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Digital Case Processing in the Laboratory: How It Works by Janice Gruber

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Remember the cartoon The Jetsons? When I watched it as a child, it seemed like the futuristic conveniences the characters enjoyed were unattainable. And yet, we're making gains every year that bring us closer to that world. Digital case processing is one of those modern conveniences.

On The Jetsons we saw the routine use of digital screens you spoke into that spoke back. Now, we use Skype, FaceTime and other comparable technologies in our personal and business lives. There are robots to clean your house, and even flying cars don't seem far-fetched.

We are all used to mobile phones and know how important and powerful that technology has become and what it allows— constant access to the internet (the Jetsons didn't have that).

So why not digital dentistry?
This technology, the ideas it spawns, and scanner improvements are moving so fast you feel like you cannot miss a day in the office or you will never catch up.

I have worked at Great Lakes Orthodontics for 38 years and have held many roles. Currently I'm the laboratory customer-service manager. Our team of more than 250 employees provides products, lab services and appliance fabrication training to thousands of orthodontists, prosthodontists, oral surgeons and the restorative and general dental profession worldwide. We sell, install and service intra-oral scanners, desktop scanners, software, printers and a wide variety of lab services.

More than two years ago when my director told me I needed to process the customer inquiries and orders from digital scans I thought, "What is this?" I felt like Judy Jetson.

We started processing digital requests in 2012. We had been converting physical models to digital scans since 2008 for our digitally milled splints. The accuracy of these milled splints and the customers saying they require less adjusting and less chair time told us this technology was going to be a big part of our future. Companies like OrthoCAD or emodel were already offering digital models and their customers loved them. It became pretty clear that you either joined in or got left behind. So, let me explain how the digital process works today.

Initially, the clinicians who saw the benefits of this technology jumped in with both feet and purchased intraoral scanners, which was way ahead of the number of labs that were ready to accept them. The bigger labs had to quickly learn what needed to change to keep our customers happy. At first, it was overwhelming because there was so much to learn. Processes we were used to had to be re-thought as the scanner companies made improvements along the way. We are human beings and unfortunately cannot plug in for an overnight update!

Today, instead of being overwhelmed by the technology, we have become impatient when a file takes too long to download. I am still amazed when I receive a digital scan of a patient's mouth via an internet cloud and send it to a printer to make an appliance. George Jetson would be proud.

For the clinician, there are a lot of features and questions to consider when purchasing a scanner, such as "what scanner software is available and what will it allow me to do?" Other questions include:
  • What are the pros and cons for each?
  • Are there annual or upgrade fees?
  • Which company will keep up to date with technology so the scanner does not become obsolete in the short term?
  • Is it powder free?
  • Does it scan in color?
  • Will it integrate with my patient management systems?
Great Lakes has spent a lot of time investigating digital, intraoral and desktop scanning and model printing and sought answers to these same questions. We now help clinicians across the country sort out the information so that they can make an informed decision that will maximize the benefits to their practices.

The 3Shape Ortho Analyzer software makes it easy to create digital study models including adding virtual bases, perform treatment planning and case analysis using 3D and 2D tools, measurements, virtual setups with digital articulators and move or extract teeth. Other vendors may offer similar software packages, so you may want to add that to your list of considerations.

In the laboratory it does not matter to us what scanner you purchase, we just need to receive the files in an open file format referred to as .STL files. For clarification, an .STL file is defined as a format native to the stereolithography CAD software created by 3D Systems. STL is also known as "standard tessellation language."

Labs need to establish a connection with all the major companies, 3Shape via Communicate, iTero via Myaligntech, 3M Connection Center, Cerec via Sirona Connect, Carestream Dental Connect and Planmeca, to name a few. We spent the time to learn how their systems operate and what's involved in getting the files in the .STL format. These are usually converted as they are exported via the connection cloud or FTP site. Labs need to acquire and learn the necessary software, purchase printers and train staff to work in this new non-dental expertise.

Once all that is set, the process is pretty simple. To get the scans to your lab you either export .STL files and log into your lab's portal or use file-sending software such as Dropbox, ShareFile or WeTransfer. Great Lakes has a portal where customers can upload their files, enter case instructions and monitor their orders whenever they need to. The files are safe, password protected and accessible 24 hours a day.

If the scanner you purchase uses a connection cloud, the process is even easier for you. The lab you want to send to may need to set up a connection with this company before you can upload your scans to them directly from your scanner. For example, with 3Shape you can add a connection from your Trios scanner to your lab just by adding their email address on file with the company. You fill out the lab prescription on the scanner and scan your patient.

Once complete you click send—there are no incoming freight charges either! The lab receives your order and begins order processing, model printing and appliance fabrication usually with a much faster turnaround. That style connection cloud process is similar with iTero and 3M True Definition scanners while the other vendors allow export of .STL by the clinician.

There are different printed model options available depending on what appliance you are ordering, or you can allow the lab to make the proper selection for you. The print options range from segmental, horseshoe, with palate and lingual anatomy, low profile or full study model base printing.

Of course the printed model is as good as the scan submitted. You need to keep in mind that whatever you tried to capture in an impression must be clear in the scan. With physical impressions you had to deal with bubbles, the tongue, tray size, voids and distortions. The biggest issue with scans is missing data, which appear on your scanner screen as holes. We can repair the files digitally, but anywhere these holes are repaired is not 100 percent accurate. We work with our customers until they are more used to what we need and what may affect the fit of their appliance if we repair it with the software.

We can fabricate any orthodontic appliance, splint or sleep apnea device with the exception of the Narval MRD, which still requires stone models. If the appliance requires soldering, the resin model will need to be duplicated because you cannot solder directly on the resin model. For banded cases it's the customer's decision to allow the lab to use their stock bands, or if preferred, some clinicians size their bands and send them to the lab to adapt to the printed models. The timing of this works well because by the time the models come off the printer the bands are arriving and are connected to the open order and appliance fabrication can begin. The cases are shipped back to you via the usual process.

As fast as this technology is moving, we are not able to beam your cases to you just yet! The comments we've received are that appliance fit and bite position accuracy reported as perfect and appliance adjustments, if any, are much less than from conventional impressions. That is no small statement! There just are no more distorted impressions, models to be re-done, scared or crying patients—which may be the best feature of all.

The comfort for the patient when scanning versus taking an alginate or poly vinyl impression is such an advantage that new residents are telling us they plan to market their practice as impression free. They feel that this selling feature alone is so great an advantage that it will make the patient choose their office over another dental office. Once you pass the learning curve and hone your scanning skills you can begin to see how much time you save in your day-to-day office schedule.

Acquiring a digital scanner may be seen as a large capital expense. Smaller offices, new offices, or the clinician who is starting to downsize, may decide it is not right for them today. Many are sending patients to scanning centers, which are also growing in popularity. Some customers tell us they are sharing the scanner for a fee with a local colleague until they are ready to take the plunge and purchase their own.

The office that does not plan to ever make this purchase can still be a part in the digital model advantages for record storage or sending files to referring clinicians. They send their physical models or impressions to the lab to scan on a desktop scanner and create the .STL files from them. This choice still uses the lab's portal for processing, viewing and monitoring of the orders from start to finish and maintains password-protected patient records.

Whatever decision you make for your practice, don't forget the small day-to-day expenses that are easier to live with on a monthly basis but cost you more in the long run. These may make you rethink not getting started with this technology sooner. The costs such as alginate and poly vinyl, plaster and stone, incoming shipping costs, staff time, office mess and most of all—patient comfort, need to be taken into consideration.

There are webinars available from scanner re-sellers, articles and customer service departments like mine to answer your questions. So if you take your time and do your homework, adding this digital advantage to your practice will be a decision you will not regret. This digital enhancement may not take you into the Jetson era, but it is a modern adaptation that can add value to your practice.

Janice Gruber establishes business relationships with digital partners and implements their protocols into the Great Lakes Orthodontics lab process. During her 38-year career at Great Lakes, she has held various roles from laboratory technician, to managing lab shipping and receiving, to her current position as laboratory customer service manager.

Orthotown Magazine
September 2025
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