“Buying a scanner is going to be as essential as buying a dental chair”

Dr Al-Hassiny, what guidance would you offer to a clinician still on the brink of making the switch to a digital workflow?
It goes without saying that dentistry is going digital. When you walk around trade shows today, you still have some of the older reps offering alginate and other dental impression materials, but mainly you see digital solutions, and I agree it can be quite intimidating. What can be reassuring for many people who are just starting with this, is that it isn’t uncharted territory anymore. As long as you choose reputable scanner companies, they all offer good options. It’s almost an illusion of choice because, fundamentally, what clinicians need to decide is whether they are going to be in the industry for more than about five years. If they are, then they will have to digitise. I feel that it’s that simple.

In five or ten years’ time, if a dentist doesn’t have a scanner, then I think he or she will be in a minority group. In the leading markets now, scanner adoption is close to 60%. It’s not a matter of deciding whether or not to digitise; it’s a matter of deciding whether you are going to be practising dentistry long enough. The investment is not even that high. For most practices, a scanner will cost less than a dental panoramic tomogram machine these days. Buying a scanner is going to be as essential as buying a dental chair.

So, the question becomes: how far do I go? Do I go into CAD/CAM? Do I go into milling? Do I go into printing? Do I start my own laboratory? Because I’ve used or owned every single type of scanner on the market, it’s really easy for me to differentiate between them. The more you spend, the better the software that you’ll be able to buy. If you just want the cheapest possible entry point, you can spend as little as US$5,000 (€4,776*) and buy a product that works, a Chinese scanner that will take digital impressions. Though the software is a bit average, it will work. Taking a digital impression is no longer a novelty. They all really work, unless you’re doing a lot of edentulous scanning and All-on-X scanning. But if you’re just doing crown and bridge and you use a scanner for a couple of crowns or some splints and night guards, they all will work.

How you decide which one to buy is basically down to where you live. US$20,000 for a scanner doesn’t feel the same to a clinician in the US as it does to a clinician in Egypt, as it’s just a totally different economy. I think Chinese scanners will dominate the emerging markets because they are sold at a quarter of the cost of other scanners from Europe.

I think what is more important now is education, which is what I am involved in, and of course guiding clinicians into buying the right products through iDD and our independent and unbiased reviews. Learning how to use a scanner is the missing piece of the puzzle because, even if you buy a new scanner, you need to realise it’s a new skill. It’s not like taking a physical impression.

Can you tell us something about your lecture for AEEDC Dubai and what attendees can expect from it?
Over the past ten years, the intra-oral scanner market and its focus have totally changed, even more so since the original scanner introduction in the 1980s. The first few decades involved finding out how to scan. We went from monochrome single-shoot cameras to super-fast colour cameras with realistic aesthetics, shade detection and other very complicated considerations. And then we hit a plateau. The most important year for the development of scanners was probably 2019. A large number of scanners came on the market, and they were all scanning really well. This is when we started focusing on software and some of the problems that scanners had.

One of the fundamental problems that scanners still struggle with is that of scanning full-arch implants. Though all scanners can scan crown and bridge, because of the nature of implants, you really don’t have any leeway with them. Scanning a full-arch implant is like putting a whole jigsaw puzzle of images together. When you do a full-arch implant scan on a quadrant, it’s very accurate, but as you move across that arch to the other side, it starts losing accuracy, still tolerable for crown and bridge, but when we’re talking about implant prosthetics having inaccuracies of 150 microns, this isn’t enough, especially for full-arch zirconia bridges.

“Over the past ten years, the intra-oral scanner market and its focus have totally changed.”

As people began to grow frustrated with scanners, they went back to analogue techniques of verification, such as jigs. However, necessity is the mother of invention. We tried to come up with solutions. Photogrammetry companies came on board, and they filled that void. These were engineers using geometries to fill the void of full-arch implant scanning. We started using photogrammetry devices. However, anyone who uses a photogrammetry device knows they’re bulky, they’re large, they’re expensive, and the software is unsatisfactory. It was a huge barrier to anyone trying to scan for large implants.

However, in the past year or two, we’ve had a total shake-up. All the intra-oral scanner companies and all the digital dentistry companies have been focusing squarely on these issues.

The whole idea of my lecture is to walk people through where we started with digital implantology in terms of scanning data capture. I’m doing my own study at the moment and have collected five days’ worth of non-stop scanning data with all the different photogrammetry devices. I think we’re on the precipice of a disruption in photogrammetry with this idea of intra-oral photogrammetry. Specialised scan body solutions like those from TruAbutment are also bridging the gap. The days of extra-oral photogrammetry are numbered.

You’ve seen digital dentistry evolve over time. Could you tell us about how you got involved in intra-oral scanning and the story behind iDD?
I am a full-time dentist, and I do all forms of dentistry, as our practice offers general dentistry, implantology, orthodontics, cosmetic dentistry and much more. I was fortunate because, after graduation, started working with my father in his practice. In fact, there are many dental clinicians in our family. My father has been a really important role model for me, and he had one of the first scanners in New Zealand. My mother convinced him to buy one, which I was able to use right after I graduated. As it was a monochrome single-shoot camera, we upgraded often over time to improved technology because we wanted to do same-day dentistry. Quite early in my career, I had access to three different scanners at a time when we had about five chairs in our family group of practices. Now we’ve grown the practice group to 41 chairs and a fully digital laboratory with six technicians.

Back then, I was interested to learn more about scanners and therefore, I attended a study club meeting of dentists in New Zealand with the knowledge of the pros and cons of the three scanners I already had. A paid rep demonstrated a scanner that I personally felt was not good quality as it still required powder and had lower specifications. His sales pitch didn’t sit right with me but all the other clinicians really believed him. I thought to myself, “I’ve tried this scanner, and it’s not good.” And this is what started iDD as a passion project to help provide others with the information I already had gained from practice. Now, I think we have one of the most popular digital dentistry websites in the world. It has over two million page views a year just for its reviews. It started as a review blog that gained traction after I did a wrap-up of all the scanners at IDS in 2019. It is not a paid marketing project, as I wanted it to be something people can trust. Now we have about 12 full-time staff members, and our production quality is much improved.

Tags: