#AskT-Bone – Ep14 – Digital Impressions for Orthodontist


Hello and welcome to another edition of ask T-bone, part of the T-Bone speaks podcast!

Hopefully you listen to our full episodes on T-Bone speaks and then we have these ask T-Bone segments that are questions that are submitted by our listeners from our T-Bone speaks podcast.

Today’s question was actually sent in by an orthodontist. I’m not an orthodontist but I will do my best. the question has nothing to do with wire bending luckily so we should be ok.


Dr. Agarwal, I really enjoyed your interview on the podcast with Dr. Costes. You obviously have a great business acumen and would like your opinion. I’m an orthodontist in the Philadelphia area and I’m working on a startup practice. I have debated with myself whether spending startup of capital on technologies is justified specifically an intraoral scanner. I really like the Sirona CEREC scanner mostly because it seemed easy to use, there are no monthly fees and is Invisalign-compatible. What is your opinion on technology for startup practices? The cost of the scanner is $40,000. Purchase with startup Capital the cost 4 and a half percent compounded over 12 years. Benefits include improved patient experience, -my primary focus since no one enjoys traditional impressions- reduce costs and improve workflow process. Really is soft costs since I will not be at capacity for some period of time. Any input you have is appreciated, thank you for sharing.


So thank you again for submitting the question and very best of luck to you in opening your practice. I think it’s everybody’s dream to be a business owner and not everybody is cut out for it, but I wish everybody luck and I know that you’ll do unbelievably well because you’re asking the right questions, you are given things thought and you thinking about your future. So a couple of things, we did a podcast recently for the Dentalpreneur Podcast with Dr. Mark Costes. It is a fantastic podcast and Mark is a unbelievably interesting fellow, he is juggling a lot of different things, I think I juggle a lot of things, but he makes me feel pretty bad in terms of the number of things he’s able to juggle, and be successful at it. So really ultimately there’s a few things in this particular question that I’d like to discuss. So let’s go ahead and get out of the way the actual intraoral scanner. So listen I am clinically biased towards the Sirona CEREC system. I’m a clinical trainer, speaker and advocate for Sirona and the CEREC software, the CEREC system, so it would be, you know, it’s important for me to always disclose those things. That being said I like it not because they pay me money, because they don’t, they pay me for my time when I do events for them. But, because really it is a great system. Great camera, great software, great results. We had fantastic results using the orthodontic software which allows to capture full Arch impression. On average were taken between 8 and 12 minutes per full arch, upper and lower combined impression with the bites. The accuracy is there and the detail that we get is there.


So what are the benefits for orthodontist or even general dentist doing Orthodontics for digital impression machine?


One: I think the economics can make sense. I don’t think we realize how much it actually costs us to take traditional Impressions. First you have the cost of the material itself, if using polyvinyl on average each arch is going to cost you $20 to $25. So for an upper and lower impression you’re looking in the $40 to $50 ballpark for the materials alone. Now you add in your personal time, your team member not to take the impression because that’s part of the cost of taking the impression, but now they have to pull up these mod bold, they have to, you know, trim these models, they have to make sure that, you know the orthodontists, they want this absolutely perfect pristine models, you have to pour them up, then you have to soak them and do all these things with them, and I get it, all these things add time and time is cost money. So the advantage of digital from that perspective is: Number one you can take a digital pressure without any impression material. It’s a unique and cool and differentiation way of working with your patients. You can see their teeth and occlusion right away. There’s no models that have to be pour up to be able to evaluate the case and do drawings and everything on the case. Also there’s no models to be poured up, so in fact what you can simply do is you can virtually add the base to your specifications, all those little angles on the base that you have, how tall you want the bases and you simply click “print” and you can order printed models to your specifications. So that there’s no human labored time involved in your office to produce these models. Also it’s a great way to minimize how many models that you have to keep in your practice. One of the things I’ve seen with orthodontist, I think this is going the way now but they have this whole closet full of all these old model records. I don’t know how long they keep these things. But when you digitize these things you have access to them at any point time on demand and you no longer have to have all of these things in place. So it makes all the sense in the world, the Sirona CEREC system with the CEREC ortho software is a fantastic choice. It does work with Invisalign it does work with clear correct it does work with hundreds of Laboratories for orthodontic appliances whether that is retainers, weather that is expansion appliances, whether that’s you know, any number of things you can have made for it. In fact we utilize the CEREC Ortho software to take our full arch Impressions for our sleep appliances, for occlusal guard and many of these things along the way. So there many more uses for the CEREC Ortho software than just Invisalign Orthodontics. You can also, in fact, send it in to have Inman aligners made, you can send it in to have indirect bonding setups done, So a lot, lot of choices exists in how you want to use this data.


The other part of the question that I wanted to address was: Startups and technology, and paying out some of the startup.


Now, personally, I would never recommend financing out your technology as part of the startup cost on a long-term loan. And I consider anything longer than 5 years is a long-term loan, so if you going to start your practice up, and you build out and all those things are going to finance out of over 7 to 12 years typically. I would not include technology equipment in that. I believe technology should only be financed out of 5 years plus or minus a few months, for skip that you may be doing, and the reason is technology changes, more so now than ever this technology will change every so often, I don’t know how often that is, maybe that is every 5 years, 10 years, but the technology changes, upgrades are inevitable, so the last thing you want to do is have a long-term loan on something that becomes obsolete or needs to be updated, and now you’re paying for the update and you’re paying for your old technology because you finance out so long. so I’m a big believer in 5 year loans, no more than that.


So and then the other question is, do you invest in technology as a startup?


And really, to me as an orthodontist I would tell you that a digital impression machine in my opinion would be a wise choice. And the reason I say that is, it is going to become more standard before an orthodontic cases, because it does give the benefits that I had laid out earlier, and it also has a way of differentiating yourself. Now when I say it’s wise to spend money on Technologies as a startup that doesn’t mean that you go out and buy every piece of equipment known to man, to me that would be a recipe for disaster. So I think as an orthodontist a digital impression system make sense, it is something that you will use on a daily basis, it’s something that you can use to differentiate yourself, and to me, one of the benefits of using CEREC specifically, is you can tap into the large CEREC user base within your community and use that as a, get in the door say hey I also have CEREC, you know what we want to work with your patients, we speak the same language that you do, and this litterally  major Metro areas hundreds and hundreds of the current CEREC owners and I don’t think enough attention is given to that fact, that as a specialist if you’re going to be choosing different systems, I think you should choose something that speak the same language as many of your potential referral base out there.
So I hope this helps thank you for submitting the question and enjoy your day and best of luck to you on your startup practice.

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