Tech experts chart a digital path

The divide between dentistry's technology enthusiasts and the general dental population is usually quite wide, but that gap appears to be shrinking as digital dental technologies are picking up momentum and gaining wider adoption and acceptance.

Evidence of this trend is clearly visible in both the results of the 2010 Dental Products Report Tech Census, and the products and categories honored as recipients of the second annual Pride Institute Best of Class Technology Awards.

In many cases, product categories showing increased adoption or on the wishlists of Tech Census respondents matched up with the categories and products honored with the Technology Awards, which were selected by an expert panel. The panel members selected the winners based on what they believe will have the greatest impact on the dental industry.

“Some of them are one-of-a-kind products, and some of them are products that have competitors but certainly are the best in that particular class,” said DPR Technology Editor Dr. John Flucke, who served on the selection panel “I think we did a good job of highlighting things that were so new they had no competition, and others that provide a great slant on an established idea.”

Panel proceedings

To choose the winners, the panel of seven dental technology experts met via conference call and had what several members described as a passionate discussion and debate over both what products are making a difference and what makes one of those products stand out from others in the same category.

“The fact that the winners were chosen by majority vote and none of them were a unanimous selection from the entire panel is a testament to the large number of high-quality technology products making inroads into the dental industry,” said Dr. Lou Shuman, President of the Pride Institute.

Dr. Shuman said he created the Technology Awards last year to help provide the dental community with a resource to turn to when exploring new technologies. He hopes the awards themselves bring attention to worthy products that can help dentists improve the care they provide, while the accompanying Technology Expo at the ADA Annual Session meeting will give dentists hands-on experience with the technologies in an environment free of sales pressure.

“The introduction of technologies into our space is exploding,” he said. “Because of both the amount of new technologies being introduced and the cost of some of these technologies, I felt there needed to be guidance that the dental community could trust and have faith in.”

Having a mix of writers, speakers, researchers and educators bringing different perspectives and clinical experiences with technology to the panel was a positive part of the process, said Dr. Titus Schleyer, who teaches at the University of Pittsburgh’s School of Dental Medicine.

The debate divided technologies into four categories-Foundational, Diagnostic, Therapeutic and Emerging-and the discussion did not begin or end with a set number of awards to hand out or even a set number or type of products to honor within each category. Dr. Shuman said the fact that only four of last year’s winners repeated this year speaks to the pace of innovation in the industry, and the six panel members interviewed for this article all said they are pleased with the final outcome of their efforts.

“That gives you an idea of the amount of introduction of new technologies, as well as the existing technologies focusing very hard to improve on an annual basis,” Dr. Shuman said. “The panel was very tough on the technologies. There was significant debate before they were chosen.”

The value of recognition

Panel member and dental technology writer and speaker Dr. Larry Emmott said creating and handing out awards such as this is about more than just highlighting what a small group of people feel is the best of the best. Instead, he said the real purpose is to help drive the industry forward by educating and inspiring clinicians while encouraging quality and innovation from manufacturers.

“Part of the idea for this is to help the dental profession use technology effectively,” he said. “By focusing on both individual products and categories, the idea is to guide the development of new products in those areas, and to reward excellence.”

While not every product brought to the table for consideration was honored, Dr. Parag Kachalia, who teaches restorative dentistry at University of the Pacific, said the end results found a good balance between recognizing well-established categories and brands while bringing attention to smaller innovations that are capable of making a big impact on the industry.

“I think there’s a little bit of a misconception that any piece of technology needs to be a $10,000 item to really make an impact, and that’s just not the case,” he said.

Still, many of the biggest companies and most-popular brands in the industry were presented with the awards, which is something Dr. Emmott said reflects the fact that while, “the industry leader isn’t always the best, it often is. People have chosen it for a reason.” Dr. Schleyer added that panels selecting the Technology Awards in the future have a great opportunity to put a spotlight on the innovations coming from smaller companies with great ideas but limited marketing and exposure.

For Dr. Flucke, the entire process was a great and validating experience. Based on participation guidelines, he was not allowed to vote in the category that included the Gendex GXCB-500 HD cone beam system he promotes, so he was excited to see it was selected as best of class along with other digital technologies he felt were important to recognize, and most importantly, he feels he now has more allies in his efforts to promote wider adoption of technology in dentistry.

“It’s an entire choir of voices out there saying how important these technologies are,” he said.

Survey says

According to the results of the 2010 Tech Census, that message is starting to make real headway in the industry. Viewed as a whole, the survey shows a picture of relatively widespread adoption of core digital technologies, increasing numbers of dentists using bigger-ticket and specialized technologies, and many of the product categories spotlighted by the Pride Awards topping dentists’ wish lists.

In the Foundational category, the panel focused on core items that fit into every practice such as practice management software where Dentrix G4 was chosen, and digital radiography where the DEXIS Platinum digital sensor was honored. While not every practice has adopted those products or technologies, calling them “foundational” is no longer a stretch, as 87% of survey respondents said they own practice management software, while 58% own digital radiography systems with an additional 21% planning to purchase the technology.

Writer and speaker Dr. Marty Jablow said he feels honoring those technologies as foundational makes a lot of sense because they have the potential to change the way dentists practice on an everyday basis. Switching to digital radiography may require new training and infrastructure investments, but the benefits will quickly be realized and noticed throughout the practice.

“The investment is well worth the time because there are savings in various areas that continue on in personnel time, and it’s also greener,” Dr. Jablow said. “Most dentists don’t understand the benefits of some of these efficiencies.”

Dr. Schleyer agreed that those technologies truly are foundations for a practice, and said, “I cannot imagine how you can run a practice without that.” However, he cautioned that every technology will not be a fit for every practice, or for every patient who comes into a practice using the technology. Learning how and when to best use a technology is the key to getting the most from the investment.

The technologies honored in the Diagnostic category are some of the areas seeing the greatest growth with cone beam and CAD/CAM the two technologies most often cited when respondents were asked to name what technology they would add if money were not an issue.

According to the survey results, chairside CAD/CAM is now in 18% of practices, up from 15% in last year’s Tech Census. An additional 11% of respondents said they plan to adopt the technology, and Dr. Kachalia said this is good for the industry because the technology continues to expand in scope.

“We’re headed to a point where in-office CAD/CAM is going beyond simple single-unit restorations,” he said. “We’re thinking about it in much broader terms and treatment planning approaches.”

Caries detection technologies, such as the Best of Class Spectra from Air Technologies, also made significant headway in terms of adoption throughout the industry. Currently 42% of respondents say they have some kind of caries detection in their practice and if the 12% who plan to purchase follow through, the technology will be in place in more than half of American dental practices.

“The days of the explorer are gone. This technology is going to change the way we practice dentistry for the benefit of the patient and the practice,” Dr. Shuman said when discussing the potential of caries detection technologies.

Dr. Flucke agreed, and said while the systems will continue to improve, the technology is not something from the future, but a key tool for dentists today. Along with diode lasers, he believes caries detection systems can have some of the biggest impact on the care dentists can provide to patients and they are not devices coming in the future, but technologies ready for widespread use.

“These are things that are now. I’m using these devices everyday,” he said. “People need to avail themselves of these technologies and use them now, because they’re game changers.”

For diode lasers it seems the general dental population is starting to catch on in a big way. In last year’s Tech Census, 17% of respondents said they owned a diode laser. This year, that number jumped to 30%, with an additional 18% of respondents saying they plan to purchase a laser for soft-tissue applications.

Every member of the panel said the recent drop in price for diode lasers is a big reason for greater adoption. While Dr. Kachalia said he thinks the prices have reached a point where the technology can become commonplace throughout the industry, Dr. Jablow said dentists still need to dedicate themselves to learning to use their technology investments.

“I think the price drop in diode lasers was a big deal,” he said. “I think the price drop has seen many more lasers come into the hands of dentists. But there is one caution. The training on these lasers has not caught up.”

Of course, not every technology is on the rise. While cone beam technology tops people’s wish lists, and the Technology Awards panel members all strongly believe in the diagnostic benefits of the detailed 3D images cone beam CT can provide, just 7% of survey respondents said they had already invested in a cone beam system.

Price is still the biggest hurdle to greater adoption of cone beam systems, and even if prices come down, not every general practitioner will have a regular need for cone beam imaging. Dr. Flucke said he believes dentists are very aware of the technology, but are still not fully grasping the potential of what it can do for their practice. However, Dr. Jablow said that will eventually change because the imaging benefits from cone beam are, “something that stands above everything else.”

“It just gives more information, and allows the dentists to have all the information when they’re talking about implants or surgical procedures, and in many cases, to be able to perform those procedures less traumatically,” he said. “More information allows you to be a better dentist.”

Technology matters

Improving dentistry is really the point behind adopting new technologies and the reason for creating and presenting the Technology Awards. Dr. Shuman said part of the panel’s discussions focused on not just what technologies are brand new and exciting, but on which of these technologies will have the longevity needed to provide lasting benefit to the dentists who adopt them.

Publicizing awarded technologies has the potential to impact buying habits, Dr. Shuman said. So as the Technology Awards establishes itself as an annual assessment of the state of the art in the industry and an informational resource for the dental community, he wants to make sure the selection panel looks at the technologies from a variety of perspectives, including the company and training behind the products, so the program can help improve the overall quality of care being provided.

“When you start to look at choosing technologies, those companies that train the best, service the best and plan upgradability will have significant impact on decision making,” he said.

To Dr. Flucke, that impact on the patient experience is the driving force behind his personal adoption of new technologies and his efforts to promote technology throughout the industry. He said providing the best care to his patients is always his goal, and technology is a vehicle that allows him to do just that.

“My determining factors on technology are if it allows me to provide better care, or the same level of care but provide it either faster or with less discomfort for the patient, that’s all I need to know to make a purchasing decision,” he said. “If you really have your patients’ best interests at heart, you’re going to embrace technology because that’s the engine that drives the world.”

A key factor that ties many of the technologies honored by the awards together is the ability to provide dentists with more detailed information about their patients. Dr. Jablow said better information at the start of a procedure can mean better outcomes and less invasive treatments for the patient.

So while every dentist doesn’t need to adopt every single new technological development, they should be aware of industry trends and staying within the middle ground in terms of adoption. Staying informed, researching new developments and moving to adopt the technologies that fit an individual practice will lead to an overall higher quality of dental care, Dr. Jablow added.

That is a message that seems to be getting across as 64% of Tech Census respondents describe their approach to technology as “a researcher” who looks for data and hands-on experience before purchasing. An additional 27% said a proven record of return on investment is the key factor triggering their technology purchases. Dr. Kachalia said those are the right approaches because not every technology will work for every practice, and having trusted sources for finding out about new technologies is critical so clinicians can truly understand the impact of their technology investments.

“At the end of the day, it doesn’t matter what technology you have if the patient’s experience or the doctor’s experience is not improving,” Dr. Kachalia said. “If there’s not an end clinical outcome change, efficiency change or greater patient comfort, it’s great to have but it’s not needed.”

Setting the stage

Just knowing about the benefits of a new technology often is not enough to make an investment really pay off for a practice and its patients. Dentists need to have a good foundation of core technologies to maximize use, and Dr. Emmott said a big part of this is realizing computers are more than just business machines for the front office, and should be fully integrated throughout the practice with a presence in the operatories.

This set-up can help a practice make the move to a chartless or completely paperless environment and more fully integrate digital technologies on the clinical side of the practice. Dr. Emmott said that eventually will lead to greater use of the Internet for clinical purposes along with the front office uses, such as billing and patient communications, that are already being successfully integrated into the workflows of numerous practices. The key to everything will be solid computer network software systems that can communicate with each other.

“If you don’t have a good foundation of technology, adding on the advanced stuff very rarely works well. If you have good basics, adding on the next level is relatively easy and relatively efficient,” he said. “It’s not just having the technology, but it’s using it effectively.”

Once again, this message seems to be gaining widespread acceptance in the industry with 63% of survey respondents saying integration with existing  systems is very important and an additional 19% designating it somewhat important.

“We are, whether we want it or not, in the process of digitizing the world,” Dr. Schleyer said. “It’s a trend that you can’t put your head in the sand and say you’re not going to do this, because it means you’ll go the way of the buggy whip 100 years ago. The way we handle information affects the core work of clinicians, and we will not be able to do things down the road without these digital technologies, and that’s why we need to make sure we stay on top of them.”

This is why research in dental informatics, a discipline in which Dr. Schleyer is an international leader, is needed to inform how best new technologies can help support clinicians and patients.

“Without it, it is like trying to build a house without an architect,” he added.

Generation next

But staying on top of the technologies does not mean rushing in if you’re falling behind the state of the art. Dr. Jablow said change is coming, but more like a glacier than a wave so there is always time to plot a path to integration and return on the technology investment.

Even as prices for some technologies begin to fall, it is important to research and spend time evaluating any technology investment. Proper training should be part of that planning. Staff involvement also is key.

“It would be a daunting task to integrate all of these things at once, and in fact in most cases that would end up in a failure,” Dr. Jablow said. “What you want to do with any of these technologies is set up a plan. Give yourself enough time to integrate it in, and in most cases you’ll never go backwards.”

Waiting for prices to drop before adopting is not always a wise move. Dr. Emmott said that while prices on consumer electronics almost always drop significantly after a time, dental technology prices do not always drop to the same degree because of the relatively small size of the industry.

Still, while adoption of technologies such as cone beam remains slow, the pace is likely to increase as a younger generation of dentists raised on computers and the Internet continues to enter the industry. Both Drs. Schleyer and Kachalia said their students are being trained on technologies such as CAD/CAM, cone beam and lasers.

Dr. Schleyer said the current generation of students are used to being in a paperless environment and are likely to question working in a practice that continues to keep paper records. He said the next generation of dentists could be change agents for the profession and industry as they believe strongly in using technology to provide the best possible patient care.

“I do see it as our job to expose students to the best technologies for which there is evidence that they actually do help improve care,” Dr. Schleyer said. “Technology-and the rate of change of technology, more importantly-is something that’s completely normal for them. The newer generation of students and practitioners, I think they’re much more likely to adopt new paradigms.”

Dr. Kachalia said he thinks the current generation in dental school has an easier time with technology because they’ve grown up in a world with iPods and e-mail. Instant access to information is almost a given to them, so while they are certainly being taught the same fundamental principles of dentistry, they have an easier time fitting technologies into their model of providing care.

“All the fundamentals are there, but they’re able to see things in a 3D graphic world better,” he said. “That’s what they can adapt to, that’s what they like better. To some degree they’re pushing education to really look at these new realms that are out there.”

But learning about new technologies is not just something for new students, and Dr. Kachalia said there is no reason dentists should be practicing the exact same dentistry at the end of their careers as they did when they first began seeing patients. Instead, he said the industry needs to do a better job of providing lifelong education that keeps the entire industry up to date on the best available technologies and techniques for providing patient care.

Dr. Shuman said this upcoming generation of dentists who are so comfortable with technology provide one more reason for practices to keep up to date. Young dentists are going to be looking for practices to take over, and they’re going to be far more attracted to a practice with technology than a practice that is barely wired. But regardless of the way technology can impact a practice’s value, Dr. Shuman said technology should be a serious consideration because of how it can impact patients.

“We feel very strongly that even at the end of your career you should be passionate about looking at new technologies,” he said. “At the end of the day, no matter if you’re at the beginning of your career, the middle or the end, our passion as practitioners, and our goal as practitioners, is to provide the very best care we can.”

About this survey

The August 2010 Technology Census was sent via e-mail to general practitioners and hygienists in the United States. The link was promoted on the MH and DPR Facebook pages, where we currently have 5,246 and 5,417 fans, respectively. The survey was completed by 144 people.