By Paul Feuerstein, DMD
I was recently asked, "With all of the latest high-technology products around, which ones do you absolutely need to practice?"
I am not sure if there is a universal answer, but I had to think how I implemented the myriad of devices in the office that have electrical power and flashing lights.
The first step is to set up the infrastructure of the office to make all of this work. This means computer hardware in the treatment rooms, a network, and a solid Internet connection. You will need a computer monitor in the treatment room to see and show digital images and access the software for appointments, treatment entry, and more.
Chartless is coming in loud and clear. In designing or redesigning the treatment areas, consideration must be made for location and access of input devices (keyboard, mouse, trackball, tablet) as well as disinfection. All of these devices can be wireless. This will give the most adaptability.
Small tables on moveable and/or flexible arms may be necessary. If you are using software in the treatment room, do you really want the monitor in the patient's view with the appointment schedule and the notes you are inputting? Think of using a dual monitor setup with one in front for the radiographs, images, and patient education while the second is behind the patient. It is not difficult to do, but you have to plan for it with the room cabinet/dental unit configuration.
Also we are in an interesting transitional time with respect to network-based, practice- management software. With the advent and interest in cloud-based applications, the future of practice-management systems may not need an actual server in the office.
The Internet connection is also important for gathering the information about a patient's medications by using services such as Lexi-Comp. Patient-education software by some companies is available using a web browser.
Some of these are now cloud-based, and allow easy access to content, which is updated automatically. This model, when implemented with the complete practice-management software, has great benefits such as updates and backups. It has to be considered in the long-term plan.
Once this infrastructure is in place, or properly planned, the next two puzzle pieces are digital radiography and intraoral cameras.
In my mind, this is not up for discussion. These two technologies are critical for proper diagnosis, and perhaps more important, to bring the patient into the experience. A good digital camera is also important for treatment planning and patient input. But unless you are quite adept at cheek retraction, mirror placement, and glove changing, the intraoral camera is the go-to piece of equipment that can be used on every procedure.
With computer storage space virtually unlimited today, you can take a quick image of every tooth you are restoring before, sometimes during, and after the restoration. It is quite helpful, especially if a fracture, exposure, or other "surprise" is found during the process.
No matter what we as dentists think will wow patients, their biggest thrill is seeing a preop picture of a tooth with an amalgam and the postop with a "white" tooth. They love it.
With the advent of USB connections, it is now easier than ever to move a camera from room to room. No longer are we stuck with large docking stations, although some companies make this even easier with USB cables that can stay connected to the computer and a quick disconnect for the camera. Of course, if there is a camera at every provider's fingertips, it will be less of a hassle to run into the other room to get one.
Digital radiography is simply better and more diagnostic than film. There is no excuse not to have some sort of digital sensor in the office. The resolution of the new sensors and phosphor plates is far beyond what we saw at their introduction.
The magnification and software filters allow us to see amazing detail, as well as added diagnostic software. The speed of capturing the images improves the workflow, and of course, the chartless aspects are obvious. In Gordon Christensen's CR report a couple of years ago, the question was posed, "When should you convert to digital radiography?" The answer from the evaluators was "As soon as possible."
Speaking of radiography, we are well aware of the new 3-D cone-beam systems that are not only becoming more popular, but are finding their way into more and more offices. The diagnostic and treatment-planning capabilities that use these scans are in a place we never have been. Many disasters are avoided, and more treatments are better planned using this technology.
The physical size of the units has come down as has the cost. But these still seem to present an obstacle to many practitioners. The bottom line, though, is that this will become more mainstream in the coming years. Once again we have to plan for space and workflow, especially if you are designing a new facility.
It would be safe to say that the area that might have been allotted for a (digital) panoramic device should be similar. There is, of course, still a place for a "pan." Some practitioners prefer the simplicity (and lower cost), and can send patients to other offices or imaging centers if a 3-D scan is necessary. When and if the time comes to upgrade to 3-D, the infrastructure is in place once again.
As we push the envelope of digital technology in the practice, one has to look at the new influx of devices that help us diagnose caries.
CAMBRA precepts tell us to salvage as much natural tooth structure as we can. Early intervention should allow us to perhaps remineralize an area that has incipient decay or decalcification. If we want to "watch" this, we can do so quantitatively. Devices use lasers, fluorescence, fiber optics, and more with ultrasonics and other noninvasive processes coming to diagnose present or impending caries. If you have been following this column and others in DE, you do not need the details.
The other hot area of technology integration is digital impression scanning. Currently, the "space" is changing, and may require less work in integrating these units physically into the office. The time to get into this "game" is not as hard and fast as digital radiography. The benefits to those using these systems and workflow are obvious. But there are many of us who can get along just fine with today's state-of-the-art impression materials.
New impression materials, as well as delivery systems, are coming out as quickly as new scanners. The one thing that is changing in the landscape is the configuration of the intraoral systems. A few new designs are eliminating the wand/computer/monitor cart and are going to a more portable, small, USB-based unit that can be connected to a dedicated laptop or desktop computer.
This changes the space requirements and the portability of these systems. So, in this case, we are talking about physical integration as compared to workflow integration. Once again there are volumes written in articles and studies that validate this technology and simplify the impression experience.
Laboratories are moving rapidly into digital design and fabrication of every type of prosthetic restoration. They welcome with open arms the practitioners who are willing to submit digital impressions. Now there is a new proliferation of in-office mills that can integrate with the scanners.
In thinking of entering this space, you need a plan. There will be extra time involved if you are designing and fabricating restorations. You might need an extra room or extra chair for the patient to stay in during this sequence. The dentist has to think about changing the workflow of patients and staff to make this efficient. Of course you need some extra space for the milling center, no matter how small.
Without using specific examples, I am trying to get you to think before you jump into this process. There has to be a plan. You cannot just call up a company and say that we are buying this new (whatever) and put it to work the next day.
Even if you need it (based on the recommendations offered in this column), work with a dealer or distributor to make sure you learn how to get this technology working before it arrives in the office. The word to remember is implementation, not installation.
Paul Feuerstein, DMD, installed one of dentistry's first computers in 1978, teaching and writing about technology since then while practicing general dentistry in North Billerica, Mass. He maintains a website (www.computersindentistry.com), Facebook page (Paul-Feuerstein-DMD-Dental-Technology), is on Twitter (@drpaulf), and can be reached via email at [email protected].
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