analog virtual interchangeIn my previous articles, I made mention of the concept of Analog-Virtual Interchange. In a nutshell, AV Interchange is a treatment presentation that walks a patient from analog to digital and back to analog. To put it even more simply, it’s drawing some lines and doing a wax-up.

I am only partially joking. As simple as the concept sounds, one must remember that the most amazing things in life are not the most complex, but are the most simple. The most incredible songs, the most universal melody you’ve ever heard, is perhaps is the “Ode to Joy,” Beethoven’s 9th Symphony. It’s simple and universal and beautiful and beloved. The key was for somebody to think of it.

AV Interchange is not a symphony, but it is no less simple and powerful. Just take a look at the case presentation below to see how I put it to use and I know you’ll see how it can vastly improve your communications with your patients.

The Patient

Not long ago, a woman came to me seeking a second opinion on previous dental work. She had a very bad defect associated with missing central incisors. Now she’s wearing a provisional restoration from lateral incisor to lateral incisor, which looks halfway decent from an extra-oral standpoint, but clinically you can see how bad that defect is. This woman had sought treatment already from a very renowned clinician. He tried a graft in that area, but unfortunately it ended up getting infected.

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As I mentioned in a recent article, second-opinion patients come in seeking one of three things: price, validation or exploration. This woman was seeking validation, and ultimately exploration (of other options). But before I even thought about telling her how I could help her or utilizing the AV Interchange, I made sure to follow the buyer’s journey. I heard her out, listened to what had been done, what had not been done and what she did not want to try. I became truly aware of her situation and needs, and because I listened, she was willing to listen to me.

(Click the link to learn more about using the buyer’s journey to optimize results and improve case acceptance.)                                   

So what did I learn? The surgeon she saw before was unwilling to try anything other than another surgery. So I knew that by trying that graft again, I would be exposing her to go through another potential failure. She was not ready to go through more surgery.

Knowing all this, it was time to begin the process of Analog-Virtual Interchange.

The Steps

1. I took photos of her retracted mouth. I do not use mirrors for this process. First of all, I want to be sure we are both looking at the same thing. When you have a mirror and you point out things to the patient on the mirror, you don’t know what she’s looking at. They could start combing their eyebrows or cleaning their lips. You don’t know what they’re thinking. When you have this retracted image and walk them through what you see, then it becomes very easy to ensure you’re both looking at the same variables.

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(Click this link for six tips to improve your occlusal photographs.)

2. Next, I opened up Powerpoint. This is a very powerful tool in AV Interchange. Again, it comes back to simplicity. Very simply, I opened Powerpoint and added the retracted mouth image I just took. Then I selected the line tool. With that tool selected, I started plotting what the natural central incisor looks like over the image of the patient’s mouth in its current state. Tools like lines, curve and freehand will all allow you to plot out the natural tooth. After I drew the one central incisor, I copied, pasted and rotated that drawing so a drawing of two central incisors were then laid out over the photo. At this time, I let the patient know this what the normal length of the central incisor should look like. I further explained to her where I wanted to have the gingiva. This again goes back to the buyer’s journey; she is now aware of the issue and what needs to be done. Now it’s time to lead her to the consideration stage.

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3. I next took a pickup alginate impression of the provisional restoration. Then I poured it up with fast setting stone and I had a cast with the provisional. And I then very quickly took some pink wax and I waxed the gingival contours, pretty much in front of the patient. Now she can see what this can potentially look like.

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4. Finally, I went into the patient's mouth and seat it back her own provisional with the waxed gingival contou​rs so she could see it in the mirror this time. This lets her really visualize what she would see in the mirror each day if she went for our proposed treatment.

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5. Finally, I took the picture of her with the wax-up in her mouth and put it back digitally into Powerpoint so she could see the difference between the two photos. Now she sees what we may be able to provide her.

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What did she say? “Yes, yes! That’s exactly what I want! Can you do that for me?”

I finished the presentation by adding enough bulk so that I can see how much lip support I am able to provide. And I take pictures laterally so she can see how I can rebuild the bridge laterally. That right there allows her to see the light at the end of the tunnel.

And that’s what is important, isn’t it – helping the patient see the light at the end of the tunnel in a way that’s so straight forward. That’s beauty of the Analog-Virtual Interchange. You let the patient see the consistency between what you say you can do and what you can do. You drop all the complexity of dental jargon, you drop the disingenuous sales pitch and you just draw a few lines and do a wax-up.

And that, my friends, will have your patients humming their own Ode to Joy.

As always, I encourage to let me know your thoughts in the comments. Do you use a method similar to AV Interchange? Do you use both analog and digital models when explaining treatment to your patients? Let us know!

(Click here to ready more articles by Dr. Ricardo Mitrani.)

Ricardo Mitrani, D.D.S., M.S.D., Spear Faculty and Contributing Author -


Commenter's Profile Image Carolina Z.
May 11th, 2016
Beautuful! I love how your articles are starting to build up, much like melodies turning into a symphony; the information you provide in each of these turns into a great way to learn and develop protocols and a work philosophy.
Commenter's Profile Image Hunter D.
July 3rd, 2018
Can you elaborate on home hygiene instructions for this restoration and how you work with the lab to make the FPD as hygienic as possible?