Dr. Touchstone is a general dentist practicing in Hattiesburg, Mississippi, USA. He has been using clinical applications of digital dentistry in his dental practice for 20 years. He joins us for this blogpost to answer a few questions about the use of digital technologies in dental practices—CAD/CAM (Computer-Aided Design and Computer-Aided Manufacturing) in particular. According to Dr. Touchstone, the future of quality dental care is digital.


NDI-Blog-Why-Every-Dental-Practice-Needs-Digital-Dentistry-An-Interview-with-Dr-Alex-Touchstone-DDS.jpgQ: Can you tell us a little bit about CAD/CAM technology’s role in dental care?

A: CAD/CAM in dentistry is actually not new at all. In fact, CAD/CAM in its various forms has been used in dentistry for over 30 years. What is new and exciting around CAD/CAM is the expanding scope of procedures that are now possible. In fact, CAD/CAM is really a component of a larger vision for dentistry going forward: fully integrated digital dental workflows that allow us to diagnose, design and complete treatment for patients without ever leaving the digital space.

Q: Can you give us an example of a case when this technology improved patient evaluation and treatment?

A: For example, recently a patient presented to my office with painful upper anterior tooth. A clinical exam led to a diagnosis of an abscess with bone destruction that rendered the tooth hopeless. She also requested that her smile be improved. Four types of digital data were generated for the patient to facilitate creation of a treatment plan, conventional x-rays, cone beam CT scan, intra-oral digital scans, and photographs. All four of these data sets were entered into one planning software and were then used to generate a virtual diagnostic wax-up and to assess the viability of various restorative options.

The treatment plan that resulted included periodontal surgery, hard and soft tissue grafts, veneers, full crowns and one implant crown. Briefly, the grafts and implant placement were more predictable through virtual planning while the crowns and veneers were fabricated via a digital CAD/CAM process. All of these procedures were made more precise throughout by leveraging digital data.

Q: Which dentists will be able to use CAD/CAM effectively to provide innovative dental care in the future?

A: I would like to think beyond CAD/CAM and discuss “digital dentistry,” because this encompasses our current and future reality. Virtually all dentists are already using some form of digital dentistry. Digital x-rays, practice management software, digitally created lab-fabricated restorations, chairside CAD/CAM, digitally assisted orthodontics; these are just some of the ways dental practices already use digital technologies. The really exciting element of this story is how all of these will integrate with one another. In tech circles, people are currently working on the “internet of things,” through which our world will become more deeply connected. In a smaller sense, that same concept is finding its way into our dental offices. Each “thing,” whether it is a diagnostic tool, a restorative process, or a patient communication platform, becomes a part of a unified digital patient care experience. This has great potential to benefit both the patient and the dentist / dental practice team.

Q: Does the technology simplify processes and treatments in a dental practice? What is the benefit for the dentist?

A: Workflow efficiencies are greatly improved when we move from physical to digital processes. That is not to say that the work is simpler, but rather that it’s better because we can accomplish more in less time. When dentists realize that they may save significant time while concurrently improving patient care the only question that remains is one of cost. While return on investment is outside the scope of this article, generally speaking a practice technology investment will render a positive return provided the technology is used frequently enough to surpass a break-even point. For example, in the US, the break-even point for producing CAD/CAM crowns in-office ranges from 8-12 crowns per month.

Q: What kind of special machines and equipment will allow a dental practice to take full advantage of digital technology? Are there ways that dentists can minimize costs?

A: In cases where a doctor may not reasonably reach the break-even point for the use of a given technology, there are still good alternatives. In the case of CBCT (cone beam CT), the volume of scans an office might need in a month often falls well short of the break-even point. In these cases, a doctor may elect to write a prescription for a CBCT scan to be acquired at a colleague’s office. The scan data may then be sent back to the prescribing doctor for his or her use during the patient’s care.

Q: Do you think the new technology could change dentistry in a negative way?

A: We are undergoing a disruptive period in dentistry that is characterized by consolidation. This consolidation is occurring in all three major spaces: the dental laboratories, dental offices and dental manufacturers. There will inevitably be winners and losers. The winners will see the future by observing the present and innovate toward it. Integrating the latest technologies into your dental practice is one way to improve your practice management. Read into our blog to find some more information on how to optimize your practice.

Dr. Touchstone is in a key position to evaluate the benefits and costs of the newest advances in digital dentistry. In the last several years, he has taught thousands of dentists how to improve and grow their practices through the inclusion of thoughtfully selected technologies. He is on the Clinical Advisory Board for Natural Dental Implants, AG, and is the founder and Editor-in-Chief of LearnDigitalDentistry.com, an online education and networking platform.

Dr. Alex Touchstone can be reached at: alex@learndigitaldentistry.com 

Categories: Innovation