If you’re thinking about adding some hi-tech dental equipment, you may assume it will not be an easy task. This may be correct if you do not have a plan in place before you buy. A well-thought-out plan that systematically considers every aspect of incorporating technology into daily practice can significantly streamline the time, effort, and money required.
In 2004 I added an erbium laser (Hoya ConBio), oral sedation dentistry (DOCS), surgical microscopes (Global Surgical), a diode laser (Ivoclar Odyssey) and a CEREC (Sirona) in just nine short months! Were there bumps along the way? You bet! But thanks to my persistent nature, a supportive wife, an open-minded staff, and a well-thought-out plan, the bumps were not as big as I had anticipated.
I will describe the system I use to successfully integrate new technologies into my 1,300-square-foot, three-operatory office. You don’t need a large office to incorporate technology as long as the office is well organized. The system and methods are in general terms and can be used when integrating any new technology or procedure.
When contemplating the addition of a new technology, several considerations need to be evaluated and addressed. Some of the major issues include:
▲ Financial arrangements
▲ Which technology to add first (if more than one is desired)
▲ Which manufacturer to choose
▲ Getting your staff onboard
▲ Obtaining the needed training
▲ How to successfully integrate the newly acquired technology into daily practice and become proficient in a short time.
The system I use to integrate technology into my practice can be broken down into five phases:
1) Research and discovery
2) Staff education and motivation
3) Acquisition and office preparation
4) Education and training
5) Frustration and integration
Integrating technology is a process that begins when you start thinking about adding it - not when the technology arrives at the office. Let us examine each phase individually.
Phase 1: Research and discovery
This phase involves much time and little money. It is the most important phase of all. Learn as much as you can about the particular technology of interest. By the end of this phase, you should discover either that the technology will augment and enhance your current practice, or that it will simply not work unless some structural changes are made first. This can mean changes to the physical office, your practice style, or both.
Spend the time to read the literature as well as speak with dentists who already use the technology. Clinical and university studies on almost anything can be found through sources such as PubMed. When speaking to other dentists, ask them why they like or dislike it. Keep in mind that their reasons for liking or disliking a technology may not be the same as your reasons for liking or disliking it. For example, if a CEREC user tells you he hates it because he hates doing all-porcelain restorations, the same reason would not apply to you if you love doing all-porcelain restorations.
As silly as that sounds, there are dentists who have bought a CEREC and have never placed an all-porcelain crown. How do I know? Because I am one of them! I’m sure I’m not alone. The point is this: Learn as much about the additional techniques required as you learn about the technology itself. This twofold approach is crucial to make the technology work for you.
The next bit of research is for deciding which manufacturer to choose (if there are more than one). To ensure you will be happy with your choice, closely examine the specifications and features of each unit. In the case of erbium lasers, for example, some doctors find that a handpiece resembling a conventional air rotor is more comfortable, while others find a canula-style handpiece more comfortable. The physical size of the unit also may be important, especially if operatory space is limited. Erbium lasers usually need an air and water source. Some companies offer a self-contained water option - a priority if the laser will be moved between operatories. The fewer things to hook up, the easier it is to set up and the more likely you will use it regularly. When the unit is not being used, it should be stored near the operatories for easy access.
In my dental office, I can have my erbium laser ready in less than a minute. Fast set-up enables more frequent use. This results in more rapid proficiency. Map out all these things in your mind before buying anything. Allotting sufficient time in this phase will help prevent the technology from becoming an expensive flower stand.
Phase 2: Staff education and motivation
This phase can start at any time during the research phase, and is ongoing. Your staff will play a major role in the integration process, so you need to have them onboard from the start. Inform them about the technology you’re considering, approximately how long it will take to integrate it, and what to expect along the way. You just can’t walk in and say, “I just bought a CEREC and, according to the sales rep, it’s going to be great!” They will soon begin to doubt how “great” it is after watching you struggle with it for several hours only to get a crown that cracked on try-in - which is exactly what happened to me with my first few CEREC restorations before I received formal training. Make your staff aware of the thought and research involved in your decision, and that you’re not just buying something on the recommendation of a sales rep.
The best approach in educating the staff is to keep them informed every step of the way -
✔ Tell them the reasons you’re considering a new technology.
✔ Point out the projected benefits for patients and the practice.
✔ Admit that there will be failures along the way, but it doesn’t mean the technology is flawed.
✔Explain that the new technology may not be indicated in every situation and, in some instances, conventional methods may still be indicated.
✔ Help them understand that initially, procedures are going to take more time than usual.
When failures occur, share your analysis with them while maintaining objectivity. It can significantly increase their interest and help keep them motivated when things do not go as planned. A properly educated and motivated staff can ensure a smooth and proficient integration that results in a gratifying experience for everyone.
Phase 3: Acquisition and office preparation
Unlike Phase 1, Phase 3 requires little time and much money. If adequate time was spent researching the technology and educating your staff, this should be the easiest phase of all. If you find yourself struggling because of indecision, staff resistance, or both, then you need to either spend more time in Phases 1 or 2, or, the technology may not be a good fit. Nevertheless, even when you’re sure you’ve spent adequate time in Phases 1 and 2, it is not uncommon to be nervous when signing on the dotted line. This feeling is normal and usually short-lived; soon replaced by a feeling of excitement.
The acquisition phase also requires time to properly prepare the office to accommodate the new equipment. It is crucial that all preparations are completed before the equipment arrives. For instance, you may need to install an electrical outlet or air line in a more convenient location to facilitate set-up and use of the equipment. You need to determine where the equipment will be stored when not in use (if a dedicated operatory is not possible). The storage area should be located as close to the operatories as possible. If your office is small, you may need to reorganize some space. With all preparations complete, the only thing requiring your concentration is learning how to use it.
Phase 4: Education and training
It is extremely important that you receive the proper education and training immediately following acquisition. Training sessions are well-organized with excellent educators. They give you an idea about the types of cases you can easily treat as a beginner, as well as cases to avoid until you have more experience.
If possible, arrange for delivery just prior to attending the training session. Allow time to familiarize yourself and your staff with the new equipment, and address any last-minute issues. If the equipment will be moving between operatories, practice with your staff to find the most efficient method. The technology should be ready to use upon your return from training. Try to have some easy cases to treat the first day you get back. This is very important. You need to jump right in while the training is still fresh in your mind.
Although training sessions do an excellent job teaching how the equipment works and how and when to use it, they do not adequately address how to integrate it into daily practice. The reason is that integration borders more on practice management, which is usually beyond the scope of a training session.
Some dentists have no problem integrating a new technology into daily practice, while others experience extreme difficulty and frustration resulting in infrequent use. Infrequent use of a newly acquired technology will cause three unpleasant things to happen:
✘ Nonintegration
✘ Increased stress, especially when the monthly payments are due
✘ A very expensive flower stand for the office.
Obviously, the only way to avoid this gruesome threesome is to use the equipment frequently. This may require additional education and training from technology-integration consultants. Just as practice-management consultants can help dentists become more profitable by teaching how to practice more efficiently, professional technology-integration consultants can help dentists become more profitable in using their newly acquired technology by teaching how to integrate it into daily practice more efficiently. Efficient, frequent use is the only way to realize a return on investment.
Phase 5: Frustration and integration
As the heading suggests, this phase will be the most frustrating - initially - but it will also be the most rewarding. Successful integration occurs when the technology is routinely used in an efficient manner without resorting to conventional methods unless the technology is contraindicated for a particular situation. So, why does frustration happen during integration, and what can you do to limit the amount and duration?
Frustration occurs when things do not proceed as planned or the final result does not turn out as expected. Frustration is perfectly normal when learning anything new. To help limit frustration, three key ingredients are necessary - time, analysis, and persistence. (A fourth will be revealed at the end of this article.)
Allow adequate time in performing the procedures. No one can effectively learn to operate anything new when rushed. I do realize that time is money, but why invest all of the money and time needed in phases 1 to 4, and then not spend the time needed to use it proficiently? It makes no sense, yet it happens all the time.
Insufficient time when using a new technology will only result in resorting to more routine methods of doing things. Having an expensive piece of equipment sit in a corner during a procedure for which you should be using it creates more frustration which can later develop into feelings of resentment for the technology. Once resentment sets in, it is increasingly difficult to successfully integrate it into daily practice.
When you plan adequate time and things still do not go as planned, analyze when and where it went wrong, make changes or adjustments, and try it again the very first chance you get - be persistent! Go at it again on the very next patient even if you’re running behind schedule. The more you persist, the sooner you become proficient and the sooner frustration dissipates - a good indicator that successful integration is finally taking place. You and your staff will experience an ever-increasing sense of accomplishment that is renewed every time the technology is used successfully.
Closing thoughts about technology and microscopes
I am often asked by colleagues and patients if I feel the added technology has helped make me a better dentist. With the notable exception of microscopes, my answer is no. The only thing technology does for dentistry is provide a means to render a service a different way. The final product may not differ in quality regardless of the methods or technologies used. So why offer a different way? The short answer is to give consumers what they want, keeping in mind that not all consumers want the same things. To some, having a crown done in one visit may be important. To others, it may not. Some may want a cavity prepped by a laser. Again, others may not. Conduct your own surveys to find out which technologies your existing patients consider important.
The microscope has definitely made me a better dentist. I am reminded of this every time I see one of my restorations I did prior to using the “scopes.” I am reminded every time I do endo and find an accessory canal (which happens a lot more often since I added my scopes). The feature I like most is the ability to take photos of teeth as I am working on them without needing to sit the patient up. This ability is priceless, not only from a documentation and risk-management standpoint, but from a patient-education standpoint as well. When a tooth is giving me a lot of trouble, I can later show the patient the reason I was breaking a sweat!
If I had to do it all over again, knowing what I know now, the microscopes would have been my first acquisition. They are now the centerpiece of my practice. I use them for just about every procedure. They have enabled me to use all the other technologies more effectively and become proficient in a shorter time. The only downside is their cost and a bit of a learning curve. Aside from that, unless you try one for yourself, you really have no idea what you’re missing. Magnification is the key ingredient to successfully integrate technology into daily practice.
Dr. Donato Napoletanoowns Donato Dental in Middletown, N.Y., the first office in Orange County, N.Y., to use lasers and microscopes in the diagnosis and treatment of cavities and gum disease. He also owns Donato Dental Systems, a company which helps dentists streamline the amount of time needed to integrate various technologies into daily practice. He can be reached by e-mail at donato@donatodental.com, or by phone at (845) 342-6444.
