Digital Dentistry with Paul Abrahams

Transforming Clinical Practice, Patient Communication and Treatment Delivery 

Digital dentistry is transforming the way dental practices operate, from diagnosis and treatment planning to patient communication, laboratory collaboration and the delivery of restorations. In this lecture, Paul shared his experience of adopting digital technologies throughout his career, explaining how they have improved his clinical workflow, enhanced patient understanding and helped differentiate his practice in an increasingly competitive environment.

Having qualified in the early 1990s and built a successful practice in St John’s Wood over more than three decades, Paul emphasised that digital dentistry is not simply about purchasing equipment; it is about changing the way we practise dentistry. Successful implementation requires investment, training, leadership and, above all, a willingness to  evolve.

Paul described how his professional development has been shaped by colleagues, specialist collaborations and his involvement with the British Academy of Cosmetic Dentistry (BACD), including serving as its President.

His philosophy is that dentists must continually develop their skills and services to remain engaged with their patients and relevant to their profession. A practice that stands still risks being overtaken by others that embrace new techniques and technologies.

Digital dentistry encompasses much more than equipment used in the surgery. It includes online booking, patient communication systems, digital record-keeping, artificial intelligence (AI), laboratory workflows and the integration of technology throughout the practice.

Paul illustrated this with examples from an ordinary clinical day, including same-day CAD/CAM crowns, digitally designed and printed occlusal splints, clear aligner treatment and digital consultations. These technologies can make treatment more efficient while offering patients a more convenient and informative experience.

Intraoral scanning: far more than taking impressions

A central theme of the lecture was the value of intraoral scanners, particularly iTero, which Paul has used since the technology's early development.

Traditional impressions can be uncomfortable, messy and time-consuming. They may also fail to capture preparation margins adequately, potentially compromising the quality of the final restoration. Digital scanning avoids many of these difficulties and allows the dentist to inspect the preparation immediately.

However, Paul stressed that scanning is not simply a replacement for impression-taking. Its greatest value lies in visual communication, patient education and clinical assessment.

A scan allows dentists to magnify and examine preparations, identify deficiencies and communicate more effectively with their laboratory technicians. Better visualisation can improve the quality of the work submitted to the laboratory, although a scanner cannot compensate for poor tooth preparation or inadequate clinical technique.

Paul also highlighted the importance of working with a laboratory that understands digital workflows. Successful outcomes depend on the quality of the scan, the clinician's preparation, the technician's expertise and effective communication between them.

The choice of scanner should reflect the practice's intended applications, whether these include restorative dentistry, orthodontics, implant planning or digital printing.

One of the most important benefits of intraoral scanning is its ability to help patients understand their own oral health.

Many patients have tooth wear, chipping, crowding, failing restorations or other problems that are difficult to explain verbally. Looking in a mirror is often insufficient to demonstrate the extent of the problem. A digital scan displayed on a screen makes these conditions visible and helps patients understand the dentist's recommendations.

Paul described routinely scanning patients, including those attending for check-ups and those who have been coming to his practice for many years. Comparing current scans with previous records can help demonstrate changes over time, including wear, recession and deterioration of restorations.

He gave the example of a patient attending with a chipped tooth. By comparing the new scan with one taken previously, the dentist could demonstrate how the problem had progressed and explain why simply repairing the tooth might not provide a lasting solution. This created an opportunity to discuss orthodontic treatment and restorative options.

Digital visualisation also supports treatment planning for cosmetic cases. Scans and photographs can be combined with simulation software to show patients potential changes to tooth position, shape and appearance before treatment begins. This enables patients to consider their options and participate more fully in decisions.

Paul's message was that treatment acceptance should follow understanding, not pressure. Patients may decline treatment initially, but repeated opportunities to see and understand their dental condition can help them make informed decisions when they are ready.

Digital restorative dentistry and 3D printing

The lecture explored the expanding role of computer-aided design and manufacturing (CAD/CAM) in restorative dentistry.

Chairside systems such as CEREC enable dentists to design and manufacture restorations, including crowns, within the practice. This can reduce the need for temporary restorations and additional appointments. For busy patients, completing treatment in a single visit offers considerable convenience.

Paul described treating a patient who required a replacement anterior crown. Using digital workflows, the restoration could be completed during the appointment, allowing the patient to leave with the tooth restored rather than returning for a separate fitting.

Three-dimensional printing extends these possibilities further. Depending on the equipment and materials used, practices can produce occlusal splints, impression trays, surgical guides, models, temporary restorations and other appliances.

Paul discussed emerging systems such as SprintRay's MIDAS printer, which aims to produce definitive restorations using a specialised ceramic-composite material. He suggested that advances in printing technology could change the economics and accessibility of in-house restorative production.

Nevertheless, new materials and workflows must be assessed carefully. Long-term clinical performance, appropriate case selection, material handling, bonding protocols and the learning curve remain important considerations. Digital manufacturing does not remove the need for sound clinical judgement.

Digital workflows in complex and aesthetic cases

Digital planning can be particularly valuable when several stages of treatment must be coordinated.

In implant dentistry, scans, radiographs and cone-beam computed tomography (CBCT) images can support planning before surgery. Collaboration with specialists can take place remotely, allowing treatment plans, provisional restorations and surgical requirements to be discussed in advance.

Paul described how digital communication enabled a visiting implant specialist to review cases remotely, plan treatment and prepare for surgery without  needing to attend the practice for every consultation.

He also acknowledged the limitations of certain digital workflows. In complex full-arch implant cases, for example, additional verification may be required to ensure that the final framework fits accurately and passively. Digital scanning should not be assumed to eliminate every source of error.

For aesthetic dentistry, digital design allows clinicians and technicians to explore different shapes and proportions before treatment. This is particularly useful when patients want to preserve the character of their existing teeth or when a minimally invasive, additive approach is preferable.

However, Paul cautioned that techniques such as composite bonding and injection moulding still require considerable clinical skill. Digital planning can improve predictability, but it cannot replace the dentist's technical ability.

Artificial intelligence and practice management

AI is increasingly being incorporated into dental software. Paul discussed tools for radiographic analysis, clinical documentation and administrative processes.

Systems such as Pearl and Overjet can assist with the analysis and visualisation of radiographic findings. These tools may help clinicians explain conditions to patients, but they should support rather than replace professional interpretation and diagnosis.

He also described using AI-assisted clinical note-taking software, such as Heidi, to convert dictated information into structured clinical records. This can save time and reduce administrative workload.

Other digital systems can analyse telephone conversations, support reception teams and improve patient engagement. Online booking is another important development, particularly for patients who prefer arranging appointments electronically rather than making telephone calls.

Paul argued that technology must be integrated throughout the practice, rather than confined to the surgery, to achieve its full potential.

And the future?

Purchasing technology is only the beginning. Paul acknowledged that his early experience with digital restorations involved a learning curve and that initial results were not always satisfactory. Persistence, training and a willingness to adapt were essential.

Practices must also consider the financial implications, including equipment costs, maintenance, materials, staff training and the fees charged for treatment. Investment should be linked to a clear clinical or business objective.

Looking ahead, Paul discussed developments in AI, advanced 3D printing, digitally guided tooth preparation and robotic assistance. These technologies may make some procedures more predictable and efficient, but they will not remove the need for clinical expertise.

Paul concluded  that digital dentistry should be viewed as a comprehensive approach to modern practice rather than a collection of technological gadgets.

Its greatest benefits arise when digital tools improve diagnosis, enhance communication, support collaboration and enable efficient, high-quality treatment. Intraoral scanning is particularly valuable because it helps patients see and understand their dental conditions, creating opportunities for more informed treatment decisions.

Technology can support better dentistry, but it cannot replace sound diagnosis, technical skill, clinical judgement or the human relationship between dentist and patient. The practices most likely to benefit will be those that embrace innovation thoughtfully, invest in their teams and continually adapt to changing patient expectations.

Did I really eat all those bagels before lecturing ??