OFFICE LOGISTICS UTILIZING SCANNERS It is my opinion that when you integrate a scanner into your practice, you should find as many reasons to use it as possible. The obvious reason is aligner therapy. Aligners fabricated from scans (versus PVS impressions) fit better and result in a better patient experience, in addition to the faster turnaround time. My practice has been impression free since mid-2013. The road to get there was not without bumps, but we have developed the systems to support our plaster free practice. The ability to take a scan and send it to a lab that is experienced with indirect banding has been an amazing paradigm shift for us. For most appliances, we scan and allow the lab to fit bands on the models. The appliance is delivered two weeks later. Debands are a different animal because we do not want to wait an extended period of time between removing the appliance and retainer delivery. To prevent this, we deband the patient and include a scan with our final records. The retainers are turned around quickly enough for us to deliver within five days. While it does cost more for appliances (due to the model printing and indirect banding), the patient experience is significantly improved. There are many labs that have experience with indirect banding (Specialty Appliances, NEO
Lab, AOA, and Dynaflex are among the largest). A common question that arises is: do labs fabricate soldered appliances directly on the printed models? Yes and no. Most labs use traditional soldering methods, which require that the model be duplicated in stone for appliance fabrication. However, laser welding (which is significantly smaller and stronger than soldering) can be performed directly on the printed models. Very few labs use laser welding at this point in time because of the extra cost and expertise involved, but it is an emerging trend. DIGITAL RETENTION To me, the single greatest use of a scanner is the ability to virtually eliminate lost retainer appointments for those who have been wearing their retainers. By combining the digital model and 3D printing, we have the ability to fabricate as many retainers as we want on a single printed model. As long as the patient has been wearing their retainers, a new Essix can be easily fabricated and mailed out; thereby eliminating a trip for them to the office and opening up a chair for a more profitable procedure. According to my math, it costs approximately $30 to fabricate a retainer from a printed model off of a previously scanned patient versus approximately $100 to fabricate a retainer
Printed Models Chair Time* (impression)
$0
$75 (15 min)
Model Materials
$24
$.50
Pour Up (staff**/stone)
$0
$2
Retainer fab (staff**)
$2.50
$2.50
Retainer fab (plastic)
$4
$4
Chair Time* (delivery)
$0
$25 (5 min)
Total Cost
$30.50
* Assuming $300/hr/chair of production ** $15/hr employee
FIGURE 2 36
Stone Models
It’s just BUSINESS
$109
from an in-office alginate impression (Figure 2).
–––––––––––––––––– It is my opinion that when you integrate a scanner into your practice, you should find as many reasons to use it as possible. –––––––––––––––––– IS IT TIME TO BUY? Many people believe that the cost of scanners will be coming down significantly over the next few years. I am not in that camp. I don’t believe that any scanner company wants a race to the bottom with regard to fees. Align raised the price of the Element shortly after it was released. While it is true that technology tends to become more affordable over time (look at TVs – we all remember when a flat screen HD TV was several thousand dollars, and now they are basically disposable), but I don’t see the trend for scanners to come down in price in the near future. Those that wait for the price to come down are going to find themselves behind the times and struggling to keep up. I do not believe that a scanner will MAKE you money. They are a significant purchase that ends up costing much more than the initial price due to software fees and consumables; however, most of us are willing to spend more money on pre-adjusted or self-ligating brackets, NiTi/TMA wires, and digital radiography because they make the patient experience better and your staff happier. In the long run, this is what will make you money. A happy staff and an office that does not take impressions will help you build a brand that attracts patients and differentiates yourself from the practices down the street that are waiting for the price to come down.