Digital Technological Choices within the General Practice

By By John C. Cranham DD

It is hard to imagine now that when I left dental school in the spring of 1988, the vast majority of dental practices did not have a computer on the premises. At the time, the public Internet did not yet exist and a single E-mail had yet to be sent or received. In dental practices the front desk routinely used a ldquo;peg board” to manage the patients’ accounts. All the clinical information, X-rays, and clinical photography were kept safely in the patients’ charts. That was a short 23 years ago.

In the fall of 1990, my practice bought our first office computer. I remember bragging to a colleague that it had a 20-megabyte hard drive. Amazing when we consider that even the most simple software options available to us today take up more space then what we had available on the entire hard drive of our first computer.

As computer power has exponentially evolved, software companies have responded and provide us with a myriad of options. Now, practice-management software allows us to precisely manage the business aspects of the practice (We use Dentrix®.). Utilizing the scheduling option, we can focus on increasing the quality, efficiency, and profitability of the care we provide. Treatment plans are created, sequenced, and customized on the fly, as well as closely followed over time so patients do not fall between the cracks. Utilizing the reports and practice analysis features has allowed us to run our businesses like any seasoned CEO.

By the new millennium, digital clinical applications were being developed that would forever change how we practice dentistry. When hardware prices came down, computers found their way into the clinical environment. At this point the paperless office, something that we couldn’t even imagine in the early 1980s, became a reality. Today technologies are being developed so fast that, for many dentists, it is difficult to know which will be right for their practice. Additionally, with the downturn in the economy, justifying any capital expenditure needs to be carefully considered. The goal of this article is to review the return on investment of four key digital technologies, with the hope that it will help other professionals with today’s great question: ldquo;When and which technology should I become involved with?”

In our practice, potential technologies are evaluated to see if it will have:

1. A positive effect on the predictability and efficiency of our clinical procedures. Will it make us better?

2. Allow us to expand the professional services we are offering.

3. Provide the practice with cost savings through the utilization of the technology.

If a potential technology is viewed to have a positive effect on the practice, then the cost of the technology (over time) can be evaluated to see if the return on investment (ROI) makes sense. Your CPA as well as your Henry Schein Dental Equipment Sales Specialist should be involved in these computations.

Digital Radiography

As dental teams integrate computers into the chairside clinical environment, the ability to take and analyze digital X-rays is an ideal first digital technology (Our office uses Dexis®.) At first glance, the cost may not justify what dentistry has been able to do with traditional film for over a century. However, the ROI comes from the combination of increasing efficiency and decreasing expenses over time.

Not having to wait for dental X-rays during an endodontic procedure or an implant surgery is a tremendous benefit. Trial files and master cones can be evaluated without waiting. Films can be taken momentarily to verify precise angulation during implant surgeries. A full-mouth series or a bitewing series can be taken and ready for viewing in a quarter of the time. Increased efficiency translates to increased profitability.

Lastly, digital X-rays are simply better. Having the ability to easily retake films that are not optimal, as well as adjust for brightness, contrast, and numerous other parameters dramatically increase our diagnostic capabilities. This is an excellent entry level digital technology that I would not want to practice without.

Digital photography

There is not a single thing a dental team can do that will improve the quality of their dentistry faster than routinely taking quality digital photographs. At The Dawson Academy, we teach a 21-photo series as part of the new patient examination. Photos are taken for shade communication with the dental laboratory, communication with specialists, case presentation, and documentation of our clinical skill.

Take the time to get your office trained, and take pictures every day, the same way every time. You won't regret it.

The ROI on this technology comes from expanding the scope of the procedures you are doing. The dental team will diagnose more comprehensive dentistry, as well as be able to communicate better with patients.

Chairside CAD/CAM

Dental practices that are doing even a moderate amount of crown & bridge will benefit from having the ability to fabricate chairside CAD/CAM restorations. Although workflow issues have to be worked through to maximize the efficiency of this process, the ROI comes from the savings recuperated when decreasing your outside laboratory expenses. It is important to realize that it will not completely eliminate the relationship with the dental lab.

In our practice, we utilize our E4D machine for inlays, onlays, and crowns (1-4 units at a time), primarily in the posterior. Larger cases we work traditionally and mount on a semi-adjustable articulator. A good way to see if this technology is for you is to keep track of the number of units per month that you would be comfortable keeping in-house. Multiply this number by the average dollar cost per unit you currently pay. Simply compare this number to your monthly payment for this technology. Most offices are surprised by the savings.

Computerized Cone Beam Tomography (CBCT)

Having the capacity to look at mandible and maxilla three dimensionally has dramatically increased our diagnostic capabilities. Boney pathologies, changes in the TM joints, and potential implant surgical sites can all be viewed without dimensional change and in incredible detail. Although our reason for purchase was to increase the diagnostic capabilities of our TMJ patients, it has dramatically improved our diagnosis in the other areas already mentioned. The ROI in this technology lies in the scan itself, combined with the expansion of services we were currently providing. CBCT allows us to recognize the straight forward implant cases and provide the surgical service in house. For advanced cases, we provide the surgeon with the surgical and prosthetic plan in order to control the case.

The future of digital technology looks extremely bright. Hardware and software will continue to evolve, and the architecture between the various technologies will open.

The Future

The future of digital technology looks extremely bright. Hardware and software will continue to evolve, and the architecture between the various technologies will open. As the various technologies learn to speak to one another, our ability to evaluate, treatment plan and provide dental services will only improve. Soon cone beam computerized tomography will integrate with digital models in a way that precise virtual articulation (4D and 5D modeling) will be a reality. The opportunity to utilize one of the intraoral digital impression systems and have a choice between sending the information to a dental laboratory or to a chairside mill will also be possible.

My suggestion is to devote a small percentage of your time to stay up-to-date on current technologies, as well as the ones that are on the horizon. Apply the three principles we have in our practice to see which one will be best in your practice. Do your homework with regards to which technology will make you better, as well as positively affect your bottom line. If you do, your practice will evolve in a financially healthy manor, while providing optimum care for your patients.