The trend is neatly illustrated by the proliferation of wearable biometric health-tracking devices, the rise of DTC (direct-to-consumer) testing, and in popular culture with celebrities like Maria Menounos and Kim Kardashian publicly sharing their experiences. 

As science underscores the connection between oral and overall health, it’s fair to say that along with neurological, arterial, and fitness scans, any comprehensive diagnostic snapshot of patient well-being should necessarily include an oral examination like the Diagnostic Scans (also known as wellness scans) offered by Dandy. 

Below, you’ll find a brief overview of some different arenas in which such scans are being performed, who they serve, and why they all seem to fit a growing trend of quantified health and wellness. 

What are Diagnostic Scans?

“Diagnostic Scan” refers to voluntary medical imaging performed with the intent of surveying patients’ well-being. As opposed to ordered scans in which practitioners seek an underlying cause of discomfort/presenting symptoms, Diagnostic Scans are a facet of preventative medicine i.e. a prophylactic measure taken absent of symptom or pathology.

All Diagnostic Scans utilize medical imaging, but the inverse is not true. X-ray, for example, uses electromagnetic radiation to pass light through soft tissue, taking what is, essentially, a black-and-white photograph of the skeletal structure within a specific area. While this kind of imaging can provide valuable insight, X-rays’ limitations make them less suited to Diagnostic Scanning than other imaging methods. 

Diagnostic full-body MRI scans 

MRI (magnetic resonance imaging) is a scan that uses strong magnetic fields, radio waves, and magnetic field gradients to image a patient’s entire body, including skeletal structure, joints and connective tissue, internal organs; the vascular, cardiac, neurological, and spinal systems. 

Primarily located in hospitals, MRIs have traditionally been prescribed to interrogate abnormalities such as injuries, tumors, aneurysms, hemorrhages, and degenerative diseases. 

The detailed nature of MRIs makes them a more popular choice for Diagnostic Scans in the DTC (direct-to-consumer screening i.e. retail health screening performed without prescription from a doctor or healthcare professional) market. 

Some experts assert that as a screening tool for healthy individuals, MRI imaging’s potential to produce false-positives and inconclusive results may ultimately do more harm to than good. However at least one study of DTC MRIs found the frequency of psychological harm to be low.

Diagnostic brain scans

Within the mammalian brain, certain psychological and/or emotional states have been correlated with particular structures, chemicals, and connections. This means that, using medical scans, certain mental disorders can actually be observed. 

“Functional imagining” refers to medical scans that show change over time, e.g. video rather than a single image. PET (positron emission tomography), fMRI (functional magnetic resonance imaging), and CT (computed tomography) are all examples of functional imaging. Using these, it is possible to observe the behavior of certain neurotransmitters, electrical activity, and/or blood flow in response to various stimuli, giving doctors valuable insight.

Considering the proven link between genetics and mental health disorders (i.e. dementia, anxiety disorders, schizophrenia) it should come as no surprise that DTC brain scans are seen by some as a proactive step toward mental healthcare, theoretically identifying potential problems before symptoms ever arise. 

Diagnostic carotid artery scan

Whether caused by a buildup of plaque or a blood clot, the result of a blockage in the carotid artery is likely a massive stroke. 

Noninvasive ultrasound scans (a.k.a sonograms) can quickly and effectively reveal blockage and/or potentially troublesome buildup. Ultrasound scanning interpolates sound waves to form a picture of soft tissue inside the body. 

For certain at-risk patients, a simple DTC ultrasound of the carotid artery can lead to fast, life-saving interventions.

Fitness scan

As previously mentioned, the rise of brands, styles, and varied functionality in the wearable biometric device space (i.e. Fitbit, Apple Watch, and Oura) demonstrates a growing demand for fitness tracking. 

More granular than any single health metric, DEXA scans (dual-energy X-ray absorptiometry) can show where on the body one carries mass; the composition and density of soft tissue, fat distribution, and bone mineral density.

DEXA scans take just about 15 minutes and cost about $100 per, so that makes them attractive to anyone for whom fitness is a top priority. If one has the means and the motivation to target specific fitness goals, a fitness scan can be highly informative. 

Diagnostic Scans in dentistry

Most people are familiar with the standard dental exam; the poking and mirrors and sore jaws. But Diagnostic Scans like those made possible with Dandy are revolutionizing the way dental professionals and their patients assess oral health.

A dental Diagnostic Scan begins with a digital impression using an IOS (intraoral scanner). Using harmless light pulses, the IOS takes comprehensive measurements of a patient’s entire oral cavity including teeth, occlusal surfaces, and gums. This data is automatically fed directly to a nearby monitor where Dandy’s incredible Chairside software stitches it into a precise, fully manipulable 3D model of the patient’s entire mouth. Using this digital model dentists and patients can plan treatment, track progress, visualize treatment outcomes, and more. 

The process is so quick and comprehensive, that many dentists find that a partnership with Dandy streamlines everyday workflows.

Diagnostic Scans can be offered at every visit because they: 

A. Are a no-cost practice

B. Facilitate co-discovery between dentist and patient, increasing patient satisfaction and case acceptance 

and C. Generate ‘wow!’ factor and set a practice apart from the competition

Conclusion

Patients care more about health and wellness than ever before. Wide adoption of premium health and fitness consumer products like Peleton, Apple Fitness+, and wearables proves that patients’ appetites for health metrics are insatiable. However the rising popularity of DTC health scans like genetic testing and diagnostic MRIs suggests a willingness to plunk down top dollar out of pocket. 

Dandy is the industry leader when it comes to dental technology, and Diagnostic Scans are no exception. Using an intraoral scanner and Dandy’s Chairside software, Diagnostic Scans are not only free but comprehensive, can lead to greater case acceptance, and improve patient satisfaction across the board.

But the benefits of partnership with Dandy don’t end with advanced scanning; not only does Dandy offer a free intraoral scanner and software training, switching to a digital workflow means revolutionizing your business with a 5-day turnaround for zirconia crowns, 2-Appointment Dentures, and real-time clinical support when you need it. That’s the Dandy difference. 

Curious about what else Dandy can do for your practice? Start here.

The post Health trend: The rise of patient wellness and diagnostic scans appeared first on Dandy.

Your business’s name is a fundamental part of marketing and branding–bedrock to which every business owner should pay close attention. Marketing is your overall strategy for reaching patients. Branding–the central focus of this article–is your identity, that is, how you want your patients to see you and manage their associations. “Brand identity is more than just finding the right logo to place on coffee cup sleeves or mount above your front door,” says Wayfair Senior Brand Manager, Jared Rosen. “It’s about crafting a personality that amplifies the core elements of your brand’s DNA.” 

Things to consider when naming your dental practice

We at Dandy know you didn’t go to business school. That’s why we’ve assembled a series of simple, easy to understand Do’s and Don’t’s to consider when naming your new dental practice. These are based on marketing, branding, and social psychology wisdom. Some hew close to common sense, some are less obvious–all are worth consideration.

Do understand your market

One of the primary considerations when opening your practice is, not just location, but the population therein. You must ask yourself: what is the market I am aiming to serve?

If you assume that general dentistry functions about the same in all areas and with all populations, you’d be wrong. And if you believe that a generic name for your general practice is the safest play, you might be failing to capitalize on an opportunity. 

But how does this kind of information help you decide on a name for your practice? Well, naming your practice “Sonrisas Felices” makes a whole lot more sense if you’re setting up shop outside of San Antonio than Bangor, Maine. If you’re appealing to a mostly-female clientele, “Hardcore Chompers Inc.” probably isn’t a smart play. If Emmetsville, USA is home to Emmetsville Grocers, Emmettsville Physicians, Emmetsville Bookstore, etc. and they like it that way, you may just have yourself a good hint.

Take a long look at the existing local business landscape, examine population and census data, go out into the community and get to know folks personally–get an idea of your clientele and their values because they will be your practice’s lifeblood. By getting the lay of the land, so to speak, you can put your business’ name to work establishing yourself as an alternative to an already dominant competitor, appealing to an underserved population, or creating a connection to local lore and history.

Do consider local signifiers

If you aren’t going to put your name on the shingle, think about using the power of landmarks, location, or community in your name. We know that patients only want to travel within a small radius from their home so a name can impress the locality. When naming your dental practice take inspiration from geo-specific “Downtown Dental,” “5th Avenue Dental Services,” and “Riverview Dentistry.”

Don’t rely on short-term trends

You’re not trying to make an initial splash, you’re trying to set down roots and go the distance. You want a name for your dental practice that stands the test of time. While catchy, buzzy phrases may initially grab attention, they often become overused, lose their appeal, and wind up feeling dated. It might have seemed like a great idea circa 1999 to use the names “Millenium Dental,” or “Dental 2000,” now… not so much.

Regardless of what the kids are TikToking these days, you should aim for a name that will feel good 10, 20, 50 years from now. By focusing on timeless qualities and avoiding trends, you’re giving your practice an opportunity to establish an enduring identity.

Do consider your strengths

Your expertise can be a powerful marketing tool. This, of course, refers to clinical specializations, but it can also extend to other aspects that may give you an edge. Customer service, cutting-edge tech, affordability–the ways you plan to differentiate yourself from competition can be a great starting place for your practice’s name.

If, for example, you’re primarily a pediatric practice, it makes sense to consider how your name makes you more appealing to kids and parents. If you’re specializing in orthodontics, signaling a confidence boost may help clients reconsider that elective procedure. If visiting your office will feel like stepping into a 5-star spa, it might serve you to broadcast the fact with words that convey calm, luxury, or tranquility. Give your patients a reason to judge a book by its title and choose you over the more generic or confusing competition.

Don’t be too narrow or specific

If you offer a wide range of services (especially now when they are easy to add with digital dentistry) to a diverse audience, but if your name is too narrowly focused, that can give the wrong impression. For example, you may be a general dental practitioner with expertise in correcting sleep disorders, but a name like “Better Sleep Dentistry” doesn’t convey your whole story.

It’s also worth considering that, later on in your career, your practice may add partners with different specializations, you may widen the demographic you’re aiming for, you could adopt new tech that enables you to offer more services–in any of these cases, a name that’s too specific can present a roadblock. You don’t want to have to explain to patients that you do more than advertised, spend money on clarifying advertisements, or undergo a costly re-brand. 

Do be creative when naming your dental practice 

The early stage of planning your practice is a great opportunity to toss out possibilities and take risks. You never know what will land and you have nothing to lose in finding out. Having fun at this stage is an opportunity to get an edge over “Area Dental Associates” or “Tom Smith DDS.” According to the ADA, 90% of all dental practices have a generic name. This creates a clear opportunity to set your brand apart from the competition.

Some of the most important resources are people you trust–bounce ideas off of to get their honest feedback. You should keep a running list of words and phrases you like and update it whenever something pops into your head. Plug words into a thesaurus and see what comes out. Make a vision board with words and photos that inspire you, align with your core philosophy and/or aesthetics. And try out words that just feel right. Don’t get hung up on any one idea, rather, keep a list of top contenders and narrow it down over time.

An often overlooked aspect of a practice’s name is how it sounds when spoken, so don’t be afraid to ask others to recite the top contenders aloud and pepper the name into casual sentences. This is not just a bit of folk wisdom; studies have shown that the sounds of some words alone may make them more memorable. Rhymes, alliteration, and concrete associations all also help your name stick in patients’ minds. Consider that Häagen-Dazs, Kodak, Xerox, Sony, Google, and Ikea are all invented words.

Do get too out there with spelling

A study published in the journal of consumer psychology shows that consistency between how someone believes a brand should be spelled and how it is pronounced has a positive correlation with the ability to recall said brand name. 

And if you’re tempted to try using an inscrutable practice name to create some kind of viral interest, don’t. Consider a study in the Journal of Consumer Marketing showing that “brand names should be simple, distinctive, meaningful, emotional, make use of morphemes, [and] phonemes…” Which is another way of saying that overly complex names that are difficult to understand and parse wind up adding to your marketing burden. “In some cases, the URLs are taken so companies have to spell their names funny,” says Leonard Lodish, Wharton School of Business emeritus professor of marketing. Many startups believe that purposely misspelling a phoneme helps distinguish their brand, but, Lodish says, “It hurts, not helps.” 

This, unlike some other tips in this list, can also go directly to supporting brand awareness through word-of-mouth. While studies have shown that even older adults tend to research new dentists online, keeping your brand name simple, recognizable, and easy to pronounce can help reach those who do not. 

Apologies if your given name is not easy to pronounce, and you should be proud of your name, but when naming your practice make sure it is Googlable to someone who has never seen the name written down.

Do research 

If you take nothing else from this article, remember that it’s essential for you to do due diligence when naming your new dental practice because the cost of foregoing this step is high.

One of the most fundamental considerations is your domain name–you want to make sure that people who search for you will find you. Don’t worry if you can’t secure the exact domain name dot-com, but before you add the word ‘dentists’ or ‘dentalprofessionals’ to the end of the phrase and call it a day, it’s smart to make sure the other search results don’t have any negative associations.

There are also legal reasons you need to research potential names. Failing to do a patent/trademark search in your state can make your life difficult very quickly. This is especially important if you are (and from a legal perspective, you should be) incorporating as an LLC.

It is also worth looking at Google trends for searches in your area. This can help you start to formulate a solid SEO strategy for your site. Including generic common search terms like, “Cosmetic dentists,” “dentists near me,” and “Dentists in my area” in the text on your site will help drive traffic to you, at least in theory. But don’t miss out on more specific, more local-centric keywords and phrases.

Don’t overcomplicate things 

Remember, KISS: Keep it simple, stupid! As many other sections of this article have pointed out, a short and sweet name is likely your best bet for creating a memorable brand name–a finding supported by MIT research on word recall which says that “the most memorable words had a one-to-one relationship with their meanings.” What does that mean? Only that you should try, as much as possible, to create a short distance between your practice’s name and what you do. “Dental prophylaxis” is a lot harder for people to grasp than, “Tooth cleaning.”

In his research paper titled “Empirical Evidence for Domain Name Performance,” Karl Ulrich, vice dean of entrepreneurship and innovation at Wharton School of Business, identified simplicity as a key factor in successful branding, especially with reference to driving website traffic through domain names. Domain names with seven characters or fewer, excluding the suffix, Ulrich says, tend to generate higher traffic. 

Do seek to create positive associations 

At base, doing good business means adding meaningfully to community well-being and being seen as an indispensable source of healthcare and support. You want your community to be able to rely on you. Naming your new practice can help in this endeavor. “Emotional branding” is a term describing “consumers’ attachment of a strong, specific, usage-relevant emotion—such as bonding, companionship, or love—to the brand,” and studies have shown that fostering this connection pays dividends. While you can’t simply incept positive associations into your patients’ minds, you can use your practice’s name to help lay a foundation for such feelings by priming your potential patients. To this end, it can be a good idea to play with words or phrases associated with care, serving your community, or support, and think about how you can build your brand and marketing strategy around those ideas.

Once you get patients in the door, rendering a high standard of care consistent with your brand’s identity can create a snowball effect via advocacy marketing, that is, performing well enough that you turn satisfied customers into community supporters. 

Tip: When thinking about naming your dental practice, consider that your best referrals will come from word-of-mouth, so don’t make it a mouthful.

Don’t be afraid to seek help

You may have the best practice in the world with the highest standard of care, but if you can’t actually attract customers, your business will wither on the vine–a truism at the very core of marketing as a concept. But maybe you’re not a natural-born marketer. Maybe you’re too busy to spend time brainstorming names, maybe you don’t have that creative juice, maybe you’re paralyzed by possibility. 

Rather than resigning yourself, picking a ‘meh’ name and foregoing branding as a keystone in your marketing strategy, swallow your pride and get help. 

Advertising, marketing, and branding professionals can make all the difference, and to some, the up-front cost is worth it in the long run. With all of the moving parts and intricacies of starting a small business, employing an outside consultant to formulate your brand identity and help you name your company can take a lot of the pressure off, freeing you up to apply your expertise elsewhere. There are even dental-specific marketing companies who know the business inside and out.

What makes a great dental practice name

If you’re launching a new dental practice–becoming a small-business owner–the significance of branding and coming up with a compelling business name can’t be overstated. 

Your brand serves as the first impression patients have of your practice, shaping their expectations and perceptions, and allowing you to create connections to a community. A well-crafted brand identity not only attracts patients but can help instill trust and confidence in your care–the factors that will keep patients returning and referring their family and friends. It’s not an exaggeration to say that your business name is the cornerstone upon which your business’ identity is built; it can do so much more than help people find you. A great name can help you reach your target market, give you an edge over competition, create positive associations with your brand, and solidify your role within a community.

When naming your dental practice, it should be simple, memorable, reflective of your strengths, creative, and have evergreen resonance with your target audience. In the competitive dental industry, where patient trust and comfort are paramount, a strong brand and a resonant business name might just be the factor that propels your practice to success.

As you are starting out, consider using Dandy as your dental lab. There is a lot of overhead to launch a practice, if you work with Dandy we’ll provide a top-of-the-line intraoral scanner for free. Contact us today to learn about more benefits.

The post Naming your dental practice: Essential do’s and don’t’s appeared first on Dandy.

KPIs or Key Performance Indicators are metrics indicating how effective a business or organization is at achieving its goals. KPIs help to paint a picture of both the business’s overall health and the role of its discrete components, giving the owner or executive a concrete basis for developing ongoing strategy. KPIs may be different depending on a business’s industry, specific objectives, and risks/opportunities. KPIs for dental practices can be tracked and represented visually using a dental KPI dashboard. By identifying and monitoring critical dental practice KPIs, you can begin to mitigate the challenges to growth and jump-start progress toward your goals. 

Following, you will find a list of six essential dental practice KPIs that you should apply to your own practice. Whether you have ambitions to expand your customer base, raise brand awareness, enter new markets, diversify your product and/or service offerings, or some combination of these aims–even if you simply want to streamline your business’s overall efficiency, KPIs pave the way forward.

Active patient numbers

The number of patients currently scheduled for an appointment is a vital dental metric that should be front-and-center on your dental KPI dashboard, daily. Analyzing your annual production and collection numbers and dividing them by the number of active patients allows you to calculate the average value for each. Doing so will clarify why dental patient retention is your practice’s bedrock, how damaging each instance of attrition is to your business, and why any patient on your roster without a scheduled appointment represents potential loss. 

Considering the cost of acquiring new patients is between $150-$300, it’s important to maximize your existing stable. Ideally, growth would mean that 98% of patients are scheduled at all times, but a practical target of 95% will still yield positive results. You can begin getting on top of this number by: 

• Carefully tracking overdue vs. inactive vs. active patients
• Proactively scheduling every patient to prevent inactivity (scheduling a next visit before a patient has left their current appointment)
• Using multiple communication channels for outreach i.e. mailers, emails, texts, phone calls, etc.

After this effort, you can compare the number of patients contacted daily to those who have been reactivated i.e. scheduling and showing up for appointments after a period of dormancy. Closely tracking which methods of contact work best can also help you more efficiently apply resources. You should aim to reactivate 85% of inactive patients. It’s also worth noting that Inactive patients don’t refer friends and family to your practice; doing an outstanding job with a larger number of patients is the thriftiest form of advertisement for your practice.

Case acceptance

Case acceptance is a critical dental metric as it directly impacts production, revenue, collection, and profit. National averages indicate case acceptance rates of 50-60% for established patients and 25-35% for new patients. You want to see those little squiggly lines on your dental KPI dashboard jump by doubling case acceptance rates for new patients and bumping current patients up to 85-90%. That may sound daunting, but luckily most of the tools you need to facilitate meaningful change cost nothing more than concerted effort.

If data shows that 85% of case acceptance was due primarily to patients’ emotional response, it is clear that success of this endeavor goes directly to clear communication, bedside manner, and trust. 

Dandy has in-depth strategies for increasing dental case acceptance, but in short, you should aim to:

• Encourage patient involvement in their treatment 
• Offer thorough explanations for every step of treatment
• Use simplified language
• Use visual aids (like a wellness scan) to help edify your patients
• Approach every case empathetically 
• Motivate your team to prioritize case acceptance

Creating a patient-centric environment is crucial as patient comfort and trust have measurable affects on your bottom-line. Tracking this dental metric using a dental KPI dashboard will promote treatment efficiency by allowing you to work within the constraints of production costs, patients’ budgets, and insurance obligations to maximize opportunity. 

It is also well worth noting that data shows case acceptance and overall patient satisfaction is positively correlated with the use of visual aids and adoption of new tech, both. Many dentists have reported the demonstrable effect from the ‘wow’ factor of presenting patients with digital scans and 3D models created with an intraoral scanner. Patients who post before/after scans showing positive results are a smart, free form of advertising, especially if your practice has an account to @ or tag.

Production

Production is widely considered a foundational dental practice KPI, serving as a significant measure of business health in itself but also as a means of measuring other KPIs. Production is defined as the average sum of money a dental office anticipates receiving over a specific period. 

Your production KPI for dental practice can be categorized into various subcategories, including production per hygienist, dentist, patient, and within specific date ranges with each providing valuable insights into different aspects of practice performance. These divisions can help you target areas for improvement, but they can also help you with other important analyses, like reducing overhead or calculating revenue.

In addition, different factors such as insurance or practice partnership will make calculating your production different from other practices. Determining, understanding, and improving this dental metric is essential to improving practice growth; there are few other ways to quantify the value of different aspects of your business.

Revenue

While its utility as a KPI is fundamental, there is actually no single definition of revenue. The metric can be defined in different ways to similar effect, for different reasons depending on a number of variables. Some practices find it useful to equate revenue with total aggregate production, while others see revenue as collections or payments received. It may help to think of revenue as essentially all the income your practice earns before deducting expenses. But revenue should not be considered one single number with a single, fixed referent; there are four main sources of dental practice revenue to track on your dental KPI dashboard:

• Customer payments
• Insurance payments
• Interest on liabilities
• Reimbursements

Many factors can significantly impact how revenue plays into your business calculus, especially for the purposes of goal-setting; patient financing, insurance, and how you’ve decided to classify revenue itself all play a role. However you define revenue for your practice, keep two critical considerations in mind: revenue does reflect total income generated by your practice’s primary operations and does not deduct any associated costs or expenses associated with operating the business.

Profit

Tracking profit is, unsurprisingly, a critical KPI to track. Profit or net income or your bottom-line may simply be defined as total income after expenses. Many complex factors will affect your calculation of profit. Consider the old paradoxical but nevertheless accurate chestnut, “You’ve got to spend money to make money.” Sound understanding of exactly which factors influence your bottom line and its overall utility will guide smart decision-making, i.e. investing in new efficiency-boosting tech that pays for itself, raises profit, and increases your practice’s value. Any and every business decision should, at base, aim to improve your bottom line. 

Overhead

Overhead is any expense incurred in the course of running your business, and is one of the primary KPIs that must be carefully monitored. In fact, reducing overhead can have a similar positive impact on your business as increasing profit. On your dental KPI dashboard, you should categorize overhead into two types: 

Fixed overhead is any expense not subject to change month over month. The ADA suggests aiming to cap fixed overhead at 4–7% of total production. Examples of fixed overhead are: 

• Rent
• Staff wages
• Taxes
• Insurance

Variable overhead is any expense that may vary depending on business activity. The ADA’s recommended range is 45-55% of total production. Examples of variable overhead are:

• Office and dental supplies
• Marketing costs
• Shipping and logistical costs
• Lab fees

Fixed overhead is difficult to change, reverse, or reduce, which puts consistent pressure on business performance, especially when you consider that the median dental practice overhead accounts for 75% of collections. Dividing overhead into sub-categories i.e. salaries, equipment, investments, can help you track and control it. An essential practice for reducing overhead is benchmarking, or comparing your monthly or quarterly expenses to previous equal timeframes in order to gain valuable insight.

How to track dental practice KPIs

KPIs for a dental practice are indispensable. Monitoring the health and success of your business aids in strategic decision-making and facilitating growth; a healthy business is good, but a successful one is better. Whether you’re tracking patient activity, case acceptance rates, production, revenue, profit, or overhead, KPIs provide indispensable insight, allowing you to evaluate your practice performance and identify areas for improvement. By utilizing a dental KPIs to visualize these metrics and setting clear targets, you can effectively streamline operations, maximize profitability, and–most importantly–enhance the quality of your patients’ experiences and care. 
To learn more, including statistical analysis and insights from expert sources, download Dandy’s KPI e-book today!

Free Dental KPIs Ebook

Want more insight into Dental Practice KPIs and how to measure them?

 

Six KPIs, Benchmarking, and Ways to Improve Your Practice Health is an eBook that equips practice owners and managers with a reference guide to managing practice performance and improving their literacy on what data matters when tracking practice performance.

 

Download now

The post Dental practice KPIs: What to track and how appeared first on Dandy.

The point is that your hard work as the practitioner is the foundation of any successful restoration, but the majority of the steps in complete denture cases are simply out of your hands. For this reason, Dandy wants to demystify the denture fabrication process, revealing each of the steps that transform your work into smiles. 

Types of dentures

Dandy’s digital complete dentures come in two primary types: milled and 3D printed.

Dandy’s milled denture (also known as our Aesthetic Denture) is made from polymethyl methacrylate (PMMA), specifically, Ivoclar Ivobase Milled Base and Ivoclar DCL milled teeth, explains Van Maele. “It’s a great material; very high-end acrylic, tried and true.” Milling is what’s known as subtractive manufacturing; a five-axis mill carves and hones designs from a block of crude material. “[Dandy’s] milled denture material is the same as an analog denture,” Van Maele explains.

Milled dentures

Dandy’s 3D printed denture (also known as our Signature Denture) is made from Dentsply Sirona Lucitone Digital IPN. “That material is just next level,” says Van Maele, explaining that, while Lucitone is comparable to the Aesthetic Denture material in most ways, “it can do things that these others can’t… [Lucitone] is a newer type of polymer resin that is a body-activated material, meaning that it doubles in strength while it’s in the patient’s mouth. Our milled dentures won’t do that.” 3D printing is known as additive manufacturing; the liquid resin is extruded, bonded, and cured layer upon layer until the final design is realized.

3D printed dentures

So what is the main qualitative difference between these two types of denture? In digital dentistry, if all of the steps in complete dentures are essentially the same, it comes down to strength and aesthetics. “Milled dentures, they have these little red fibers in the acrylic that emulate capillaries in the patient’s tissue… Our printed dentures do not have those fibers, so it’s just more of a plain pink.” 

Analog (traditional) denture fabrication

Materials may have evolved from beeswax to PVS impression material, but the order of operations has remained more or less the same since the invention of dental trays themselves in the 1800s: 

• Patient’s teeth are cleaned and prepped
• Impression material is mixed
• Impression material is loaded into a tray which is affixed to either the upper or lower teeth
• After setting, the tray is carefully released
• Repeat for the opposing set of teeth
• Dental stone is mixed and poured into molds, ensuring any voids or bubbles are eliminated
• After the stone cures, models are shipped to the lab 

Taking these preliminary impressions lasts between 10-15 minutes–a gag-inducing, jaw-aching eternity for the patient. And unless you can physically deliver items to the lab yourself, you have no choice but to entrust your work to the many different sets of hands comprising each link in the logistical chain. 

As you can see, even before a lab tech can begin crafting a piece, the analog process requires quite a few steps. In complete denture cases, only once the stone models have been packaged and shipped to the lab can the denture fabrication process begin in earnest. Note that the process is different for dentulous and edentulous patients, as well as for a patient with an existing prosthetic. 

The following outlines all of the standard complete denture steps once the stone models arrive at the lab:

• Using stone models, a custom tray is fabricated
• The custom tray is shipped back to the dentist
• Using the custom tray, the dentist takes another impression of the patient’s oral cavity
• The custom tray is shipped back to the lab
• Using the custom tray, the lab fabricates a wax rim 
• The wax rim is shipped back to the dentist
• The wax rim is fitted and bite registration is taken. Correct VDO, midline, lip support, and incisal edges are determined
• The adjusted wax rim and master impression materials are shipped back to the lab, along with photos for color reference and any other pertinent notes
• The wax rim is fitted onto an articulator
• Teeth are selected by the technician to best match the size, shape, and color of the patient’s natural dentition. If there are no photos and/or a lack of notation, the technician uses their best judgment 
• More wax is added to reproduce the patient’s palatal/gingival tissue, then smoothed to create a more natural look
• The wax up is then shipped back to the dentist for a try-in
• The patient returns to test the wax try-in. Any minor adjustments are made chairside using warm water or a torch to melt the wax
• The dentist ships the adjusted wax try-in back to the lab
• A flask is prepared i.e. coated with a separating agent, often petroleum jelly
• Plaster is poured into the bottom half of the flask, the wax try-in is fitted into the plaster in order to lock the model in place and create a seal. Dental stone is then added, investing the entire surface of the model
• The incisal and occlusal tooth surfaces are minimally exposed and a separating medium is added to the stone surface in order to facilitate de-flasking. More stone is poured on top
• This same process takes place again with the opposing teeth
• Both halves are fitted into a flask clamp and the stone is allowed to set. 
• The flasks are submerged in hot water in order to melt the wax
• The flasks are opened and any residual wax cleaned out using hot water. The teeth whose surfaces had been exposed are left in the stone 
• Separating medium is applied to the stone surfaces, being sure not to get any on the tooth surfaces
• Acrylic is mixed 
• Acrylic is packed into the stone mold still in the flasks, which are subjected to pressure from a hydraulic press, repeating this process numerous times until maximum density is achieved
• Flasks are returned to hot water for curing
• The acrylic prosthetic is de-flasked, destroying the master mold
• The prosthetic is re-articulated to check bite
• The prosthetic is cleaned, finished and polished
• The prosthetic is shipped back to the dentist

At this stage, the denture may be finally placed. If the patient and dentist are both happy with the fit, the process is complete. Denture steps up to this point have been labor intensive, so if the patient does not like the fit, the dentist must hope a wash impression and round of relining will address the issue. If not, the entire denture fabrication process must begin again. 

A note on dental laboratories: The process described above does not account for every different permutation of the dental laboratory; some may have a single technician. Some may use heat injection as opposed to cold pour. Many work on a first-in-first-out basis. Often, larger labs will function like an assembly line, with each stage of fabrication performed by a different person. Regardless, expect the analog process from first impression to final placement to last anywhere from six weeks to three months. 

Digital denture fabrication

With digital dentures, patients need only visit their dentist twice: once for an initial scan and once for a final fitting of the complete denture. Steps in between preclude all of the additional appointments and the back-and-forth of shipping. 

We’ll walk you through the digital denture process with Dandy. It begins when the patient’s oral cavity is mapped in minute detail using an intraoral scanner that emits painless pulses of light. This information is immediately translated into a 3D model, which not only maps tooth and gingival surfaces, but matches shades, and acts as bite registration. The entire process takes two-five minutes. From here, the dentist can digitally send the scan data, additional notes/info, and any reference photos to the lab where Dandy’s technicians step in. Complete denture fabrication begins the second you hit ‘send.’

• Once the lab receives the scan data, techs use software to check bite, shade, and shape. Dandy’s powerful design software makes it possible to rearrange dentition instantly, with all teeth automatically fitting to accommodate any adjustment. 
• The tech loads the correct color resin/PMMA into the 3D printer/five-axis mill, respectively and initiates the process, which continues automatically until the denture is complete. This process takes approximately one hour and a half.
• The newly printed denture is liberated from the raft, inspected, and refined if necessary. This may take approximately 30 minutes.

• The finished prosthetic is then shipped to the dentist.

At this point, the patient can return to the dentist to fit their prosthetic. As the scanning technology underpinning the prosthetic is so advanced and the fabrication tools are so precise, the fit is highly unlikely to need any adjustments. If an adjustment is needed or a prosthetic must be remade, there’s no need to worry. “All that information is preserved digitally,” says Van Maele. “Even if your office were to burn down, we’ve still got [all of the patient’s data and scans] ready to go.” From the moment you hit “send” on that first scan to the final product, the process takes approximately one week. It’s that easy.

Complete dentures in 2 Appointments with Dandy

Even a cursory comparison of the traditional and digital denture fabrication processes reveals clear superiority. If your goal is to get your patients fitted with a complete denture, steps like articulating, shade-matching, and shipping are crucial to the traditional process. But if you partner with Dandy, these and many others in between are simplified if not entirely eliminated.

Still skeptical? You’re not alone. “I got chosen to be one of the pilot offices to go digital,” Van Maele explains of a previous job. At the point in question he already had years of analog fabrication under his belt. After going through the initial digital training, he returned to the practice where he’d been working. “There was skepticism [among the dental staff] right up until we did our first case,” he continues. “You know what my biggest problem with that case was? I did a try-in when I didn’t need to because it was perfect. [The patient] literally said ‘No changes. How soon can we have the final?… that was the moment the skepticism melted away.” Advanced scanning, incredible software, and state-of-the-art tech mean that you can increase the volume of cases your practice can handle, improve outcomes, and increase patient satisfaction overall. Reach out to Dandy today to unlock the efficiency of 2-Appointment Dentures.

The post Complete denture steps with digital dentistry appeared first on Dandy.

Yet despite all of the benefits afforded by quality maxillary dentures, the traditional process they necessitate might just make some patients (and even practitioners!) think twice. Uncomfortable impressions subject to error, fragile molds, gratis follow-up appointments for rims, try-ins, color matching, articulating; shipping and waiting before more follow-ups and more shipping and more waiting–and that’s not include the inevitable repairs and remakes–the potentially monthslong ping-ponging can test both doctors’ and patients’ patience.

Good news: digital dentistry has revolutionized everything about maxillary dentures. Now, a patient goes from initial scan to final prosthesis in as few as two visits. And not only is the entire process more comfortable and convenient for the patient, not only is every step of the way from initial scan to fabrication of the finished restoration faster; the final product is more durable, more accurate, and more affordable than traditional methods.

Taking impressions for maxillary dentures

It all starts with an initial scan using an intraoral scanner. Using painless light pulses, the scanner instantly maps the teeth, gums, and bite in minute detail, all in mere minutes. Using this data, Dandy’s Chairside software instantly constructs a color, fully-manipulable 3D model of the patient’s entire oral cavity. If you’re looking for the “wow” factor, you can’t do much better than enabling your patient to see their present dentition and visualizing their treatment outcome. 

Compared to the alternatives, digital impressions are more accurate, more comfortable for patients, and more streamlined than traditional methods. And because electronically transmitting complete scan data to the lab is as easy as a few mouse clicks, digital impressions eliminate the risks posed by human error; drops, warps, inclusions, and logistical SNAFUs are all history. 

Your patient’s scan is also saved securely on Dandy’s servers, meaning that, in the event of a denture’s loss or damage, ordering an identical replacement takes about as much time as sending an email—no patient appointment required. 

Maxillary denture material selection 

What is considered the “best” denture material? That depends on the use-case and the patient’s preferences. But what’s clear is that the flexibility of digital dentistry means that you and your patients have many excellent options. Considering the refined workflows and timelines touted by digital dentistry, you might be asking: what are Dandy’s dentures made of and how do they compare to traditional dentures? 

Dandy offers two choices for maxillary complete dentures: Signature 3D printed Denture and Aesthetic Milled Denture. 

Dandy’s Signature 3D Printed Denture

Both the base and teeth of our Signature 3D printed denture are constructed from formulations of Dentsply Sirona’s cutting edge acrylic resin, Lucitone. This advanced material experiences minimal water retention and material loss, and has higher tensile and flexural strength than the competition. Plus, Van Maele explains, Lucitone is “a body activated material–it builds in strength when it’s in the patient’s mouth; it becomes twice as strong.” Additionally, he says, the 3D printed construction addresses a common cause of denture repairs. “The way the [Dandy Signature 3D printed Denture] teeth are designed monolithically means that you no longer have teeth that will pop out of the denture–it’s simply impossible with these digital dentures.” But the 3D printed material does have some minor drawbacks inherent to the 3D printing process, namely monotone base color and a lack of subsurface venous detail. But that, Van Maele says, is about it. “The advantages of the printed material is that the denture comes to you faster than milled (seven business days instead of nine),  it’s a little more cost effective (it’s $100 cheaper to go with printed material), and that Lucitone is a bit stronger [than milled.]” 

Dandy’s Aesthetic Milled Denture

Dandy’s Aesthetic Denture is milled–rather than being built layer by layer as in 3D printing, the milled maxillary complete denture is, for all intents and purposes, carved from a block of solid material. The base is made from Ivoclar Ivotion and the teeth from multi-layer polymethyl methacrylate (PMMA). These exceptionally strong and durable materials support an incredible level of realism and detail that are not currently achievable with 3D printing technology. With Dandy’s milled denture, patients who naturally sport more visible gingiva will find their denture faithfully recreates their smile replete with multifaceted color and subsurface venous detail. “Basically, it’s the exact inverse of [the 3D printed denture’s pros/cons] for the milled material: the pro is that the milled has the fiber veins and more realistic color, but the cons are that it costs $100 more and takes two extra business days (nine instead of seven) to get the denture to you. And it’s not a body activated material, so it’s not quite as strong as the printed material.“

Both materials have their advantages and drawbacks for maxillary dentures, but compared to traditional materials, either yields a superior product in less time for lower cost. “These new materials have advanced to be stronger than analogue (non-digital) material,” says Van Maele… “Stronger material, better design, faster, and many times more cost effective than analog.” 

Adjusting maxillary dentures

It may be the case that a patient’s new maxillary denture is a remake of a traditional hand-fashioned appliance to which they’re accustomed. Or maybe it’s their very first maxillary complete denture and they’re refining their preferences in real-world use-cases. Either way, normal wear-and-tear and post-extraction bone loss and the unforeseen all mean that no patient is likely to go the entire lifespan of their prosthesis with zero adjustments.

With traditional dentures, inferior materials meant lower bond strength, higher water retention, discoloration, and breakage. “When a patient would come in with a broken denture, they’ve lost their ability to talk correctly, smile and eat until that denture can be fixed,” says Van Maele. “For many dentists, this is not a quick thing… 90% of dentists out there. The experience is that they mail it off to a lab and maybe a week or two later they get it back. In the meantime, that patient is just without until it gets fixed.” If a patient wasn’t coming in for a simple re-line you might be looking down the barrel of new bite registration, scans, VDO adjustment; a complete remake from scratch. Dentists, Van Maele says, “may be eating the cost of that repair because… the lab’s gonna charge a repair fee to the doctor one way or the other, whether that doctor charges that patient or not… Sometimes the dentist will just flat out eat that cost.”

“Introducing digital dentistry to your practice will give patients a better experience with fewer appointments, and a better product with fewer adjustments,” says Van Maele. What does he mean? Not only are digital maxillary dentures stronger and more durable than traditional and therefore less likely overall to require fixes, not only is fabrication quick, not only are 3D printed materials less expensive than traditional overall, fine-tuning the fit of an existing denture couldn’t be easier: 

• Patient arrives with their existing denture
• They insert it and you apply wash to make adjustments
• You or an assistant perform intraoral scans and a 360 extraoral pass
• You upload the information to Dandy’s lab software including all patient feedback
• In about a week, the new maxillary denture arrives at your office and the patient returns.

“When the patient has an existing denture, [the fabrication process] boils down to just two appointments because we are simply able to capture more information.” Van Maele says. “That’s the biggest impact I’d say for [Dandy’s] patients and our doctors: eliminating all those–I don’t wanna say extra appointments because they’re not extra for analog–but basically, you’re accomplishing more in those appointments with digital.”

Maxillary complete dentures with Dandy

Maxillary dentures can be a long complex process with major implications for patients’ health and self-esteem. Introducing digital dentistry to your practice can shorten appointments times, streamline your workflow, and increase patient comfort all while yielding industry-leading products. 

All of that is incredible, but it isn’t the Dandy difference. 

“The true Dandy difference–that no other lab is doing–is our level of support,” Van Maele says. “We don’t just give you a scanner and then say ‘good luck figuring that out!’ We give you training, and then beyond training, we give you support with technicians that’ll log in while you have a patient in-chair… Being at Dandy has given me a real opportunity,” he continues. “Because we’re digital, I’m able to–in a very kind of real sense–be in 1,000 different offices at once, so if [a practitioner is] having trouble, I can log into their computer and we can discuss the case, or I can check the scans. With analog dentistry, that might require a plane ride! With Dandy, I can more greatly impact more doctors’ lives and thereby more patients’ lives… that’s just something no other lab has. Dandy’s philosophy about the doctor/lab relationship is that it’s not a business relationship—we’re partners. We want to share their successes. That’s the Dandy difference.” 

Partnership with Dandy means that you can offer maxillary complete dentures, possibly in just two appointments. Learn more about Dandy’s 2-appointment denture offering here!

The post Master your next maxillary denture case with digital dentistry  appeared first on Dandy.

VDO or vertical dimension of occlusion (also known as occlusal vertical dimension or OVD) is the measurement of the vertical distance between the maxilla and mandible during maximum intercuspation. It is a key factor in designing many dental products, especially dentures and overdentures. There is no objectively correct VDO, rather, it is relative to the individual. 

A suboptimal or distorted vertical dimension of occlusion (due to tissue loss, improper denture fit, congenital malformation, etc.) will result in not only an odd aesthetic but discomfort; difficulty chewing, speaking, and smiling, or any combination thereof. This erodes the sufferer’s quality of life, and may potentially lead to temporomandibular disorders. 

What determines the dental VDO? 

Visually, VDO registers as the relationship between the position of a patient’s nose, lips, and chin. But, underlying this superficial presentation, VDO is determined by various interrelated factors:

• Tooth size, shape, wear, and occlusion 
• Natural VDR (vertical dimension of rest)
• Alveolar bone structure and health
• Neuromuscular reflex and function (i.e. chewing and swallowing)
• Speech and phonetics
• Patient comfort 
• Necessity for accommodation of appliances/prosthetics (e.g. dentures, nocturnal bruxism mouthguards, mandibular advancement appliances, etc.)

Many (but not all) of these factors can and will be assessed during a comprehensive examination that includes bite registration and patient history.

Methods of recording vertical dimension of occlusion 

When recording VDO, you, the dental professional have several methods to choose from. There is no single “correct” method of measuring vertical dimension of occlusion.

Here are a few methods:

Freeway space – Freeway space technique (the distance between maxillary and mandibular teeth in the mandibular postural position–prototypically between 2mm to 4mm) is appropriate for edentulous patients and is used almost exclusively for mounting models and setting teeth for denture try-ins. Freeway space is derived using various techniques (i.e. having the patient say “M” or “Emma;” lick their lips, swallow, and relax) during which the distance between two fixed, vertically-aligned points on the face and mandible are recorded. Later, during the try-in phase, patients are assessed for proper phonetics and aesthetics, allowing practitioners to finalize a VDO. 

Lateral profile photography – Using a lateral photograph of a patient’s head during occlusion, a measurement is taken recording the relationship between four key maxillofacial landmarks. Using these landmarks, VDO can be mathematically derived.

Face-bow and articulator – A face-bow is used to register the relationship of the patient’s maxillary dental arch to the Frankfort horizontal plane or hinge axis-orbital plane. This measurement provides reference for the articulator, into which plaster dental models are fitted allowing dentists to measure an acceptable VDO range.

Trial splint or appliance – The patient is asked to use an appliance with an adjusted VDO to determine if, over time, the new VDO can be tolerated comfortably.

Transcutaneous Electrical Neural Stimulation (TENS) – Electrodes apply a mild electrical current over the coronoid notch, stimulating the contraction of mastication muscles through cranial nerves. Electromyographic recordings of the temporalis, masseter, and digastric muscles, along with jaw-tracking, are used to assess the mandible’s position relative to the maxilla. Neuromuscular rest is achieved by relaxing the mastication muscles. The relationship between neuromuscular rest and freeway space is used to determine VDO.

Facial proportion – This method for determining vertical dimension aims to correct facial balance by adjusting the length of the lower face to match the midface based primarily on aesthetic  considerations. While suitable for orthognathic surgeons, it poses challenges for orthodontists or restorative dentists due to difficulties in making significant vertical changes that impact facial proportion while maintaining correct occlusal relationships. Additionally, attempts to alter vertical dimension may significantly affect overjet, making it challenging to achieve proper anterior occlusal contact. 

Cephalometry – Using X-ray images, various anatomical landmarks are identified. The relationship between these points is analyzed and compared. Analysis of this information in conjunction with an assessment of the patient’s comfort and needs is used to determine a likely VDO. 

Keep in mind: Some methods of recording vertical dimension occlusion may be more or less appropriate depending on the patient’s dental/medical history (i.e. dentulous vs. edentulous patients) and the purpose of the measurement (i.e. fitting for immediate dentures vs. setting a baseline). The most advisable approach would be to assess the patient’s needs and utilize the appropriate method accordingly.

What happens if VDO is recorded incorrectly? 

Although it has no single, objectively “correct” measurement, imprecise recording can have significant consequences when it comes to VDO. Dental professionals who fail to account for a patient’s highly specific physiology and/or needs may fail to record a correct VDO. As a result, in addition to sunk cost of time and money associated with adjusting or entirely remaking dentures, just a few millimeters’ distortion from optimal VDO can cause discomfort if not health risks. The problems associated with incorrectly recorded VDO are distinct depending on whether the dimension has been increased or decreased.

Some of the potential consequences of an improper vertical dimension occlusion are as follows:

Increased VDO 

• Joint and muscle pain 
• Occlusal issues 
• Speech issues 
• Difficulty eating 
• Aesthetic disfiguration 
• Increased tooth sensitivity
• Increased susceptibility to damage
• Pathologic bone resorption 

Decreased VDO 

• Angular cheilitis 
• Speech issues
• Aesthetic disfiguration 
• Increased susceptibility to damage
• Temporomandibular disorders 

Is changing a patient’s VDO clinically acceptable? 

“Changing a patient’s VDO is clinically acceptable,” says Chad Van Maele, a highly experienced laboratory technician specializing in denture fabrication at Dandy. Van Maele says that in cases related to dentures, changing VDO is, “more than acceptable—it is often necessary to get your patient into a proper restoration.”

Changing a patient’s vertical dimension of occlusion may be indicated for several reasons: to enhance aesthetics, make space for restoration, and to improve overall occlusal relationships. In cases where VDO may be changed, it is crucial that the dentist consider 

• Effects on speech 
• Anticipated muscle pain 
• Changes in bite force
• Impact on temporomandibular joint or tooth loading
• Stability 

Van Maele has witnessed the positive results of proper VDO adjustment, saying that patients “would hold up that mirror and smile again and, for the first time in a long time, they can actually see their smile… you can definitely see their self-confidence come back… not only are they no longer in pain, but they can also speak and smile without being embarrassed.” Achieving optimal vertical dimension of occlusion, he says, “is definitely life-changing on many levels.”

It bears stating that unintentional changes to VDO are not clinically acceptable. Dentists who prescribe appliances indicated for bite, bruxism, or respiration correction should take great care over the course of treatment to track their patient’s VDO. You are obliged to preserve a healthy patient’s natural vertical dimension of occlusion. 

VDO in dentistry: The ticket to better patient education and case acceptance 

Proper VDO combined with a state-of-the-art intraoral scanner and digital impressions greatly aid the perfect outcome for you and your patients. The greatest tool for case acceptance is showing someone how their smile can look, and proper VDO doesn’t just realign teeth, it can reset a person’s whole visage. Seeing is believing. The new smile starts right there.

Beyond visualization capabilities, VDO gives data that guides skilled lab technicians to ensure they are delivering the best-fitting mandibular advancement devices, TMJ pain relief appliances, and/or confidence-enhancing dentures.

Explore related glossary terms

Implant Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Denture Terms

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Crown & Bridge Terms

Composite veneers

Implant Terms

Denture Terms

Crown & Bridge Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

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Wax rim for dentures

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Immediate dentures

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The post Vertical Dimension of Occlusion: A modern dentists’ path to better treatment planning appeared first on Dandy.

Immediate dentures, also known as “temporary dentures,” are customized full-dentures (upper, lower, or both) prosthetic devices designed for immediate use following dental extractions. Modeled in anticipation of extractions, immediate dentures replicate the patient’s original teeth and bite.

Immediate dentures fulfill various functions: promoting aesthetic continuity, phonetic function, and masticatory efficiency. Additionally, immediate dentures help protect extraction sites from post-surgical complications during the healing process, and promote tissue retention and overall healing until adoption of a permanent restoration or prosthesis.

The pros and cons of immediate dentures

“Immediate dentures come into play when there’s no way [the patient] can afford a crown and bridge style restoration or an implant style restoration without it being an implant or full denture,” says Chad Van Maele, a Dandy lab technician with over 16 years of experience fabricating dentures. “They act as a Band-Aid,” he says, explaining that they help facilitate healing and protect extraction sites. “They definitely help avoid dry socket…that’s no fun at all.” But perhaps the most important aspect of immediate dentures, he says, is that “the patient has a smile day one, so they can smile more confidently and speak and be seen in public, versus a mouth full of open wounds.”

But, Van Maele notes, immediate dentures do have some major drawbacks. “When you first get [immediate dentures], they almost never fit great because the patient has just gone through major trauma,” says Van Maele. “Tissue will shrink and change shape and those immediate dentures will become loose and ill-fitting very quickly.” Which is why monthly relining is necessary. Van Maele also notes that, following extractions, patients newly-fitted with immediate dentures are “still gonna be on a soft food diet for a couple of weeks, if not months… they lose about 70% of their biting force, so those who expect that they’re gonna be eating corn on the cob and steak are more likely gonna be eating creamed corn and steak burger, cut up into little bits.”

Pros:

Immediate restoration – Immediate dentures provide immediate replacement for missing teeth on the same day as extractions, ensuring no extended period without teeth.

Preservation of aesthetics – Temporary dentures maintain the patient’s facial appearance. This can have a huge effect on self-confidence and reduces the likelihood of the prosthesis’ abandonment. 

Functional continuity – Immediate dentures allow for continued phonetic function and masticatory efficiency, aiding in speech and eating during the healing period. Though, masticatory efficiency is limited, it is still better than exposed gums.

Preservation of oral structures – By protecting extraction sites, immediate dentures help prevent complications like dry socket and tissue loss. 

Facilitates bite and size replication in permanent dentures – The immediate placement of temporary dentures allows the dentist to note the patient’s overall experience with a denture. Patients’ preferences and the overall look/function of the fabricated appliance serve as a dry-run of sorts, helping to refine the forthcoming permanent prosthesis. 

Cons:

Need for adjustments – Chairside adjustments are necessary due to the dynamic changes in oral tissues during the six-eight month healing process during which immediate dentures will be worn. 

Temporary nature – They serve as an interim solution and are ultimately replaced by more permanent dentures, hence their other name: temporary dentures. As their function is largely cosmetic and protective, immediate dentures are not a good replacement for permanents or implants.

Discomfort – Patients may experience discomfort while they heal when comparing immediate dentures vs permanent. Whereas permanent dentures are applied after recovery, the active healing process when immediate dentures are worn means they are likely to contact sensitive tissues. Immediate dentures may also trigger gag reflex in some sensitive patients.

Speech and eating challenges – Some patients may face challenges in speech as they adapt to the new dentures, especially with ‘s’ and ‘t’ sounds. Bite force is also limited with immediate dentures vs permanent. In addition, liquids can loosen the denture reducing its overall functionality, and some patients report attenuation in their sense of taste.

Cost – As they are not strictly necessary, immediate dentures incur cost in addition to that of surgery and permanent restoration. 

The immediate dentures workflow

In the last few years, technology has fundamentally changed the possibilities for taking dental impressions, visualizing fitting, and fabricating oral appliances–immediate dentures are no exception. Below, the traditional, analogue workflow that you most-likely learned in school is outlined versus the newer digital alternative. 

Note: With both digital and traditional workflows, the process begins with the same initial step: a patient undergoes a full preoperative assessment including a cleaning, evaluation of present overall oral health, imaging both for evaluative and aesthetic reference purposes, and a full medical history. This assessment culminates in the dentist making a recommendation for a long-term solution (i.e. permanent dentures, implants, snap-ons, etc).

The traditional workflow for immediate dentures

1. Teeth are prepped.
2. Upper and lower dental impressions are taken using trays and alginate (or other comparable material) from which a stone cast is made. 
3. Custom trays are fabricated for wash impressions (aka border molding). Wash impressions are taken. 
4. All impressions are inspected for any inclusions or defects–if any are present, Steps 1, 2, 3 must be repeated as needed. 
5. Impressions are shipped to the lab. 
6. Lab technicians hand fabricate occlusal wax rims. 
7. Wax rims are shipped back to the dentist.
8. The patient returns for evaluation of the wax rims and tooth selection, the dentist noting any/all adjustments that must be made. 
9. Wax rim is shipped back to the lab. 
10. Using the notes from Step 5, reference images, and all dental impressions, the wax rim is fitted with acrylic teeth for a try-in.
11. The wax try-in is shipped back to the dentist.
12. The patient returns for an evaluation of the wax try-in. Notes and adjustments are made.
13. The wax try-in is sent back to the lab.
14. The immediate denture is hand crafted. Once finished, the immediate denture is inspected 
15. The immediate denture is shipped back to the dentist.
16. The surgical appointment takes place.
17. The immediate denture is placed and fitted.

The digital workflow for immediate dentures

1. A scan of the patient’s mouth is taken using an intraoral scanner. This scan records the patient’s entire mouth including occlusal surfaces, gingiva, and bite in precise detail. These scans are automatically converted into a 3D model. Patient notes and/or feedback can be included as well. The scan is immediately sent electronically from the chairside to the dental lab.
2. Scans are inspected by a lab technician observing any notes made on the 3D scan. Upon approval, the immediate denture is 3D printed. Once finished, the digital denture is refined and inspected for quality control. 
3. Immediate dentures are shipped back to the dentist.
4. The surgical appointment takes place, and the immediate denture is fitted.

As you can see, the traditional workflow for immediate dentures necessitates at least four of patient visits over the course of months whereas the digital workflow can be completed in just two visits with a possible turnaround of a single week.

How long should a patient have immediate dentures? 

A patient should have immediate dentures for the duration of their full convalescence, allowing all tissue to completely heal and natural shrinkage to take place–typically 6-8 months. During this timeframe, relining is common to maximize patient comfort and function. After a patient is deemed fully recovered, the switch to a more durable, more permanent prosthesis can safely be made.

Indications and contraindications for immediate dentures

Immediate dentures are not appropriate for all cases. Below, we will outline indications and contraindications for temporary/immediate dentures.

Indications for temporary dentures

Immediate dentures are ideal for any patient who will undergo complete upper, lower, or full mouth extractions and is otherwise healthy with no underlying conditions. While they are not a medical necessity and do not significantly increase bite strength, temporary dentures can reduce post-extraction pain and promote healing. They are a great choice for people who have concerns about facial aesthetics, speech clarity, and/or want to get used to the feeling of life with an oral prosthetic. 

Contraindications for temporary dentures

Immediate dentures may not be suitable for patients who

• Only require extraction of a minimal number of teeth. 

• Have active oral infections, severe periodontal disease, or suffer from uncontrolled systemic conditions or other significant medical issues/conditions that may complicate full post-operative recovery. 

• Have inadequate bone support in the oral cavity. 

• Have poor overall oral hygiene habits and/or a lack of willingness to adhere to post-operative care/follow-up appointments.

• Women in the late stages of pregnancy.

• Fully dentulous patients seeking a purely cosmetic measure.

Patient FAQs

Q: What do immediate dentures look like?

A: Immediate dentures look almost exactly like permanent dentures i.e. like the patient’s natural teeth.

Q: How long will it take to get used to temporary dentures? 

A: This depends on the individual, but most patients report an initial adjustment time of two-three weeks.

Q: How long is the immediate dentures recovery time? 

A: Immediate dentures should stay in place for 24 hours following extraction. Full recovery time depends on the progress of post-extraction healing; approximately six-eight weeks.

Q: How do immediate dentures stay in place?

A: Immediate dentures stay in place primarily using suction and liners. Commercially available oral fixatives may also be used.

Immediate dentures: A temporary solution

Immediate dentures are worn from the day of tooth extraction until the day you get your permanent new dentures, but not every patient is the right candidate for temporary dentures. If you’re a dentist, patient education is the best course of action to ensure that your patients know their options when they are getting teeth extracted for partial dentures or full dentures.

Explore related glossary terms

Implant Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Denture Terms

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Crown & Bridge Terms

Composite veneers

Implant Terms

Denture Terms

Crown & Bridge Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Composite veneers

Explore all glossary

The post Immediate dentures appeared first on Dandy.

What are 3D printed dentures made of? 

Alongside progress in scanning, design, and manufacturing technologies, materials science has advanced lightyears from the ivory, porcelain, and vulcanized rubber of yesteryear. 

Dandy’s Signature Denture is constructed from two forms of Lucitone. “This is space-age stuff,” says Chad Van Maele, a Dandy dental laboratory technician specializing in removable prosthetics with over 16 years of experience. “Lucitone denture base material is next level… It’s leaving the old analogue materials in the dust.”

A Boston University study compared offerings in the market, and found that teeth made from Lucitone have a higher wear resistance than others, as illustrated in lower volume loss.

Lucitone’s high performance can be identified along several key dimensions:

• Strength – Lucitone is what’s known as a Body Activated Material (BAM), meaning that, even if the denture just in your pocket it is still just as strong as a top-tier analog denture, but in your mouth–where it really counts–it’s twice as strong. Additionally, Lucitone Digital IPN exhibits minimal volume loss of only 0.09 mm³ meaning that it is highly durable over time. 

• Water resistance – Lucitone boasts 4.3x better water resistance than its top competitor, Flexcera™ Smile. This impermeability helps prevent denture materials from weakening, warping, or degrading. It also makes the prosthesis less vulnerable to bacteria growth.

• Dimensional accuracy – The goal of 3D printing dentures is a 1:1 recreation of the patient’s natural oral tissue. With Lucitone, 90% of the printed denture base intaglio surface is accurate within 0.13 mm of the CAD/CAM design. This guarantees superior fit, comfort, and aesthetics. The tooth resin is also incredibly accurate with 95% of the printed tooth surface falling within 0.13 mm of design parameters. 

• Tooth bonding/stability – By manufacturing both base and tooth resins, the Lucitone system guarantees minimal debonding–a leading cause of denture repair. 

• Color accuracy and stability – Lucitone Digital IPN 3D Premium Tooth resin comes in a staggering 18 shades, which means that patients’ teeth can be faithfully recreated. Additionally, neither base nor tooth resins are subject to color change. This means that, if properly cared-for, patients’ dentures will retain their natural look for years.

3D printed denture workflow

The digital denture workflow streamlines the entire denture process start to finish. As opposed to the conventional methods that may require five or more visits of measurement, fitting, and refining before a satisfactory product is produced, highly detailed 3D printed dentures can be achieved in as few as 2-appointments.

Appointment 1 – Scan

A digital scan is taken using an IOS. With just a few clicks, this data is transmitted to Dandy’s lab, along with any notes and photos you’ve taken for reference. You’re officially halfway done!

Fabrication

Now the behind-the-scenes magic of 3D denture printing happens: using your digital scans, photos, and notes, Dandy’s technicians use CAD/CAM software to review and refine the highly detailed digital model. Correct occlusal relationships can be determined by manipulating the 3D rendered model in software. Once the design is finalized, it is fed to the 3D printer. The printer autonomously carefully extrudes Lucitone layer by layer, bonding and curing each to ensure integrity. Once the denture is realized, technicians free it from the raft (also known as a brim–the base on which any 3D printed object is built). After refining the denture’s edges, it is checked for quality and color consistency before undergoing final testing. If it meets standards, it is time to ship.

Appointment 2 – Fitting

It’s been about a week, and you’ve already got the patient’s new denture inspected and ready to go. All that’s left to do is have the patient pop their new denture in, ensure fit, and flash a smile.

Note: For fully edentulous patients, a third visit is often necessary. The added challenge with these patients is recreating their bite. In the first appointment, the initial upper and lower arch scans are taken and uploaded to the lab. From there, a wax rim is fabricated and shipped to the dentist. During the second appointment, you register the patient’s bite using the wax rim and performs a 360° scan, digitally merging that imaging with an intraoral scan to create a complete model. This data is sent back to Dandy who then fabricates the denture. All that’s left is the third appointment where the patient can try on their new smile. 

Compared to the traditional processes, 3D printing dentures follows a faster, easier, and more efficient workflow resulting in:

• Improved dentist chairside time
• Speedier denture delivery
• Reduced shipping logistics
• Foolproof record-keeping
• Reduced need for adjustments/remakes
• Easy replacements
• Better overall clinical outcomes
• Reduced appointment times
• Reduced total appointment count
• Increased overall patient satisfaction
• ‘Wow’ factor

Advantages of 3D Denture Printing

Durability: Because they are manufactured from Lucitone, Dandy’s Signature Denture demonstrates impressive flexural strength (135 MPa) and compressive strength (142 MPa)—making them much more durable in real-world usage compared to analogue dentures. 

Reproducibility: Since they are based on digital scans that are saved securely in Dandy’s database, in the event of a loss or breakage, an identical replacement denture can be manufactured using existing scans and data.

Efficiency: 3D printing dentures means lab technicians can apply their expertise and skill to a much greater volume of orders; the lion’s share of 3D printing is autonomous with the printer only using as much material as needed to accomplish its task. This means minimal material waste and minimal labor costs, both of which contribute to the high cost of analogue dentures. 3D denture printing is also faster than traditional, with a brand new prosthetic at your door about a week. 

“The difference in the way that Dandy’s Signature Dentures are designed and the advancements in the material–that just makes them stronger and better overall than an analog denture,” Van Maele says, explaining that with traditionally fabricated dentures, tooth debonding is the most common cause for repairs. “With Dandy Signature Dentures the substructure is one solid piece, so you absolutely cannot pop just a single tooth out… ”

Van Maele goes on to note that the cost of repairs for inferior dentures usually lands on the dentist. “The lab’s gonna charge a repair fee to the doctor one way or the other, whether that doctor charges that patient or not… not good for the dentist, not good for the patient… Ultimately, every dentist would rather have the next patient in the chair, not the patient they should have already been done with.”

Disadvantages of 3D printed dentures

The disadvantage of a 3D printed denture comes down to aesthetics. Since 3D printing cannot yet account for the subtle variation in gingival shades nor recreate subsurface venous tissue, Dandy offers Aesthetic Dentures milled from Ivocar Ivotion and PMMA; base and tooth, respectively. These Aesthetic Dentures are distinct from our 3D printed products in that they’re made from a subtractive rather than additive manufacturing process, but that does not make them inferior.

“The main difference between a milled denture and [Dandy’s] printed denture is going to be an aesthetic one,” Van Maele says. “Our printed dentures, the tissue portion of it is monochromatic. It is just one color of pink… Analogue dentures traditionally would have fiber veins running through the pink part to emulate capillaries in the flesh so that the tissue portion of the denture looks more natural. Our milled denture does have those fiber veins, the printed denture does not.”

Reviews from real practitioners prescribing 3D printed dentures

Advanced materials, fabrication techniques, and workflows aside–none of it would be worth much if the product didn’t stand up to real-world conditions and everyday usage. Luckily, there is no shortage of positive reviews for Dandy’s Signature 3D printed denture and the workflow it enables. 

“Our [traditional] denture process would take, probably–minimum–four appointments,” says Dr. Alex Linares, DDS of Houston, Texas. “Adjustments typically add another two to three.” But he says, with Dandy Signature 3D printed dentures, his practice can “bring maybe seven appointments down to two… that’s four appointments that can be used with other patients.”

Dr. Charlie Lucero, DDS of Grandview Dentistry in Kingman, AZ echoes Dr. Linares: “Dandy’s digital denture workflows enable us to see more patients in a shorter amount of time, so we’re working more effectively with our resources.”

Dr. Robert Lee, DMD of Omaha, Georgia has over 40 years in practice. Dandy’s digital dentistry enables him to complete 30-50 full denture cases per month. “I’ve been making dentures for over 37 years,” Dr. Lee says. “Once I made the change over to digital, it started being fun again–it’s not laborious…” Dr. Lee says that, after all of his experience, Dandy’s products are so precise and well-made that, “I know when I walk into a room, the denture is going to fit. There’s very few sore spots. The accuracy is incredible.” Dr. Lee notes that, besides superior products and turnaround times, the streamlined workflow itself has a massive effect on his bottom line. “I do a lot of dentures for patients on medicare and I can’t afford to offer this service if the process is going to take more than a few appointments. With 3D printed dentures, I can now do 40, 50, even 60 units a month. It just makes life a lot easier” 

3D printed dentures with Dandy

Dandy’s approach to digital dentistry is epitomized by our 3D printed Signature Denture–an innovation, not just in terms of product quality, but workflow, support, and efficiency. Featuring Lucitone, our Signature Denture features unparalleled durability and detail.

“One of the things [in the past that had been] holding back digital dentures was not the technology of how to design or how to print, it was the materials being good enough that they would actually hold up for a general restoration.” But, Van Maele adds, things have changed in a big way. “What’s cool about Dandy’s 3D printed Signature Dentures is not only do they match the strength of the analog materials, they best them.” And the improvements don’t stop there. With 3D printed dentures, “you remove the room for human error in the processing of the denture–there’s not a person making a physical mold, boiling wax, packing acrylic and all that. It just goes through a printer and the printer doesn’t make mistakes.” Brilliant smiles, built to last–that’s the Dandy difference.

Partnership with Dandy means you can count on superior products made from cutting-edge materials in a fraction of the time, all with the amazing support of Dandy’s team of expert technicians.

“I just never take it for granted that that’s what I do for people every day,” Van Maele says. “I get to give them back their smile. That’s a pretty cool thing to do.”

Get in touch with our team to get started today!

The post 3D printing dentures: Everything you need to know appeared first on Dandy.

In dentistry, patients can sometimes feel a similar sense of bewilderment–they go in for a cleaning and walk away with a diagnosis. With no real frame of reference, this can leave a bad taste in their mouths, which can potentially lead them to decline your help altogether.

Can this kind of scenario be prevented? Is there a way to get patients on the same page, more inclined to accept treatment? Is there a way to concretely portray results? In the age of Dr. Google and WebMD, how can you foster trust and understanding? 

The solution is simple: Dandy’s Diagnostic Scans (also known as wellness scans) are both you and your patient looking under the hood together.

What are Diagnostic Scans?

Diagnostic Scans are an overall dental health evaluation that uses digital technology to create a detailed 3D image of a patient’s teeth, gums, and bite. Every single patient can benefit from a Diagnostic Scan, whether they’re seeking remediation of a specific issue or simply getting a checkup. An excellent way to add ‘wow’ factor to appointments, Diagnostic Scans aid in formulating treatment plans, creating detailed digital records, visualizing outcomes, and enabling practitioners to monitor changes over time, allowing your practice to grow beyond single-tooth dentistry. 

How do Diagnostic Scans work?

An intraoral scanner, a small wand-like device, scans a patient’s mouth by projecting and capturing harmless light, taking thousands of pictures of the teeth and gingiva in a fraction of a second. The information from the intraoral scanner is then automatically transmitted to software that stitches the data together and generates a manipulable 3D model on a nearby monitor. In less time than it takes to cook Minute rice, practitioners and patients have access to a highly accurate and infinitely durable model of a patient’s entire mouth.

Why would a practice want to perform dental Diagnostic Scans?

Increased efficiency

Fully digitized information means you and your staff have near-instant access to records, and makes transferring them as easy as the push of a button. In addition, the scan’s simplicity allows for them to be performed by any trained member of staff, reducing appointment times and allowing you to maintain focus on what matters. Finally, adoption of an intraoral scan means an end to traditional dental impressions–this enables your practice to monitor a patient’s mouth more frequently than traditional molds allow and reclaim the valuable office space required to store plaster models. 

Higher case acceptance means higher revenue

The digital scanner’s sensitivity allows for far more detailed analysis of patient’s mouths than is possible with the naked eye. This means that you can zoom out from single-tooth dentistry to view the whole mouth–closely tracking the rate of gum recession, tooth/enamel wear, the fit and condition of prostheses, and more–encouraging preventative care. 

It is worth noting that a handful of practices are performing Diagnostic Scans for free with the knowledge that said scans will help lead to revenue both while the patient is the chair, and in the future. Scans can lead to reduced attrition, more long-term care, referrals to friends and family, and elective procedures, which our 2023 survey of patient priorities, The Dandy Dental Survey: Patient Experience tells us are highly motivated by practitioners’ suggestions. “[Patients] love to see [Dandy’s imaging] before they leave,” says Dr. Rahul Kallianpur. Scan images, he says, are “the thing [patients] hold onto before they come back. You’re more likely to convert, or get a second consult… it’s that emotional tie.”

Higher overall patient satisfaction

Diagnostic Scans make it possible for patients to quite literally see issues and results.

Also as mentioned earlier, Diagnostic Scans reduce patient discomfort overall by eliminating the need for gag-inducing dental impressions, but they can also reduce the time you spend probing with a mirror and light. That means patients spend less time in the chair, which leads to less time in the waiting room–a factor that our patient priorities survey tells us, represents the single highest correlation with overall satisfaction. 

Our patient study showed that they are more comfortable when they know exactly what’s going on; transparency and thorough explanations—both of which are facilitated by Diagnostic Scans—earned dentists high ratings from patients. 

Finally, our survey showed that adoption of new tech in itself is correlated with lower patient attrition and a higher likelihood of recommendations/referrals–a finding to which dentists we’ve interviewed can attest: “It’s cool having [intraoral scanners] to show patients what’s possible,” Dr. Kallianpur tells us. “[Patients] tell their friends, ‘My dentist does this differently. There’s some cool technology.’ It’s all about the ‘wow’ factor.” Dr. Kallianpur continues, “I also believe wellness scans are powerful as a comprehensive planning tool,” telling us that they help his practice achieve an important aim in dentistry: co-discovery. 

What is co-discovery?

Co-discovery is a relationship-based healthcare practice model whereby a practitioner and patient learn together. For our purposes, this means a practical shift facilitated by technological advancement, that is, the 3D scanner makes it possible for you and your patient to study their mouth in tandem. 

Like a driver stretching their time between oil changes, patients are unlikely to address a known problem unless they are in pain or discomfort. An initial consultation’s Diagnostic Scan is the perfect opportunity for you to contextualize any findings, making them real for the patient. As you explore their 3D rendering together, you have the opportunity to glean detailed information on their history, issues, concerns, and goals for treatment. This connects them with their own health and with you as the person advocating for it. This can lead to greater case acceptance—a vital factor in preventative care—and represents a significant step toward comprehensive dentistry.

What is comprehensive dentistry?

Dentists don’t just treat mouths, but the people to whom they belong. Comprehensive dentistry is the idea that dentistry is an integral part of any holistic approach to health.

Central to comprehensive dentistry is an extensive exam interrogating patients’ current issues or concerns, full medical history, and imaging i.e. X-rays and a Diagnostic Scan. Laying this foundation can lead to a widened scope of care. “Dentists showing patients a zoomed-out view of their teeth are able to do more comprehensive care because patients are seeing their mouth as a whole rather than single tooth problems,” says Dr. Kallianpur. He continues: “Treatment planning, bigger cases–I can zoom-out on cracked teeth and big fillings that look like they’re about to break–wear problems. Patients love to see this all in 3D.”

The benefits of Diagnostic Scans to comprehensive dentistry can’t be overstated. Findings in an initial Diagnostic Scan may have far-reaching implications for a patient’s long-term health overall. For example, if a Diagnostic Scan detects tooth-grinding, the comprehensive dentist can mitigate the damage, then encourage the patient to treat its root cause, e.g. sleep apnea or anxiety. The list of health issues that can be tipped off by a good intraoral scan are lengthy as we all know the mouth can be a check engine light for the body. 

Why dental Diagnostic Scans are gaining in popularity 

Performing Diagnostic Scans on every single patient introduces an amazing opportunity for you to connect through co-discovery, building trust, and transparency. This can lead to higher case acceptance, more revenue for your practice, streamlined workflows, and more comprehensive health solutions including preventative care–a core aim of comprehensive dentistry.

Diagnostic Scans with Dandy

Give every patient the ‘wow factor’ of intraoral scanning with a Diagnostic Scan. Contact us to learn more about Dandy’s digital dental offerings including how to use the new diagnostic tool.

The post What are dental Diagnostic Scans and why is everyone talking about them? appeared first on Dandy.

And lest you think digital impressions are just bells and whistles, an apt analogy would be comparing a coal-power locomotive to a mag-lev bullet train; both accomplish essentially the same task, but there is no question which is superior. And let us be clear: besides adding a ‘wow’ factor, adopting digital dental impressions can and will have positive dollars-and-cents effects on your business, improving your practice’s efficiency, competitiveness, amenity, cost, and precision. Still skeptical? Well, we have the receipts to prove it.

“[Patients are] used to the old-fashioned impression material. Nobody likes that stuff because it’s dirty and messy. When patients see the scanner, … every patient is impressed. It’s the ‘wow’ factor.”

Dr. Angela Leung, The Endodontics Implant Center

In today’s complex market landscape, dental practices are challenged by rising costs, labor shortages, and insurance billing – among other things. Small practice owners are looking for ways to offset these issues and stay competitive. One way to do so is to expand into high-growth specialty services like orthodontics and endodontics. Embracing digital technology like an intraoral scanner will help you prepare for these new growth opportunities.

So below, we’ve outlined the top 5 reasons that digital impressions with an intraoral scanner will push your practice into the technological vanguard, helping keep your business growing well into the 21st century.

What is a digital dental impression?

By utilizing digital dental technology, we can generate 3D images of a patient’s teeth and gums using a handheld wand known as an intraoral scanner or digital impression scanner.  Once this simple process is complete, the images are sent to the dental lab immediately, where the tooth restoration tools can start being made.

Compared to traditional impressions, digital impressions are a lot less invasive. They also take less time to administer—typically just one to two minutes in total. Compared to intrusive and potentially inaccurate methods, digital dental impressions are faster, more efficient, more accurate, and more comfortable for your patient–a factor that, data tells us, increases their overall satisfaction and makes them more likely to recommend your practice. So how does this remarkable technology work and what are its practical applications? 

A handheld device called an intraoral scanner is inserted into the patient’s mouth. In just one to two minutes, the scanner records the size and shape of the mouth including each tooth as well as the gums, bite, and hard and soft palates. This data is automatically converted into a detailed 3D rendering available–near-instantaneously–for viewing on a nearby monitor. This model can then be inspected from any distance or angle, removing the need for abstract descriptions and generic replicas. Data shows that patients have an overwhelmingly positive reaction to this process and the understanding it facilitates (Data can be found on page 25 of the 2023 Dandy Dental Survey).

But digital dental impressions are much more than an awe-inspiring visual aid. With the push of a button, your patient’s data can be sent directly to a lab where skilled technicians and dental professionals use computer-aided design and computer-aided manufacturing (CAD/CAM) to ensure proper alignment and spacing before using precision tools to fabricate the crown, prosthesis, overlay, or any other intraoral appliance. No curing, no air-pockets, and virtually no room for error.

5 advantages of digital dental impressions

1. Digital technology gives dentists a competitive edge

In our 2023 Dandy Dental Survey of 600 dental patients’ priorities, just 27% of respondents reported the use of an intraoral scanner. That leaves almost ¾ of all patients surveyed who have not experienced this incredible tech. Why does this matter? That same survey showed an overwhelmingly positive response to those practitioners who did use a digital scanner, with the use of digital dental impressions seeing a 46% correlation with patients’ highest possible overall satisfaction ratings. Add to this the fact that patients who visited practices using an intraoral scanner are 12% more likely to recommend said practice, and a clear picture forms: if patients have a choice of where to go, they’re much more likely to be happy with–and therefore recommend–a practice that utilizes digital impressions.If that’s not enough to convince you that adoption of an intraoral scanner will make you stand out from the competition, our data shows that patients are much more likely to switch dentists due to long wait-times and low transparency about the processes they undergo–digital impressions both reduce time in the chair and create an engaging visual model to which practitioners can refer. And when data shows the overwhelming importance of a dental practice’s online presence, reports of patients excitedly taking photos of their 3D digital impression for posting on their socials translates to a real competitive edge.

2. Digital impressions improve your patients’ experience

Happy dental patients can mean many things: less stress, higher case acceptance, and–perhaps most importantly–more patient referrals. Dr. Angela Leung of San Francisco’s Endodontics Implant Center said: “When patients see the scanner… every patient is impressed. It’s the ‘wow’ factor.” And Dr. Leung is far from alone. 

Dr. Layla Baidas, owner of the successful Illinois practice, Signature Smiles of Park Ridge, has observed the same reactions in her patients. “The first impression when I scan a patient’s teeth is, ‘What is this? This is amazing!’ They are impressed with the technology and love seeing their teeth. And it’s a lot faster [than traditional impressions], so patients love it.”

Dr. Delaney Spaulding of boutique practice, Ross Bridge Dentistry in Hoover, Alabama tells us that, because intraoral scanning is so overwhelmingly impressive, quick, and easy, she’s begun using it as a standard part of every patient’s visit as part of an overall wellness scan. “Any change [our practice makes] is a small tweak and it’s a small tweak in a positive direction,” Dr. Spaulding explains. “[Patients] are already blown away by our technology and now adding the wellness scan–it’s a small tweak that increases how amazing their visit is.” And, as mentioned earlier, versus the gag-inducing traditional molds, an intraoral scanner uses light and takes mere minutes to complete; anybody who has ever endured a PVS mold can attest: a quick, easy alternative for getting into and out of the chair is a no-brainer.

3. Digital workflows make your job easier

In a clinical study comparing intraoral scanning and conventional impressions, the vast majority of practitioners preferred the digital scanning technique (89%) over the conventional impression technique (11%). This could be owed to a number of factors, all of which translate to: digital impressions are just plain easier. No more mixing compounds, filling trays, cleanly releasing the molds, inspecting them for imperfections or air bubbles–with digital impressions, the scanner goes into the patient’s mouth, a few buttons are clicked, and the machine takes care of the rest. And all of this would be great if it alone saved you effort, but perhaps most importantly, digital dental impressions are far more accurate than PVS dental impressions. In fact, practitioners who go digital enjoy a staggering 89% reduction in impression errors overall, saving the time and hassle associated with shipping pieces back, adjustments, or dreaded remakes.

Dr. Barry Bartusiak of successful crown-and-bridge practice, Bartusiak Dental Care of Washington, in Pennsylvania can attest to the ease of digitally-derived appliances. He tells us that, as opposed to those from PVS dental impressions, appliances derived from digital scans rarely have any issues or need any adjustments at all–they tend to just work. “The fit and quality–the crowns and bridges [made from digital scans] are superior to the traditional way,” he says, definitively. Dr. Bartusiak tell us that the scanning process can begin almost immediately when the patient sits down, and the fabrication process can start before a patient has even left the office, done and done. “Are you kidding me?” Dr. Bartusiak exclaims when asked if digital impressions take less time to arrive in his hands. “I get my [fabricated appliance] back in like, seven to ten days–it doesn’t take a month.”

Related

• What is Digital Dentistry?
• Trends in Dentistry: 5 Crucial Takeaways You Can Actually Use
• The Top 5 Benefits of a Digital Workflow for Dentistry According To Real Dentists

4. Increase productivity with digital impressions and workflows

An aspect of digital impressions we have touched on, but not explicitly said until now, is the massive benefit of digital impressions and digital workflows to your practice’s overall productivity. 

It almost goes without saying that, when you have a busy day and a full plate, not having to fiddle with compounds, or carefully release/inspect a mold allows you to keep your attention on what matters. 

Since intraoral scanners are so advanced, so straightforward, and so accurate all on their own, operation is virtually fool-proof–any member of your practice staff can easily take digital impressions. This means a new hire can begin taking digital impressions on day-one, a team member with minimal training can help jump-start a visit, and an assistant can confidently take initiative. “[Digital impressions free] up my time since my assistant can do the scanning,” explains Dr. Leung whose thriving business relies heavily on implants’ accuracy and precision fabrication. By allowing others in her practice to take this task of her plate, Dr. Leung explains, “I can do more procedures and increase my productivity.”In addition, digital workflows help keep focus oriented on what matters. Digital workflows mean your patients’ data stays organized and readily accessible, facilitation lightning-quick communication between parties. This places vital information at your staff’s fingertips–no more digging through messy folders, rooting through cumbersome filing cabinets, deciphering spotty faxes, buying postage, insurance, or packing peanuts. Plus, digital data transfer means your office will no longer have to abide by shipping companies’ limitations or liabilities–your patients’ data can travel instantaneously, directly, securely with just a few clicks.

5. Digital impressions help reduce costs

In Dandy’s 2022 Dental Industry Report–a survey of dental professionals–it was found that a majority of respondents cited increasing costs as both an acute priority and challenge. By adopting digital dental impressions, you can begin to realize tangible savings on day-one, helping you address this stubborn, high-priority issue. 

Digital impressions mean a complete reduction of impression materials–no more paying for compounds, replacing expired stock, or carving out office space the store them. You know better than anyone the value of square footage; every inch of your office well-utilized equals a dollar well-spent. 

Without the cost associated with the back-and-forth of shipping molds, your office saves on everything from bubble wrap to postage, reducing your office’s budget for these materials overnight. 

If time is money, every minute your patient is in the chair represents real value for your business. With this in mind, as mentioned earlier, adoption of digital impressions means an 89% reduction in appliance remakes–a massive reduction in additional (usually unbilled) fitting appointments. You can also enjoy a near-total removal of the scheduling and rescheduling associated with refitting or adjusting restorations. And gone are losses of valuable time due to delayed shipping, limited delivery windows, or any other SNAFU arising from courriers. 

Finally, as the 2023 Dandy Dental Survey has shown, a satisfied customer is a return customer, and a return customer is a potential recommendation, and a recommendation or review online is a great piece of free advertising all on its own–your happy customers and good work can in themselves help drive customers to your business.

Digital impressions in the dental industry

Digital impressions are becoming more popular among dentists and patients alike, and for good reason. With the overwhelming betterment of the patient experience, reduction in overhead costs from office to treatment, and overall efficiency in process, digital dental impressions are earning their popularity.In summation, adoption of digital dental impressions using an oral scanner are virtually all upside. So what is the largest barrier to entry for most practices? The initial outlay, that is, cost. Intraoral scanners are an a cutting-edge technology and, like the newest smartphone or electric vehicle, can induce some sticker shock. But an investment in this incredible technology is an investment in your practice’s future and, luckily, when dentists partner with Dandy—the first and only Digital Dental Lab—we will help get you up and running by supplying your practice with a free best-in-class 3Shape TRIOS intraoral scanner.

Learn more and get started on your future, today!

The post 5 reasons digital dental impressions are the solution you’ve been looking for appeared first on Dandy.

Medical billing for sleep apnea oral appliance therapy

Oral appliance therapy (OAT) for sleep apnea is medical insurers’ most commonly approved dentist-applied treatment. This is primarily for two reasons: 1. the danger posed by sleep apnea to patient health and wellbeing, and 2. intraoral appliances tend to be much less costly than the cumbersome C-PAP machines overall. 

But this does not mean that medical insurance makes the billing process straightforward for dentists treating sleep apnea with an oral appliance (though dentists who partner with Dandy have medical billing partner that streamlines it, see next section). Policy Limitations, lengthy pre-authorization, high deductibles, and/or the rare C-PAP requirement may all complicate an otherwise straightforward process. 

That’s why, if you want to offer medical insurance billing for sleep apnea treatment as a dentist, it’s crucial for you to:

• Set the motion to obtain OAT approval
• Have all of the relevant medical provider-side documentation at the ready (including your NPI number and current HCFA forms)
• Include questions related to sleepiness/sleep apnea in your normal medical history/intake process
• Set proper financial expectations for medical insurance reimbursement 

Sleep apnea oral appliance pre-authorization

During pre-authorization, insurers make a determination regarding a procedure’s medical necessity. The system can be protracted and obtuse, but if you prepare yourself and office staff, it can be streamlined, eventually becoming a regular part of your billing process.

When billing medical insurance for sleep apnea, there are a few elements you can almost guarantee will be requested by insurers during pre-authorization. 

As much of these initial steps require a relatively higher level of coordination with your patient, it may be a good idea to regard this stage as pre-pre-authorization, that is, an initial agreement between yourself and your patient to begin treatment, which starts the ball rolling. 

Virtually without exception, pre-authorization will require obtaining a concurrent diagnosis/referral from an M.D., including a letter of medical necessity. This almost certainly requires a sleep study, but more on that later. 

Another element you’re sure to need is recent imaging for the patient; most likely a pano X-ray and/or CBCT.

Finally, it is vital that you contact the insurer to obtain a list of all the required pre-authorization elements, including paperwork. Do NOT rely on any custom or boilerplate forms, or any obtained from a different insurer. Most medical insurance companies make their forms available for download on their website, but to save yourself from doubling-back, contact the insurer regarding your specific patient’s policy. In some rare cases, a pre-authorization is not required at all, but you should still make contact with the insurer to request a pre-determination of benefits for review with the patient.

If pre-authorization is denied, you can contact the insurer to find out how you can address their concerns/which additional information is required before re-submitting or appealing the decision. If the pre-authorization is denied again, it’s time to have a discussion with the patient about other options i.e. Carecredit or payment plans.

If all goes well, pre-authorization typically takes two to three weeks. Once it has been approved, now is the time to begin the treatment process in earnest. 

Note: Every state and insurer has different rules and guidelines for pre-auths, so before embarking on the process, it’s important to familiarize yourself with state policy and consult the medical insurance in question. 

Do insurance carriers accept home sleep testing results when approving the pre-authorization for oral appliance therapy?

As previously stated, a sleep study is virtually guaranteed to be required as part of pre-authorization for a dentist billing medical insurance for sleep apnea, but there are different types of sleep studies and different regulations for prescribing them.

The gold standard of sleep studies is an in-lab polysomnogram (PSG) requiring a patient to spend the night in a lab. This test is comprehensive and monitored, but inconvenient and may not be feasible for your patient. With very few exceptions, insurers accept the results of at home sleep tests (HST). HSTs involve loaning small, minimally invasive devices out to patients who wear the equipment during sleep. Airflow, arousal, and blood-oxygen level data are collected and interpreted upon the devices’ remand.

Many state dental boards find prescribing a home sleep study falls within the scope of dental practice. In others, only an M.D. may prescribe sleep studies. If your practice is located in a state that allows you to prescribe HSTs, consider purchasing the equipment for rental to patients. This can save time, make your practice feel more comprehensive for sleep apnea patients, and reduce variables like coordinating with a third-party. 

Note: regardless of where an HST was prescribed, medical insurance pre-authorization will require the results to be analyzed by an M.D. As such, it makes good sense for you to cultivate relationships with local M.D.s and/or sleep specialists. 

How recent should a sleep study be to qualify a patient for sleep apnea treatment with an oral appliance?

Except for Medicare patients whose test must have taken place within the last 12-months, most insurers will accept the results of any test performed within the past 24 months. Please contact an insurer just to make sure.

Sleep apnea insurance billing workflow with Dandy

Dandy has partnered with Nierman Practice Management to provide an option for our partner practices to streamline medical billing for sleep apnea. Nierman Practice Management (NPM) is an expert in this space and uses intuitive and simple to use software for doctors to easily track everything for medical billing and they deal with the actual process of obtaining reimbursement for the practice. Dandy dental practice partners are able to register with NPM with a 50% reduction in the registration fee (if you are a current Dandy partner adding the service please contact your account manager for code). Just one case per month justifies the cost and margins multiply with volume—for sample dollar amounts per patient contact a Dandy rep.

Dandy and NPM sleep apnea workflow

1. Dentist and patient will upload insurance information to NPM’s website
2. NPM will check the patient’s insurance eligibility
3. Dentist will scan and order the intraoral appliance through Dandy
4. Dandy will design, fabricate, and ship the appliance
5. Dentist will place the appliance in the patient’s mouth and ensure proper fit and comfort
6. NPM will bill the medical insurance
7. Dentist will receive reimbursement
8. If the insurance does not cover the entire charge, dentists can bill the patient for the remainder

Does Medicare pay for sleep apnea oral appliances?

Medicare will indeed pay for sleep apnea oral appliances, but only custom devices purpose-made for treating obstructive sleep apnea.

“Oral appliances used to treat obstructive sleep apnea (OSA) are covered under the Durable Medical Equipment benefit (SSA 1861(s) (6)). In order for a beneficiary’s equipment to be eligible for reimbursement the reasonable and necessary (R&N) requirements set out in the related Local Coverage Determination must be met… All follow-up care, including fitting, adjustments, modifications, professional services (not all-inclusive) required during the first 90 days after provision of the oral appliance are considered to be included in the payment for device.” (Source: CMS.gov)

Dental codes for sleep apnea

OSA ICD10 (diagnosis) code:
G47.33 (adult & pediatric)

HCPCS/CPT (service rendered) code(s):
E0486

Note: the above code is only for custom-fabricated mandibular advancement devices specifically for treating obstructive sleep apnea. 

CPT Home Sleep study codes:

95800 — Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg. by airflow or peripheral arterial tone), and sleep time.

95801 — Sleep study unattended w/ respiratory analysis.

95806 — Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort.

G Home Sleep Study codes:

G0398 — Sleep study, w/ type II portable monitor; unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort, and oxygen saturation.

G0399 — Sleep study w/ type III portable monitor; unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation.

G0400 — Sleep study w/ type IV portable monitor; unattended; minimum of 3 channels.

(Sources: CMS.gov, AASM.org)

CDT 2024 codes:

D9947 — Custom sleep appliance fabrication and placement
D9948 — Adjustment of custom sleep apnea appliance
D9949 — Repair of custom sleep appliance

Different insurers require different codes. Please contact the specific insurer to confirm which codes you should utilize.

Why your practice should offer sleep apnea oral appliances

There are some excellent reasons for your dental practice to offer sleep apnea treatment.

First and foremost, treating sleep apnea will allow you to help a greater number of people. In the US, there are 202,536 practicing dentists and only about 7,500 sleep specialists. In large swaths of the US, a dearth of comprehensive medical care and specialists has historically kept diagnosis let alone treatment of obstructive sleep apnea out of the general purview. But it doesn’t have to be that way. If a patient gets into your chair and you suspect they may suffer from sleep apnea, you can now offer treatment for a serious health-risk of which they might otherwise be totally unaware. 

Second, by broadening the scope of your practice, you’re growing your business. This is pretty self-evident, but even if a person doesn’t regularly see a dentist, by treating their sleep apnea, you have increased their lifetime value as a patient and you remain connected to their network of friends and family—if you take a look at the Dandy Dental Study: Patient Experience, you’ll see the collateral value of a patient’s network.

Finally, dentists’ effective treatment of sleep apnea can help change the larger conversation around ‘wellness’ and a holistic approach to overall health. At one time, slight to moderate obstructive sleep apnea’s potential affects on weight, productivity, psychology, and heart-health may have been easily outweighed by the known life disruption and cost of a C-PAP. Now, as the technology for fitting sleep apnea appliances has gotten so precise and comfortable, treating the disorder (wearing the appliance every night) can be portrayed as a low-commitment aspect of overall self-care akin to regular dental cleanings and medical checkups. By introducing sleep apnea treatment to your practice, you can be the face of your community’s changing attitudes toward health.

The post How to bill medical insurance for sleep apnea as a dentist appeared first on Dandy.

People with untreated sleep apnea have an increased risk of health complications including hypertension, diabetes, heart disease, and depression. Obstructive sleep apnea (OSA) is a sleep-related breathing disorder in which a person experiences an obstruction to the upper airway during sleep. 

Common signs of sleep apnea include:

• Gasping or choking during sleep
• Snoring
• Fatigue or sleepiness while awake
• Impaired cognitive function

Dentists can check patients for signs of sleep apnea when performing an oral exam. Anatomical features such as a high-arched palate, large neck circumference, large tongue, large tonsils, or craniofacial structure can contribute to sleep apnea. If a patient’s partner or family member mentions that the patient chokes, gasps, snores loudly, or stops breathing during sleep, these may be signs of sleep apnea.

Patients with these symptoms should be referred to a primary care physician or a sleep medicine specialist for further examination. 

If a doctor or specialist determines that a dental device is required, a qualified dentist will take a scan or impression of the patient’s mouth to make a sleep apnea oral appliance. That is then sent to a dental lab for custom device fabrication. When the appliance is completed, the patient returns to the dentist’s office for further adjustments.

Dentists who work collaboratively with a patient’s primary care physician and sleep physician provide the best care for their OSA patients.

Sleep apnea with Dandy

Dentists can offer both the Herbst and the Dorsal intraoral device for sleep apnea with Dandy. Both products are 3D printed to ensure a high level of accuracy and comfort. This ensures a high degree of efficacy when treating sleep apnea.

Explore mandibular advancement devices

Traditional treatment for sleep apnea

OSA is a result of anatomical structures constricting airways (i.e. large neck circumference, large tonsils, obesity, etc.). Breathing’s partial blockage (hypopnea) and complete stoppage (apnea) may last from several seconds to more than a minute. 

Diagnosis of OSA and its degree of severity are determined by a sleep study measuring patients’ apnea-hypopnea index (AHI), that is, the combined average number of apneas and hypopnea events that occur per hour of sleep. OSA severity is categorized into three tiers:

• Mild (5-15 events/hour)
• Moderate (15-30 events/hr)
• Severe (> 30 events/hr)

It is important to note that even mild cases of OSA can impact the sufferer’s health and quality of life. Symptoms of mild sleep apnea can include:

• Daytime exhaustion 
• Difficulty concentrating
• Memory issues 
• Reduced libido
• Mood disorders
• Complications with anesthesia during medical procedures
• Reduced reaction-time when driving or operating machinery
• Nocturnal bruxism
• Insomnia 
• Increased strain on relationships.

It is not an understatement to say that treating OSA can change patients’ lives significantly, leading to improved overall health, relationships, and work productivity. 

Traditionally, some of OSA’s treatments have included patient-motivated lifestyle changes such as:

• Weight loss 
• Diet changes
• Smoking and alcohol cessation

Such lifestyle changes may only prove out over time, may have limited effectiveness, and can carry high risk of abandonment.

Craniofacial/maxillofacial surgery has been used to effectively treat OSA, but these surgeries are often onerous to patients considering their cost, painful and uncomfortable recovery periods, and potential changes to the patient’s physical appearance.

The most common and reliably prescribed traditional OSA treatment is nightly use of a continuous positive airway pressure (CPAP) machine–a motorized device that keeps airways open by supplying a constant flow of air through the nose, mouth, or both via a mask worn over the face during sleep. 

The rise of the sleep apnea oral appliance

The practice of manipulating anatomy to unblock an otherwise constricted airway has been common practice in anesthesiology for decades; sleep apnea dental appliances work according to the same proven principles. Studies have shown that sleep apnea oral appliances can be an effective alternative for those who cannot tolerate a CPAP.

While pre-made dental devices for sleep apnea can be found in online marketplaces, these are, more often than not, imprecise, cheaply made, and uncomfortable with limited-to-no ability for adjustment. Studies show higher rates of device failure and user abandonment with these thermoplastic appliances compared to custom-made ones. Furthermore, these so-called “boil and bite” appliances are available without a dentist consultation; treatment predicated on self-diagnosis may fail to remediate the condition and/or cause entirely new jaw and bite issues. 

By contrast, today’s digital dental labs and scanning technology have profoundly refined the fit and fabrication process for sleep apnea dental appliances. Most patients do not know that obtaining a superior product that is lighter, sturdier, more durable, more comfortable, and tailored to their specific needs is easier than ever. Furthermore, it bears stating that, as a dentist, you can check-in on patients’ progress with their oral appliance, making you an instrumental part of this life-changing treatment.

Oral appliance for sleep apnea vs. CPAP therapy

The goal of both CPAP and dental devices for sleep apnea are the same: Keep airways clear during sleep. However, the choice of which route to take depends on the individual–their needs and tolerances and anatomy. 

Every CPAP machine consists of three components: mask, hose, and the machine itself. The machine pumps air through the hose to the mask worn around the sleeper’s face. Each machine has its own options, interface, and controls that must be mastered for proper use. 

There are three primary types of CPAP: 

• Traditional CPAPs supply constant air pressure. 
• Auto-adjusting machines raise or lower pressure according to the user’s breathing patterns. 
• Bilevel machines toggle between high and low pressure during inhale and exhale, respectively. 

There are also many different styles of mask, but three primary types: 

• Full-face masks cover both the nose and mouth 
• Nasal masks fit over the nose 
• Nasal pillows fit directly into the nostrils 

By contrast, oral devices consist of very few parts: either a single piece worn in the mouth or two connected pieces worn on the top and bottom jaw. There are different types of oral devices, but all work by adjusting and/or immobilizing anatomical structure.

Comfort

CPAP: Regardless of the type of CPAP mask used, the business end will still need to be secured to the head via a strap or headgear. In addition, the mask must always have uninterrupted connection to the hose, and the hose to the machine, effectively tethering the user’s head. This may feel uncomfortable for users. All CPAPs are effective, but none run silently–if a patient or a partner are sensitive to noise during the night, they (along with 30% to 50% of patients) may find a PAP machine difficult to tolerate. Finally, while advancing technology has shrunk their size to about that of a tissue box, CPAP machines still require users to find space to fit the machine for optimal airflow and user comfort, which may present a challenge for those with limited bedroom space.

Oral appliance: There are several different varieties of custom dental device for sleep apnea, but all fit into a user’s mouth much like a retainer or mouth guard, or in the case of tongue retaining devices, pacifier. There are no moving parts, harnesses, or additional pieces of equipment. The user is free to move during sleep and all the devices are silent. 

Maintenance

CPAP: As they constantly blow air, most CPAP machines have a built-in humidifier to prevent users from dehydrating during sleep. However, these CPAPs must be supplied with fresh distilled water; tap or conventionally filtered water are not recommended as they may contain minerals or bacteria that can not only damage or contaminate the machine, but the user as well. CPAPs (including hoses and masks) must also be cleaned weekly (at a minimum) in order to keep the machine in working order and prevent buildup of dangerous allergens, mold, and bacteria. Finally, as a CPAP has electronic, software, and motorized components all working together, like any machine from car to PC, error or failure in one or all of these systems requires troubleshooting, maintenance, or even replacement. 

Oral appliance: Keeping a dental device for sleep apnea clean and bacteria-free is easy. On a daily basis, the patient is simply required to brush and floss before use. In the morning, give the device a once-over with a soft-bristled brush before storing it a clean, dry box. Both the box and the device require a weekly deep cleaning, but, depending on the device’s material components, that usually just consists of a soak with denture tablets or in white vinegar solution.

Convenience

CPAP: Like a desktop computer, home CPAPs can be transported, but doing so is cumbersome and inconvenient. If a patient is sleeping away from home, there are indeed excellent smaller, travel-sized CPAP devices, but these still require the user to wear a mask connected to a hose. Note that these miniaturized devices often lack important quality-of-life features (e.g. limited air pressure, no humidifier) and can be costly as they are not typically covered by insurance. Finally, CPAPs of any kind are difficult to use in transit (e.g. overnight flights, buses, or trains) or communal sleep settings (e.g. dorms, road trips, hostels) where space is limited and their operation can disturb others.

Oral appliance: Dental devices for sleep apnea fit in the palm of your hand and can slip right into a purse, backpack, or even pocket. Since patients are transporting one single device with no accouterments (besides a small clamshell carrying case), there is no interruption in the quality of treatment at home versus on the go. Finally, since there are no moving parts and they take up no extra space, they are convenient to pop in in any setting from camping tent to trans-continental flight.

The benefits of an oral appliance for sleep apnea

The best oral appliance for sleep apnea is one that patients will use consistently, and studies have shown that, in general, patients tend to stick with custom made oral appliances over both off-the-shelf alternatives and CPAPs. 

The benefits of custom made oral appliances include:

• Increased sleep quality – Eliminating snoring and obstructed breathing leads to more restful nights and improved daytime functioning. 
• Easy and straightforward use – With no extra equipment or parts, a user simply has to insert the device into their mouth.
• Higher comfort – Users who find the over-the-head harness, equipment over their face and/or tether to the machine uncomfortable often find an oral appliance much easier to tolerate. Oral devices are also silent, so no worrying about disturbing a partner.
• Individualized treatment – Since they are fabricated according to the user’s own anatomy in consultation with a dental professional, those who opt for a custom appliance can be assured that their specific needs and preferences are baked into the device, so to speak. 
• Convenience – Oral devices can fit virtually anywhere and only require daily brushing and weekly soaking for maintenance. 

The disadvantages of oral appliances for sleep apnea

No treatment of any medical condition is free from drawbacks, and sleep apnea dental appliances are no different. Simply put, there are those for whom an oral device is not an option and for those who do opt for the treatment, there may be side effects.

Patients who have loose teeth or advanced periodontal disease should not use an oral appliance as it could exacerbate or complicate the condition. The anatomy of those who are under 18 years of age may still change, so it’s not advisable for them to use an oral device. It is possible that use of an oral appliance for sleep apnea can change the position of users’ teeth or bite, sometimes permanently. It is also possible that sleeping with a device held in the mouth can lead to excess salivation, obstruction of oral breathing; gingival, dental, and/or temporomandibular joint pain/soreness. 

It is of paramount importance that the root-cause and severity of a patient’s sleep apnea is determined before prescription of an oral appliance as there are serious contraindications:

• Severe sleep apnea (AHI > 30) 
• Central sleep apnea (i.e. neurophysiological) 
• Complex sleep apnea (i.e. central comorbid with obstructive)
• Sleep apnea resulting from morbid obesity 

To reduce the risks of complications, dentists should take a patient’s full medical history including any history of asthma, breathing, respiratory disorders, or other relevant health problems.

Finally, it should be noted that, while oral devices for sleep apnea are shown to be as efficacious in reducing the severity of OSA as CPAP on average, this may be attributable to the inferior compliance of CPAP compared to oral devices. One out of three users of a dental device for sleep apnea experience negligible improvement of their symptoms which, compared to CPAP, makes them a less reliable treatment.

Oral appliances for sleep apnea therapy: How do they work and what role does a dentist play?

OSA most commonly occurs because soft tissue naturally relaxes during sleep, collapsing into airways, making normal respiration difficult if not impossible. The tongue may fall back occluding the airway, the mandible may be underdeveloped or positioned too far back, smoking might cause inflammation, alcohol consumption may lead to excessive relaxation of throat muscles, a patient’s congenital craniofacial structure may narrow airways–as there is no single cause of the condition, there is no one-size-fits-all solution. 

Oral appliances are devices that help to reduce physical blockages of the airway. They are placed in the mouth to help keep the airway open while the patient sleeps. The appropriate device is predicated on the root-cause of a patient’s sleep apnea. As a dentist, you can play a crucial role in diagnosing a patient’s sleep apnea by:

• Evaluating patients for OSA
• Evaluating patients for the suitability of an OSA appliance
• Choosing the most appropriate oral appliance for the patient
• Facilitating device fabrication
• Follow up: Adjusting thr appliance or assessing patients for possible adverse effects.

There is no objectively ‘best’ oral appliance for sleep apnea, only the one that’s best suited to the individual. 

Types of oral appliances for sleep apnea

There are different categories of oral devices for adults with sleep apnea, each with its own mode of action: Soft palate lifters, Tongue retaining devices (TRDs), and mandibular advancement devices (MADs) also known as mandibular advancement appliances (MAAs) mandibular repositioning appliances (MRAs) or mandibular advancement splints (MASs). 

Soft palate lifters elevate the soft palate and uvula, but are least effective of the three. TRDs are worn at the front of the mouth between the lips and use suction to hold the tongue forward, preventing it from falling back into the airway. These devices are shown to be effective, but less than others. MADs are the most effective and therefore most commonly prescribed of the three and as such, MADs are considered by some to be best oral appliance for sleep apnea. However, again, ‘best’ is subjective and effectiveness depends on the patient and their individual needs.

Mandibular advancement devices

MAD is an oral appliance that keeps the mandible and the tongue in a protruded position, widening the upper respiratory tract. This prevents the patient’s airway from collapsing during sleep. A MAD is placed in the mouth before sleep. The appliance is removed when the patient wakes.

Tongue-Stabilizing Device (TSD)

A tongue-stabilizing device, often called a tongue-retaining device, uses suction to move the tongue forward during sleep to keep the tongue from blocking the airway. During use, the tip of the patient’s tongue protrudes through the lips. Research suggests that TSDs may reduce breathing lapses.

Mouth guards

Over-the-counter sleep guards are similar to mandibular advancement devices, they attempt to work by repositioning the lower jaw forward to keep the airway clear while the patient sleeps. Mouth guards are available without a prescription and sold in pharmacies or online. The patient immerses the mouth guard in a cup of boiling water for 60 seconds and firmly bites down on the softened plastic to create a custom-made impression. While these devices are the lowest barrier to entry, they run the inherent risk of the patient not creating a good bite in the mold they make at home.

Rapid Maxillary Expansion (RME)

For children with OSA, rapid maxillary expansion (RME) is an orthodontic device that opens the airway by expanding the roof of the mouth. The child wears a custom-fitted expander, which is placed over the upper molars. The child wears the RME continuously. RMEs are designed to adjust the airway of children who have highly arched or narrow hard palates. Studies suggest that RME combined with surgery for tonsil removal or adenoid removal is more effective than RME treatment alone.

Popular oral appliances for sleep apnea from Dandy

Dandy’s digital labs create custom 3D printing MADs sleep apnea devices that may best treat your patient.

Dorsal appliances

A dorsal sleep apnea appliance is a two-piece appliance. The lower jaw is held in the correct position while allowing considerable jaw movement for the patient. The upper section has adjustable segments to control how much the lower jaw is advanced. The device has a dorsal fin that engages the maxillary and mandibular components and ensures the lower jaw stays in place during sleep. 

Herbst appliances

A Herbst sleep apnea appliance is another type of oral appliance used to treat sleep apnea. The Herbst appliance was invented in 1909 by Dr. Emil Herbst (1872–1940). It’s a mandibular repositioning device originally designed to correct Class II malocclusion. The device has been improved in recent years and is a popular choice for treating sleep apnea, bruxism, TMJ, and chronic snoring. Known for its flexibility, the Herbst appliance allows the patient to maintain their full range of motion, including movement from side to side. 

Setting the patient up for success with an oral sleep apnea appliance

The oral appliance will only work for sleep apnea if the patient uses it, an obvious thought but one to always consider. While a patient won’t spit out a crown, it is important to make sure they adhere to the plan. A partnership between physicians and qualified dentists in sleep apnea treatment is essential. The physician will confirm the diagnosis and may recommend oral appliance therapy (OAT). The dentist will confirm that treatment is appropriate and begin patient therapy. Both the dentist and the physician perform follow-ups with each medical professional providing their unique expertise, ensuring thorough patient communication throughout enabling that they stick to the treatment.

Explore Dandy’s custom 3D-printed oral sleep apnea appliances to treat your patients.

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