“The beauty of exocad is that it’s a universal open-source tool”

At exocad Insights 2022, Dental Tribune International sat down with Dr Miguel Stanley, who is a passionate advocate for high-quality dental care and the clinical director of the White Clinic in Lisbon in Portugal. In this interview, he shares how exocad supports him in treating his patients with personalised solutions and how the open exocad software ultimately supports beginners and advanced practitioners in improving patient care.

Dr Stanley, to what extent do you use exocad solutions in your daily workflows?
We started working with exocad in 2017/18. We didn’t have a laboratory per se and only started working with exocad when we acquired an in-office milling machine. With this, we started gradually making small crowns and learning to use the technology, because integrating a new technology or software in the clinic requires new staff and keeping those people happy and trained. You have to slowly integrate new solutions into a team and understand and find the ideal workflow.

Today, we do everything digitally, having a fully integrated in-house laboratory. We have two milling machines, three exocad stations, tabletop scanners and several furnaces. The only thing we don’t fabricate in the clinic is large metal structures, but mostly because we have phased out metal almost completely. We produce zirconia, lithium disilicate and nanohybrid composite dentures, zirconia abutments, surgical guides, impression trays, the whole gamut. We are very happy with the software.

Do you use exoplan for your implant treatments?
We actually want to get more involved with it based on a lecture that I saw at exocad Insights. It seems like exoplan just did a massive leap into simplifying and reverse-engineering the whole process, including the dental design. As an implant surgeon, I’ve always believed that implants should be placed in function of the prostheses. Having a surgical guide that does optimal placement for the later prostheses—which exoplan can do—is very clever. The system that I’m currently working with has its own implant guided system. We’ve been pretty much very fluidly outsourcing that.

And what about Smile Creator?
We use this a lot; I would say that we use it for 100% of our full-arch cases. I couldn’t imagine beginning a major reconstruction without it. It offers so many possibilities. Sometimes, we scan a family member of the patient in order to use his or her smile as a donator, which is really cool. We even had one case of a patient who was in transition, gender-wise, and we had designed masculine shaped teeth for the patient because at first we weren’t aware of the transition. After we had found out, we used the software to give the patient more feminine shaped teeth.

Moreover, the shape and angulation of the teeth can be directly correlated to the patient’s character, for example triangular or square or rectangular teeth. Without exocad, there is only the archaic technique of a dental technician fabricating the teeth by hand in a lab. That is still happening today. Most dental technicians have their signature shape. What happens is that patients receive a shape that looks beautiful, but it’s not their shape. For example, if the patient is organised, structured and methodical, but gets teeth of a triangular shape, which is more extroverted, more dynamic, she or he will have a smile that isn’t hers or his. Even though everybody’s saying it’s fantastic and it looks okay, it doesn’t feel right for the patient. I call this depression induced by poor design.

Let’s take Johnny Depp as an example, because he was the first method actor who changed his tooth shape for every major role he took on, be it Willy Wonka in Charlie and the Chocolate Factory or Captain Jack Sparrow in Pirates of the Caribbean. These tooth shapes were central to him being in character, something Hollywood understood early on. That is why exocad is really cool: its smile design software allows you to test not just aesthetics but an emotional connection to the tooth shape.

According to Dr Miguel Stanley, Smile Creator allows patients to test whether the new tooth shape fits aesthetically but also emotionally. (Image: exocad)

This sounds really interesting. So, what would you say is your favourite exocad product? Is it Smile Creator?
Actually, the greatest product is the people. I really do mean it, because I don’t just like a product and I don’t just like a service; I like the people behind that product and that service. There are some companies that suffer from corporate arrogance. I’ve been doing this for long enough to know that if you’re not an important person you don’t get good service. The thing about exocad is that it’s open-source. Tillmann [Steinbrecher, CEO and co-founder of exocad] had the vision of creating something that was ubiquitous and fair and democratic, so exocad is a tool for everybody.

What would you tell dentists or dental technicians who are still struggling to enter digital dentistry or go fully digital, and can you share some examples of how your work has improved by using digital workflows?
The thing about going digital is that you can’t just think about it. You actually have to do it. The beauty of exocad is that it’s a universal open-source tool for the beginner or advanced practitioner. It can be tailored to how you want to practise. If you don’t want to buy it, then find a planning laboratory, for example, and pay the lab to do the design for you. However, you need to get your physical impression digital, for which you have to get or rent an intra-oral scanner. Once that impression has been scanned, then you’re a digital dentist. You don’t have to own the machines; you can partner with people who do.

If there’s any issues with the final product, the reason is your impression. In the past, you could have blamed the laboratory, but you can’t blame exocad. The restoration will be fabricated precisely unless the milling machine is broken or the printer is terrible. However, the design, which is based on that STL file, is accurate.

Even at my clinic, we don’t always take the best impression because maybe we are treating a difficult patient. If that impression goes into exocad and has an issue, it is flagged straight away. We know we have to go back and take a new impression; there’s no discussion. With analogue dentistry, however, sometimes you can fake it: you might make a bad crown and get away with it. Inevitably, the digital industry is improving the quality of patient care because you can’t hide your defects any more. It is a great equaliser. So, I think that if you’re a bad dentist, you might want to stay away from exocad [laughs].

Dental software
Digital dentistry
Dr Miguel Stanley
Exocad insights
Exoplan
Smile Creator


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