What Can Be Done in a Day with Same-Day Dentistry

Planmeca PlanMill 30 S

Early on, many patients, and even dentists, were a bit leery of same-day dentistry. They were worried the quality wouldn’t match up to what a human could provide, and that same-day treatment meant rushed, ill-fitting restorations that lacked the esthetics they desired.

But as the technologies and workflows have evolved, that perception has flip-flopped, Dr. John Flucke says. Hesitant patients and dentists will have a better understanding of the digital world and the streamlined workflow technologies such as intraoral scanners, cone beams, mills and 3D printers can provide. They now know same-day dentistry is faster, better, and more accurate than traditional methods, reducing the number of appointments and overall treatment time to create a better patient—and doctor—experience.

These days, most patients now prefer same-day dentistry and will seek out offices that offer it.

“It really becomes a powerful treatment option. Being able to deliver same-day dentistry transforms the relationship dentists have with their patients. It also allows clinicians to free up time,” says Dr Elisa Praderi, clinical protocols & KOL manager for Formlabs. “They might need to adjust their schedule at first, but in the long run same-day dentistry frees up more space in the schedule because they’re able to deliver treatments faster. It adds flexibility to what they can offer.”

While traditional crowns, inlays, onlays and veneers are still popular same-day treatments, implants, aligners, nightguards, multi-unit restorations and smile designs are also now within reach. As the possibilities continue to grow, dentists need to decide what same-day services they want to provide to their patients, and then invest in the technologies and training they need to make it happen.

Bread and butter same-day services

Back in 2006, Dr Jeff Rohde wanted to offer his patients the convenience that comes with same-day treatment. So, he invested in a CEREC CAD/CAM system from Dentsply Sirona and like many dentists starting out with same-day, he began offering restorative dentistry such as crowns, inlays, and onlays in one visit.

Patients loved the fact they didn’t have to deal with the hassles that come with a temporary crown or return for multiple visits to complete treatment, Dr Rohde says. Skipping the temporary also helped reduce sensitivity, as patients no longer had a two-to-three-week period with an exposed, poorly sealed tooth. They were also impressed with the quick 30 second scans, and certainly didn’t miss the more time-consuming and uncomfortable process of traditional impressions.

Then of course there were the financial benefits for the practice. Reducing the number of appointments required for a restoration opened up more chair time. The technology also kept more cases in-house, further boosting revenues.

For Dr Chad Duplantis, milling single unit restorations is the most efficient and beneficial service for his patients. He mills a lot of zirconia crowns and onlays out of hybrid ceramics with the Glidewell fastmill.io, and not only do patients appreciate the efficiency, but they also notice he’s invested in technology that keeps his practice on the leading edge—ultimately improving the level of care they receive.

Dr Dhaval Patel has offered same-day dentistry for about 15 years, and touts the five Cs it offers: convenience, control, cost effectiveness, customization, and clinical joy. He never wants to go back to dealing with impression materials and calls from the lab telling him the margins or reduction are off, and that they need a new impression.

“If I don’t do something right, the software tells me. I know if my margins are off right away because the software points it out. I can see it,” says Dr Patel, who uses the Primescan and other Dentsply Sirona technologies. “And that actually makes me a better dentist.”

One-visit implants

Once dentists are comfortable with traditional same-day services, many seek opportunities for further growth. One area gaining momentum is implants. While it does take some prep work ahead of time, it is now possible to place an implant, custom abutment, and crown in one appointment—something Dr Riley Clark does in his practice often.

Dr Clark takes the information gathered during a records appointment, using technologies like the Carestream Dental CS 8100 3D extraoral imaging system, CS 9600 CBCT system and CS 3600 intraoral scanner, to create a surgical guide and a custom abutment before the patient comes in for surgery. The guide he uses produces such a high level of accuracy that he’s comfortable creating the abutment before the surgical phase, making same-day implant delivery possible.

On the day of surgery, he tries the surgical guide in to make sure it’s a good fit, and then the implant is placed, Dr Clark says. If primary stability of the implant is achieved, a jig is used to seat the abutment in the proper location and then the PMMA crown is placed. This cuts out an entire appointment and gets the patient to the final restoration sooner.

“What’s nice about putting the abutment in same day is it helps the soft tissue heal a bit more thoughtfully to the custom abutment, which leads to advantageous long-term outcomes,” Dr Clark says. “This doesn’t just save me time, there’s a biological benefit to putting the abutment in early. The body heals around it beautifully.”

Using the CS 3600, he obtains a scan of the custom abutment that can act as a scan body. This scan, which the lab libraries, indicates where the margins are and the exact fit, providing a streamlined workflow for the lab and dentist to design the final crown. There’s no need to take an impression to build the permanent restoration.

Dr Shea Tolbert also completes implant cases same day by combining the intraoral scans with the CBCT. He can 3D print a surgical guide and have a temporary crown milled and ready to go before the surgery, and plan the case using Planmeca’s TruAbutment workflow for exact placement and rotation. He also uses Planmeca’s Emerald S intraoral scanner, Planmeca Romexis software, and other Planmeca technologies.

“Patients ask when we can do it, and we say today. They’re no longer scared of the procedure because we show them we can 3D print the guide for guided implant placement,” Dr Tolbert says. “The workflow with TruAbutment has helped cut down our costs. Everything is working together instead of us having to outsource.”

Carestream Dental also offers software that merges data from CBCT images and intraoral scans for same-day implant treatment planning, Chief Dental Officer Dr Edward Shellard says. Prosthetic-Driven Implant Planning (PDIP) helps clinicians understand what type of implant will work best with the case and where exactly it needs to go based on bone position.

PDIP puts final form, fit and function into play from the beginning, and allows practitioners to have everything ready to deliver the abutment and temporary crown in one appointment. Carestream Dental software also merges 3D datasets and intraoral scans to create surgical guides.

“Younger doctors are being asked to do more advanced procedures and older doctors are wanting to keep more procedures in-house,” Dr Shellard says. “Gathering datasets and using this software gives doctors the necessary information and support to deliver excellent care time and time again, even if they don’t do these types of cases that often.”

In Dr Rohde’s practice, laser dentistry also plays a role in same-day implant, abutment, and crown placement, significantly shortening what used to be a months’ long process. He uses the Solea laser from Convergent Dental to expose the implant, and because there’s no bleeding, he can get a clean digital scan. He then designs the abutment and crown, mills, and two hours later places the crown.

“In this case we’re using multiple technologies to allow for good exposure of the implant and tissue for anatomical emergence profiles that allow us to do a scan immediately and get a good porcelain restoration on there right away,” he says. “That’s pretty standard operating procedure for us now.”

3D printing aligners, nightguards and trays

With 3D printers, clinicians can now provide same-day aligners, retainers, and bleaching trays. Giving patients those first few aligners to take home after their initial appointment can have a strong impact, Dr Praderi says, engaging them in the process while they’re still excited about treatment. Typically, patients must wait three or four weeks to receive their first aligners; now they can get started right away.

Taking extraoral 2D and intraoral 3D images and placing them in software like CS Model+ makes it possible to design aligners and develop a treatment plan in one day, Dr. Shellard says. The software employs AI, allowing clinicians to segment out the tooth from the tissue so they understand where the tooth stops and where the tissue begins.

“The software can link to a 3D printer, and the printer can print models for the case,” Dr Shellard says. “The doctor can use a standard thermoform machine to create the first two trays in the office, and then fabricate the remaining trays later.”

The same process can be completed for bleaching trays, sports guards and night appliances in a single visit, Dr Shellard says.

It’s also important for dentists to remember they can get their lab involved in same-day services; not everything has to be done in-house. In fact, a lot of these services are built around using the lab in different ways. Dr. Rohde, for example, uses SprintRay’s design service to create nightguards. The scan is taken at his practice and then sent to the lab to design. The lab sends the 3D file back and he prints it in-office.

3D printing dentures in-office is also an option, Dr Praderi says, but it isn’t done that often yet. Dentures require more analysis and advanced post processing skills but are a service that dentists can offer same-day if they have someone with the skill and time to dedicate to dentures in-house. And once the denture is digitally designed and delivered, that design is already stored and can easily be reprinted if needed.

“3D printed dentures and bite guards aren’t as durable as traditionally made dentures and bite guards,” says Dr Todd Ehrlich, who offers a variety of same-day dentistry services in his office. “So, you can make them but they’re not as good.”

More complex cases

Same-day dentistry is no longer just for single-unit restorations, though that’s a good place to start. Today, doctors are providing more advanced restorative services, including multi-unit restorations and smile design delivery in one appointment.

“With Planmeca, we can take images and do the smile design chairside,” Dr Tolbert says. “Case acceptance for cosmetic cases is almost instant. We can do everything from diagnosis to digital scan to smile design to 3D printing a model for same day smile design delivery. We don’t have to do back and forth appointments anymore.”

Dr Ehrlich, who uses CEREC, just completed a 12-unit veneer case in his practice, giving the patient a new smile without the hassle of temporaries. He didn’t have to numb the patient a second time to take the temporaries off or deal with irritated gum tissue. He simply had to prep, image, design, mill, run the restorations through the oven and then bond them in.

With Dr Flucke’s Versamill 5X400 milling unit, he’s able to make up to 10-unit bridges, though he’s sticking with a max of 3 for now. But multiple unit cases are the norm, and with his system, which can mill metal, there are plenty of opportunities to take on more complex cases in the future, including bar supported dentures.

“There are a lot of possibilities,” Dr Flucke says, “almost anything you can imagine.”

Other same-day options

Same-day dentistry isn’t just about delivering restorations and aligners. It’s about doing as much dentistry needed as possible in one day while still providing high-quality care, says Dr Rohde. For example, if the patient is waiting for a crown to mill, dentists can finish any needed fillings rather than bringing the patient back to complete the work.

Crown lengthening is an example of another service Dr Rohde provides before a crown is delivered. Traditionally, patients need to visit a specialist for surgery for this treatment, but with the Solea laser he can finish the procedure with no bleeding and minimal healing time.

“Rather than giving them a temporary, I’m putting lithium disilicate like e.max down as a final restoration,” he says, noting the fact he collects another fee for the crown lengthening as a benefit. “Who doesn’t want that kind of dentistry?”

Of course, there are times when a temporary solution is best for the patient, and same-day technologies can help with those cases too. For example, if someone comes into the office dentally debilitated, it may take time to develop a treatment plan. Maybe the patient has badly worn, over-closed teeth, and it’s important to determine how tall they are before developing a plan to get them back into their natural position.

Creating temps makes it possible to “work those problems out in plastic before you put it in permanent material,” Dr Flucke says. Without a mill, that must happen by hand, which is “horribly time consuming and pretty inaccurate.”

Dr Rohde recently saw a patient who shattered her bridge after a fall. When she arrived at the office, he took a digital impression, sent it to the lab and then 3D printed the provisional stent the lab created in-office while she waited.

“It looked fantastic because it was done from a digital design. We were able to create a provisional that wasn’t cobbled together. It’s really hard to make something like that look good when sculpting by hand,” Dr Rohde says. “We then sent that same scan back to the lab to make the long span bridge, which came back a few days later.”

The future

As the technology evolves, the possibilities will continue to grow and more dentists will embrace same-day dentistry, Dr Clark says. Milling will get better and faster, and the various systems will come down in price, making it even more attractive to dentists who like the idea of the benefits same-day dentistry provides but who are hesitant to make the investment. And as dentists see successful case after successful case, they’ll be more open to offering same-day dentistry in their practices.

The learning curve will flatten and AI will “really take hold,” Dr Duplantis says, making the design services seamless. There will be less user interaction with the design software, and the mill capabilities will only continue to expand.

Dr Praderi agrees that AI will play a bigger role in case planning and says advancements in materials will allow dentists to complete even more complex restorative cases in one visit. More studies need to be done that support the safety and reliability same-day dentistry offers, giving dentists even more confidence in the technologies.

But 3D printers will also start to play a bigger role, Dr Duplantis says, competing with mills to produce restorations like crowns. Dr Ehrlich sees 3D printers as the future and says they will only get more efficient and easier to use.

The hardware is getting more powerful by the day, Dr Tolbert says, and that is obvious across all IOS platforms. The ease of scanning has significantly improved since he started in 2008; instead of stitching pictures into a model, he receives a video and real-time rendering in just a few minutes. It’s so easy to do anyone, even someone without dental experience, can scan an accurate full arch in a minute or less.

Software is the future, he says. AI will be a game-changer, making it possible to create a detailed plan for just about anything with a click of a few buttons. Today, workflows rely on the dentist to sort through the data to come up with the findings and a plan, a process he enjoys but one that can be a huge barrier for others. That learning curve will disappear as everything will be automated.

“Imagine after the IOS or CBCT in minutes you can get a detailed report to print off for the patient and your office records,” he says. “That is where the future is going. Technology making our lives and our patient care more dummy-proof and more efficient. Everyone wins.”