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The digital workflow in dentistry: definition and benefits
With the arrival of digital technology in dentistry, clinical and dental laboratory workflows have become faster and more efficient. But what exactly does a digital dentistry workflow look like? Digital workflows in dentistry look different from indication to indication.
But regardless of treatment, the purpose of digital workflows in dentistry is to combine digital file formats and software to allow for efficient and high quality planning, communication and execution of the dental treatment.
What is the difference between conventional and digital dentistry workflows?
Digitizing dental workflows is not an all-or-nothing scenario: a doctor or dental lab can digitize one step -usually the imaging- in the workflow, and leave the rest to analog. As this DMFR study1 points out, the ‘main ingredient for digital workflow recipes is the imaging chain’.
Dental practitioners can also choose to digitize 90% of the workflow and do in-house design. They would for example scan, plan, design and manufacture digitally, and collaborate with partners digitally on a dental platform like 3Shape Unite if the case they are working on allows for it.
As Dr. Scherer says in his blog: there is no such thing as a 100% digital dentist.
“When it comes to dentures, implants, and reconstructions, digital pathways have made my work more predictable and time efficient. But I am not ignoring analog techniques because I work more digitally now.”
A digital dental workflow generally consists of three steps:
- Scanning or impression taking with an intraoral or desktop scanner.
- Treatment planning and design with dental CAD/CAM software.
- Manufacturing of the approved digital designs, either by milling or 3D printing.
An example: from impression to dental lab workflow
Let’s take a look at the single crown workflow. This workflow, after all, is the bread and butter of any practice, seeing a typical practice places some forty crowns per month.
As you can see from the comparison, there are fewer steps in the digital workflow. When taking a digital impression as the foundation for the crown workflow, you do not need to mix material, do the pouring, finding a tray, and there’s no disinfection of the impression (although you do need to disinfect the scanner).
And when working from a digital impression, you can check contacts and occlusion virtually on your digital model – a model-less workflow. Dr. Ferencz’ case study gives more details on the differences between a digital and conventional single crown workflow.
Some dentists claim that they can double the number of cases in the same amount of time, because of the increased time efficiency.
What is the role of CAD/CAM in digital dentistry?
A digital workflow in dentistry encompasses everything from imaging formats such as digital photography, CBCT scans, or 3D impressions, to systems and dental softwares to communicate between patient, clinic and dental lab or print and mill the restoration or appliance.
These systems and softwares are also referred to as CAD/CAM: Computer Aided Design and Manufacturing. They impact the workflow in multiple ways. Firstly, solutions such as smile design software or orthodontic software allow for easy sharing of the treatment plan on-screen with the patient.
Secondly, with 3D printers becoming more affordable, in-clinic production of restorations or appliances becomes more attractive which can reduce patient visits. And thirdly, collaboration engines like 3Shape Unite ensure for efficient communication and exchange of information. Read on for example treatment workflows.
“The single crown normally takes two to three visits to complete. Maybe the patient loses his temporary and needs to come in for an extra visit… now with CAD/CAM, the single crown is done in one visit,”
says Dr. Ferencz in his blog article on how his clinic and patients benefit.
Digital workflows in reconstructive dentistry
While in the beginning of digital dentistry, it was mostly single-tooth restorations that provided reliable results, ‘the limits of complete digital workflows in dentistry have almost been overcome’2.
In the digital crown workflow, which is the most common in restorative dentistry, we see two types of workflows:
70% of clinicians send their case straight to the lab, who handles design and production of the restoration.
Doing this via a secure software connection or a workflow platform like 3Shape Unite saves courier and material costs.
With the advent of CAD/CAM solutions to design and produce in-house, the clinic also gets more opportunities to handle parts of the workflow in the clinic, with one of the dental design software solutions that are on the market these days.
Scan, send, repeat. With a good digital ecosystem, your crown workflow can be more efficient, more patient-friendly, and more cost-effective.
See the crown workflow explained step by step in this ebook ‘The digital send to lab workflow’.
Digital denture workflow
In 2022, less than 3% of dentures produced around the world were produced with the help of digital tools such as scanners. Using these tools can reduce a patient’s clinic visits to two or three, versus five in a conventional workflow. This means there is a potential for time savings for the 97% analog denture cases.
Some of the leading experts in the field of dentures agreed that scanning and producing digital dentures does not only lead to a reduction in chair time and less appointments, but also to higher consistency in the quality, design, and overall fit of the prosthesis. Download their ebooks with example workflows below.
Two example digital denture workflows
DEEP DIVE
COLLAPSE
The reference denture protocol
- Start with a digital smile design
- Take a conventional impression using the reference denture
- Document the functional movement
- Scan the reference denture with an intraoral scanner
- Intraoral scan the edentulous arches/
- Fabrication of the occlusal rims with CAD design software
- Determine the maxillo-mandibular relationship by scanning
- Design the trial and final denture
COLLAPSE
The dental implant digital workflow
In the field of implantology, digital precision is key. Digital implant dentistry for example allows the surgeon to plan and execute fully-guided surgery, based on a surgical guide.
Or, as Dr. Sonia Leziy says in her blog piece ‘to guide or not to guide’:
“It has become my norm to plan and execute guided surgery, other than in cases where there is inadequate space to place a static guide due to restricted opening and access.”
Even though this takes more time in the planning phase of the workflow, it can be solved by more intense collaboration with the laboratory in the preparation and planning phase.
When technicians get trained in digital implant planning, it leads to a streamlined process that makes implant surgery a better experience for both doctor and patients.
Dr. Choi’s case demonstrates digital implant planning for an immediate implant placement restoration with a temporary crown using a full digital workflow and modeless approach.
- Scan: capture surface and CBCT for complete clinical insights.
- Plan: prosthetic driven implant planning with AI-powered crown proposals.
- Design: implant crown design and surgical guides.
- Print: production of the restoration and surgical guide in-house or by sending to a lab.
- Surgery: conduct the surgery with a surgical guide for high efficiency and accuracy.
- Temporary crown delivery.
The digital clear aligner workflow
Clear aligner demand is growing fast, so it’s an interesting area to explore for dentists looking to expand their offerings. One reason it's especially interesting is because with digital scan technology, general practitioners can now offer clear aligner treatments to their patients with just a scan and a collaboration with a clear aligner provider.
The rest of the workflow can be done through partners, if the software the dentist works with allows for easy collaboration. In-house production is also an option if the dentist has the treatment software.
Dr. Sagar Bombe shares his in-house clear aligner treatment for spacing, deep bite, midline shift, canine crossbite, and mild proclination.
- Scan an accurate full-arch impression.
- Plan and design: send to a clear aligner provider of choice or plan and design in-house.
- Produce: print the dental models with an open choice of 3D printers.
- Cut and finish, so the aligners are ready for the patient.
The digital smile design workflow
For cosmetic dentistry, we also see how digital technologies provide clinicians and dental ceramists with sophisticated tools and software to reach precision and esthetics.
Practitioners have said that using digital imagery, digital smile design software and combining these in the right dental CAD software can lead to fewer patient visits and elevate the patient experience and treatment outcome.
This case study, for example, shows a patient with a bite that had been off for many years, and had resulted in jaw and muscle discomfort. The digital smile design workflow looks as follows:
- Use smile design software to identify anatomical landmarks and visualize new smile.
- Bring smile design into CAD design software for anatomy planning
- Intraoral scan taken and imported into the dental design software, for restorative mockup.
- Temporary on prepared digital model planning in the CAD software.
- Provisional restorations seated.
- Final restorations try-in on model.
Learn about digital esthetic dentistry workflows from start to finish in our digital smile design courses
A great intraoral scan is just the beginning
When looking at what makes or breaks a successful digital dentistry workflow, we can conclude that a great digital impression is the first step in delivering a successful patient outcome. The engine and ecosystem behind the scanner is the next step: it is what unlocks a world of opportunities with the scan.
When looking at the software and systems, it is important to look at what workflow possibilities it comes with. Some suppliers of digital dentistry solutions work with an entirely closed system, which means that hardware, software and production methods are fully compatible with each other but will not accept external file formats. Other suppliers work with open or partially open systems, where file formats are more or less exchangeable.
3Shape, for example, works with a workflow engine that is open and allows for over 8000 external labs and over 100 treatment partners to be represented in the Unite Store. This allows for full democratization of dentistry, so that dentists can choose who they work with and how.
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step by step
Scan the patient. Share with your lab. Get a crown design back. All within a few clicks, without file downloads or email attachments.
This ebook outlines the 3Shape send-to-lab workflow for crown treatments in the greatest detail. Download it now and see what your practice could look like.
Resources
- Sohaib Shujaat, Michael M. Bornstein, Jeffery B. Price, and Reinhilde Jacobs. Integration of imaging modalities in digital dental workflows - possibilities, limitations, and potential future developments. Dentomaxillofac Radiol. 2021 Oct 1; 50(7): 20210268. PMID: 34520239
- Kraemer-Fernandez P, Spintzyk S, Wahl E, Huettig F, Klink A. Implementation of a Full Digital Workflow by 3D Printing Intraoral Splints Used in Dental Education: An Exploratory Observational Study with Respect to Students’ Experiences. Dentistry Journal. 2023; 11(1):5. https://doi.org/10.3390/dj11010005