This year I celebrated my 25th year of practicing
dentistry and looking back over the last quarter century,
sometimes I wonder if dentistry is just getting
too darn easy.
The first five years I practiced, I had a 24-hour-a-day, 7-day a week, callous on my thumb and index
finger from carefully moving stainless steel endofiles
up and down all the time. When I graduated from
dental school, it literally took me two hour-and-a-half appointments to manually clean out a tooth.
Dentists today are so lucky! Now we have 300RPM
nickel-titanium files that takes care of business in
less than half the time - and in a single appointment,
Radiology is also undergoing a complete revolution
right now, and endodontics has become so much
easier because of it. There is a high percentage of
American dentists who use two-dimensional X-rays
and it's so surprising to me how few have moved over
to the new 3D technologies. I have still not met a single
dentist who's gone from 2D to 3D and will ever go
back. So many skeptics who still use 2D ask: "Well
does insurance cover it? Will I have to charge extra?"Yet every single dentist I know who uses 3D says they
don't even care. It's just amazing what you can see with
the new technology. I mean, look at endo again. For
years, every time a root canal failed we just assumed
we did something wrong. Like, maybe we
were just short of the apex and we didn't
get it all cleaned out. When you use 3D
imaging, you can plainly see the root is
fractured. If you can see that, just
imagine how much more dentistry you
can diagnose and treatment plan!
I predict, within a few years, general
dentists will not refer to endodontists
who don't have 3D X-rays - how
would the endodontist even know
if the tooth had a vertical fracture
if she can't even see it?
Root canal failure is
why so many endodontists
their work. If it
fails in the first year, the patient will get 3/4 of their
money back; if it fails in two years, the patient will get
half of their money back and so on. If the root canal
lasts four years, it's good enough. The best endodontists,
on the other hand, outright refuse to warranty
their work. They're good at what they do, and if
they're using 3D imaging, they can see everything!
You're telling me you're OK with taking $1,500 of
someone's hard-earned money to perform a root canal
that's not going to last a year and you don't feel any
shame or guilt about it? That ruins endo and root
canals for everyone! What sort of connotation does it
carry when someone tells you: "I don't want a root
canal. Just pull the tooth. My cousin got a root canal
and they had to pull the tooth a year later anyhow.
What a waste of money."
The American Dental Association was way ahead
of the curve when they granted specialty status to oral
radiologists. In the future, the dentist isn't going to be
the person reading X-rays. Oral radiology is going to
explode - not just in the United States but internationally.
That's all thanks to the Internet! I see practices
taking 3D X-rays and e-mailing them to an oral
radiologist somewhere else on the planet, and within a
few minutes, the oral radiologist reads the X-ray and
tells you what you've got.
The best endodontists in the profession use 3D
cone beam computed tomography (CBCT), and they
have the ability to place implants. I want my retreats
to go to an endodontist who can take an accurate
3D X-ray and if she decides that the tooth isn't salvageable,
the money isn't an issue because she can
either make $1,500 doing the retreat or she can make
$1,500 pulling the tooth and placing the implant
right then and there. That is outstanding customer
service to the patient!
You'd have to agree with me; dentistry is getting so
much easier! Look at CAD/CAM. Since I've been a
dentist all the best labs that I know will tell you that
all the best dentists have about a six percent remake
rate (couple that with the dentists who say they have
never had a remake in 25 years, you know the truth is
somewhere in the middle). Now with impressions
going digital with optical scanning, those same labs say remakes drop from six to one percent. One percent!
When you digitally scan the teeth, if you've got a
huge monitor that's two feet by a foot, you just can't
see a prep better than that. You can't even see a prep
that well with loupes on. Taking it further, if you have
a milling machine right there in your office you don't
even have to send the impression out to the lab, and
you can take care of your patient in the same day. I
mean, CAD/CAM technology is something we only
dreamed about and wished for 25 years ago. Now it's
a reality, and there are still some of you who won't give
it a shot. You can't afford to sit on the sidelines with
CAD/CAM. If you've been thinking about it, take the
Look at implants! I got my fellowship from the
Misch Insitute, I got my diplomat from the
International Congress of Oral Implantology and I'm
telling you, just thinking about placing implants in
the 1980s makes my stomach turn. Placing implants
has come such a long way since then. When you
placed an implant back then, you were talking about
long incisions, and when you thought you had an inch
of bone to work with, you really didn't know until you
got in there, and you'd receive such a shock that you
really only had half as much bone. You had to stay so
far away from the mental foramen for fear that an
anterior loop could ruin your day. It was such a difficult
procedure! Today, you don't even need to extract
the teeth before you get started on placing an implant.
You take a 3D X-ray, send it to a lab, the lab makes a
snap on retainer with a pilot hole, you get it back,
numb the patient up, snap on the retainer, drill right
through the pilot hole and the tissue and place the
implant. There are dentists who come up to me at
seminars to tell me they don't pull wisdom teeth and
that they can't stand the sight of blood, but they purchased
a 3D CBCT machine and are placing seven to
10 implants a month. They've gone from zero to 60 in
about three seconds in the implant world. I mean, tell
me dentistry hasn't gotten too easy!
And then there's orthodontics! I remember doing
ortho in my practice from 1987 to about 1992, bending
stainless steel with these three prongs, trying to figure
out the best way to improve someone's smile. You
could literally get a migraine headache trying to figure
out what you had to do with the wire. Some things are
extremely difficult to wrap your head around and
orthodontics in the 80s and early 90s was one of them.
There's a reason orthodontists take so much more
school! Then nickel-titanium wires came out, where
they could pre-cast the archwire so everything was at
the right angle, and all you have to do is bend it into
the bracket. The wire straightens all by itself and drags
the teeth with it! It's just gotten so much easier!
What's even more amazing is thinking how much
easier dentistry is going to be in another 25 years!
Think about it!
What ways has dentistry become easier for you?
When you've finished reading my column, I wish
you would jump onto Dentaltown.com and post
your thoughts under my column this month. See