558: Difficulties in Digital Dentistry - Dr. Marcos Vargas

Difficulties in Digital Dentistry

Episode #558 with Dr. Marcos Vargas

If you're wondering when to jump into digital — now is the best time! It’s been proven to work, the technology keeps improving, and your labs are already using it. So, why are dentists still hesitant to change? To explain some of the hurdles in digital dentistry and ways to overcome them, Kirk Behrendt brings back Dr. Marcos Vargas, Professor of Family Dentistry at the University of Iowa. Start using digital to improve your patients’ experience! To learn how to get started, and to sign up for his free webinar, listen to Episode 558 of The Best Practices Show!

Episode Resources:

• Dr. Vargas’s email: marcos-vargas@uiowa.edu 
• Dr. Vargas’s Facebook: https://www.facebook.com/marcos.vargas.1963
• Dr. Vargas’s social media: @marcosvargas999
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Links Mentioned in This Episode:

Composite Mastery Webinar with Dr. Bob Margeas, Dr. Marcos Vargas, and Dr. Stephen Phelan: https://phelandentalseminars.com/cmo-webinar-wj 

Main Takeaways:

Don't be afraid of change.

Now is the best time to jump into digital.

Your world will open up with digital dentistry.

Start slow, get your team’s buy-in, and practice often.

Keep an open mind and continue learning for the rest of your life.

Quotes:

“I think, more and more, dentistry is moving towards digital. I think there's more interest, not only from the younger generation, but the older generations are jumping in there too. This is a subject that moves so fast, and there are so many components. The implementation, when we’re thinking about why it is difficult and you think about economics, one of the difficulties is, where do you jump into it? It’s kind of like buying something new. When do I jump into it? Do I [get] the model of this car now? Do I wait a couple of years with more features? So, it’s a little difficult to know where to jump [in].” (4:12—5:01)

“There's no right or wrong when you jump. The sooner you jump, the sooner you are going to get into digital, obviously. I would say, looking at the market and looking at what I know [about] digital, I would jump right now. I think the technology has been proven. There is a lot of research behind the scanners we have right now, to the point that I will say, yes, you can jump right now and immediately get good results.” (6:05—6:34)

“Now, how do you jump into it, and what areas? Is it aligners? Restorative dentistry? I think, in general, most dentists will do restorative dentistry. So, jump into buying yourself an intraoral scanner. I will say that is the entry point. Buy yourself a digital scanner. With that, you are going to scan upper and lower arches, bites, crown preparations. Maybe start with a crown preparation that is supragingival, something relatively simple. And then, communicate with your lab that you are jumping in. And the labs, surprisingly — it’s not everyone, but the grand majority — they already are digital. So, dentists, we haven't jumped into digital when laboratories already are way far ahead than the dentists in digital technology.” (6:35—7:32)

“We still, in some cases, do analog impressions with impression material. The laboratory is going to scan those impressions and work everything digital. So, what I think is much easier, faster is if we scan and send that data to the laboratory. The communication is faster. You don't have to wait for the impression to get to the laboratory. It’s immediate. I send it now, and in two seconds they’ve already got it, so they can start your case.” (7:34—8:04)

“It’s a parallel. We’re teaching the principles of, let's say a crown preparation. And then, there is a [fork in the road], and we say, ‘Now, we have to take an impression. You can do it either way, digital or analog.’ And then, we start talking a little bit about the advantages and disadvantages of maybe one over the other. But also, we need to be conscious that some of those students are going to be practices where they don't have digital yet. So, we need to teach them both. I will say more and more people are jumping, but not everybody is digital. So, in academics, it’s a little difficult to make that complete change, or maybe what percentage says digital and what percentage says analog. So, that’s why we teach them both, parallel.” (8:35—9:29)

“We think about AI as something that can do everything. ‘Artificial intelligence, that's everything. I don't have to even touch it.’ But artificial intelligence has different degrees. We already have artificial intelligence in these machines. So, some of this equipment, you scan for a crown, you're telling it what crown you're looking at, and the AI in the machine immediately finds your margin. So, there's already something incorporated in these systems to help you design what you're doing. A lot of the digital process is driven by AI; we just don't realize it. A lot of things are already going into modern dentistry with AI.” (10:10—10:54)

“This is one of the difficulties when we talk about implementation, is that sometimes, as a dentist, you want to jump into something. You go to a meeting, and you go talk to a rep, or go to the exhibit floor, and you get excited about implementing something in your practice. You come back, and your staff is like, ‘Well, just settle down a little bit. We need to talk about it. We need to think about it.’ So, it’s important to have the people in your team buying into the concept of digital.” (11:38—12:06)

“In restorative, you're doing a crown. And when you do analog, you might not get a margin. What does it mean? You have to retake the impression. In digital, it means you delete that area you didn't get, do an [area of] isolation, rescan, and you get the margin. So, speed and comfort for the patients are things that when I talk to my team, I discuss it and say, ‘Think about the advantages. We don't have to have the material for five minutes in the mouth. The patient is going to be more comfortable because there is not that — they call it “goo”. ‘I hate that goo,’ people will say. And the first time you do digital with those, it’s like, ‘Oh my god. I love it, doc! I hate that goo. I feel like salivating, saliva all over.’ And they love it. So, again, bring the team in that way. I found out that is a very good way.” (12:23—13:15)

“The benefit [of digital for team members] is that there's less cleanup because you don't have all that impression material going around and you have to clean it. It’s faster. Patients like it. They're happier with your system, happier with the dentist. And some of the assistants get excited about this. So, they can scan. Instead of taking alginate models, you can take scans. And then, you can print them. That's probably the next step into digital, maybe getting a printer in your office. I think that's the second step, once you are comfortable with the scanning. So, I think the team realizes the advantages. And once you explain the advantages to your team, I think most teams are excited with the technology and improving patient service.” (13:17—14:06)

“We think, ‘I am happy with what I'm doing. Why change? Why modernize myself if I'm already happy with what I am [doing]?’ I wouldn't say that that's not right. But I think we produce fear in ourselves because we are afraid of change. Moving from analog to digital is change, by itself. So, people are like, ‘No, it’s working fine. Why do I have to change? And then, the expense.’ They make more excuses than there really are to not jump into digital.” (15:05—15:51)

“I don't believe that [digital decreases traditional skill and craftsmanship]. I really do not believe that. Because what do we know? We know that the better dentistry we do, the easier for technology to follow up on that. Like my margins. The better margins, the smoother margins I give to digital, the better the fit is going to be on my crown. So, the craftmanship, I see it’s still there. When we try to teach somebody digital, I tell them digital is just a different way to get an impression. Instead of analog, it’s digital. But the quality of the work should be good for both. It should be the highest quality you can put out there. So, I will never equate loss of quality, loss of craftsmanship, to digital. I will say that it should be maintained. We need to maintain that quality of dentistry.” (16:20—17:16)

“Once you [start doing digital dentistry], maybe start designing your cases [digitally]. Move a little further along to digital smile design or bridges. Scan your restorative and mix it with esthetic. Meaning, you can take photos of the face, the smile, at repose, and then get your scans, put them in the computer, and you can design. You can start showing the patient, ‘If you do veneers, you will close the diastema.’ So, all of a sudden, it becomes a diagnostic tool at the same time. Not only tools for the restorative dentist, but also for the diagnostic portion of the dentist. You can incorporate CBCTs in that. That's maybe another step, incorporating in their designs, CBCT. You can plan your implants.” (17:34—18:26)

“The world opens up after you go step by step. I think the first one is the scanner. The second one is the printer. And the third is design into the computer. Now, does every dentist want to get in there? Maybe not. Maybe some would like to get in there from a diagnostic point of view. Some of them like to go diagnosis plus treatment. You start combining things in the digital world, and that's very doable. Some people already do it that way. We try to teach it that way. At least from the esthetic point of view, the senior students will take photographs, scan CBCTs. And then sometimes, for an esthetic case, now with the CBCT, I know where the bone is. I know where the gingiva is, where the CEJ is. We can plan to the detail how the surgeon, the periodontist, is going to trim the tissue for me to have the ideal length of the crown. And then all that planning, maybe I have a missing tooth, I have an implant, how everything fits. So, digital also brings multidisciplinary dentistry together, I would say.” (18:28—19:32)

“Stage number one, getting the scanner and to start scanning, it should be maybe a week or a couple of weeks. Because again, if you're going to start scanning for models, things like that, you scan and send it to the lab. They print it, you get it back. Or for a crown, you send it, they send your crown back with a model and everything. So, that's one or two weeks, I think, there. My suggestion to everybody getting into scanners, don't start with five, six-unit bridge, or even a three-unit bridge. Start with a single crown because I think that's the easiest that you learn.” (19:54—20:35)

“Practice. The more you practice ahead of the patient, the better you're going to be at scanning. For a long time, once we started getting the scanners, like probably ten years ago, I would come in the morning and then fire up the scanner. We had the 3M scanner. I don't remember the name nowadays. But you had the powder and everything. So, I would go and practice on my model. Because your patient comes in, and every time, it becomes faster, and faster, and faster. So, practice. Don't think that, immediately, you're going to run with it. You need to start slow with easy dentistry. You don't want to start with very complicated dentistry. So, be patient. Be patient because, eventually, that piece of equipment will pay for itself.” (20:36—21:25)

“I don't have any doubt that a lot of the things that we’re doing is going to get even more mainstream, digital. I might even say, now, it seems like it’s mainstream. You go and talk to a group of people, and the idea of impressions is kind of foreign to some people. Some people have gone completely digital. So, whether it’s mainstream or not is kind of difficult. But every time I try to foresee the future, it’s like, oh my god. I think it’s bigger, bigger, and better. Faster scanners. Eventually, the scanners are going to become cheaper, scanners that can see through blood, through saliva. Wouldn't it be great that you prepare the tooth, and it’s bleeding because you nicked the gingiva, and all of a sudden, the scanner with doppler radar or whatever, they get you the margins, get you everything? And AI will give you warnings, ‘Oh, there is a rough margin here, a J margin.’ Things like that, I think, eventually, is going to happen. That is going to make the life of the dentist much easier. It just has to be.” (21:42—22:50)

“With the explosion of knowledge over the last 10, 20, 30 years, if I look back on myself, when I went to dental school 35, 40 years ago, the dentistry that I knew in that time is dentistry that I don't practice anymore. It’s completely changed over the years. That dentistry that I learned is not the dentistry that I practice now. So, to students, I will say dental school is boot camp, to give you the basics to go and pass the board and start practicing dentistry. But learning about dentistry doesn't stop that day. The next day, you need to keep learning, learning, learning, and learning. Because if you drop the ball in learning, you are going to fall behind your colleagues that are learning, learning, and learning.” (23:57—24:46)

“Keep learning throughout your life. Expect that everything is going to change that you learn. And with the explosion of knowledge, cramming basic information in four years is so difficult for us. And then pushing to do three years — I don't think three years is enough to get you the boot camp. Now, I call it boot camp because so much knowledge is out there. So, is it easy? No. I would never say that getting through dentistry is easy. But it’s exciting. It’s fun. It’s a very rewarding profession in a lot of aspects. So, go do dentistry.” (24:53—25:35)

“This is as good a time as any to jump into digital. Start slow. Involve your team. Reach out to educators or people that teach a little bit of the tips and tricks of digital dentistry. Keep an open mind. Be patient. Practice. Those are the things that I will say are the initial hurdles to go into digital dentistry. But I will say jump in now because it’s exciting. It’s going to get better and better.” (29:14—29:46)

Snippets:

0:00 Introduction.

1:44 Dr. Vargas’s background.

3:52 Where we are with digital dentistry.

5:34 When is the best time to jump into digital?

8:17 Are students today learning both analog and digital?

9:49 AI's role in digital dentistry.

11:19 How to get your team to buy in.

14:45 What dentists get wrong about digital.

16:03 Is digital linked to a lack of skill and craftsmanship?

17:17 Digital smile design.

19:34 Practice, practice, practice.

21:26 The future of digital dentistry.

22:52 What to expect in dental school.

26:18 More about Dr. Vargas and his future courses.

29:05 Last thoughts on digital dentistry.

Dr. Marcos Vargas Bio:

Dr. Marcos Vargas attended Cayetano Heredia University School of Dentistry in Lima, Peru, and graduated in 1985. He spent two years, 1990 to 1992, in the AEGD program at the Eastman Dental Center in Rochester, New York. He received his Certificate and Master’s Degree in Operative Dentistry in 1994 at the University of Iowa, where he is currently a Professor in the Department of Family Dentistry. His primary research interests are in the areas of dental materials, including glass ionomers, dentin bonding, composite resins, and esthetic dentistry.

Dr. Vargas is also recognized for his expertise of Direct Restorative Treatment Procedures and conducts numerous lectures and hands-on seminars in the U.S. and internationally. Dr. Vargas has published extensively in the areas of dental adhesion and resin composites for over 25 years. He maintains a private practice limited to operative dentistry with an emphasis on esthetic dentistry.