Digital has arrived...Have you? By: Gordon J. Christensen, DDS, MSD, PhD

Would you have thought 20 years ago that the digital era would emerge as rapidly and as profoundly as it has? The dental profession has had many changes because of the unbelievable computerization of familiar concepts. Some dentists have kept up with the changes, and others have given up and let the computerization of dentistry pass them by. Several years ago, I made the decision that if I was going to offer my patients the best up-to-date care possible, I would have to keep up with the changes taking place. Some of you have not made that decision. Perhaps it is now the time to do so. This article provides my opinions as a mature practitioner-researcher on the subject of digital dentistry and makes suggestions for your integration into digital dentistry. The suggestions are based on my own experiences, my observation of global dentistry, and research carried out at Clinical Research Associates.

Digital Cameras
I will start at a level that is easy for everybody to enter. Digital cameras are everywhere. You cannot pick up a newspaper without seeing an assortment of relatively simple digital cameras available from your local photography store. Film photography is dying. A few years ago, digital cameras were extremely expensive, but now they are in the financial range of most people. Photos can now be made and observed immediately on the viewer of the camera. Within minutes the saved picture can be transferred to a computer screen for editing, and the image can be stored, printed, or used in a projected form for a presentation to patients or others. I find it unpleasant to remember the laborious past when photos were unpredictable, and altering them was a major two-week task. I remember well sorting through hundreds of slides to make a presentation to a patient or to a dental society. Those days are history!

Pictures of patient treatment accomplished by you are invaluable for educating other patients. Photos are also excellent for assistance in remembering your patients. The photos can be easily stored in the patient’s electronic file. There are several digital camera kits available on the dental marketplace for around $2,000, or if you desire to do so, you may put a kit together for less money. If you are a novice at photography and computers, I suggest that you get a kit. Some examples are: Lester Dine–(800) 624-9103 (Olympus 3000), PhotoMed– (818) 908-5369 (Epson 3100Z) and Eastman Kodak– (800) 933-8031 (Kodak DC 290).

Digital Imaging
This concept has been in use for a long time. It was introduced into dentistry over 10 years ago, but it caught the attention of only a few dentists. It is becoming popular again. There are many devices on the market, and several are relatively easy to use. There are some challenges with digital imaging. One of the main ones is that it is easy to create changes in a patient’s photo that are not possible to achieve by the best dental practitioner. In such cases the patient has higher expectations than can be produced.

However, when good clinical judgment is combined with digital imaging, predictable results can be obtained. This concept is certainly a great patient education tool.

Dental imaging packages are available as add-ons for most office management software programs. Examples include Dentrix, Easy Dental, and SoftDent.

Digital Radiography
I predict this concept will gradually dominate the dental radiography area. Most practitioners find the immediacy of the image observation allowed by digital radiography is a superb characteristic of this concept, especially when accomplishing endodontics or implant surgery. Additionally, the storage and retrieval of radiographic images on command, the ability to enlarge or alter images, and the reduced radiation used by this concept are advantages. However, there is still continued development and change taking place in digital radiography. Clinical Research Associates accomplished a major study on digital radiography recently in which many devices were compared with those produced by other companies. The resultant radiographic images were compared and judged by CRA Evaluators. The actual images may be observed on the Internet at www.cranews.com. This constantly changing Internet site provides information on all projects that are completed or underway in CRA. When observing the digital radiographic images on the CRA site, you will see that there are great differences among the image qualities that can be achieved from company to company. When selecting a digital radiographic device be sure to compare images among companies before making a choice. A brand that has had consistently high quality images is Schick Technology (888) 472-4425.

The Total Digital Dental Office
The day is coming when most of the business activities in all of life will be accomplished by using digital methods. In the meantime, many dentists are using only certain parts of the digital concept in their practices. I predict that over a reasonable period of time, dentists will move toward having all aspects of the business affairs of their offices converted to digital applications. If you are especially interested in this concept, I suggest that you work toward it.

Remember that the change will require time, effort, energy, frustration, and money, and that as soon as you set up one system, another one will be present to replace it. Some dentists are very willing to let others experiment with the total digital office for a while, allowing themselves the ability to go toward the concept at a later time. There is no doubt that digital offices are in the near future.

Digital Restorations
If you saw the November 2001 issue of the CRA Newsletter you saw a very optimistic report on CAD/CAM in dentistry. CRA has had ongoing clinical projects on CEREC 1, 2, and 3 for many years. It is interesting to note that over the years CRA has studied the computer directed milling of crowns, inlays, and onlays, the computer concept restorations have outperformed the laboratory made indirect restorations. I predict that computer directed restorations are definitely in our future. In fact, many of you are already using Procera, and there are numerous other computer oriented restorative concepts either on the market or coming soon.

Summary
Digital dentistry is here! The only question is how long do you want to wait until you become involved either partially or entirely? The concept is revitalizing for many practices, and when fully implemented, it provides faster, easier, and better quality dentistry. DO IT!

Dr. Gordon Christensen, a Prosthodontist in Provo, Utah, is co-founder and Senior Consultant of Clinical Research Associates, which conducts research in all areas of dentistry and relates it to clinical practice. The well-known CRA Newsletter has published research findings for the dental profession on a monthly basis since 1976. Dr. Christensen is also Director of Practical Clinical Courses, a continuing education career development program for the dental profession initiated in 1981. He is also an Adjunct Professor at Brigham Young University and the University of Utah. You can contact Dr. Christensen at: Practical Clinical Courses, 3707 North Canyon Road, Suite 3D, Provo, Utah 84604-4587. FAX: (801) 226-8637. Visit his website at:www.gordonchristensen-pcc.com