How to gain control of patient outcomes
Damon Jenkins wanted to be a dentist since he was a kid. He can’t recall what first captured his interest, but says, “As I got older and actually got into dentistry, it became about being able to change people's lives.” He remembers making his first set of dentures for a patient during dental school. “After seeing the patient respond and be so ecstatic about having teeth, I knew this is what I want to do. I want to do prosthodontics.” Damon took a break from seeing patients at his picturesque practice in Coventry, Connecticut (situated next to an actual waterfall!) to tell us why he chooses digital dentistry again and again and how these tools help him give patients what they deserve: predictable outcomes.
Q: Which exocad software do you use in your practice?
A: DentalCAD. I’ve got all the bells and whistles. Everything works great. The only thing I really haven't tried out is exoplan and PartialCAD because I don't do that many partials.
Q: You’re an early adopter when it comes to digital dentistry. You’ve been using tools like Cerec and Planmeca since they came on the scene in the U.S. What led you to start incorporating exocad into your work?
A: I wanted to do more! As a prosthodontist I knew how to do lab procedures. I just hated it. I wanted something that could allow me to make the work easier and more predictable. I was initially looking at another company’s software, and it seemed expensive because of all the things that I would have to constantly add on. Then exocad just kept popping up everywhere—in dental magazines, in lab blogs—everywhere! I started learning more about it. The ease of use and practicality were perfect. It was exactly what I needed. It was easy to go from doing just a single crown to doing an implant. The whole workflow for the process is almost better than working with my plug-and-play intraoral scanner. I like the availability to change on the fly if I need to do something. If I need to import a bunch of scans, it's so much easier with the exocad software than it is in my native scanner software.
If I did impressions, it would take me hours and hours in the backroom getting the case together. Now with digital tools, I know right when I bring the scans into the software, I can have a prototype designed quickly.
Q: How does being digital impact your workflow?
A: The major benefit is flexibility and speed. Speed is going to be relative to how experienced you are. I'm doing a lot of intraoral scanning with my full arch cases, and I've noticed that’s reduced the number of appointments. The first scanning appointment is still long. I have to scan both arches, the tissue, and six scan bodies. Doing the full workup and all the scans might take me two and a half hours. But even if I did impressions, it would take me hours and hours in the backroom getting the case together. Now with digital tools, I know right when I bring the scans into the software, I can have a prototype designed quickly. I'm also doing more digital denture workflows. Just to be able to bring the scans in, create a model and then start designing because I already have the bite and everything else. It gives me more flexibility. I can do maybe three wax setups, print them, and say, ‘How do you like this one?’ The patient might say, ‘No, I hate that one.’ And then, ‘Oh, this one I love. This is great’. The bites are going to be the same for the most part, so maybe I'm just changing the anterior six. It works great.
Q: How did you go about training the staff? Was it all new to them or did they have some prior experience?
A: The staff was learning right alongside me. As far as chairside stuff, it's really simple. You’re guided step-by-step through the process. Typically, I always mark the margin. So, if there's going to be an error, it would be on my side, but for the most part, the software helps you through the rest of it. There are heat maps for distances. You can always click the question mark tab, and it brings you to the exocad Wiki page and explains what you need to do. I always check my staff’s designs. If I see an error or something that they missed, it's an easy fix. We can always just backtrack. We don't lose anything. Especially with the new DentalCAD updates, even with implant selection, I can maintain my design after deconstruction—change the implant and then click forward—and the only thing I did is just change my platform. If that was an analog case, oh man, you put the wrong analog in and you break the model apart, you're starting from scratch. There's no way around it. Whereas in the digital world, as long as you don't go into the final product, you can backtrack, fix it, edit and move forward.
For me, it’s about being able to control outcomes. A lot of times, we send things out and something gets lost in translation. This way, I have a little bit more control, at least in the preliminary stages.
Q: How aware are your patients of the digital side of what you do?
A: I would say for chairside cases, they're really aware and always fascinated. They say, ‘How come more dentists don't have this?’ I don't know why they don't. Some dentists are just really resistant to it. I mean, good for me, and the other people using digital because it allows us to stand out a little bit. But digital makes it easier all around. For instance, there have been times when the patient didn't bite correctly in a scan. So I go ahead and mill. And I'm like, why the heck is this crown not fitting right? I ask the patient to bite down again and see that he bit down differently last time. Then I can mill a new crown. It might take me only 10-15 minutes to mill it out. Because I can produce so much in-house, there’s almost no wait time.
Q: Do you think everyone should try out digital?
A: Yes, for chairside work, every dentist should be digital. With the more complex cases, I do see why some might hold back. But I’m a prosthodontist, and prosthodontists can be a little bit controlling with everything. For me, it’s about being able to control outcomes. A lot of times, we send things out and something gets lost in translation. This way, I have a little bit more control, at least in the preliminary stages. When I know it's right, I can send it out to be milled or glazed, and it's perfect. At the lab, I know they're going to do an excellent job making this look very natural and real, and I know I did my job as far as giving the appropriate silhouette: the height and shape of the teeth, the facial support right, vertical dimension and the functional aspects. Everything that is needed for the patient to feel comfortable, natural and functional is done. Then the lab can do what they do to make things look as natural and beautiful as possible.
Patients have to wait a little longer but it’s important that the patient understands the process. I tell them, ‘You're going to have a final crown today. It's your final crown. Not a temp crown that could fall out of your mouth, and it's one visit.’
Q: How do you prepare patients for the treatment in terms of workflow?
A: It’s important that the patient understands the process. I tell them, ‘You're going to have a final crown today. It's your final crown. Not a temp crown that could fall out of your mouth, and it's one visit.’ I tell them to bring a book, music, or something to work on during the downtime. They're relaxed, I'm relaxed. I'm trying it out, asking ‘How's that feel?’ They say, ‘That feels great.’ Then it gets stained, glazed and we're back. We’re constantly moving. As your workflow gets refined and developed and you understand your heat maps, where all your contacts for occlusion and proximal contacts are, then the time gets shortened dramatically. It also depends on how you utilize your time. Right now, I book about two and a half hours, but I also see another patient in between.
Q: Time for a few fun questions. Best music to start your day?
A: Either R&B or hip hop.
Q: Do you have a favorite podcast, movie or book?
A: I listen to a lot of audiobooks. My current favorite is Start with Why by Simon Sinek. It touches on understanding what's behind our motivations. For me, with digital dentistry, I want to be able to provide my patients with more predictable outcomes. That's the main reason I got into it because I felt like, I do, or the lab does, temporary restorations for the patient, I send the case to the lab for the final restorations, and it’s not exactly the same as the original temporary design that the patient really loved. But digital allows me to achieve better results. We can duplicate everything the patient loved and retain or improve the functionality of the restorations. Simon Sinek's book really helped me to solidify my thoughts on why I wanted to go into digital and why I do dentistry.
Q: Do you have a favorite tooth?
A: The central incisor. It always breaks. and you always have to fix it. On my Instagram, I have a bunch of pictures of crowns or composites I did to fix central incisors.
Q: What's your passion?
A: Dentistry. Saving lives a smile at a time. For sure.
Q: One word for exocad?
Damon T. Jenkins DMD, MPH graduated from Hampton University with a degree in molecular biology after which he attended the dental program at the University of Medicine and Dentistry in New Jersey. After obtaining his Doctorate in Medical Dentistry (DMD), he furthered his dental education and attended two general practice residencies: Lutheran medical center in Brooklyn, NY, and LSU Charity Hospital in New Orleans, LA. He enjoyed his year in Louisiana, and, with his desire to pursue more dental education, he started at Louisiana State University School of Dentistry, where he obtained his specialty degree in Prosthodontics. Dr. Jenkins is not only a General Dentist. He is a Prosthodontist, a specialist in implant restorations, crowns, bridges, veneers, partial dentures, full dentures, and everything prosthetic. Dr. Jenkins also obtained a master’s degree in public health (MPH) from LSU. In addition to practicing dentistry, Dr. Jenkins was a part-time clinical instructor at the University of Connecticut School of Dental Medicine until December 2012. He currently teaches as a volunteer. Dr. Jenkins was also an Army Reservist. He has served in Operation Iraqi Freedom as a Captain in the U.S. Army Dental Corps and was promoted to Major in the Army Reserves. He currently serves as the President of the Connecticut American College of Prosthodontists and a Board member of the American College of Prosthodontists Education Foundation.
Dr. Jenkins spends his free time with his wife and two children. He loves traveling, books, cars, dogs, art and music. You can follow Damon’s work on Facebook, YouTube, and Instagram.