Using Digital Technology to Create an Analog Smile Mock-Up with Your Patient

February 21, 2022 Daren Becker DMD

Today we move between the digital and the analog world to accomplish the goals of aesthetic dentistry. A mock-up is a key tool in helping patients want aesthetic dentistry and visualizing what the changes will accomplish.

Lots of us have learned from masters like Dr. Susan Hollar how to hand-lay composite on the patient’s teeth so the patient can see their possible new smile. This trial smile technique is a fabulous way to motivate patients. It’s also a great way for us to learn what might be possible.

For many dentists, that technique is not natural for us, and it takes chair time. Another way we can model possible changes is through digital technology. In our office, we are using digital smile design as follows.

1. We do our initial records, which includes facial photos and an intraoral scan using our digital impressions intraoral scanning system.

2. Either on the software in our office or at the lab, a 3-D version can be designed of what the new smile approximately could look like.This doesn’t have to be a definitive wax-up. Remember, we call it a diagnostic work-up. In fact, this is oftentimes where we discover the need for gingival changes and/or orthodontic procedures in order to achieve the desired outcome. I find this extremely helpful in communicating with the patient as I can show them what the compromised outcome would be if they choose not to correct the gingival levels or align the teeth if that is in fact appropriate.

We’ve learned it is very efficient to collaborate with the lab, the lab creates the 3-D design, and the lab emails us the STL digital file of the design. Alternatively, the lab can send printed models, matrices, or even milled/printed PMMA shells of the design.

3. On the 3-D printer in our office, we print the model from the STL file.

4. We make a matrix from that, either in a suck down material or a putty matrix, and we take that to the mouth, fill it with our temporary material (usually bisacryl), and seat it right onto the teeth.

5. After letting it set, removing the matrix, and peeling off excess material, the patient is wearing their trial smile. This last step takes all of two minutes.

Using this process enables us to do the lab work between appointments, and when the patient returns, they can very quickly preview the possibilities.

It is a wonderful communication tool, because the patient can look in their own mouth, not at a picture of someone else, not at pictures of other shapes of teeth, and say, “I like that,” or “I thought they would be shorter (longer, fatter, narrower…).” You can go in with your handpiece and reshape the temporary material or add material with flowable to make something more pronounced.

Patient participation in the tweaking of the design draws the patient into deeper engagement with and commitment to the smile they want. Now, we can scan the corrected and approved trial smile while it is in their mouth and take photos to send to the lab to help them as we move into the definitive design phase, including working out the occlusion and function.

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Daren Becker DMD

Dr. Becker earned his Bachelors of Science Degree in Computer Science from American International College and Doctor of Dental Medicine from the University of Florida College of Dentistry. He practices full time in Atlanta, GA with an emphasis on comprehensive restorative, implant and aesthetic dentistry. Daren began his advanced studies at the Pankey Institute in 1998 and was invited to be a guest facilitator in 2006 and 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. In 2011 he was invited to be a part time faculty 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.

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Up Your Game

October 26, 2020 North Shetter DDS

Over the years I have visited many offices and found every office has a special “hideaway” reserved for the new technology that the doctor is going to implement that never happens. I just looked over an article by Dr. Lou Shulman in Dental Products Report that reviews a multitude of technology options available to us. I was surprised to note the number of doctors who stated that they do not plan to purchase three specific tech areas that we have found to be significant in increasing our production, quality of care, and positive patient reaction. Based on our practice experience, these three items will very quickly provide a return on your investment when you integrate them into your practice.

Voice Activated Software

We have been using Dentrix VoicePro, a voice-activated perio charting and clinical note dictation, for over 15 years. Our hygiene staff would quit if we took it away. We do a full perio charting on every re-care appointment. This software makes it quick and easy, AND the patient hears the numbers and pays attention. There are numerous other features, but the perio charting is worth the price and learning curve. In today’s environment, the system eliminates the need for added staff as a recorder or the constant picking up and putting down of pens or probes.

Intraoral Scanner

We are using iTero and love it. We have had a CAD/CAM system for years and use it routinely. However, if you are doing any aligners or sleep appliances you will love the scanner. Your patients are so appreciative that you no longer have to have them sitting with “goo” in their mouths. There is a learning curve, but it is not too steep. The accuracy of the images is excellent. The unit will not let you send a poor impression to the lab. The cost of a scanner is far less than CAD/CAM. Your lab loves getting your impressions electronically. Your patients are fascinated by your ability to image their teeth with ease and accuracy. Our staff has quickly adapted to the use of the scanner and loves it.

Soft Tissue Laser

The price of soft tissue lasers has dropped dramatically. We were relatively early adopters of the soft tissue laser. We use ours for soft tissue shaping in crown and bridge, desensitization, and soft tissue periodontal procedures. We have had near-zero post-operative complaints in any of these procedures. The desensitization of teeth is amazingly quick and easy. All of our hygiene staff has been trained in laser use and feels that was worth the effort. Patient acceptance of soft tissue laser in hygiene/periodontal procedures is very high.

We try to be at or near the leading edge of the technology curve, not the “bleeding edge,” and we expect technology to have long term value as well as a rapid payback. These items have proven to be time savers, improve our quality of care, and are recognized by our patients as adding value to the experience in our office.

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North Shetter DDS

Dr Shetter attended the University of Detroit Mercy where he received his Doctor of Dental Surgery degree in 1972. He then entered the U. S. Army and provided dental care at Ft Bragg, NC for the 82nd Airborne and Special Forces. In late 1975 he and his wife Jan moved to Menominee, MI and began private practice. He now is the senior doctor in a three doctor small group practice. Dr. Shetter has studied extensively at the Pankey Institute, been co-director of a Seattle Study Club branch in Green Bay WI where he has been a mentor to several dental offices. He has been a speaker for the Seattle Study Club. He has postgraduate training in orthodontics, implant restorative procedures, sedation and sleep disordered breathing. His practice is focused on fee for service, outcomes based dentistry. Marina Cove Consulting LLC is his effort to help other dentists discover emotional and economic success and deliver the highest standard of care they are capable of.

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Embracing Digital Technology

April 17, 2019 Pankey Gram

On day one of the 2019 Annual Pankey Meeting, Dr. Gary Severance and Angela Severance will explore how digital technology continues to expand the opportunities dental professionals have to know their work and to provide better dentistry and ultimately better care.  Preliminary to this presentation, we share this quote with you.

“Be not the first to try the new or the last to leave the old aside.”

This is a statement from Dr. L.D. Pankey in his 1985 interview with the International College of Dentists. As a well-read and literary man, Dr. Pankey was familiar with Alexander Pope, an 18th-century English poet who is best known for his satirical verse and translation of Homer. Because Pope is the second-most frequently quoted writer in The Oxford Dictionary of Quotations (after Shakespeare), it is highly likely Dr. Pankey was inspired by the following famous couplet from Pope’s Essay on Criticism.

Be not the first by whom the new are tried,
Nor yet the last to lay the old aside.

We offer this conjecture, because Pope’s couplet is often used across the professions in the context of evaluating and adapting to technological change.

Pushing Forward Mindfully

Dr. Pankey was on the forefront of the technological and methodological changes that rapidly occurred in dentistry during the 1950s and onward. He was internally driven to be and do his best for his patients and profession. He urged dentists to “know your work” to provide better dentistry and ultimately better care.

Digital technology in dentistry has advanced to address special needs, just as Dr. Pankey advanced in his systems of thought and practice to address special needs. He did this mindfully.

His genius, in concert with those of Dr. Arvin Mann and Dr. Clyde Schuyler, had produced the “P.M.S. Technic.” They had selected the best of the procedures that had been developed by outstanding practitioners in their special fields and assembled them into a system that functioned well for addressing full mouth rehabilitation. They applied their intelligence to “try” new techniques and new materials. They gained knowledge through carefully doing their best for patient, after patient. They then stepped out to share what worked successfully for them. Along the way, Dr. Pankey was mindfully developing his philosophy of practice. He intentionally set out to learn from many great minds, and the composite of principles he lived by and generously shared through his lectures, publications, and ceaseless conversations with other dentists have rippled into our lives today.

Learn, Converse, Lead with Confidence

As a community, you can share your knowledge, immerse in conversation, and lead with confidence. The L.D. Pankey Institute from its beginning was a radical departure from dental school settings of the day. The Institute pioneered a training clinic with overhead cameras and closed-circuit TV, anatomical simulators (which had heretofore only been developed for training in medical schools), and it’s characteristic “hands on” learning process. The Institute’s founding leaders conceived of novel ways to fulfill their goals. But—building the unique learning environment and learning process involved tens of thousands of hours of research, thought, and conversation. A group of “top” minds in dentistry worked together to close the gap between what was known (the science) and what was practiced.  Adaptation to emerging digital technology is no different.

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