TRIOS MOVE allows me to align with patients' expectations
Interview with Dr. Lanoiselée
Good afternoon, Doctor. Could you introduce us to your dental practice? When did you start your career as a dentist? What types of treatments do you offer? What is the typical profile of your patient?
Good afternoon. I started my career in January 2007 as an employee. Our practice is a general one: we treat all types of patients and perform almost all types of procedures. Due to the small number of dental practitioners in the area and the absence of specialists, we are called upon to see all types of patients: children, young adults, retired patients, even extreme ages. We have a retirement home on the other side of the road and, indeed, patients are referred to us, or sometimes we go there. In 2015, we joined a multidisciplinary health center, so we decided to become partners. This has allowed us to completely revitalize the center, expand, invest in a panoramic X-ray system and include an operating room. Our practice is what I would call a rural practice, far from major city centers, but with a truly versatile offering.
How long have you been using an intraoral scanner in your practice? What convinced you to go digital?
I used several systems, first as an academic and then as a practitioner, so I was able to evaluate the benefits of each. I started as a lecturer in 2010 with a direct CAD/CAM system. We had a system that was efficient, but quite complex to use, because we had to apply powder and correlate the scans, which limited the size of our impressions. And then, I was lucky enough to have people who trusted me and provided me with a 3Shape system that I had also been able to test when I was a lecturer. As for my private practice, it was when I became a partner in 2015 that I moved on to the digital impressions at the clinic.
Why did you choose the 3Shape brand?
For several reasons. First of all, the quality of the scan. Because, when you work with several systems, you quickly realize that quality varies and that, in relation to prosthetic needs, it is essential to have an accurate scan with a very high level of detail. So, I discussed with my dental technician which scanner could meet my requirements, and the 3Shape system was one of the options. Having a system that was ergonomic was also important to me. I scan several times a day, so it must be pleasant for the patient and more efficient than a conventional impression material.
Which TRIOS scanner do you use today?
How did the transition to digital dentistry go for you? What improvements can you see compared to traditional impression-taking?
It was done in a fairly simple way. Working at the university with the TRIOS system, without having to do any patient management afterwards, allowed me to gain my first experience. Indeed, the learning curve is very fast. It helped me to identify the key points to scan correctly and especially, to work a lot on my preparations. You can see that with a digital impression, the accuracy of preparation is higher, which considerably improves our work in terms of precision and quality for the laboratory. It also gives us the opportunity to make slightly bolder preparations.
I started to polish my preparations a little more, to smooth small edges to have quality work to show my patient and then send to the laboratory. I have completely revised my sets of burs and also equipped myself with optical aids, and many fine and ultra-fine instruments, including ultrasonic ones. With a traditional impression, as long as it has not been poured and trimmed, it is difficult to get an idea of the final result. The scale of analysis is macroscopic, while with a digital impression we almost reach the micro level, relatively speaking, of course. It allowed me to get a better view of my preparation and therefore to be more efficient.
Do you use TRIOS for all impressions? What are the most common indications?
According to my personal statistics, I make digital impressions for 87% of my cases today, and I think these numbers will increase even further. With the exception of repairs, for which I use conventional impressions, I choose digital impressions for fixed prosthesis, cemented or bonded. I am working more and more on removable dentures, especially on metal frameworks, using digital impressions, and for combined prostheses, I also tend to systematically make a digital impression. My dream is to master complete dentures, and I expect to do so in the near future.
How can you describe the scanning experience from the user's point of view? How is different from its predecessors in this respect?
In terms of ergonomics, I can easily adjust the position of my unit according to the case, whether the patient is lying down or sitting. The articulated arm is relatively long, so it allows me to turn the screen as I wish, despite the cumbersome cuspidor on the side of my dental chair. When my assistant comes to help me with an impression, she can position herself more easily. It is not the unit that will determine her position, but it is she who will position the unit. The goal is to always work under direct vision on the screen and not to have, at any time, to check in the mouth. While with previous systems, I tended to go from one to the other, because the screen was not well-centered, the unit did not always have a good position in terms of ergonomics. So, it is much more comfortable in that respect. Another point I really like is that you only have to slightly adjust the screen so that everyone – the assistant, the patient and I – can follow the impression-taking process.
What is the first reaction of patients when they see this new equipment? Does this have an effect on their visit satisfaction?
There is a great curiosity at first, because most have not yet experienced the digital optical impression. So, there is a little apprehension about its functioning: I explain to them that it is a photo system and not an irradiation system, because many people think that's how it works. Sometimes, I even create the order form with them to show how I will proceed. Then, in a rather entertaining way, I take the impression, and the patients are able to watch it in real time.
A lot of patients tell us: "The impression material has an unpleasant taste," or have a nauseous reflex. All these patients are quickly reassured. If they're a little anxious, I can take breaks during the impression. A short time ago, I had the opportunity to take an impression of a patient with a mental health condition. This patient tended to panic during the process of physical impression-taking, but there, with a dematerialized impression, he really got into it, and for him it was really more comfortable.
So, surprise and then envy. And patients who demand digital impressions for their comfort. Many of them want to get the printed models at the end to have their little souvenir of the treatment in the clinic.
Does showing the scans to patients help you to support your treatment proposals, to convince the patient to accept treatment?We have a very good communication tool. A gypsum cast is colorless, making it more difficult for patients to understand. Having a model in occlusion allows us to explain why teeth have extruded or have been worn down. We can also show them caries, damaged teeth and explain to them the reasoning we have with an image. This will allow the patients to better understand their treatment and to become more involved. It will also be easier for us to convince them of the need for treatment, which is essential.
What do you think about the possibility of tracking the evolution of the patient's oral health over time with digital impressions and an application like TRIOS Patient Monitoring?I am very interested in it for patients suffering from bruxism, because they are not necessarily aware of their state of wear. With the possibility of comparing scans, the practitioner can confront them with the problem. There are also patients who have had relapses with regard to orthodontic follow-up and who are afraid of having a new relapse. Offering them to scan their mouth regularly, without inconvenience to them and without risk to their health, makes it possible to monitor the treatment progress and reassure them.
What has changed in the way you cooperate with your dental laboratory?The communication with the laboratory is now much more dynamic and interactive. Before, there was a lot more back-and-forth and phone calls. Either my dental technician had the model, or I did, but it was rare for each of us to have the information. Today, I even communicate in real time with him to achieve an ideal insertion direction and make sure the tooth preparation is sufficient. For example, in bridge cases where it is necessary to parallelize the abutment teeth, I do a first scan, I send it to him, and then we discuss together the design and the adjustments to be made so that the prosthesis can be inserted correctly.
The quality of the discussion is also higher. In the event of a problem or failure, it gives the opportunity to exchange ideas without engaging in negative criticism and always provide constructive feedback. With his technical competence and my expertise as a clinician, it is easier to meet halfway thanks to digital impressions. We work much closer together than before. In implantology, my dental technician usually makes an ideal crown design, and then I position the implant in relation to it. This makes the process more consistent: it's the prosthesis that guides the implant placement and not the other way around.
We recently launched 3Shape Community. Are you considering registering on this platform? If so, why?Yes, I am already registered. An interactive platform allows us to discuss the problems we may encounter and to come up with new ideas, whether technical or clinical.
You also find yourself with people who use the same type of equipment. In addition, community members are located all over the world: it creates links, interactions, dynamics. Not only dentists, but also laboratories and resellers can access it. It's versatile: everyone can make their contribution. For me, this kind of community is essential today to connect us.
In your opinion, what are the future prospects for technological progress in dentistry?Our industry is increasingly moving towards a computer-assisted dentistry, especially in restorative work. I would also like to have all the screening aspects integrated into the continuous monitoring: caries detection, in particular.
I know that 3Shape has a tool that allows to simulate orthodontic treatment, TRIOS Treatment Simulator. Other simulations, for example for periodontal surgery, could also help make the patients understand the treatment and convince them of its necessity. These tools would help us to validate our treatments from a purely theoretical point of view as well as to exchange with colleagues.
What are the main challenges facing dental practices in France today, beyond the strictly medical context? What role would digital technologies play in these processes?It is above all the economic factors that must be considered. In the past, you would run a dental practice simply with due diligence; now we have become business owners that have companies to manage. And it is not only our management skills that are important, but also our external image. If you want your company to be successful, you have to be able to adapt, even if dentists are trained to be health care providers, rather than managers.
In this respect, my TRIOS system offers me an excellent communication tool, a tool that allows me to obtain quality restorations, with much less prosthetic adjustments and much less returns to the laboratory, which is very important. I also think I have a tool that allows me to have a good image outside my practice: an image of modernity, an image in line with the dentistry that the majority of patients expect.