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Digital dilemmas – what is the role of intraoral scanners?

12 June 2019

Dr Simon Parsons, dentolegal adviser at Dental Protection, explores the integration of scanners in contemporary dental practice 

As the digital age continues to disrupt how we interact with the world around us, many clinicians are keen to adopt new technologies in their practices. Any improvement in the patient’s experience is likely to improve overall satisfaction with care and reduce your risk of a complaint or claim. With technology supposed to be about making life easier, there can be tangible benefits for both clinicians and patients in adopting intraoral scanning.

Intraoral scanners (IOS) are devices used to record the teeth and soft tissues digitally, in lieu of conventional dental impressions. They promise increased efficiency, can be easy to use after a period of familiarisation, and may help patients avoid gagging, among many other benefits. But what should a prospective purchaser consider before going down the path of “digital impressions” and what risks might such an approach pose? What should existing users also remember when using these devices?

How might this technology impact my practice?

All brands use various proprietary methods to image the oral environment. Despite their differences, all scanners incorporate a visible light source in a scanner tip that projects on to the teeth. The reflected light is captured by sensors and converted via algorithms to meaningful three-dimensional data. This data is processed and can be exported via the internet to dental laboratories or chairside mills, to enable the construction of indirect restorations and even dental prostheses such as splints and dentures, without the need to manufacture a model in most instances. When used carefully they offer high accuracy, as the digital files cannot undergo distortion in the way that impression materials and dental stone can.

In this way, IOS has the potential to greatly alter chairside and back-end processes. Bypassing the need to order custom trays or disinfect and pour impressions, treatment planning can be simplified and surgery staff used for other value-adding activities. Of further benefit is simplified infection control and a reduction in the need for inventory of impression trays, adhesives, impression materials, dental stone, packaging and couriers.

Elimination of most remakes is a tangible benefit for all parties, as IOS enables assessment of preparation margins, undercuts, occlusal clearance and other critical parameters by the clinician before a job is submitted; any correction required can be performed while the patient remains seated in the chair. This greatly improves confidence in the quality of one’s work and reduces the risk of adjustments to completed cases for reasons of poor fit, occlusion or path of insertion reasons.

Getting a job right first time instils confidence in the entire clinical experience and the clinician’s ability, while helping to justify the costs of high quality treatment. Further, the option to mill restorations at chairside using a linked chairside mill is of great convenience for patients who travel long distances or who prefer immediate results.

What are some ethical and practical considerations with IOS?

Many clinicians may spend considerable sums on purchasing IOS and/or chairside mills and it can be tempting to seek opportunities to achieve a prompt return on the considerable investment made. Using scanners for patient education is an ideal means of deriving value from the technology, even where restorative or orthodontic treatment may not be warranted. It is becoming increasingly common for clinicians to employ full colour, dual arch scans as an adjunct to the dental charting for new patients, recording a detailed baseline visual assessment of a patient’s initial clinical presentation. While there is no current ruling on the suitability of such scans to be used in place of a detailed odontogram recording, we would consider it unwise to rely solely on an intraoral scan to document a patient’s presenting teeth and their condition.

To ensure full utilisation of scanners in practice, clinicians are grappling with the notion of whether it is appropriate for dental assistants or other support staff to perform an intraoral scan of a patient. The usual justification for this is that the risks of injury, allergy or misadventure are low with scanning, while the benefits may be significant. As an intraoral scan is a direct alternative to a conventional physical impression, we would advise that only those staff trained to take dental impressions should be using IOS in clinical practice, providing it is within their scope of practice.

Finally, as with all digital technology, the quality and security of information transfer is paramount. Although limited personal details are transferred following scanning, this information remains part of the overall dental record and must be treated appropriately. Dental staff must be trained in the setup and maintenance of networks and ensure that robust procedures are in place for the transfer of files to “trusted connection” laboratory partners. Similarly, laptop computers and mobile computing devices require regular backups and these need to be kept offsite and should be checked regularly for integrity, should they be required in the future.

Summary

Intraoral scanning promises benefits to clinicians and their patients when used wisely and where a sound business case already exists for their implementation. Dentists should consider the product features that best fit their service mix and ensure effective training occurs to maximise the opportunities for positive results.

© 2019 The Medical Protection Society Limited

DPL Australia Pty Ltd (“DPLA”) is registered in Australia with ABN 24 092 695 933. Dental Protection Limited (“DPL”) is registered in England (No. 2374160) and along with DPLA is part of the Medical Protection Society Limited (“MPS”) group of companies. MPS is registered in England (No. 00036142). Both DPL and MPS have their registered office at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. DPL serves and supports the dental members of MPS. All the benefits of MPS membership are discretionary, as set out in MPS’s Memorandum and Articles of Association. “Dental Protection member” in Australia means a non-indemnity dental member of MPS. Dental Protection members may hold membership independently or in conjunction with membership of the Australian Dental Association (W.A. Branch) Inc. (“ADA WA”).

Dental Protection members who hold membership independently need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA National Insurance Pty Ltd (“MDA”), ABN 56 058 271 417, AFS Licence No. 238073. DPLA is a Corporate Authorised Representative of MDA with CAR No. 326134. For such Dental Protection members, by agreement with MDA, DPLA provides point-of-contact member services, case management and colleague-to-colleague support.

Dental Protection members who are also ADA WA members need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA, which is available in accordance with the provisions of ADA WA membership.

None of ADA WA, DPL, DPLA and MPS are insurance companies. Dental Protection® is a registered trademark of MPS.