Wings and Exocad. The other week, I had a customer from England who needed help to install our dental libraries in his computer software. And so I used TeamViewer to connect to his computer and help him with the installation, which was very appreciated.

I also get more specific questions, for example about our Elos Accurate Scanbody®. A while ago, I had a dental technician who had received a digital impression of a patient’s implant from the dentist. He couldn’t figure out why he couldn’t continue designing the prosthetic solution in the CAD software. It turned out the scanbody actually came from another medtech company; it wasn’t ours. As to our own scanbodies, they are based on our Open Dental Solution, meaning that they are available for all the major dental implant systems. But in this case, he obviously needed another library compatible to the scanbody.

Also, there are some questions about our Elos Cresco® products. I had a dentist with a new patient who had an old bridge and needed to replace the screws, but he wasn’t sure which type of screws were needed. He sent me an x-ray of the patient’s implant, and I managed to identify the screws together with my colleagues and provide him with the right answers.

What is the most important thing when communicating with customers?

The most important thing when communicating with customers is to always get back to them within a given time frame. Dental technicians have a time-critical job, they work at a fast pace and things need to be done rapidly. It is very important for them to get their products in time and to not have to wait for reply. Therefore, I always try to help our customers immediately or get back to them as soon as I can.

What do you enjoy the most about your job?

I very much enjoy talking to customers, or, even better, meeting them face-to-face. I also find the new digital techniques very interesting. I am intrigued by the changes that are happening right now and the digitalisation making its entrance into the dental labs and clinics around the globe. It is exciting to move away from the dusty, dirty and noisy environments that we have traditionally had in the labs, and instead turn towards clean, digital, and high-technology labs.

Do you recognise any specific trends when talking to customers?

One large trend is that more dental labs and clinics are keeping their production in-house. For example, traditionally, dental technicians have been sending their dental prosthetic restorations to off-site milling centres to produce the finished product. But now, more labs and clinics do their milling in-house. This simplifies the workflow and contributes to a more cost-efficient production flow. Another large trend is 3D-printing, which is slowly but surely on the rise in the dental industry. Elos Medtech visits a few dental exhibitions, and each year there seem to be more 3D-printers available on the market. Also, the use of intra-oral scanning continues to increase among dentists. The trend of going from taking conventional impressions to taking digital impressions is still going strong.

Enough talking about work! What do you do outside of the office?

When I am not at the office, I spend as much time as possible with my family. I also enjoy going for dinner and drinks with my friends. To boost my energy levels, I like to wander the woods and experience the glory of nature.

Last but not least: Do you have a motto in life?

I am not sure if I have a motto in life, but I always try to meet the people I come across with kindness and respect – whether they are customers, friends, family or complete strangers. To me, it is important not to judge a book by its cover, so to speak, but have an open mind and be curious about other people.

Thank you so much for a nice chat, Johanne! And keep up the good work with supporting and helping Elos Medtech’s customers!

Also, read:

• Dental Libraries Simplify the Design of Dental Implant Systems
• How Digital Dentistry Can Help Simplify the Digital Workflow
• Digital Impression Technique in the Dental Industry

In my previous blog post 4 Challenges in Digital Dentistry (Part 3), dentist, dental technician, and researcher, Michael Braian talked about the gap between dentists and dental technicians, the conventional model as the holy grail of dentistry, the use of intra-oral scanners, and the importance of maintaining a balance between simplicity, speed, and reliability in digital dentistry. This last part, however, will be all about the future!

Michael, what are your thoughts on digital dentistry and the future?

It is impossible to say what will happen in the future. But we do know for sure that technology is developing rapidly and that the dental technicians are at the forefront.

A while ago, I visited the Baltic countries to give lectures in digital dentistry. Over there, I witnessed something fascinating. In one of the labs, there were six or seven engineers who had no education in dental care, except for a crash course in ontology. In other words, the engineers were not very skilled regarding teeth, but when it came to handling digital equipment and CAD/CAM skills, they were unbelievable! I have never seen anything like it. I was so amazed watching their workflow, going from one process to another in no time.

Based on what I saw, I think that in the future, engineers will get more influence in dental care because of their digital skills and efficient way of working with the digital techniques.

That sounds spectacular. Does that mean that the use of digital equipment will also increase in the future?

Yes, one of the trends in digital dentistry, which is already strong here in Scandinavia, is the implementation of 3D-printers into the production process.

I recently gave a lecture to a group of 150 dental technicians here in Sweden and asked them if they had a 3D-printer. Surprisingly many raised their hands. This is because today, you can buy a 3D-printer without having to invest a fortune. For a reasonable amount of money, you can get a 3D-printer that increases the efficiency of the production process and the entire digital workflow.

Intra-oral scanners, however, are still quite expensive. There are many dentists out there who are very intrigued by digital dentistry and who are considering purchasing new digital equipment. But the somewhat high price eliminates the sweetness of moving towards a digital workflow. In the future, I hope that more manufacturing companies are willing to further invest in new technology so that a wider range of digital equipment becomes available on the market at a lower price.

About the plaster models – what will happen to them as the digital techniques grow stronger?

I don’t think the plaster model will disappear. But I think the conventional dental labs will become smaller while the digital dental labs will increase in size. This also means that the digital dental labs will have to employ more technicians with digital skills and that digital dentistry will have to constitute a larger part of the educational dentistry programs.

What improvements will be made to the digital equipment in the future?

When it comes to intra-oral scanners, lab scanners and 3D-printers, I think they will become smaller, faster, more precise and more cost-efficient. For 3D-printing, I think there will be a wider range of materials on the market.

At the moment, we are doing a study here at the Faculty of Ontology at Malmö University where we try to figure out exactly how precise and accurate the 3D-printers are at printing polymers compared to using conventional methods. Metal laser sintering is a 3D-printing process that is already frequently used by dental technicians. But I think the use of 3D-printers also for printing polymers will be used to a much larger extent in the future.

What will drive innovation in dental care in the future?

Innovation and new ideas often come from the dental labs and clinics. So I would say dental technicians, dentists, and also researchers will play a big part. The technicians and dentists work in an environment where they can easily combine their creativity and knowledge with the production techniques. Take the 3D-printers for example – they don’t have any limitations in terms of what geometry they can print – just use your imagination! The printing is also extremely fast. If you have an idea today, you can have it printed by tomorrow. The possibility of going from idea to finished products in less than 24 hours allows for learning by trial and error and exceptionally quick feedback, which only nourishes creativity.

As to the researchers, one of their tasks is to keep their eyes on what is going on in the clinics and labs and try to find methods for improving what they do. If the researchers do a good job, the clinics and labs will start using their methods, and there will be a change in market demand. This, in turn, will affect the manufacturing companies to adapt their products to meet these new demands and improve the digital workflow for dental professionals.

Looking at digital dentistry from a global perspective, is there any country that will stand out in the future?

The USA is, and will continue to be, at the forefront of new technology when it comes to digital dentistry. A lot is happening over there, and internet is, of course, playing a huge part in the globalisation of digital dentistry. The fact that a dentist in the USA today can send a digital impression by email to a dental technician here in Sweden means that physical boundaries are erased, and that technology is bringing us closer together.

Last but not least: Do you have any new exciting projects ahead of you?

Yes, I do! We have a group of students here at the Faculty of Ontology at Malmö University who are very interested in the digital techniques, and we do research on intra-oral scanning, lab scanners, and 3D-printing. The number of people in our group only grows by the day as there is a large interest in digital dentistry among the students. We have initiated a number of exciting projects and do all sorts of cool studies, including clinical studies in cooperation with the National Dental Service here in Malmö. But all of them are kept secret until published!

Thank you so much for a lovely conversation, Michael! I hope everything goes well in the future and good luck with that research.

This was the fourth, and last, part of our video blog series with Michael Braian about digital dentistry.

Also, read:

• Improving Dental Care Through Digitalization (Part 1)
• The Importance & Advantages of Digital Dentistry (Part 2)
• 4 Challenges in Digital Dentistry (Part 3)

In my previous blog post The Importance & Advantages of Digital Dentistry (Part 2), dentist, dental technician, and researcher Michael Braian, talked about digital dentistry and its importance for the dental care, the advantages of a fully digitalized workflow, and how the dental landscape has changed over the past few decades. In this third part, Michael summarises 4 challenges in digital dentistry.

What challenges does digital dentistry bring?

Digital dentistry brings many challenges to both dentists and dental technicians as well as society.

1. There is a large gap between dentists and dental technicians

First of all, when it comes to the use of digital techniques, there is a large gap between dentists and dental technicians. The technicians are steps ahead of the dentists, and many have had a full digital workflow for years; receiving digital impressions, designing the models in a computer software, and sending the digital information to milling machines that create the prosthetic restorations. Many of the dentists, on the other hand, have not yet come this far. Many are still using the conventional techniques, taking moulded impressions of their patients’ teeth and physically transporting the impressions to the dental labs.

In order to truly achieve a fully digitalized workflow in dental care, the dentists need to start using the digital techniques to the same large extent as the technicians. Implementing the use of intra-oral scanners is a big change for many dentists as it challenges the dentists’ digital skills. I think it will happen in the near future but proceed slowly.

2. The plaster model is the holy grail for dental technicians

As much as the dental technicians have digitalized their workflow, there is always the opinion amongst technicians that the plaster model is the holy grail. This is because, in conventional dentistry, the final result of the prosthetic restoration is completely dependent on the plaster model. If the plaster model breaks, the entire procedure needs to be repeated all over again.

As the digital techniques are entering the labs, technicians today are not yet sure which one is their new holy grail. Is it the scanner? The computer software? The milling machine? The 3D-printer? When it comes to the digital techniques, there are so many different parameters to take into consideration, making it difficult to decide. Right now, this is a hot topic in digital dentistry research, and there is a big challenge for technicians to determine their new holy grail – or simply accept that there no longer is one?

3. The use of intra-oral scanners require high digital skills and precision

A third challenge is the use of intra-oral scanners. Intra-oral scanners are excellent tools for simplifying the workflow for dental professionals, but they require high digital skills and precision. It is crucial for dentists to know exactly how to use the intra-oral scanner to get a perfect digital file to hand over to the dental lab. If the digital file does not correspond correctly to the patient’s mouth, the final result of the prosthetic restoration can lead to problems. Unlike taking a moulded impression of the patient’s teeth, which allows for dentists to make minor mistakes as they can be fixed by the dental technician, a digital impression does not allow for any mistakes at all.

This means that if a dentist sends a mediocre digital impression to a technician, for example, an impression with an incorrect index between the maxilla and the mandible, the dentist will also receive a mediocre prosthetic restoration. In the end, the patient may end up with a prosthetic restoration that doesn’t fit their mouth, which is clearly not desirable.

The challenge here is for the digital techniques to be implemented early in the educational dentistry programs, but also practising; dentists need to be trained in how to use the intra-oral scanners correctly and continuously practice their digital skills. When the dentists learn to master the intra-oral scanning technique, they will also gain a better understanding of the complete process of digital dentistry. This way, they will also help close the gap between dentists and technicians.

4. Maintaining a balance between simplicity, speed, and reliability

Another challenge is that digitalization, in general, put higher demands on simplicity and speed. Our entire society is permeated by the digitalization, and it is not for nothing we call our younger generation “the click-and-go generation”. Today, we expect things to happen quickly and easily. We don’t have the time to wait, and there is no room for errors. I like to call this the “digital tolerance” – and digital dentistry is no exception. The digital techniques; intra-oral scanners, lab scanners, milling machines, and 3D-printers all need to work seamlessly.

However, as technology develops rapidly, the manufacturing companies seem to move a bit too fast. Instead, they need to stabilise their hardware and software so that the digital techniques maintain their reliability. This is a great challenge, and also a responsibility they carry, to ensure quality and help simplify the workflow for dental professionals.

To sum it up, there are many challenges in digital dentistry. But I think, in the future, the digital techniques will become better, the gap between dentists and dental technicians will become smaller, the removal of the plaster model as the holy grail will become a fact, and the cooperation between manufacturing companies and clinics and labs will become stronger – all leading to amazing gains in efficiency and accuracy as well as patient benefits.

This was the third part out of four in our video blog series with Michael Braian about digital dentistry. The interview continues in our fourth part. Also, read:

• Improving Dental Care Through Digitalization (Part 1)
• The Importance & Advantages of Digital Dentistry (Part 2)
• Digital Dentistry and the Future (Part 4)

In my previous blog post Improving Dental Care Through Digitalization (Part 1), I spoke to the dentist, dental technician, and researcher Michael Braian about his passion for 3D-printing and intraoral scanning. I was very intrigued by his latest study about the possibilities to improve dental care through digitalization. In this second part, Michael and I get a bit deeper into the subject of digital dentistry and talk about its importance for the dental care, the advantages of a fully digitalized workflow, and how the dental landscape has changed over the past few decades.

About your study, Michael – I happen to know that last year, you won the Swedish Researchers’ Grand Prix. Why did you win?

Yes, that is right. The Swedish Researchers’ Grand Prix is a national competition that challenges researchers to present their research to a public audience in an engaging and informative way, in just a few minutes. The aim is to inspire scientists to communicate more about their research and bring the studies into the public domain to benefit society.

So why did I win? Well, I never asked the audience why they voted for me, so I don’t know really! But I guess, what made me stand out from the other competitors, was that I visualised my research using a lot of pictures and graphic design in my presentation. This way, I made it easy for the audience to understand my research and also remember it. The reason I visualised my research to this large extent, is simply because this is how I learn the best. Apparently, other people work the same way. You know the saying: A picture is worth more than a thousand words. I guess I used a lot of pictures and got a lot said!

How important is the digitalisation for the dental care, would you say?

It is still early to say. Imagine that a digital workflow did not exist at all in dental care. Would it still work perfectly fine? The answer is: Yes, it would. The conventional techniques in dental care have worked excellent for decades. However, if dental professionals are looking for a simpler, faster, more accurate, and more efficient workflow, there is a large potential in digital dentistry.

Tell me more about that potential. What are the advantages of a fully digitalized workflow in dental care for dentists and dental technicians?

A fully digitalized workflow brings many advantages to the table for both dentists and dental technicians but also for the patients. For a dentist, the advantages of taking a digital impression of the patient’s teeth using an intra-oral scanner are that the scanning itself only takes a few minutes and provides an immediate 3D impression with very detailed information about the patient’s teeth. It allows for the dentist to zoom in on the patient’s teeth and discuss the case with the patient straight away. As the impression is digital, the dentist can then send the file to the dental lab in seconds – the same as sending an ordinary email.

For a patient, the advantages of having their teeth scanned with an intra-oral scanner, is that it allows for a much more convenient dental experience. A conventional moulded impression involves bad-tasting impression material inside the patient’s mouth for quite some time, that is often uncomfortable and, worst case, activates the gag reflex. The intra-oral scanner is much more comfortable and requires only a few minutes of the patient’s time. With direct access to the digital impression on the computer screen, the patient will get a much clearer picture of their own case. It also allows for the patient to ask questions related to the impression and discuss further treatment with the dentist.

For a dental technician, the advantages of receiving a digital file of the patient’s teeth – instead of having to wait for a conventional moulded impression for hours, or even days – is that the technician can start designing the prosthetic construction directly in a computer software. This eliminates a number of steps for the technician including creating a plaster model, articulate the case, do a wax-up, turn the wax model into the end product, and so on. Instead, once the design is finished, the technician can send the digital information to a milling machine that creates the prosthetic restoration.

To sum it up: While a traditional workflow includes many different steps, the digital workflow only includes a few. Minimising the number of steps also minimises the risk of errors. Digital dentistry simplifies the entire workflow and helps improve the communication between dentists and dental technicians as well as the communication with patients. Using the digital techniques such as CAD/CAM, milling, and 3D-printing allows for a faster and more efficient workflow, also leaving the patients with a more pleasant dental experience.

No wonder more dental professionals are looking into a digital workflow! How has the dental landscape changed over the past few decades?

The dental landscape has changed a lot, and that is mainly because of the digitalization of the dental production techniques. The most prominent part is the digital transformation that the dental technicians are undergoing. They have made a shift, going from using their bare hands to using digital tools to create prosthetic restorations. The technicians have gone from working 100 percent manually, using conventional techniques only, to working 50 percent manually and 50 percent digitally, or, if the dentists are using intra-oral scanners, to even working 100 percent digitally. This means that some of the dental technicians today have practically digitalized their entire workflow.

This was the second part out of four in our video blog series with Michael Braian about digital dentistry. The interview continues in our third part. Also, read:

• Improving Dental Care Through Digitalization (Part 1)
•  4 Challenges in Digital Dentistry (Part 3).
• Digital Dentistry and the Future (Part 4)

He has never been able to keep his hands still, has always been thirsting for new knowledge, and is completely passionate about 3D-printing and intraoral scanning. A while ago, I met up with Michael Braian who is a multitasking dentist, dental technician, and researcher at Malmö University in Sweden – one of the world’s leading institutes for dental education and research. We had a delightful conversation, Michael sharing his thoughts and insights on digital dentistry and his latest study about dental care and digitalization.

Hi, Michael! You are not only a dentist but also a dental technician and a researcher. How did you get into odontology in the first place?

I was fairly shy in high school and wasn’t really sure about what I wanted to study at the University. But my dad made sure I went to the school counsellor for advice, and she introduced me to a few University programs. I took a shot and applied for three very different programs: Fire Protection Engineering, Industrial Design, and Dental Technician. I was put on the reserve list for the Dental Technician Program at Malmö University, and after a few weeks, I got accepted into the program. The whole thing wasn’t very well thought through! However, from the very first moment I had a hands-on experience with the dental techniques, I realised this was completely right for me – I was hooked!

Fascinating! But how did you know?

I have never been able to keep my hands still. All my life, whenever my friends and I have gone for coffee, just sitting down talking, I have always been fiddling around with a napkin, a package of cigarettes or anything really, trying to construct a new object. This is just what I have always done. And when I started studying dentistry, I continued doing the same thing, only now, I used my hands to construct dental components.

So how come you decided to also become a dentist and researcher?

I have always been thirsting for new knowledge. After spending five years at the Dental Technician Programme at Malmö University, I wasn’t entirely satisfied. And so I also decided to apply for the Dentistry Programme. After five more years at Malmö University, and another graduation, I still wasn’t satisfied, which is why I decided to become a researcher in digital dentistry at the Faculty of Odontology. I guess it is fair to say that I am simply a person who is always keen on learning more, and truly loves the dental business.

Impressive! So it was a natural step for you to become a researcher?

Yes, it was. But I was particularly intrigued by digital dentistry. In my family, we have always had a great interest in anything digital. My brother is an architect and construction engineer, my other brother is a graphic designer, and my parents are both artists doing digital as well as traditional artwork. When the 3D-printers made their entrance into the houses of ordinary people, I was an early adopter. I would sit home and experiment, and it didn’t take long until I learnt how to design in 3D using CAD/CAM software. One day, one of my colleagues asked me: If you are so passionate about 3D-printing, why don’t you start doing research on the subject? And so I did. I turned my hobby into science research.

Tell me about your latest study. What is it about?

In my latest study, I look into the possibilities to improve dental care through digitalization. The growing interest and use of intra-oral scanners stress the use of computer-aided design and manufacturing techniques. The additive manufacturing techniques, or 3D-printers, have the potential to help improve the digital workflow for dental professionals. Thus, it is important to have knowledge about production accuracy and repeatability.

My study is about determining the production tolerances of four commercially available 3D-printers and presenting a method to test 3D printers for accuracy and repeatability. It is divided into five parts: In the first part, I analyse which tolerances are required in dental care for producing teeth replacements that are going to be attached to dental implants. In the second and third part, I investigate whether it is possible to produce objects made from plastic, cobalt-chrome, and titanium materials that meet the required tolerances, using and comparing four different 3D-printers.

In the fourth part, I do the same thing but with digital intra-oral scanners, investigating whether it is possible to regenerate the physical object into virtual 3D objects with the same tolerances. For this part of the study, I took help from Elos Medtech that has got a lot of measurement instruments and great knowledge in precision engineering, which I benefited greatly from. In the fifth part, I tied together the entire production process to obtain the best possible end result.

Speaking of Elos Medtech, you have tried Elos Accurate scan bodies for intra-oral scanning. What is your experience?

Yes, Elos Medtech has developed scan bodies for all the major implant systems for dentists who use intra-oral scanners. The scan body is mounted on the dental implant to transfer the correct position and angulation of a digital impression, which is sent to the dental technician. So far, I have only tried Elos Medtech’s scan bodies on three patients, but they have worked really well. I am positive based on the fact that I have only tried a few!

Glad to hear that! Now, back to your study – what impact do you think your study will have on dentists and dental technicians?

Well, it is difficult to say. I think it depends on what the future holds for the digital dentistry. The purpose of my study is not only to make an impact but to provide a useful method for dentists and dental technicians to measure and compare 3D-printers and intra-oral scanners. My ambition is that dental professionals, with the help of my study, will be able to design an object, 3D-print it, measure it, and know the exact accuracy and repeatability of that specific 3D-printer. Today, investing in a 3D-printer can be on the more expensive side. It is therefore very convenient to have a proven method to use before making your purchase.

My goal is that my study will be relevant also in the future. It is unique in the sense that I have gathered knowledge from the dental industry and companies such as Elos Medtech who have been working with dental implants for decades and implemented their engineering knowledge into odontological methods.

This was the first part out of four in our video blog series with Michael Braian about digital dentistry. The interview continues in our second part. Alos, read:

• The Importance & Advantages of Digital Dentistry (Part 2)
• 4 Challenges in Digital Dentistry (Part 3)
• Digital Dentistry and the Future (Part 4)