Is there more to Orthodontics &
Dentistry than just Technology?
I have practiced Dentistry for 20
years; I have worked as a hospital dentist, a sole practitioner general
dentist, an orthodontic resident and now, for the last 15 years, as a sole
practitioner Orthodontist in arguably one of the most progressive and
tech-savvy cities in America. In this
time I have seen the introduction of computers, the use of software to organize
schedules and billing, the advent of electronic claims for insurance, the
development of the Internet and the introduction of the digital age. Lasers were introduced first for soft tissue
incising and then for hard tissue preparation.
I have seen film-based radiography morph into computer imaging and have
watched as digital images were created from three-dimensional laser-scans;
digital files that were then used with new milling machines that could transfer
the digital world back into porcelain crowns and prostheses. In Orthodontics, this digital age introduced
the advent of clear aligners made from sequentially altered digital scans of
entire dental arches allowing incremental changes (tooth movements) to correct
mild crowding.
With all of these wonderful
technological advances, it may be prudent to stand back and balance the new
shiny tools and machines with the older and well-tested dentistry of the recent
past. Today, technology is pushed by
large dental supply companies to young dentists and specialists as almost a
status symbol of modern dentistry; a kind of litmus test of how modern and
up-scale a dentist may be perceived. But
is this really a good way to judge a dentist or Orthodontist? Is there some point of diminishing returns
where technology is just more expensive?
In addition to all of the “wonderful”
technological advances, I have seen overhead climb from 50% up to 75% or more
in “modern” dental offices. Radiograph
machines are now $80K to $150K up from $10K in the past and since they are
digital, they come with expensive software and regular updates that challenge
existing hardware and may lead to obsolete machines within just 5 years. It used to be a dentist could count on 20
years for almost every item in their office but now computers must be all
replaced to keep up with new operating systems and added hardware such as printers
and scanners. Software programs will
cost a new office $25K to $40K initially with a “forever” maintenance fee of $2K
to $4K yearly even if you have your own server however we now can expect higher
Internet fees ($200/mo or more) as we move to cloud-based systems and un-ending
revolving charges to keep the system working seamlessly.
On the treatment side, the digital age
brings more automated systems that reduce doctor time (and sometimes patient
time) driven by a need to produce more (to pay for the new overhead) in less
time. Crowns can be made in a single
visit as teeth are digitally scanned and porcelain is milled in special
machines (another $50K to $75K) and aligner trays can be made to move teeth (at
10x the cost of braces) albeit with less accuracy and many more limitations.
This has driven up costs and made the
sole practitioner less common than larger multiple doctor offices and companies
that can share these expenses. This
trend has also lined many pockets along the way from software companies to
computer companies, from third-party labs to local and regional dental supply
companies and of course companies that have learned to employ dentists that
cannot afford to keep up with the Dr. Jones’ of the world.
But is there something inferior to
lab-built porcelain crowns? Is the new
material better than the old? Is the
technology actually better than the doctor’s own hands and skills? Perhaps in some cases, maybe in many cases
but the truth is that there are still many things the doctor can do better
without the newest technologies.
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| Laser scanning a tooth prior to preparation of a milled crown |
“Is the technology actually better than the doctor's own hands and skill?Perhaps in some cases, maybe in many cases
but the truth is that there are still many things the doctor can do better
without the newest technologies.”
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| Milled single-day "advanced" crown (dull, monochromatic and bulbous) |
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| Hand-stacked laboratory fabricated crown; beautiful and natural with blended color to match teeth |
Hand-made, Lab-fabricated crowns can
be very beautiful by matching color variations and translucencies of adjacent
teeth and matching the sizes of existing teeth more exactly while milled crowns
have a tendency to be more opaque and mono-chromatic even to the point of
looking like “chiclets” (referring to the white rectangular chewing gum). Lab crowns may take 2 weeks to return from a
good lab, and yes there is a lab bill for $100 or so per tooth, but there is no
scan or milling machine necessary that must be paid for before it becomes
obsolete.
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| Milled single-day crowns, opaque and "Chiclet gum" appearance |
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| Beautiful laboratory hand-stacked fabricated crowns with natural translucency and color |
Lab-created aligner trays are heavily
advertised to the public as “Invisible Braces” in attempt to equate them to
braces; these trays are made from laser scans sent to third-party companies (Invisalign,
Clear Correct, etc.) and they appear to move teeth like braces but in fact, research from the Journal of the American
Association of Orthodontics & Dentofacial Orthopedics (as well as any good
orthodontist’s own experience) has repeatedly shown accuracy of movement to be
on average, a dismal 18% to 57%.
These aligners will many times leave patients with poor or even no posterior
occlusion which can then lead to excessive incisal wear and possible TMJ over
time (see my blog Does Invisalign Work as Advertised?).
Digital radiographs are convenient and
fast (I certainly do enjoy the positive aspects of my digital machines) but
they are not necessary to treat patients v. the older standard film based
radiographs and in some ways are inferior.
Once an office goes digital, you can add another 10% to the overhead and
therefore to the costs of treatment. If you choose 3-dimensional radiography, expect anther 5% overhead for pretty pictures that are simply not necessary for the majority of cases and will introduce significantly more radiation.
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| Modern Cone-Beam Radiographic Machine |
In short, dentists and dental
specialists (Orthodontists in particular) must weigh the advantages of new
technology v. the added overhead, the shortfalls and the maintenance of such
advances. As doctors, it is our
responsibility to offer the best treatment, even if it is not the newest or
most trendy available (i.e. braces v. Invisalign) and we should strive to keep
patient costs down by keeping our own overhead reasonable. If we continue to equate quality with
technology, we will most certainly end up with automated dental care and
faceless companies treating patients (usually to some average parameter instead
of providing specific and unique quality care to each individual patient) and
will lose the ability to develop a real doctor-patient relationship.
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| 3-D Image of the skull with Cone Beam Radiography |
“dentists
and dental specialists Orthodontics in particular) must weigh advantages of new
technology v. the added overhead, the shortfalls and the maintenance of such
advances. As doctors, it is our
responsibility to offer the best treatment, even if it is not the newest or
most trendy available ..”
If you have questions or comments
concerning this or any orthodontic question, please feel free to make a
complimentary new-patient appointment at either my Steiner Ranch location or my
North-central Austin location on West 35th street and MoPac.
Dr.
James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio,
1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001
Valedictorian graduate from the prestigious Saint Louis University Orthodontic
Program receiving the J.P. Marshall award for clinical excellence in 2001. He holds a Bachelor’s Degree in Science,
Doctorate in Dental Surgery, a post-doctorate certificate in Advanced
Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics
and a Master of Science Degree in Orthodontics and is a Diplomate of the
American Board of Orthodontics. Dr.
Waters and his wife of 20 years live in Austin, TX with their 4 children where
he has a thriving, multi-faceted Specialist practice with locations in Steiner
Ranch and North-Central Austin. You can
learn more about Dr. Waters at www.BracesAustin.com.
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| Steiner Ranch Orthodontics 4302 N. Quinlan Park Austin, TX 78732 512-266-8585 |
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| Contemporary Orthodontics & Dentofacial Orthopedics 1814 W. 35th St. Austin, TX 78703 512-451-6457 |
