A new decade, new technologies and new opportunities are presented to implant dentists — read Dr. Jay Reznick’s insights into running your practice more efficiently and with less stress.
As we usher in a new decade, the outlook for the advance of digital technology in dentistry is gaining momentum. It seems like just yesterday I was completing surgical residency and starting in private practice. Digital technology was just entering mainstream medicine. CT scans were only available in the hospital or medical imaging center, and digital 2D radiography was just beginning to appear in physician practices. Impressions for study models were taken with alginate, polyvinyl, or rubber impression material, and the models were poured-up in plaster or stone. Sending a patient for a CT scan to plan implants was expensive, and the planning software was primitive. And since implants were placed freehand, the implant placement might need to be modified from its planned location anyway.
Now, cone beam CT systems are commonplace for evaluating dentofacial morphology, pathology, trauma, airway obstruction, and TMJ disease. Fully guided dental implant systems have improved the accuracy and success of implant surgery. Highly accurate surgical guides can now be printed in-office; restorations can be designed and milled chairside with CAD/CAM systems; piezosurgical systems reduce the trauma and improve the outcome of bony reconstruction; and lasers can help treat pathology and reduce peri-implant disease. Dental appliances and models can be printed in the office in a few hours, or the data can be transmitted to a dental lab with quick turnaround.
As digital technology has become more commonplace, so has the ability of these systems to communicate and improve workflow. CAD/CAM data can be imported into CBCT implant planning software to plan implant placement based on a proposed final prosthetic plan. Conversely, information about virtually planned implants can be transferred to CAD/CAM software so that prostheses can be planned, and 3D printing and milling can be utilized to create the prosthesis before the surgery. With fully guided implant placement, the prosthesis can be delivered with minimal or no adjustment, leading to more efficient procedure times, enhanced recovery, and better overall outcomes.
Yet with new technologies come new challenges. The first is learning new techniques after having successful careers with techniques we learned and materials we used in dental school and residency training. At first, we may be unsure if these newer technologies are as good or as easy as those we have already experienced. We also worry about the time that it will take to master, or at least to become competent, in scanning, treatment planning, and clinical use. From personal experience, I know that you have nothing to fear but fear itself. Even though most systems were designed by engineers, the refinement of the clinical workflow, user interface, and work product was done by clinicians. We also fear that our office staff will resist change. I have found that involving them in product evaluation and training actually gets them more excited about new technologies. The best way to move in to the 21st century of dentistry is to do it gradually. Start with a CBCT, which can be used for most of what we do as surgical specialists; and then with comfort and experience, add 3D printing and CAD/CAM to your arsenal.
As wonderful as they are, these technologies on their own do not make us better clinicians. They are merely tools to improve our efficiency, accuracy, and success. Therefore, we must ensure that those of us with the credentials and the experience avail ourselves to the education of those who wish to expand their clinical horizons. For those starting on their implant surgical journeys, start with the basics and advance only to more complicated patients and procedures once you have the requisite clinical expertise. As I tell my students, it is not enough to “think” that you can treat a particular patient; you have to “know” that you can. That confidence comes from training and experience.
I like to compare 3D technology to cars’ GPS systems. I have driven from my house to my office and back thousands of times. Yet without using GPS, I don’t know about traffic, road closures, accidents, and other challenges to a smooth commute. Even though I have done thousands of implants, I still use CBCT, CAD/CAM and a surgical guide for every case. With GPS, I get where I am going faster, more efficiently, and with less stress. 3D technology does the same for me. Finally, remember, even though you have GPS, you still have to know how to drive. And you still need to know the rules of the road, so you don’t crash. Have a great 2020, and enjoy this first issue of the new decade.
Dr. Jay B. Reznick
Editor’s call to action
The new decade, new technologies, and new avenues to office efficiency are focuses of Dr. Reznick’s practice philosophy. Read more about him in his practice profile.