Latest / Straumann® ProTalk / Clinical edition: Intraoral scanning as the foundation of modern digital dentistry with Dr. Kimberly Schlam

Transcript

Clinical edition: Intraoral scanning as the foundation of modern digital dentistry with Dr. Kimberly Schlam · Straumann® ProTalk

• 0:00
  For myself, I could not imagine going back to analog workflows.
• 0:03
  There are so many touch points, and in your point of view, what is in
• 0:08
  reality the most essential steps that you would consider in the office?
• 0:11
  Intraoral scanning.
• 0:12
  I think that's the door opener.
• 0:13
  That's the door opener, of course, a 3D radiograph, CBCT, things of that nature.
• 0:18
  And then now really with overlapping a scan of the face or a 2D photo is really
• 0:24
  changing how we can view our patient.
• 0:41
  Ever wondered if digital dentistry is making us, in fact, better clinicians?
• 0:46
  The way I see it, it changed everything for better the way we plan and execute
• 0:51
  our cases to how we communicate with our patients and our peers in each
• 0:55
  time, more and more multidisciplinary approach in our practice.
• 1:00
  Today, I'm joined by Dr. Kim Schlam from the United States.
• 1:04
  She's a passionate advocate about digital technologies, and she's
• 1:07
  been roaming the world, teaching clinicians and helping them achieve
• 1:12
  precision and efficiency without losing what makes our work truly special.
• 1:17
  The human factor, right?
• 1:19
  That's right.
• 1:20
  Dr. Schlam, thank you for joining us on Straumann ProTalk Clinical.
• 1:23
  Thank you so much.
• 1:24
  I appreciate the kind of invitation.
• 1:26
  First things first.
• 1:28
  Speaking of digital workflows, and I said you are an ambassador.
• 1:32
  I'm curious in your perception, digital workflows are a trend or a
• 1:37
  real shift in modern implantology.
• 1:39
  It's a great question because there's so many new technologies that come
• 1:42
  out and it's easy to think that these things are fads, and maybe I'll try
• 1:46
  this and try that, but for myself, I could not imagine going back.
• 1:49
  To analog workflows?
• 1:51
  I would say that it's it's changed not just the experience for myself, for my
• 1:55
  fellow team members, but my patients.
• 1:57
  In terms of is it going to change, I think it's gonna keep becoming more and
• 2:00
  more digital with the predictability of our results and just the efficiency we
• 2:04
  can have, and again, truly communicate with our partners in a multidisciplinary
• 2:08
  way as well as our patients.
• 2:11
  If you could pick one or all of the above, which one do you think it makes?
• 2:16
  The highest impact?
• 2:18
  The efficiency, the accuracy or even patients with gag reflex, for example?
• 2:23
  Yes.
• 2:23
  Yes.
• 2:23
  That the patient experience matter equally as the treatment?
• 2:26
  Absolutely.
• 2:26
  I think I'm torn.
• 2:28
  I have two, so I argue that I, the two are very important for me, but the intraoral
• 2:32
  scanning aspect, I think at this point in dentistry, we can offer something better.
• 2:37
  Than how we used to do it.
• 2:38
  And I think that intraoral scanning again, it's quick, if you have a
• 2:42
  mistake, you can redo it easily allows overlap of our bone scans.
• 2:46
  And so yeah just really has changed the game on how we can prototype restorations
• 2:51
  and come up with a clean and easy result.
• 2:53
  And when we say digital work flows right, there are so many touch points.
• 3:00
  And in your point of view, what are.
• 3:02
  What is in reality, the most essential steps that you would consider in
• 3:06
  the office if somebody would like to start investing now, for example?
• 3:09
  Yes.
• 3:10
  So I think as I mentioned, my favorite intraoral scanning.
• 3:13
  I think that's the door opener.
• 3:15
  That's the door opener.
• 3:15
  And it's almost once you have that, you are now connected
• 3:17
  to so many other technologies.
• 3:19
  Once you have that model digital that you become, then, a bigger
• 3:23
  partner in the team approach because now you can start to overlap that
• 3:27
  data and see more diagnostically.
• 3:28
  So intraoral scanning, of course A 3D radiograph, CBCT, things of that nature.
• 3:34
  And then now really with overlapping a scan of the face or a 2D photo
• 3:39
  is really changing how we can view our patient from a truly facially
• 3:43
  generated treatment planning standpoint.
• 3:46
  And I'll be curious, as you said from the facial perspective speaking of certain
• 3:51
  scanning options and simulating, because we used to assemble all our cases in
• 3:57
  semi adjustable articulators, right?
• 3:58
  And we see all the chewing.
• 4:00
  Possibilities and how this will play a role into how fast the wearing or
• 4:05
  certain curves should be structured.
• 4:08
  Is this reproducible as well in digital workflow?
• 4:11
  Yeah, I think now we have the ability to put everything in the digital workflow,
• 4:15
  which I didn't truly jump on board before and now I think we're there.
• 4:19
  We absolutely can.
• 4:21
  Can design things in the patient's anatomy.
• 4:24
  And I think what this does is it leads to another level of rehabilitation.
• 4:28
  It's not just replacement of teeth.
• 4:29
  It is truly oral rehabilitation in the highest degree.
• 4:34
  And now going back to my second question when I said, what are the
• 4:38
  digital touch points, because it can be a very broad word, right?
• 4:42
  Digital workflow, yes.
• 4:44
  But it can start with a scan and it can lead you to.
• 4:48
  Print something prior to surgical procedures.
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  What are the definitions and that.
• 4:53
  That you think it's more valuable to clinicians to pay attention
• 4:57
  or all of the above again?
• 4:58
  Yes.
• 4:58
  Hard to answer.
• 4:59
  I think I started with Intraoral scanning and the coDiagnostiX® having the 3D
• 5:04
  planning for my implant surgeries.
• 5:06
  So I think that was my first jump into digital.
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  And now we have the ability to pre-plan the entire case before surgery, meaning
• 5:15
  that we can then acquire a scan the day of surgery and fabricate the teeth
• 5:19
  with my own printer in my little lab.
• 5:21
  Clinic the exact same day.
• 5:23
  And this concept of retrofitting prosthetics and things of that nature,
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  I just, the inaccuracies with that.
• 5:30
  So I just feel that now that we have digital, we really can give the patient
• 5:34
  what we've discussed ahead of time.
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  So it's a beautiful process.
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  It, as we evolve into the definitive prosthetics, we can print new prototypes.
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  This is cost effective for the clinician in private practice.
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  Easy for the technician to update.
• 5:47
  So I think, yeah, it becomes a really nice process throughout the whole experience.
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  And an easy way to take care of the patient in the future
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  because now we have the data.
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  We actually can see everything we did along the way is like cookie crumbs
• 5:59
  back to their initial pre-planning.
• 6:01
  So it's all there.
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  Not a bunch of models in boxes.
• 6:04
  Exactly.
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  We can get rid of those.
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  It's very interesting you say that because.
• 6:08
  I had this conversation with Herman Gallucci from Harvard, right?
• 6:12
  Yes.
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  And we were discussing the role of digital technologies with more precise planning.
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  Now we see structures in ways and dimensions and perspectives that we
• 6:21
  couldn't, I never anticipated 15 years back, I would see the way we can manage
• 6:26
  all those structures and plan better.
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  Place implants more precisely the assertiveness of certain procedures.
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  And he was saying, Christian, I hope I'm still alive.
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  To see the evidence 20 years from now to see the shift in success rates that he
• 6:44
  was driven by how more accurate and more.
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  Better planning is that we were able to do with digital
• 6:51
  technology entering implantology.
• 6:53
  Isn't it amazing?
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  And
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  I agree because also we can be less invasive.
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  It's much like medicine, right?
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  What we do now, we can see so many things ahead of time that we couldn't see before.
• 7:02
  And I think that's the real success, is we can be less invasive.
• 7:05
  Yeah.
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  More efficient, and actually have to do less procedures physically on the patient.
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  The waste part is also really important.
• 7:11
  You talk about having.
• 7:12
  To hold onto models, we just have less physical waste as well.
• 7:16
  So I think that ultimately it, it just feels like I'm providing
• 7:20
  dentistry in a better way.
• 7:21
  And I like how he contextualized saying, we get that a lot.
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  The question, if it's a trend, but 20 years from now we'll tell
• 7:28
  Yes, absolutely.
• 7:29
  Reflected
• 7:30
  on the benefits on a patient.
• 7:32
  The long-term
• 7:32
  results.
• 7:33
  Exactly
• 7:33
  right.
• 7:34
  Exactly.
• 7:34
  And if we shift, all right.
• 7:37
  It's not a trend.
• 7:38
  You're an advocate.
• 7:39
  If I walk into your office, yes, I know.
• 7:41
  There are many workflows that we can explore from single crowns,
• 7:45
  posterior and tear, and full arch as we discussed previously.
• 7:48
  If I walk in right now, I just stumble in it.
• 7:52
  Bang my tooth.
• 7:53
  You're please don't, on this microphone, what would you do to me?
• 7:59
  Yes.
• 8:00
  Yes.
• 8:00
  How would be my digital path in your practice?
• 8:02
  And I think that's a beautiful thing you highlighted.
• 8:04
  What would you do for me?
• 8:06
  And it's.
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  It's what my team can do for you, because that's another beautiful
• 8:09
  part about being a business owner and a clinician, is I can delegate
• 8:12
  the capturing of a lot of the data.
• 8:14
  So I would bring you in and give you a nice tour of my office.
• 8:17
  We would start by acquiring some radiography and some photos.
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  Then I can do a SMILE Cloud workup before I even meet you.
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  So that's a beautiful thing about my team getting the
• 8:26
  photos and putting all that in.
• 8:27
  Smile cloud we have the radiographs.
• 8:30
  My team would also acquire the intraoral scans and then we can align all of that so
• 8:35
  I can truly get a picture of the patient before I even shake their hand, right?
• 8:38
  So it becomes, not only is it a nice, nicer experience for me, but when I
• 8:43
  go in that room, I have everything there to communicate properly.
• 8:46
  Because we say it, we've said it for years.
• 8:48
  A picture or a video now tells a thousand words.
• 8:52
  Yes.
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  And so you just cannot communicate with other team members the same, or
• 8:56
  with your patients the same without something physical to show them.
• 8:59
  So I would show you your scans.
• 9:00
  We would talk about things that I saw, help you understand the treatment needs
• 9:04
  that you have, and help show you how we can get you to a successful result.
• 9:09
  So what do you think?
• 9:09
  Are you on board?
• 9:10
  Oh, I'm getting there.
• 9:11
  I.
• 9:15
  And then let's assume,
• 9:17
  yeah,
• 9:18
  I looked at everything and I, I. And I said, yes, let's do this.
• 9:22
  Yes.
• 9:22
  Okay, wonderful.
• 9:23
  What's next?
• 9:24
  What's next?
• 9:24
  So I would take your Intraoral scan and align it with your CBCT and coDiagnostiX®.
• 9:30
  Again, we would have your face aligned to design your smile if it
• 9:34
  included one or more than one teeth.
• 9:35
  And so we can pre-plan that whole case and.
• 9:38
  I don't do the surgical component myself.
• 9:40
  So we would engage this oral surgeon or the periodontist, depending
• 9:44
  on the team and our technician.
• 9:46
  So that's again the beautiful part about something like SMILE Cloud and AX S,
• 9:50
  where all the data is being shared in the same portal so we can have a true
• 9:54
  treatment planning discussion and plan out the entire surgery before it happens.
• 9:59
  Then we could design the guides.
• 10:00
  My technician could print the guides or I can print the guides.
• 10:03
  And then same thing with our same day restoration.
• 10:06
  That can be printed by my technician or myself, and then give you a
• 10:10
  protective appliance to wear and off you go for appropriate healing.
• 10:14
  But and then with the definitive restoration, same thing.
• 10:17
  You can just go back to that portal of data, take photos along the way, shade
• 10:21
  match things, all that information that we want to say directly to all the
• 10:25
  partners involved can be done through that portal in a very efficient way.
• 10:30
  I love how you just laid out at least six, seven touch points in which digital
• 10:36
  dentistry and technology is helping you be more efficient, not only more efficient,
• 10:41
  but to be more transparent in the communication with your patient as well.
• 10:45
  Yes.
• 10:46
  Let's shift gear a little bit.
• 10:47
  We have this sessions called, it's not what we think, it's what we know.
• 10:52
  And I would like to know from you if there was any article or case that you
• 10:58
  saw there was like it changed the way you think or how you do things that you think
• 11:03
  our audience should know about as well.
• 11:06
  Excellent.
• 11:07
  Yeah, I love this question.
• 11:08
  I'd been practicing implant dentistry for a long time, and I've always practiced
• 11:12
  as a multidisciplinary clinician.
• 11:13
  I just love a team.
• 11:15
  I love the shared win.
• 11:16
  And the article that really took that to the next level for me was Florin
• 11:20
  Cofar published and the Journal of Aesthetic Restorative Dentistry in
• 11:24
  2002 about this multidisciplinary treatment and how we can get on the same.
• 11:29
  Page the same perspective as what he talks about.
• 11:32
  And he mentions how in the analog workflow, there's just no possible way
• 11:37
  to be reproducible in our techniques in this exact vision of the case where once
• 11:42
  we go digital and we align that data, we can all see that case to a deeper level.
• 11:47
  And do a deeper level of planning.
• 11:49
  So again, that concept of common perspective has really changed it for me.
• 11:53
  And we talked earlier about, reducing that friction to communication.
• 11:56
  I think that's, that hit it.
• 11:58
  It just sparked me and said, this is the way, this is how we're gonna do it.
• 12:02
  So getting all of our data collected, putting it all in one place, we
• 12:05
  can speak the same language and work through the case together.
• 12:09
  I love this very much, and I'm a witness of this because we had
• 12:13
  recently a few clinical validations with new Straumann products and the
• 12:18
  surgeries would take place in Brazil.
• 12:20
  Patient was assessed and was selected in Brazil.
• 12:24
  Data was captured, sent to Switzerland.
• 12:27
  Yes, we did Switzerland.
• 12:29
  In, in, in Germany.
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  A whole bunch of back and forth in communication, all
• 12:34
  within one virtual place.
• 12:36
  Oh,
• 12:37
  it's wonderful.
• 12:38
  Guides and provisionals were printed in Spain and then all sent back to Brazil.
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  So when I got there, everything was in one place.
• 12:47
  How could we have done that otherwise?
• 12:49
  Yeah, we just couldn't have done that level of expertise.
• 12:53
  I can log into a case.
• 12:54
  I can send it to you and get your opinion.
• 12:57
  It's just, yeah, it's truly changed everything for me and how I practice.
• 13:01
  And speaking of, it's not what we what we think.
• 13:04
  It's what we know.
• 13:05
  Speaking of knowing, we know that we don't know everything.
• 13:08
  That's true.
• 13:08
  That is true.
• 13:10
  And
• 13:10
  we also have this one session, it's called Experience Taught Me this.
• 13:15
  It hasn't been always sunshine and rainbows.
• 13:18
  No.
• 13:18
  You must have stumbled upon something on this path.
• 13:22
  And we have to be truthful and respectful of learning curve.
• 13:27
  Yes.
• 13:27
  In your digital.
• 13:29
  Technology learning curve.
• 13:32
  Have you stumbled upon something that was another aha moment that you say,
• 13:36
  now I have to tell everybody about this because so they don't do the same?
• 13:39
  Yes.
• 13:40
  Yeah.
• 13:40
  I think for me, because I am incorporating a lot of different technologies
• 13:44
  and overlapping a lot of pieces of data, I didn't quite appreciate the.
• 13:49
  Sequential errors that we make will add up depending on what we use.
• 13:54
  So if you choose the wrong technology for intraoral scanning and have a error
• 13:58
  of, a hundred microns or makeup based on the scanner, and now you're aligning
• 14:02
  that with the future product, you're gonna layer on the source of errors.
• 14:07
  But also in the beginning, I just probably didn't capture enough data.
• 14:11
  So I look back at some of my cases, take a full surgical case for example,
• 14:16
  full-arch replacement of teeth.
• 14:18
  I would maybe just capture the teeth in the scan and not necessarily get the
• 14:21
  outlying soft tissue or palatal rugae and things of that nature that are really
• 14:25
  helpful to pre-plan the case and then merge that data the day of surgery.
• 14:30
  So I think just didn't capture enough data.
• 14:32
  Probably in the beginning it is different than the analog world.
• 14:35
  You don't have it to hold in your hand.
• 14:36
  You have to rely on this very precise alignment.
• 14:39
  And if you don't, again, in the be beginning, I experienced some
• 14:42
  cants some midline shifting, all kinds of things you can imagine.
• 14:46
  But just really learning what part of each piece of equipment
• 14:49
  was going to create what error.
• 14:51
  And once you know that just like our old analog techniques where the stone
• 14:54
  is gonna change depending on how moist it is and things of that nature, we need
• 14:58
  to apply those same concepts at digital.
• 15:00
  So we're gonna have errors, right?
• 15:02
  It's still a piece of data, but the more we can pay attention and
• 15:05
  understand how to use that, yeah it's definitely a lot more fun now.
• 15:09
  And the beautiful thing about digital is if we don't do it the right way the
• 15:12
  first time, we can erase it and do it again very quickly and inexpensively.
• 15:16
  Just like pictures.
• 15:17
  Just like pictures, exactly.
• 15:20
  In the context, of course.
• 15:22
  It's the topic of today, right?
• 15:24
  The context of digital workflows.
• 15:25
  But we all have our little favorite things, right?
• 15:28
  Favorite movies, favorite songs or artists, and.
• 15:33
  Indications as well.
• 15:34
  I would like to know from you, Kimberly, the dentist, but also
• 15:39
  the person as that you're like.
• 15:42
  Yay.
• 15:42
  When that indication comes in, is it?
• 15:44
  Yes.
• 15:45
  Which ticks you the best?
• 15:47
  It's aesthetically challenging situation or full arch situation
• 15:52
  that what, tick you there.
• 15:54
  Yeah.
• 15:54
  I, all the dentistry that we do with implants is so challenging and exciting,
• 15:59
  but I'd say yeah, the full arch tooth replacement has got to be, one of
• 16:02
  the most exciting things we can do today, because I don't have this worry
• 16:06
  that it's not gonna come out nice.
• 16:08
  The day of surgery.
• 16:10
  This smile Design, smile cloud platform has given me the confidence to say,
• 16:15
  yep, I'm gonna show the patient this and I can actually achieve that.
• 16:18
  And so that gets me excited, right?
• 16:20
  I'm not terrified going into this very complex thing where I'm
• 16:23
  gonna take someone's teeth out.
• 16:24
  This is a big change for them.
• 16:26
  And instead I can.
• 16:27
  Rejuvenate them and rejuvenate myself and know that I'm gonna
• 16:30
  have predictability with that.
• 16:31
  Yeah.
• 16:32
  So yeah, the Smile Design software has just really changed
• 16:35
  my life and made so much fun.
• 16:37
  Again, with the communication aspect, I can show the patient something
• 16:41
  that we mutually understand, both the complications and the exciting
• 16:45
  parts of the case, and all go into it with that same end in mind.
• 16:50
  I couldn't agree more with you.
• 16:51
  It's, every situation has this very rewarding element, but taking
• 16:55
  somebody who's already at the edge of a very collapsed situation,
• 17:00
  functional, aesthetic, self-esteem, and you turn that upside down.
• 17:04
  Yeah, you change
• 17:05
  them, you change 'em as a human, they're back to being their best self, both
• 17:08
  socially and yeah, it's very exciting.
• 17:13
  Kimberly, it's really a joy to have you with us.
• 17:18
  I wish we had more time to do this, to do much longer.
• 17:21
  I have so much, so many other items that would like to pick your brain.
• 17:25
  But sadly we have to finish this to all of the clinicians out there who
• 17:31
  be interested to find you and know more about your work or educational
• 17:35
  opportunities where they can find you.
• 17:37
  Yes.
• 17:38
  So I'm on Instagram and pretty active there answering questions and
• 17:41
  helping share tips and techniques.
• 17:43
  So I do little videos in my clinic and I have my team members record those for me.
• 17:47
  So Dr. Skimm on Instagram.
• 17:49
  And then on my website, bend Prosthodontics.
• 17:52
  I'm in Bend, Oregon, so stop by.
• 17:53
  I'd love to take you to the mountain and do some skiing together.
• 17:56
  Oh,
• 17:56
  that's definitely.
• 17:59
  And to all of you out there, if this content was valuable to you,
• 18:03
  make sure you give it a because we need that, we need to be relevant.
• 18:06
  Make sure you also share your friends.
• 18:08
  Sharing is caring.
• 18:10
  And until the next episode,
• 18:14
  keep digital.
• 18:15
  Keep digital.
• 18:15
  Thank you.