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My View: Keeping pace with technology

June 06, 2016

By Stanley Markman, D.D.S.

Dr. Markman

One of the more challenging aspects of private practice is staying current with new technology. A new aspect of technology is the use of intraoral scanners for impression taking. The technology is expensive but may be even more so than you may anticipate, as I will shortly show. I decided to get involved with a new aspect of technology about two years ago as I found the idea of taking impressions with a digital device intriguing. The idea of taking an impression by simply suspending a scanner over a prepared tooth was fascinating. In addition, the image obtained could be sent over the Internet to have the crown fabricated; and it could be done without creating a model. Wow!

When I opened my first office in 1962, I had to make but one technology decision at that time. Should I go into extra debt and buy a Cavitron or should I wait until I had the money to make the purchase later. I opted for waiting. Times have surely changed.

My experience with the scanner has been less than good. In order to use it, a consultant was required to teach the technique of its use and associated software technology. Actually, the technology wasn’t so daunting. The technique of learning how to physically manipulate the scanner was daunting. I guess my cerebral cortex has shriveled over the years. During my career in dentistry, I received four fellowships; took over 500 hours of implant instruction and learned to place implants; took coursework in orofacial pain; and received both a fellowship and a diplomate of the American Board of Orofacial Pain. However, I was simply not alert or tenacious enough to learn how to use a scanner on a patient. “User-unfriendly” is way too kind of a criticism.

Yet, there I was, toiling and struggling how to manipulate the scanner in order to obtain a good image. I simply could not master the technique. I realized with the passage of time, that the scanner never really solved a problem. Unfortunately, I understand now that technology should solve a problem. There was and still is no problem in taking impressions. The scanner didn’t solve a problem. Often, I would schedule a patient for an image, after tooth preparation, and found after 45 minutes I was stuck. Yet, I was able to continue with the operative appointment and obtained an excellent impression in less than 15 minutes.

A significant problem I found with the technology was when I had to prepare a tooth with mesial and distal subgingival restorations. Using gingival retraction in conjunction with some minor laser soft tissue treatment, I easily obtained an impression. I found that using the scanner was difficult, for often, the sulcus would weep and I could not obtain a clear image of the margin. But then again, I had difficulty in obtaining mesial and distal images of the walls of the preparation too.

Another interesting aspect of modern dental technology I learned was that maintaining a warranty (something that you need to pay for) after five years of ownership, of say, a cone beam computed tomography X-ray, will leave you breathless.

With the device less than two years old, I recently saw an advertisement for a new and improved scanner by the same company. Being a masochist, I called to learn about the details. The first thing I learned was that my high-end laptop, purchased specifically for the original scanner, could not be used for the new, updated scanner. While I did not obtain the price for the new scanner, I did learn that it was more expensive than the original scanner. There was no offer to reduce the price of a new scanner even though I explained that my existing scanner was but 2 years old.

Here is my new plan. Instead of purchasing another scanner, hoping I will be able to use it to embrace new technology that doesn’t solve a problem, I will purchase a dividend paying stock from a list of the “Stock Aristocrats.” These are stocks, whose dividends have increased for 40 or more years in a row. At the end of five or 10 years, I will have a stock that will produce income without work; I will own something whose value will not likely depreciate to zero and is more than likely to increase. Also, I will be able to take impressions using old-fashioned regular dentistry. Furthermore, I will be able to pass on the investment to others when I shuffle off my mortal coil.

Technology should solve a problem. It should make what we do better. It should reduce operative time or using the same time, be more productive. A digital radiograph produces instant results. It saves time and has other benefits. When the learning curve is mountainous, the technology is not ready for prime time. I believe that what was sold to me was “sucky’’ technology. Fortunately, my unused scanner will not affect my life because I can afford the loss. You may not be in the fortunate position that I am in.

Think ahead. When you buy that magnificent, glorious CBCT that will tell the world that you are not just a normal mortal person but a high-tech progressive dentist, be mindful of the warranty support needed down the road.

Dr. Markman practices in Fort Lee and Newark, New Jersey, and is a clinical assistant professor at the Rutgers School of Dentistry.