The Group Dentistry Now Show: The Voice Of The DSO Industry

Kelly Bevington, Director of IOS Technology at National Dentex Labs, Dr. Robert Mongrain, Director of Clinical Advocacy at Heartland Dental, and Jamie Stover, CDT, Senior Manager of Dental Laboratory Applications at Carbon join the GDN show. The panel focuses in on digital dentures. They discuss:

The right time for digital dentures
When and why digital dentures should be offered to patients
Best practices for scanning digital dentures
The future of digital dentures

To find out more about digital dentures you can email Kelly Bevington at kelly.bevington@nationaldentex.com or visit https://nationaldentex.com/

To find out more about Heartland Dental visit – https://heartland.com/

To discover more about Carbon visit – https://www.carbon3d.com/

If you like our podcast, please give us a ⭐⭐⭐⭐⭐ review on iTunes https://apple.co/2Nejsfa and a Thumbs Up on YouTube.

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Full Transcript:

Bill Neumann:

Welcome, everyone, to the Group Dentistry Now Show. I’m Bill Neumann, and as always, thanks for listening in or watching us. We appreciate you as an audience. Without you, we wouldn’t have great guests. Today we are going to talk about technology, and technology as it relates to labs and dentures. We’re going to talk a lot about digital dentures today. We have three great guests on. We have Kelly Bevington. She is the director of iOS Technology for National Dentex Labs. We have Dr. Robert Mongrain. He is with Heartland Dental, Director of Clinical Advocacy for Digital Clinical Technology Scanners and Labs. It’s a big title. And we have Jamie Stover. He is the Senior Manager of Dental Laboratory Applications for Carbon. First off, thanks everybody for joining us today.

Kelly Bevington:

Thanks for having us.

Jamie Stover, CDT:

Yeah, thank you. It’s an honor.

Bill Neumann:

Let’s start with you. Kelly, if you don’t mind, could we get a little bit of your background and then talk to us a little bit about National Dentex Labs?

Kelly Bevington:

Certainly. My pleasure. Kelly Bevington. I’m an RDA EFDA by original training, so I have lots of chairside assistants prior to joining the laboratory. I’ve been with the NDX group of labs for over 25 years, wearing many hats over that time period. But most recently, probably for about the last decade, actually, I’ve been involved with intraoral scanning with numerous different scanners and numerous different types of laboratory work that we’re scanning for, whether it be full arch scans for bruxism appliances or crowns, or what we’re here to talk about today, for dentures and National. Dentex is a national group of dental laboratories. There’s approximately 60 across the country and we are a full service group of laboratories.

Bill Neumann:

Thanks, Kelly.

Kelly Bevington:

Sure.

Bill Neumann:

Dr. Mongrain, would you mind talking a little bit about, probably most people know who Heartland is, but you can certainly talk a little bit about Heartland, maybe how many practices, states, anything you’d like to there, and then your background. It seems like you’ve was looking at your bio earlier and you’ve done quite a bit in the industry and have spent quite a bit of time at Heartland.

Dr. Robert Mongrain:

Yeah. Well, thanks, Bill. Heartland is almost 1800 practices now. We have about 2,700 doctors. Last number I heard, 26,000 team members. So it’s a big ship. We’re in at least 37 states, I would guess 38 by the end of the year. We’re continuing to grow. We’re dedicated to supporting our doctors. I joined Heartland 12 years ago, practiced dentistry for 43 years, the last few years very part-time as I’ve moved into my role supporting our technology base. It’s important to note, also, that I had my first scanner in 1998, CEREC. So I’ve been doing scanning for a really long time. Really not passionate about technology, believe it or not, but passionate about the patients and improving patient care. That’s really what got me started.

Bill Neumann:

That’s great, and we’re certainly going to focus on how digital technology, digital dentures really does provide better patient care. Sometimes we think about the efficiencies and cost savings, but that patient care is so critical. Jamie, could you give the audience a little bit of your background and also talk a little bit about Carbon?

Jamie Stover, CDT:

Absolutely. Jamie Stover. My background is really as a dental lab technician. I started in the industry in 1998, so just about 25 years. Was a bench technician at a 5-person lab. Worked every position in that lab until I was general manager as we grew and was there for about 20 years. Eventually ended my time there as chief operating officer when we were about a 70-person lab. So lots of growth and lots of change in the industry in that time and lots of digital technology and working with dentists on adopting that technology and materials. My role at Carbon, I oversee application support globally, so I’m strategic consulting. Basically business consulting based around any application you can print on our printers, which leads me to what we do at Carbon. We’re a company that makes hardware, software, and materials, 3D printers, and the associated software and some of the materials that go with that. We partner with third-party companies as well, so their materials can be used to produce things like dentures and night guards and surgical guides and lots of applications. That’s it in a nutshell.

Bill Neumann:

Thanks, Jamie. I’m actually going to stay with you for a second here because I’ve got a question about the evolution of digital dentures. Maybe we could even go back before digital dentures. If you could give us a little history lesson into where we started to where we are today, and then talk a little bit about NDX Digital Dentures.

Jamie Stover, CDT:

Absolutely. I think the best way to sum it up really is the way I look at it, I’m a CDT in crown and bridge, so that’s fixed restorations, that’s kind of where I got my start in the industry. We take for granted today that, for way over a decade, the fixed side of the industry has largely transitioned from analog production processes like waxing and casting metal copings and opaquing them and stacking porcelain on them to very digital processes like milled zirconia crowns, milled Emax, and other types of restorative materials.

I saw some survey the other day or staff that said over 80% of the restorations done every day in this country are either zirconia or zirconia-based. But at one point I was at the bench and we were getting doctors to transition to those materials and those processes, and that’s really what’s happening, Bill, now with dentures on the removable side of the industry, largely because of the advancements in materials and also the technology that the 3D printers and some of the software that’s associated with designing these dentures.

So I tell dentists all the time and labs, digital dentures is just this huge bucket, this huge topic, and it can be very confusing. And digital anything in our industry, in my opinion, is really just kind of white noise now because so much of what we do is digital, either in the lab or in the clinic. So I think it’s important to realize that, really, when we’re talking specifically about the dentures that NDX does and some of these materials that we’ll be getting into today, one material, for example, the Lucitone Digital Print Denture from Dentsply, it’s an acrylic denture. Acrylic dentures have been around for almost 90 years, since 1938, I think, is when acrylic dentures started being used. This isn’t a new product or a new prosthesis. This is a new production process for an acrylic denture. And really, dentists can continue to use multiple workflows, some very impactful workflows for digital, which I’m sure we’ll get into.

But I think keeping it simple is best. And really, the removable side of the industry is now getting its chance to transition to digital from analog processes, bringing tons of benefits for patients and clinicians and labs. That’s kind of where we’re at. The NDX has a lot of experience doing these dentures and moving these processes from the bench to the software and to the printers, and I’m sure we’ll have a chance to get into that in more detail in a little bit. But hopefully that kind of answered your question. We’re really just now, the removable side of the industry is going through the same evolution that the fixed side did about a decade ago and in between that time and now as well.

Bill Neumann:

Thanks, Jamie. Kelly, do you have anything you’d like to add to that?

Kelly Bevington:

Yeah. I’d like to agree with Jamie that removables is finally becoming digitized. 2 years ago, 3 years ago, certainly 5 years ago, no one would’ve really considered digital dentures at that point. NDX has been working on it for at least 5 years that I’m personally aware of. So it’s really exciting to see it sort of come to fruition and learning something new about better processes every day. The more people that get involved with it, the more brain trust we have, the more people that think outside of the box, the better everything is becoming, in my experience.

Bill Neumann:

Is there a reason that removables lag behind fixed. What do you think? I mean, is it a more complicated process or what’s the reason behind that?

Jamie Stover, CDT:

I think I definitely have some ideas there, but I want to make sure to give Dr. Mongrain an opportunity to hear some of his thoughts. Doctor, if you have any thoughts around that.

Dr. Robert Mongrain:

Having lived through multiple generations and iterations of technology, there were always things that were advanced, but then there were gaps. And I think the reason that removable has been so slow is that, although we had digital technologies, we didn’t have all the pieces. And just now, maybe last year, this year, all of the pieces are really beginning to come together, where we can actually create a seamless and intuitive workflow, which is a big part of what this group is about.

Bill Neumann:

We’ll stay on that, Dr. Mongrain, or on you, because my question really is, you have a lot of dentists that you mentor at the Heartland, and talk a little bit about how they’re embracing digital dentures or are they embracing that? What is that transition like and how do you think it impacts patient care? Also, how do you think it impacts productivity and efficiency?

Dr. Robert Mongrain:

Bill, that’s a great question. It’s a big one. The doctors are enthusiastic about it. At Heartland, we’ve embraced digital scanning technology. We have deployed about 2,400 iTero scanners of various versions, and we’re continuing that, sending out 100 to 200 a month throughout our network. Somewhere around 80-90% of our single crowns are being done digital, and we’re seeing a significant increase in that, especially, though, doctor interest. I think the reason is that because the digital crown has become so predictable and so successful, they want to extend that to dentures and partials.

Let’s face it, dentures and partials are still very… There’s a lot of adjustments, there’s a lot of, I guess, maybe not guesswork, but there’s a lot of skill involved. And so there’s just so many layers to the benefits. I don’t think that doctors fully understand yet all the different pieces, like I mentioned before. So I think it’s really important that the laboratory be fully engaged in this process as well. That way when the doctors say, “Yes, I want to do this,” like NDX, we’ve done some pilots with them, that the lab is ready to actually move forward with that.

Education is the key. So doctors need to seek education. I think, outside of Heartland, and it doesn’t matter what scanner you’re using, you need to understand your scanner and you need to work with your lab. What workflows are they comfortable with? Kelly and I had a preheat discussion on this that we would be on the same page and we are, because what works really well today is the immediate denture or the healing denture, what I like to call it, that can be done from the scan.

The other procedure that works really well today, the labs call it reference denture, us clinicians, we’re calling it copy denture, but that’s something else. But basically taking a patient’s existing denture, relining it, and then scanning that and with a particular protocol, which it’s not rocket science, it works really, really well, you just have to know how to do it and it’s different with each scanner. That is working really well. We’re looking at three-visit dentures and sometimes two-visit dentures. And the good news is that the majority of the dentures out there today that GPs are making that patients are demanding is a replacement denture. So that’s a great place to start. Start with very predictable workflows, make sure your lab is up to speed, get the education, understand your scanner, and then it works really well.

The other thing that we have found that our doctors find and our labs tell us, just like digital crowns, if you put good stuff in, really great stuff comes out. And if you have a really great scan and you do the process well, then you’ll have few to no adjustments at the backend. It’s a little bit different than the wax process, because the wax process, things move, things happen, you’re used to doing a lot of adjustments. The labs tell me, our doctors tell me, “You do it right at the beginning, it’ll be amazing at the end.”

Bill Neumann:

That’s a great point and actually leads me to my next question for Kelly. Let’s talk about best practices for scanning digital dentures.

Kelly Bevington:

Sure, sure. It’s going to depend upon which process you want. Dr. Mongrain mentioned the language copy denture. For us in the lab world, a copy denture is an exact copy of a patient’s existing denture. So it’s great because you’re scanning the patient’s existing denture, the patient doesn’t have to be without the denture. Every scanner’s going to have a slightly different protocol as far as in what order you capture the scan of the denture, whether you start on the occlusal surface of the existing denture teeth or on the intaglio of the denture. That’s scanner specific, and we’re here to support you with that. The NDX iOS training team can help any dentist walk through that process. So that’s the copy denture.

And then as Dr. Mongrain mentioned, the reference denture, where you’re going to take a chairside reline or perhaps a wash impression inside of an existing denture is a wonderful technique that the patients sometimes get a little, not concerned, but confused as to, “Well, wait a minute, if you’re taking an impression, then why are you taking a scan also?” So that’s a little bit of a potential hurdle to make sure that we’re communicating appropriate expectations to the patient. Again, the scan process is going to be a little bit different with every scanner. And then, in many cases, the office wants to take an intraoral scan of the patient as well, of the fully edentulous patient.

We are not really making dentures from that fully edentulous intraoral scan. What we can do is provide a custom tray from that, or we could provide base plate with bite blocks from that. And the reason being, Bill, is when you’re retracting the lips and cheeks of the patient, you’re changing the vestibular muscles because you’re retracting them, you’re pulling them away, you’re moving them, whereas a denture fits when they are at rest. So you’re changing how the muscle reacts to the denture in place. I expect that we will come up with protocols to offset that discrimination that we experience sometimes now.

But basically, you want to make certain that you are scanning all of the anatomical landmarks that you would have acquired with a physical analog impression when you’re taking an intraoral scan. And that’s critically important when you’re scanning for that immediate denture, or as Dr. Mongrain mentioned, referring to it as a healing denture, which I really, really like. The healing denture language, it’s setting the expectation for the patient that it’s not necessarily going to be the long-term denture for them forever. So, critically important to capture all of the anatomical landmarks that you would’ve ordinarily captured with polyvinyl siloxane.

Jamie Stover, CDT:

Absolutely. And I think that, to Kelly’s point, scanning protocol, we’re going to see it’s an evolution and we’re going to see that continue to evolve. Well, the digital scanning hardware, iOS hardware changes every year. We see that. The software gets better and improves. And I think as those companies see digital dentures really start to grow in popularity and the acceptance, you’re going to see more dentists want to get into those workflows and those companies will put time and resources into developing those protocols, scanning protocols, that Kelly was mentioning, to capture both the tissue and also the VDO. And that’s what’s great about this process is, again, going back to one of my earlier comments is that if a clinician has an intraoral scanner, amazing workflows they can participate in like the copy reference denture workflows, using a patient’s existing denture. But if they don’t have a scanner quite yet, the labs can convert traditional impressions and bite records into digital, and it can still benefit from the end prosthesis being improved.

Bill Neumann:

While we’re on the topic of best practices, maybe we can touch on it. It seems to have come up from each one of you a couple of times is training and education. So maybe, Kelly, you could talk a little bit about this and then maybe, Dr. Mongrain, you could maybe talk about how Heartland handles that, but it’s such a key component to just about anything. What does the education process or the training process look like, Kelly, from NDX standpoint? What tools do you provide clinicians?

Kelly Bevington:

Yeah, great question. We have several different tools. We have traditional PDF documents that we have created, then we also have resources from the scanner manufacturing company in a PDF form and sometimes in a video form, and then we have us. And as trainers, each of us have the capability to do a Zoom call or a Teams call, just like we’re doing now, each of us have several different types of scanners in our home offices that we can demonstrate how to scan a denture so they can watch us do it. They can also do that on their own scanner and have us watch them. And then we also go in office and provide chairside support to not only demonstrate the technique, but in addition to, we are all clinical dental professionals, so we’re RDAs, CDAs or RDHs, and we prefer to actually work with an active patient. That’s what we have found works the best for the dentist and their dental assistants to really understand it.

It’s one thing to type it on and to scan our sample denture with a makeshift wash impression inside of it, but it’s a whole different ball of wax to actually do it with the active patient. And as Jamie mentioned, capturing the bite registration for the VDO, it’s really best if we do that in person. We’ve got a great selection, a library, of on-demand education, as well as live webinars that we conduct regularly, and also in-person seminars, live seminars. So I encourage you to visit our website, PDFs, videos, Zoom calls, or in-office training is how we’re trying to support the doctors’ education.

Bill Neumann:

Dr. Mongrain, what are you doing at Heartland? I know you have huge education programs there, so talk a little bit about specific maybe to digital dentures.

Dr. Robert Mongrain:

Well, first of all, Bill, let me digress just a little bit. I talk to a lot of doctors who are not at Heartland and they think that scanners are expensive, and we’re talking about the digital denture, but I’m sure a lot of our audience doesn’t have a scanner yet. I can tell you that only 30-35%, it depends on who you listen to, but our affiliation doctors, we’re not seeing more than that, don’t have scanners yet.

Our internal data, when we decided to go all in on scanners, and you buy several thousand scanners, that’s a big investment, 35 to 50 scans per month, that scanner had paid for itself in about 12 to 16 months. If you get up into the 60, 70 range, it’s just a few months. So I just have to say that. What are you waiting for? Because you can’t do a digital denture without a scanner. Okay, I said that.

At Heartland, we provide all the above, like Kelly said, and actually, the lab trainers are an integral part of our support system. They’re highly trained. They send them to the programs to be certified. So that’s a key part to extend our reach. We do webinars. Tomorrow, we do a monthly webinar on various topics. We do in-person. I’ve got several doctors building out a full in-person program. So we have all the above.

I think the key is, after you’ve bought your scanner, is learn how to use it and learn how to use it well. When you understand your technology, just like a filling, you’re using a composite. If you use it correctly, you’ll have great results. But if you use the adhesive incorrectly, you’ll have sensitivity. So if you understand how to use your scanner, you don’t have to be an expert, you just have to learn the basics and learn about the why. Why do they tell you to scan this part first, or whatever, then you will have great success, because those skills will extrapolate from the simple to the complex.

Bill Neumann:

As we wrap this podcast up, I have a last question here if you can get out your crystal balls and can talk a little bit about what you believe the future of digital dentures is going to look like. Maybe we’ll start with you, Kelly.

Kelly Bevington:

I think it’s going to continue to grow. I think the technology will be greater accepted as more and more dentists invest in intraoral scanners for their practice. It will just naturally continue to grow. But I think more laboratories will take on the technology, and I think more dental practices will continue to take on the technology and the manufacturing companies, like the Dentsply Sirona that makes the DLP, will continue with their research and development, continuing to make it better.

Bill Neumann:

Dr. Mongrain?

Dr. Robert Mongrain:

One of the things that we see right now is that the technology is in pieces and it’s not an easy workflow all the time because all the pieces don’t talk to each other sometimes. Working with our partners, I have a personal vision for the seamless digital workflow, from the time that the patient walks into the practice, even before, all the way through to the laboratory back, this is not just my vision, back from the laboratory was seamless communication, and then all the way out, including the insurance. And we’re working on a lot of those areas. The point of that is that this is going to bring, we’re going to see a rapid adoption.

Bill Neumann:

Jamie?

Jamie Stover, CDT:

Agreed. Just to summarize, I guess, what both Kelly and Dr. Mongrain said, I think we’ll continue to see materials evolve. There’ll be more high-impact denture materials that hit the market. I think that more clinicians just becoming aware of all the benefits for patients, some that we’ve talked about, others that we haven’t had a chance to quite delve into yet here. But something Dr. Mongrain just hit on is so key.

NADL survey demographic data shows us that 60% of removable technicians, or 60%, actually, of all dental technicians currently in the industry are over the age of 55, many approaching retirement age, and only 25% of the removable technicians that work in this industry today are in the category of most experienced versus least experienced technicians. So we have a pretty staggering shortage of experienced removable technicians. We have, according to the America College of Prosthodontists, 5.5 million denture prescriptions coming into labs every year, this year, in particular, in the US. So a lot of removable cases coming into labs. A shortage of technicians is really forcing these labs to say, “Hey, we need to adopt these digital processes.”

And thank goodness that we have really strong materials and we have excellent digital scanners. We have excellent dentists like Dr. Mongrain, who are out on the cutting edge and excellent labs like NDX Labs that have the experience to do this. So everything’s coming together right now in a great way, and I just think we’ll continue to see digital denture adoption evolve and grow. I agree with Dr. Mongrain. It’s going to hit a point where it really takes off.

Dr. Robert Mongrain:

Bill, I know we have to wrap this up. I just have to say labor, labor, labor, everybody’s talking about labor today, and we’re not going to solve that problem, but I have the opportunity and privilege to see a number of technologies, AI-driven, even just connecting things together, disparate databases. I’m very optimistic about the future. I’m very optimistic that our teams and the people that support us will be able to be so much more productive in the next 3 to 5 years, not in 20, 2, 3, 4, 5 years, where people will only do what people need to do. That’s a whole nother topic.

But I walked around my office, I did a program earlier this year, and I walked around my office and took pictures of all of the team members poking at keyboards and not talking to people or doing people things. Those are solvable problems. The digital denture is just one aspect of that. We can solve these problems. So I’m really excited about the future of dentistry with technology, helping people to be people.

Bill Neumann:

We’ll start with you, Dr. Mongrain. If people want to reach out to you or find out more about Heartland, how do they do so?

Dr. Robert Mongrain:

You’ll hopefully put the spelling of that in there. It’s really simple. rmongrain@heartland.com. And then of course, if you want to text or call me, (918) 760-3500. The phone is hardly ever far from me.

Bill Neumann:

Great. Thank you, Jamie. How does someone in the audience get in touch with you or find out more about Carbon?

Jamie Stover, CDT:

Dr. Mongrain loves calls at three in the morning, just saying.

Dr. Robert Mongrain:

I get texts at three o’clock in the morning.

Jamie Stover, CDT:

Just kidding, no. To get ahold of me actually, to find out more about Carbon, our printers or associated materials and software, you can go to carbon3d.com. There’s actually a slick page on there, a lab finder, where you can actually click on it and it will show you, in your state, in your region, who are Carbon Labs, so where you can access this stuff. Of course, NDX, huge, amazing carbon partner and highly encourage you working with one of their labs. They’re obviously way out on the cutting edge here. If you want to get ahold of me, it’s jstover@carbon3d.com. Find me on the socials. Thank you so much, everybody. It’s been a pleasure having this conversation.

Bill Neumann:

Thank you, Jamie. Last but not least, Kelly, how do people find out more about NDX and also how would they get in touch with you if they have any questions?

Kelly Bevington:

Of course. To get in touch with me, you can text or phone me at my cell phone. I, too, always have my cell phone at hand. It’s (724) 244-9499. My personal email is kelly.bevington@nationaldentex.com, and our general incoming email box for anything digitally related is a digitalimpression@nationaldentex.com.

Bill Neumann:

That’s great, and we’ll make sure that we put all that information in the show notes so you don’t have to write it all down. But thanks, everybody. Thank you Kelly, Dr. Mongrain, Jamie, for a great podcast, and thanks everybody for listening in or watching today. This has been The Group Dentistry Now Show. Until next time.