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Professional Courtesy: What Grinds My Gears by Thomas Giacobbi, DDS, FAGD

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December is a busy month for many reasons.

This is the time of year we rush to finish treatment so our patients can use their remaining insurance benefits, the time of year that we start setting goals for the next year, and preparations for "Festivus" are in full swing.

Festivus was first introduced in an episode of Seinfeld in 1997, and my favorite tradition from Festivus is the "airing of grievances." In the spirit of the season, I will air some of mine.

Big box docs
Large group practices have been a hot topic in dentistry for more than 20 years. Also referred to as dental service organizations (DSOs), these large groups have many different business models. The underlying similarities include multiple locations, a unifying corporate structure and the promise of competitive fees.

The attraction for creating these organizations is obvious—group buying power, better insurance reimbursements in some cases, and good profit margins. Sounds reasonable, but they are disliked by a high percentage of independent dentist business owners.

Why? For many of the same reasons the owner of your local pizza parlor hates Domino's Pizza or the independent sandwich-shop owner hates Subway. The owners of mom-and-pop restaurants put their heart and soul into the food they make every day and they see the franchise restaurants as factories producing the same meal in Cleveland, Atlanta and Phoenix.

This mass production can drive prices down, which consumers initially love, but the dilution of quality ultimately sends them looking for something new. McDonald's has always been the golden example of the burger on a large scale delivered consistently around the world. Today, we have Shake Shack, Five Guys and In-N-Out—all originally mom-and-pop establishments that are going nationwide.

While some people have estimated that DSOs will represent 70 percent of dental offices by 2030, I maintain that there will always be room for the independent practices.

In fact, you may one day thank these establishments for creating an environment where our patients crave the kind of service that can only be found in an owner-operated establishment.



CAD/CAM confusion
There is no disputing the growth of CAD/CAM dentistry. We are seeing new scanning and milling technology every year.

While the cost of implementation remains a major hindrance to growth, the segmentation of this category is also a big drag.

There is a handful of milling units available for chairside fabrication of restorations and a larger number of materials that can be milled chairside.

However, not all materials can be milled in all machines. Imagine taking an impression with one brand of PVS and your lab representative telling you he or she cannot make the crown you desire because that company has an exclusive with another brand of impression material.

What if your favorite direct composite was not available to you unless you cured the material with that company's curing light?

Absurd, right? There are a number of companies leading the charge to make data and materials freely interchangeable between the capture devices, the lab or the milling unit, and these efforts will make it easier for dentists to become part of this exciting technology. As long as there is confusion and uncertainly, decision making will be slow.

Implants screwed up
Have you ever wondered why there are so many different types of screw heads for implants? I'm sure it has something to do with design patents and product differentiation, but I often wonder how life would be different if a couple of the early implant companies had agreed on a universal screw head.

In the beginning, someone probably thought, "If I make my screw head different and the dentist has my screwdriver, he or she will always use my implants."

Wrong. The reality is that dentists who restore implants have a box filled with different drivers and wrenches for all the different screw heads that are out there. Did this clever concept limit the number of implant companies? Not one bit. In fact, at the last IDS Meeting there were more than 400 implant companies in attendance.

Yes, I know that the screw threads are also different from one implant company to another, and I would bet it has more to do with making certain you use their brand of screw than it has to do with anything else.

Bottom line: the variation in this one aspect of implant design has probably led to more instances of the wrong screw in the wrong implant than anything else.

As you enjoy your holiday meals and finish the evening with "feats of strength," I hope this column will motivate you to participate in the "airing of grievances" in the comments section of the online version of this article.

Others may wish to agree or disagree with the opinions shared in this article. Thank you in advance for your participation.

If I can generate some discussion on these and other important topics, I will go to sleep with my night guard in place, knowing that 2015 was a success. Best wishes for a healthy and prosperous 2016!

I am available via email at tom@dentaltown.com, or Twitter @ddsTom.



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