The visual aspect of this also applies to patients. Today’s patients are better informed and better educated about their health than ever be- fore, and if you do not engage them, you will lose them. Incorporating images in your diagnosis allows patients to understand and partici- pate in a co-diagnostic role.

When you look at CAD/CAM digital scanners and chairside milling technology, should dentists consider these advancements now or wait until longer-term data is available regarding outcomes?

Digital impression/scanner technology has been around since the late 1980s and has really hit its stride in the last 10 years. This is no longer an “if” technology, but now a “when” for every office. Digital is by far faster and exponentially more accurate. Prosthetics fit better, occlu- sion is more predictable, and patients love the fact that impressions are eliminated. Costs are already low for entry-level devices and all of these devices provide incredible clinical results. The time to make the change in your office is now.

Teledentistry is a topic I personally feel could positively impact univer- sal concerns with access to care. What should our readership under- stand about the potential of teledentistry within their own practices?

Our healthcare system is keeping us alive longer than ever before. Currently, 10,000 Americans a day are turning age 65. Those people have a life expectancy of 78.69 years. We are approaching what some are referring to as “The Gray Tsunami” where we will have a huge population living longer but also having less physical coordination and perhaps declining mental acuity as well. As a profession and a society, we need to find a way to preserve their quality of life.

My personal opinion and hope is that the proliferation of wireless In- ternet will allow hygienists or other types of credentialed healthcare professionals to perform exams, take radiographs, and take photo- graphs of patients in care facilities while a dentist in a remote location can review all of this data, make clinical recommendations, and then visit if needed to perform care that only a dentist can provide.

Fortunately, there is already a company that is making serious head- way into this problem. MouthWatch ( has created a turnkey system that allows for remote treatment and real-time communication with a dentist in their office. I am planning on doing a case study with them in the early summer to show proof of concept. I’m grateful for that because dentistry has an obligation to help this generation of patients.

Dental lasers have both strong advocates and avowed adversaries. Where do such lasers fit in the technology picture and which wavelength of laser light should a dentist consider?

Lasers in dentistry are an incredible adjunct to everyday practice. I was told by a periodontal expert in 1998 that my laser use would cause massive tooth loss and leave me liable for the damage. I’m still waiting for evidence of that disaster.

Diode soft tissue lasers are, by far, the most popular currently, and I use them practically every day I am performing dentistry. The wave- lengths of 810nm, 940nm, 980nm and 1064nm are all quite com-

mon and basically equally effective. These devices all cost less than $10,000, making them very affordable.

There also are hard-tissue lasers such as Er:YAG, EfCr:YSGG and CO₂, that can be used to prep teeth, perform endodontics and perform osseous contouring. These devices also are easy to use and predict- able, but their price tag is also at least 10 times greater than the soft tissue diode devices.

Lasers allow doctors to perform a large number of procedures, such as crown margin troughing, biopsies, frenectomies, soft tissue recontouring, and herpetic and aphthous lesion treatment/destruc- tion just to name a few. There is no reason for a laser to be contra- indicated. Sites heal quickly, uneventfully and painlessly. Diode soft tissue wavelengths also coagulate as they ablate tissue, so the field is bloodless, which is a tremendous advantage.

How will 3D printing change dental care delivery and what is its cur- rent status?

3D printing is here, but the current applications are limited. The tech- nology is incredibly affordable with printers available for well under $10,000. They are accurate, predictable and fast. Current applications are aligners, study models, bite guards, surgical guides, retainers and other non-permanent devices.

The problem that needs to be solved is a permanent aesthetic mate- rial that can be used to create fixed prosthetics. When that product is created, 3D printing will grow in a huge way. However, moving into the category of permanent prosthetics moves the product to a different level with the FDA. There will need to be studies done to provide proof of safety and efficacy. These studies will be demanding, expensive to produce, and there is no guarantee that the FDA will clear them the first time through. The costs and time involved for the FDA approval are the true “time limiting factors” for this technology. In the meantime, 5-axis mills will continue to evolve and dominate the market. Currently, I have a 5-axis mill and a 3D printer, and I don’t see that mix changing in the near- to mid-future.

In your experience being involved in new dental technology over your entire career, what one area do you feel holds the most promise and will return the most benefit to doctors and patients alike?

There are two areas I’m really excited about. The first is 3D. We’ve seen tremendous growth in the acquisition of 3D information as well as the analysis of this information in the time that CBCT has been on the market. Now we are seeing intraoral scanners also creating tremendous amounts of 3D data. Combining this into images that merge both technologies are allowing for the constantly updated 3D patient to exist. This means virtual articulation, virtual diagnosis and many other “virtual” abilities are on the horizon. The idea of being able to create surgical guides and do virtual implant placement and crown creation at your desk is here now and it will only continue to improve.


ISSUE 2 | MAR/APR 2020 | focus 23

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