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Understanding the client server relationship and what it means to your lab or practice

Dr. Alan Jurim, with a dual degree in Computer Systems Engineering and Electrical Engineering from Rensselaer Polytechnic Institute, before receiving his dentistry degree from NYU, is uniquely qualified to understand digital dentistry. He brings both hi-tech engineering and clinical expertise to his practice. If you want to discuss digital dentistry, he’s the guy to talk to. We spoke with him about the client-server relationship, a subject he will present at the inaugural 3Shape Community Symposium.

What is meant by a client-server relationship?

In honesty, I don’t like to call it a client-server relationship. I feel it’s too technical a name. Instead, I like to say that we are expanding our digital ecosystem.

What I mean by that is that we want the ability to have the scans that are stored in our digital patient library to be accessible on different computers throughout the office’s computer network.

Is something that simple or logical not possible these days?

The way that is has traditionally worked is that we have had a stand-alone system for CAD-CAM dentistry. That’s the setup most offices and universities have.

You have your scanner hooked up to a single computer and that is your digital ecosystem. That means that if you want to analyze scans if you want to send scans, you have to go into that computer. If you want to reference information that has been recorded, you have to go back to that one system.

This becomes the downfall of a practice looking to integrate digital dentistry. Because it limits access to the data or information throughout the practice.

When I explain what the digital ecosystem is, I define it as the ability for us to have information accessible on all computers that are connected within an office or school environment.

It’s very similar to the way Dentrix works: where you have one computer that is centrally storing the information and all the other computers are accessing information from that one computer.

What has this setup meant to your practice?

The 3Shape client-server relationship has given us the ability to have a patient library available throughout the entire office environment.

Because of it, we can now scan a patient for a same-day restoration in one operatory, and when that scan is done, the scanner can be used in another operatory. I can go to my workstation in my office and bring up that scan and design that restoration and send it to a mill, without having to use that same computer we took the scan original with.

That is a great example of how we can change our workflows. We can be more versatile. We don’t have to do everything on one computer that is shared by everybody.

The next way this expands our digital dentistry is through the process of allowing non-clinical members of the office to view the scans. Now when I say view scans, I don’t mean that they are viewing them from a clinically analytical perspective. They are doing more of the administrative work: making sure that the scans have been sent or properly billed or recorded into the practice management software. We enable the support staff to also have access to the digital information that has been gained.

And the third and probably most powerful advantage is that it allows clinicians to access the data to remotely study the information for diagnosis. And there are tools that help us with the diagnosis. But fundamentally speaking, if we can have twenty users all accessing information at the same time, then we are going to get twenty times more digital dentistry done.

That is something we have worked very hard to bring over to our dental school (Jurim Dental Academy). What ends up happening is that for a school to truly become a proponent of digital dentistry, they have to have an ecosystem that allows everybody access to this information.

Most schools have, for example, eight scanners. That’s great. But those eight scanners are individual systems. For that to be useful for the planning, analysis, restorative workflows, everyone needs to have access to that data or information.

When it’s on a standalone system that may or may not be online, it really inhibits what we can do with digital workflows.

In the school environment, it is allowing the faculty and students to not just record the digital data, but to access and analyze it. That’s a tremendous change!

Does this type of setup require every computer in the practice to have the same software, i.e., 3Shape Implant Studio?

The way that it works is that the same software that is on the main computer, or main server, is the same software that is on all the other computers. The various computers have the ability to run the implant planning software, the design software, any of the excitement apps that are on that system. The scans that are on the database are centrally accessible to everybody.

Couldn’t scans be shared by everyone by just using 3Shape Communicate?

That’s true. But the downside to that workflow is that 3Shape Communicate is intended to be a way for us to transfer data between Communicate users. It does not give you access to the same tools that are built into the 3Shape platforms like Dental System or Implant Studio etc., or for digital dentistry, like analysis tools, the communication, and planning tools, the excitement tools… everything along those lines. You have to have the software and bring the scan into it.

In other words, you can share a file, you can see the scan and the 3D model of it, but you don’t have the tools that make that model valuable, like comparison tools, tools to record contacts or tools to see occlusion.

Does every computer need a software license in the ecosystem?

This is one of the best parts, the software is really designed per user or use, not an individual computer. If, for example, you have a single scanner, you can scan from any computer with the same license when working with this setup. In this way, we maximize our investment in the software by using it on almost any computer in the office.

How do doctors learn how to set up a digital ecosystem?

I’ve been tasked at the 3Shape Community Symposium to give a Master Class on the client-server relationship.

I’ve been using the client-server relationship for almost two years now. What has happened, as a result of it, is that our practice was always onboard 100% with digital dentistry, but now, we have elevated the quality of our digital dentistry. Because the information is accessible to everybody. That’s all it really is.

It’s taking the same information and making it accessible. And when it is accessible you have the possibility to use that information for more than the average clinician is using it for, which is usually a simple restorative procedure.

My school (Jurim Dental Academy) is the first to use this. And the best environment to use this type of setup is at a school. Because in a school environment you have patients who end up staying. Yet the providers, the dentists, come and go.

A patient that gets transferred to a new dentist, the ability for that new student or dentist, to go back in time and have access to digital information that doesn’t degrade in quality, doesn’t change, that information can paint a picture of this patient’s oral environment and their dental situation changing over time. That really begins to elucidate what is happening with this patient. How did this patient get here? If you understand that, you can most likely generate a plan that is going to be in the long term, better for the patient and his or her dental health. Because you are visually seeing and sharing the information, also with the patient.

Expanding the digital ecosystem to the school environment has been, by far, the most revolutionary change that we have done. Now the entire community has access to this digital ecosystem. It’s very exciting!

Are universities beginning to catch on?

Yes, but not at our level.

It’s a big challenge because, in any scenario, the software and the tools that we use for digital dentistry are designed for a single practitioner. They are not designed for a school environment where you have providers coming and going.

In order to scale that and put systems in place that protect the important electronic health information, that’s what we are still working on to develop. We’ve set the system up and the students have access, but we now have to tailor it better for an environment that is going to continue to scale up in size. That is a very big priority for us.

Can dentists and practice owners contact you?

Absolutely. In fact, somehow, I am now in the field of designing offices and creating the prototype office that we all want. But I didn’t really create it. I’m just using the tools that were given to me by 3Shape. I’m applying those tools in a way that enhances the dentistry that we provide.