Charlie Ward, DDS  

Whether you want to use a digital SLR camera for documentation, patient education, lab communication, making presentations at dental events, dental publications, or accreditation in the American Academy of Cosmetic Dentistry, you have choices to consider in multiple price ranges.  

Dentists can spend $1,800 and get a good system for documenting cases, patient education and lab communication. Dentists can easily spend $3,800 or more on a setup to equip themselves to take higher quality images. 

Camera Body: Most dentists shoot with a Nikon or Cannon DSLR camera. These are comparable brands. My experience is with Canon but my lab technician uses Nikon and gets wonderful results. I am shooting with the Canon EOS 90D. The comparable Nikon is the D7500. More entry-level models are the Nikon 3500 and the Canon Rebel T8i. 

Lenses: We can get a third-party Sigma 105mm or a Tokina 105mm lens that gives us decent quality, or we can purchase the Canon 100mm or Nikon 105mm version at twice the price. When I upgraded to the finer Canon lens, I noticed a huge difference in image quality. I recommend an upgraded lens for the highest-quality images you need for accreditation. 

Flashes: The ring flash is a great entry-level option and significantly less expensive but there are limitations to what you can do to control your light. I’ve been using a dual point flash for some time. I can pull a flash off and shoot from a different angle. By changing where the light is coming from, I can accentuate the angle lines for more depth and visual clarity.  

Sometimes, I’ll take one of my flashes off, hold it on the opposite side of what I am shooting, and shoot the flash back into the lens of the camera. When I do this, I get an ethereal-appearing image or an image with a white background. I appreciate the versatility of using the dual point system.  

For my best-looking images and portraits, I’ll use softboxes. This gives smoother, more diffuse light and a beautiful appearance. These are necessary for everyday dentistry but make a huge difference in showcasing aesthetic cases.  

Consider the Long Term: When dentists invest in cameras and lenses, they typically use them for a long time. If you are on the fence about how much you want to invest, my own experience might be helpful. I honestly wish that I had upgraded sooner than I did with the Canon EOS 90D and the Canon 100mm lens. After taking photos for 12 years, the upgraded equipment has only increased the joy I have for photography and pushed me to take more pictures! 

When my daughter Kaitlyn (currently in through E2 at Pankey) finished dental school in 2020, I strongly recommended that she learn analog first, then once mastered, make the transition to digital. This lasted about four months. I learned rapidly that this generation sees things in the digital realm far better than we do. She reminded me that “she grew up with a screen in her hand.” 

We began to focus on her learning the concepts of occlusion, esthetics, biology, tooth-by-tooth structural integrity, and visualizing and planning in the virtual (digital world). We quickly learned that, although she could easily visualize things on the computer, the patient is ultimately analog. We began to utilize an analog articulator for her to learn the hand skills of what we would do on the patient. 

A great example of this is equilibration. A “trial equilibration” on a virtual articulator is a 5-minute process that lets us determine if equilibration is an appropriate treatment option. The problem is that, unlike analog, you do not learn the brush strokes that will be required to perform this skill in the mouth. I have performed hundreds if not thousands of equilibrations. I know the brush strokes. For me, once I see on the virtual articulator that I can do the equilibration without too much tooth structure removal, I am ready to go to the mouth. For Kaitlyn, who has very limited equilibration experience, once visualized on the virtual articulator, then it’s time to go back to analog. She mounts the printed models on an analog articulator to perform a traditional trial equilibration. In this way, she learns the brushstrokes of this incredibly important procedure. 

I think it is extremely important that dentists, who are learning to equilibrate intraorally, work on mounted analog models to develop their equilibration skills. 

Returning to the consideration of the financial cost of bringing new technology into your practice—input devices (scanners and CBCTs), output devices (printers and mills), and software to manipulate the data all cost money. Doctors that are going down this road usually like technology and consider the dramatic increases in efficiency to ultimately increase the productivity and profitability of the practice. This is certainly something I have seen. The bottom line is dental stone will go away. We all must make the decision when it is appropriate to make the jump. 

Dr. Lee Ann Brady has invited me to audit all the Pankey Essentials courses over the next year. I am super excited about this. She has asked me to recommend ways to appropriately implement examples of digital technologies and workflows into these core classes. While younger dentists are drawn to digital information, it is important for us to remind them that our patients are ANALOG. We are training dentists to perform complex procedures on patients, not on computers. This requires great study and a commitment to understand timeless concepts, while simultaneously developing the hand skills to accomplish these procedures accurately and use digital workflows to make things more efficient. 

In 2024, The Pankey Institute is also implementing a digital hands-on course for those doctors who would like to make the transition over to virtual articulation and digital workflows—something that I am excited to be part of. Dentistry is in a great transition. I look forward to making sure the concepts that we have all built our practices around do not get lost in the digital world. 

When dentists are considering the purchase of a new digital technology for implementation in their clinical practice, they usually have three primary considerations:

• Will it increase accuracy?
• Will it increase consistency?
• Is it possible to increase efficiency without sacrificing quality?

Often the cost is a major consideration, and I will come back to the question of cost later in this two-part series.

Twenty years ago, with first-generation CEREC, the results were not close to what we could do in the analog world. But I jumped into using chairside CAD/CAM because, at the time, I was teaching with Dr. Peter Dawson and many doctors were buying the technology. We needed to be able to talk about how it fit with complete-care dentistry.

It was a difficult time because while we could do crowns (usually one or two at a time) in maximum intercuspation or on equilibrated patients in CR, the software was not sophisticated enough to do any kind of case planning. It did, however, provide me with the first glimpse at scanning and 3D digital technology, and I became excited about the possibilities. I started to think about the ability to scan mouths for diagnostic purposes and to do waxups. Virtual articulation was not there, and we didn’t have 3D printing to print our “outputs” so I continued to wait.

As recently as four years ago, my son would spend a day mounting stone models for me. Today, he has digital models mounted on a virtual articulator before the patient leaves their appointment. Digital and AI software platforms are evolving quickly. They enable more dentists and lab technicians to visualize optimal dentistry and design occlusions and beautiful smiles easily. For implant dentistry and orthodontics, these digital and AI software platforms remove obstacles and inaccuracies.

The ability to “stack” data sets on top of one another (pre-op model, waxup, CBCT, Face Scans, photos) allows us to see things in ways I could have never imagined. The things I dreamed about 15 years ago are here now and evolving at warp speed. I honestly don’t remember a time when I was more excited about day-to-day dentistry. A special shout out to Lee Culp (Sculpture Studios), who introduced me to these workflows, and continues to lead dentistry into the digital era.

In the digital world, we can make digital impressions, face-bows, and waxups to see if we need to equilibrate, orthodontically move teeth, or change the shape/contour of the teeth. Technology allows us an efficient, accurate workflow. An experienced digital team can mount models and a virtual articulator, in CR, in 10-15 minutes. The ability to scan in CR, MI, or any treatment position can be accomplished with ease. Trial equilibrations or diagnostic designs (waxups) also can be accomplished far more rapidly, with beautiful results.

As digital workflows take hold in mainstream dentistry, one of the great challenges we face is how the next generations of dentists will learn. In treatment planning, I have the benefit of having 30-plus years of experience working in analog. I have solidified the concepts of centric relation, anterior guidance, posterior disclusion, crossover, envelope of function, incisal edge position, and all the things that go along with visualizing optimum care for your patent. This knowledge was my foundation for determining if these technologies had evolved enough to make the shift to the digital realm.