Dr Elizabeth Himel: From darkrooms to digital mastery

Dr Elizabeth Himel

Wed. 8. October 2025

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Less than ten years ago, part of my daily routine as a dental student was changing the fixer and developer solutions in the radiograph processor for the endodontics department. The sharp chemical smell, the streaked films and the anxiety of blank exposures were simply part of the workflow. At the time, we did not question it; it was just how dentistry was done.

Fast forward to today, and dentistry is nearly unrecognisable. The digital transformation of the profession is not just about advanced gadgets or keeping up with trends. It has fundamentally changed how we deliver care, interact with patients and manage our practices. As someone who has implemented these technologies first hand, I want to share what works in our practice, what has been worth the investment and where I see this heading.

Dr Elizabeth Himel at her Aspen Dental practice, where digital technologies such as intra-oral scanning, CBCT and 3D printing are fully integrated into the daily workflows. (Image: Dr Elizabeth Himel)

The reality of AI: Practical applications in daily practice

When most people hear about artificial intelligence (AI) in dentistry, they probably picture some futuristic robot performing surgery. The reality is much more pragmatic. I have started using AI tools like ChatGPT to help draft insurance narratives, and honestly, it has been helpful. What used to take me 20 minutes now takes 5, and my approval rates have improved because the language is more comprehensive and consistent.

I have also used intra-oral scans to capture what radiographs could not show and successfully reversed insurance denials by providing digital evidence that was simply undeniable. There is something powerful about being able to document findings with that level of clarity.

We are also seeing AI-supported diagnostic tools that may someday flag pathology, caries or bone loss with remarkable accuracy. I see this as a helpful second opinion rather than a replacement of clinical judgement.

From film to digital: The end of the darkroom era

When I first entered practice, having access to a CBCT unit was considered elite. Now, it is the standard—and for good reason. The ability to assess a tooth or an implant site in 3D is not just impressive; it has become indispensable for modern diagnostics and treatment planning. We have moved from hoping we had enough information to actually knowing what we are dealing with before we ever pick up a handpiece.

Digital radiography has made the process safer, faster and more consistent. Gone are the days of running behind lead-lined barriers after pushing the exposure button, thanks to devices like the NOMAD handheld dental intra-oral radiography system that have transformed how we capture diagnostic images, especially in busy practices and for patients with mobility challenges.

Digital impressions: More than just comfort

I will be honest: when I was in dental school, we were not taught how to use digital scanners. Impressions meant mixing alginate or polyvinylsiloxane, loading a tray and hoping the patient did not gag or shift at the wrong moment. It was messy, time-consuming and uncomfortable for everyone involved.

Today, I cannot imagine practising without the 3Shape TRIOS 4 and 5 scanners. These tools have completely transformed my daily work, offering an accuracy that consistently surpasses that of traditional impressions while keeping patients comfortable. With instant digital impressions, I can evaluate margins, preparation clearance and undercuts in real time, allowing me to make adjustments before the case even leaves the operatory.

The difference in patient experience is remarkable—no more gagging, no more distortions and dramatically fewer remakes. But beyond comfort, digital scanning has given me a level of confidence in my preparations that I never had with traditional impressions. It is one thing to hope your impression has captured everything correctly; it is another to see it in real time and know for certain.

That said, I have learned that digital does not always mean better. For those challenging deep subgingival margins, the good old polyvinylsiloxane impression is still king. The key is knowing when each approach serves you best; analogue and digital do not have to compete if they can complement each other.

“The key is knowing when each approach serves you best; analogue and digital do not have to compete because they can complement each other.”

3D printing: From concept to chair in a single day

Here is where things become really exciting. I can now scan the patient, create a virtual treatment plan and print a surgical guide in my own laboratory within 24 hours for fully guided implant placement. Let me say that again: fully guided implant surgical guides produced in-house, ready for use the very next day. What once required third-party laboratories and weeks of turnaround now happens overnight, thanks largely to innovations in printer speed, improvement in resins and streamlining of design software from companies like SprintRay.

This capability has reshaped not just my workflow but also the treatment experience for my patients. When someone comes in with a failing tooth, we can often go from diagnosis to implant placement in a matter of days rather than weeks. The precision of guided surgery, combined with the speed of in-house manufacturing, has elevated both the predictability of outcomes and the patient experience.

Digital workflows have also transformed the way we approach dentures. Early on, the fit of digital dentures was often superior to those produced with analogue methods, but we faced persistent issues with fractures. The resin materials simply did not have the durability we needed. My team and I cycled through different printers, materials and post-processing methods, climbing that path of learning together.

As materials science progressed, however, everything changed. Today, I am especially impressed with advances such as Dentsply Sirona’s Lucitone Digital Print materials, first introduced on Carbon’s printers. In my experience, these represent some of the strongest digital denture solutions currently available, delivering the combination of strength, aesthetics and predictability that make digital dentures not just viable but preferable in many cases.

Implementation lessons: What I have learned along the way

Implementing new technology is rarely as smooth as the sales presentations suggest. The key is being strategic about what you change and when. The benefits have been real. Digital diagnostics give us better visualisation than traditional radiographs do. Same-day treatment planning reduces patient visits. Digital workflows cut down on errors and improve case acceptance rates because patients can see what we are proposing.

Combining experience with digital tools, Dr Elizabeth Himel uses intra-oral scanners, guided surgery and in-house manufacturing to streamline diagnostics, treatment planning and patient care. (Image: Dr Elizabeth Himel)

Working within the Aspen Dental network has helped accelerate my practice’s transformation. The purchasing power of a dental support organisation (DSO) makes it possible to obtain equipment that might otherwise be too costly for individual practices. More importantly, dentists within the Aspen Dental network benefit from shared learning: when one practice works through the challenges of new technology, those lessons are passed along.

The greatest lesson has been learning when not to go digital. Sometimes the traditional approach still works better, and recognising those moments has been valuable.

Our experience with digital dentures shows the importance of persistence. We tried different printers, materials and methods as a team, learning from each mistake until we succeeded.

My advice is to invest in your people first. The most sophisticated equipment will not help if your team is not comfortable using it. Patience during the learning process always pays off.

The human element: Why expertise still matters most

Despite all these technological advances, the essence of dentistry has not changed. AI cannot feel the tactile resistance of tissue. A scanner cannot recognise when something just does not look right. CBCT, surgical guides and digital impressions are extraordinary tools, but they still require human judgement, clinical intuition and empathy.

In under a decade, I have gone from changing fixer solutions in a darkroom to planning fully guided implant surgeries in-house within 24 hours. From film radiographs to AI-assisted diagnostics—from alginate impressions to the unmatched precision of digital scanning—it has been nothing short of extraordinary!

The future of dentistry lies in the balance between digital power and human expertise. Technology can only elevate care when guided by the trained eye, steady hand and thoughtful heart of the clinician behind it. The technological revolution is not a replacement of human skill; it is a renaissance of clinical excellence—amplifying what we have always done best: caring for our patients with precision and compassion.