John Flucke, DDS, is in private practice in Lee’s Summit, Mo. He also serves as chief clinical editor and technology editor for 

® and keeps an active blog filled with thoughts and tidbits on the world of technology at blog.denticle.com.

John Flucke, DDS

Abstract

I have seen a lot of change in dentistry in my lifetime. In a way, it’s sort of funny that I became fascinated with dental technology, because my childhood dentist was anything but interested in upgrades. I decided to become a dentist at the age of 3, and that family doctor was very encouraging—but his office was a throwback. He worked alone, using a stand-up Ritter unit that used a belt-driven handpiece. Although the high-speed handpiece was invented in the 1940s, he didn’t bring it onboard until I was a teenager.

Remember when the idea of patient education and codiagnosis was handing a patient a mirror and pointing at things in their mouth with the explorer? Or holding a bitewing radiograph against a view box and trying to show where that little triangle was? A lot of you reading this probably don’t remember that, and trust me when I tell you that you are lucky.

We are visual creatures; we greatly depend on our eyes for nearly everything. There is an old saying, “I hear, I forget. I see, I remember. I do, I understand.” That saying is especially true when trying to explain something to an individual with minimal experience in the subject you are discussing.

My tech journey in dentistry began with an intraoral camera. My father, who was not in health care, happened to be with me the day I first saw an intraoral camera, and it was his influence that caused me to buy it. At that point in time, the camera was a wand attached to a huge box and cathode-ray tube monitor. It was on a large bulky cart that had to be wheeled into the operatory every time I wanted to use it, and it took approximately a minute to boot up.

Personally, I didn’t see the need to show patients their teeth on a screen. However, my father gave me a great explanation. “You see teeth all the time. You see them in books, magazines, and at seminars. You are used to seeing them. I have never seen the inside of my own mouth before, and all your patients are just like me. If your patients get a chance to see their problems, they will understand those problems and make better decisions. This thing will pay for itself.” The system cost me $15,500, and my dad was right; it paid for itself in no time.

As I began showing patients why they needed the treatment I was diagnosing, they could see and understand. And like my father, they were fascinated by the pictures and the tech that made them possible. Not only did patients more readily schedule needed treatment, but they also told their friends about this “amazing camera on a stick” that their dentist was using. This drove referrals to my office, as I was the only one in the area that had one.

The Changing Face of Chairside Engagement

Obviously, imaging has changed our profession. In addition to showing patients photos on a monitor, we also began showing radiographs on a monitor. We were using filters and enhancements in the radiography software to help the patient see decay and to truly understand radiographs. However, the drawback to any of those images was that you could only see height and width. Those images—although they were amazing and great for education—showed only 2 dimensions. Like Mario running across the screen in the original Nintendo Entertainment System, there was no depth—only up and down, left and right.

That’s why I have been such a cheerleader for 3D in our profession. We are not treatment planning or educating Flat Stanley. Our patients and our treatment are 3D, and we can only truly do our best when we are working in all 3 dimensions. That is why my office is now using CBCT, 3D impressions/scanning, 3D printing, and a dental lab mill. We changed standard operating procedures for our hygiene department, and we are routinely scanning as part of a patient hygiene/recare visit. We are currently taking these scans once per year as part of the patient recare process.

Previously, our hygienists took lots of photos, both intraoral and extraoral, and used those as well as routine diagnostic radiographs to inform and educate our patients. Now the 3D intraoral scan is part of that codiagnostic process. We position the scanner screen so the patients can see it and follow along as the scan is taken. This further involves the patient in the process, and it gives the hygienist the opportunity to show off the tech, as the patient can watch their teeth show up on the screen as the wand is passed over the dentition.

There are a couple reasons why we decided to make this change. The most important part is that despite all our efforts with our patients, we were educating them in 2D. Even simple things such as wear facets are harder to see in a flat photo, but when you can take a digital model and rotate it on the screen so that the patient can get the same perspective as the dental professional, the impact is immediate.

The second reason is for tracking and history. Some scanners have a feature that allows the team to show a video of wear and shifting of the teeth over time. We all have patients who have a hard time believing us when we tell them they are clenching and grinding. It’s hard to deny it when faced with objective video evidence.

As my dad so astutely pointed out all those years ago, patients who are better informed make better health care decisions. Although in the past patients were fascinated by seeing pictures of their teeth on the monitor, now they are practically hypnotized by watching their teeth show up on the monitor live, as the scan is being taken.

Then when the scan is completed and the hygienist begins to rotate the scan on the screen, zooming in and out and showing different aspects of the patient’s arches, the most common reaction is fascination. When I come in to do the examination, the scan will often be the first thing the patient mentions. I routinely say, “I get to see these scans every day, and yet I am still stunned by how incredibly cool they are.”

Our particular system even has caries detection through near infrared imaging that works as a type of transillumination that helps us find or verify areas of decay. We can then either treat or monitor, depending on the lesion size and the office philosophy.

These scans are such amazing tools to use. We explain that even if their mouth is in perfect shape, we still have this data in the cloud, so if they should ever break a tooth or have something else unexpected happen, we now have an exact digital replica of them that we can use when designing the solution to whatever problems they may face.

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We demonstrate how the scan can show occlusion in color, then explain that we can also use the scan to simulate orthodontic outcomes with clear aligners. Sometimes when we discuss treatment possibilities and options, patients will want to think it over and/or discuss it with their significant other. We always make the point to them that the data is here and will always be here, so if they want an occlusal appliance, orthodontics, or an appliance to help with their obstructive sleep apnea, we can get them started without a second office visit.

We routinely get patient feedback along the lines of, “this is the coolest thing I’ve ever seen,” or “I can’t believe you just slide that thing over my teeth and then my mouth is on the screen.”

For the past few years, the profession has heard the term “digital workflow” repeatedly. What started out as a technology term was rapidly assimilated into a marketing term. Something like digital radiography, which had been mainstream for over a decade, was suddenly marketed as a digital workflow. Although this was true, the overuse eventually watered down the definition. The overuse of the term rapidly led to confusion amongst practitioners as to what the term really meant. Now, I feel comfortable telling you that intraoral scanners truly do create the mythological beast called digital workflow.

Pairing the scanner with other hardware in the office allows us to take cases from start to finish while doing all the processes on a screen. Often, the only part of the process that is analogue is prepping the tooth.

Let’s use a crown as an example. The patient has had an intraoral scan as part of their hygiene visit. Once the preparation is completed, the postoperative prep scan is done. Once the prep scan is completed, that scan is the basis of designing the prosthetic crown. If we wish to exactly replicate the tooth as it was preoperatively (perhaps it is used for a clasp on a removable partial denture), then the preoperative scan is used so that the design combines those 2 scans and creates a prosthesis that is identical to the original.

Scans imported and used in digital design software

Digital design software creates file of final prosthesis

That workflow could also be used to design an occlusal guard or other types of appliances/protheses that are then either milled or printed on an in-office 3D printer. These cases can be created same day, next day, or just in time, depending on available time and the schedule.

Intraoral 3D scanners are making tremendous inroads into the dental profession. They were once considered as a way to reduce the number of analogue impressions and increase patient acceptance. However, intraoral scanners have now become an intrinsic piece of the restorative armamentarium.

Time-saving procedures, such as same-day prosthetic treatment, are dependent on scanners to create the digital files used in the design and fabrication process. The profession is now seeing these devices as not only nice to have but also a need to have, as scanners have become the key to unlocking a vast treasure of digital dental services.

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Earn up to 1/4 Continuing Education Credit after reading this article about intraoral scanning and the ways the technology is changing how clinicians interact with their patients.

Where Do We Go From Here: The Future of Hyped-up Dental Technologies. Image courtesy of Aliaksandr Marko/stock.adobe.com. 


When I was in dental school, we had procedural units we had to meet to graduate. One of those requirements was to perform 75 amalgam procedures. I find that kind of funny. We had students in a panic trying to finish up, needing to place 5 more amalgams so they could graduate. I look back now and realize I have not placed a single amalgam in the past 20 years. Crazy, isn’t it? Something I was required to learn isn’t even something I perform anymore. Honestly, I wish I had written down the last time I placed an alloy.

Don’t get me wrong; I am not against amalgams. If you are still placing the occasional amalgam, I understand why. Amalgam works. My patients, however, want esthetically pleasing restorations, and in my geographic area, composite is king. I still think it’s important that students be taught how to place amalgam. To know where you are going, you have to know where you came from.

One of the things I love most about our profession is how it continues to change and improve on a continuous basis. I’ve said it previously, but I’ll say it again: I rarely do anything the same way I was trained in school. I use many of the same principles (hence why I think learning to place amalgams is important), but those principles are applied in different ways with different devices and materials.

® decided to look at hype vs reality when it comes to dental technology. With that in mind, I’ve decided to retrieve my dusty crystal ball and discuss some topics for the future.

The idea of seeing things as they really are requires that we work in 3 dimensions. Dentistry has been heading in this direction for over 10 years, and that’s approximately how long it has been since cone beam computed tomography (CBCT) imaging began to go mainstream. Once computing power was hefty enough to process the data, CBCT use exploded in the profession. Many of us can’t imagine what it would be like to only work with 2D imaging now. Luxury becomes necessity.

This also applies to 3D intraoral scanning. This aspect of our industry is making incredible inroads. Many offices (mine included) now perform 3D scans for patients as part of a routine hygiene visit. The ability to see a patient’s mouth whenever you need to is a tremendous advantage to treatment planning. The number of impressions we take has dropped remarkably in the past few years, and that is mainly because cloud storage allows access to models at any time and any place we choose.

We are heading toward integrating all these data and merging them into a single, complete data set. Some of us are already able to merge intraoral scans into CBCT volumes. However, although it is possible in the current environment, it’s not common.

In the next few years, we are going to see what I call “the continually evolving 3D record.” Here’s how it will work: Every new patient will have a CBCT image taken and then have an image taken with an intraoral scanner. These procedures will be as much a part of the patient experience as completing a health history. The 2 files will then be merged so that the high-resolution intraoral scan is placed into the CBCT volume. Whenever new imaging is done, the new images will be integrated again.

The idea here is that anytime the patient has a new intraoral scan or a new CBCT scan, a corresponding integrated 3D record can be created. I envision the record-keeping process will not only track when something is changed by dentistry (such as a crown) but every time a patient has imaging performed. We all know that things change, shift, and wear in the mouth over time, and this will help us track that.

Many of today’s intraoral scanners have a time-lapse feature built in. This allows the patient to see a video of how their teeth have changed over time. I can see the same thing being done with merged 3D data to show patients how their oral health has improved or declined over time. The ability to communicate visually is a tremendous advantage of imaging, and better-informed patients make better health care decisions.

If you read my January 2023 article, you know our office just installed Pearl in January of this year. I am excited for what the future of this product holds. We are going to see incredible advancements using artificial intelligence (AI) in health care.

The study and discipline of AI has been getting better in fields outside of health care, where it didn’t need to help with critical and potentially life-changing decisions. Now that field of expertise has become robust enough to provide valuable information to help with diagnosis and potentially prognosis as well. Pearl currently has more US Food and Drug Administration clearances than any other dental AI product.

In the future, AI will not only provide data to help you make diagnostic decisions but may also suggest options for treatment. We’ve all had cases where you try to do what we affectionately refer to as “herodontics.” These are cases where a patient doesn’t want an extraction, root canal, or other treatment. So we try hard to meet those requests and expectations, only to be unsure of the long-term prognosis.

What if an objective third party could tell you something such as “there’s a 95% probability that this tooth will require endodontic therapy” or “80% of cases with this amount of coronal structure remaining report extraction and implant placement in less than 2 years”? Wouldn’t that be a great tool to have available to you? The opposite of this could happen as well, such as the system telling you that “you have treatment planned for an extraction, but 80% of cases with this amount of remaining coronal structure restored with a crown have a survival history of 5 years or more.”

I want to emphasize the point that the software will not make decisions. All it can do is provide more data for you to consider as you digest these data and make the appropriate treatment decisions for each individual case. You would consult the AI as you would a colleague who might sit down with you and offer suggestions on potential treatment plans.

Imaging isn’t just radiographs or intraoral scans. We can also help our patients make better decisions through extraoral photography. We are already seeing programs that can quickly and easily show patients their potential new smile. Take an extraoral photograph, and the new smile can be placed directly into the photograph. Although there are several programs on the market, one of the most impressive is exocad, which has Smile Creator. Smile Creator can show a patient’s new smile in a photograph and a 3D intraoral scan. This not only allows the patient to visualize the results but also helps the doctor design and create the needed restorations.

Let’s take this to a new level. In the not-too-distant future, you will be able to take a portrait photo with your digital single-lens reflex camera and then show your patients a complete makeover. Want to see how you would look with a new smile and green contact lenses instead of the blue eyes you were born with? Click! How about seeing how your appearance could be changed with Botox®? Click! Want to see how your lips would appear after dermal filler? Click! You get the idea. I could even see the potential for a photo booth in the reception area that allows patients to tinker with their appearance to see potential changes.

We are going to see incredible adaptation of milling soon, especially with the help of AI. Materials like zirconia and lithium disilicate are only going to improve, becoming stronger and more esthetic.

The design process will become remarkably faster and more accurate. Consider all the things I mentioned about AI in this column, and then imagine simply importing the STL file from a digital impression system and seeing the crown on the screen almost instantaneously.

If you desire, you will be able to change or improve the design so that it is exactly what you want. The system will assimilate those changes into its algorithm and learn your wants and needs. Over time, it will learn more and more about your individual preferences, suggesting restoration designs that are more in line with those preferences.

AI’s ability to design indirect restorations with ideal emergence angles, accurate margins, and spot-on occlusion is not science fiction. It is on the horizon and approaching rapidly.

I won’t go into great detail on my ideas for this one, but since 2020 I’ve had a greater interest in infection control. We do our own fast, easy, and reliable sterilization monitoring in the office. So what about an autoclave that is preloaded with a sleeve of testing vials that run in each autoclave batch and is automatically transitioned to an incubator where it could be checked to ensure sterility is achieved every time the autoclave is run? I would love to see a system like that become available.

My thought process for this article was to look at technologies the industry is already familiar with and push them a little further. This article could be pages long. Things such as robotics, bioactive materials, and single-shade bulk-fill composites will continue to improve.

How lucky are we? This is the best profession on the planet. We are on an exciting and constantly evolving journey while getting to help patients and improve their quality of life. I am closer to the end of my career than I am to the beginning, but I am still enjoying the ride. Imagine what things will be like 5 years from now!

Considering how popular dental technologies may evolve can provide an exciting outlook on the future. 

Where Do We Go From Here: The Future of Hyped-up Dental Technologies

Making Dental Data Work Smarter, Not Harder. Image courtesy of gonin/stock.adobe.com. 


What follows is a true story from a time very early in my career and something most of you will have experienced at some point. Dental technology was in its infancy then, and I was in a hotel ballroom in my hometown of Kansas City, Missouri, where a dental supply company was showcasing its cutting-edge equipment.

The intraoral cameras in particular were garnering a great deal of attention; many doctors, including me, were fascinated by the images and expressing their amazement. Then a dentist, perhaps already past the age of retirement, came by, peered at the screen, and wrinkled his nose. “That’s just an excuse to sell people unneeded dentistry!” he said with obvious disdain. The rest of us said nothing. I kept thinking that a punchline would be coming, but then with a “harrumph,” the man turned and walked away. The rest of us stood in awkward silence until one of us said something like, “Well…no sale there!” We chuckled and went back to our conversation about how wonderful it would be to be able to educate patients about their conditions with these cameras.

Later, as I continued to explore technology and all its benefits, I would occasionally hear similar arguments from naysayers. Don’t get me wrong, everyone is entitled to an opinion. I may not agree with it, but they are certainly entitled to it. I think the mistake many naysayers make is in thinking that technology makes decisions. Nothing could be further from the truth.

New technologies allow us to gather more data. A radiograph offers information about interproximal structure and bone height, and we can use that data to inform treatment. How we arrive at a decision is based on the amount of data at our disposal. The more data available, the better our decisions tend to be.

We all know I love technology, but I would be the first to admit that we are drowning in an ocean of data. I haven’t seen any numbers on the subject, but I would love to know how much digital data is generated each day at an average practice. Then we could extrapolate how much data is generated in a year. I would bet that most of us would be stunned by the number.

The good thing is that all that data give us decision points about treatment. As I tell patients, the longer they are in my care, the better I become at providing definitive treatment. We all know that some people have rapid breakdown due to decay while others experience extremely slow breakdown under the same circumstances. All deserve tailor-made treatments based on their particular data points.

For example, let’s say an 80-year-old woman presents for recare. She has only 1 buccal pit restoration, which dates back 20 years. She has been a patient for 15 years, never misses an appointment, and her home care is meticulous. This time, there is a slight stick on the distal pit of tooth #30. Should an immediate restoration be recommended? In my opinion, no. But what if an 18-year-old man—who has missed many appointments over the past decade, whose home care is atrocious, and who has multiple 1- and 2-surface restorations—presents with the same problem? Should an immediate restoration be recommended? In my opinion, yes. The situations require different decisions because the relevant data are completely different.

As I said previously, the more data we have, the better we can be at making clinical decisions. But I don’t feel that is the case at present. In addition to accumulating data, we also need to take time into account. No matter how much data you have from an exam done right now, it gives you only a small snapshot of what is going on at this moment.

As most of you have probably read here before, my grandfather was something of a philosopher. One of my favorite sayings of his was, “Experience is what you get 5 seconds after you need it.” I don’t think truer words were ever spoken, and that brings me back to the idea of a data timeline. A timeline gives you information about a patient that is almost like experience. Knowing when to do something is almost as important as knowing how to do it. There is another old expression that I think applies here, “Don’t raise the bridge, lower the river.” So how could we do that?

I am confident that 2023 will be heralded as “the year of artificial intelligence in dentistry.” Even as you read this column, the practice where I work is installing Pearl. I took a good look at what was available in the AI space and decided that, with its many clearances from the Food and Drug Administration (FDA), it was the best option available. Pearl’s Second Opinion is the first real-time dental software that is FDA cleared to detect a variety of conditions and pathologies in dental radiographs.

I constantly tell my staff that the hardest thing I do every day is multitask. Ours is a 3-doctor practice with 4 chairs of hygiene running every day. It is sometimes possible to have 1 or 2 patients who need restorative procedures from me and 4 hygiene patients who need me to examine them and make oral health recommendations. Add to this the digital data that we are amassing on each patient, and the task of being in many places at once while incorporating that data into viable treatment plans. It’s a Herculean task. Despite the high expectations our patients have and the immense pressure we put on ourselves, doctors are still human. A doctor running behind on a busy day may miss something on a radiograph. Tired doctors with tired eyes may not be quite as sharp at the end of the day as they were first thing in the morning. Then there are times when we squint at a monitor trying to decide whether we truly see a shadow on an image.

One of the best things about a multidoctor practice is that you can ask a colleague for an opinion. Even better is a having a computer algorithm that analyzes the data. Computers don’t get tired, don’t get eye strain, don’t get distracted. They just analyze data constantly, consistently, and reliably.

Pearl’s Second Opinion looks for several pathologies on radiographs and marks those areas so that you can evaluate them yourself. This brings me back to the intraoral camera I mentioned at the beginning. Only a doctor can make a diagnosis. AI is good at spotting things for you to evaluate or to confirm something you’re not quite sure about. But only when a doctor decides to perform a treatment does the patient receive it.

The other thing about AI is that it provides an unemotional, objective second opinion. It may even suggest that you look at something you might have missed. I’d much rather be told to look at something more closely than to miss it altogether.

Something else I’d like to highlight is the real-time aspect of Second Opinion. When a radiograph appears on a monitor, the software analyzes it and overlays it with markers where it sees potential pathologies. When the doctor walks in for the exam, the images have already been analyzed, marked, and made ready for the doctor to evaluate. With a dual-monitor system, the patient has already seen the images and markings. This is the ultimate in codiagnosis.

Although current AI is nothing short of amazing, time and research are only going to make it better. What really excites me about the future of AI is its potential to generate an even more complete understanding of what we see. I envision a time when we will not only see the data of the patient in the chair, but also know how it relates to that of other patients. Imagine that you take a bitewing and the system tells you something along the lines of “this data has been compared to 813 patients from a similar demographic. In that analysis, the area was found to be carious in 89% of individuals.” Wouldn’t that be amazing? Even if you don’t have the benefit of having treated the patient for several years, you can still use the timeline of other, similar patients to improve your final decisions. In fact, a company called Diagnocat is doing some of that right now.

What I hope we will soon see are highly successful AI companies that can compare what you are seeing in your office against an extensive database of patients from other offices and share statistics in a way that helps everyone’s diagnosis. AI is also making amazing inroads into the digital design of prosthetics that will greatly simplify the in-office milling process.

AI and computer learning have been growing exponentially during the past decade. Many of us are not even aware that a lot of what we do with technology in our personal lives is powered by AI platforms.

Now, at long last, we are seeing breakthroughs in our profession being labeled as AI. When the end of next year comes around, I hope the profession declares 2023 “the year of AI in dentistry.” If that does happen, remember that you heard it here first! See you next month.

Digital data are plentiful in the dental practice, so it’s vital to know which are relevant where and how to use them to make the right decisions.

Making Dental Data Work Smarter, Not Harder

Top 5 plus 1 Test Drives of 2022

2022 has been an amazing year for new products. This year was one of my more difficult Top 5 Test Drives to write, simply because there were so many new products I was really impressed with. I think one of the best things about our profession is the almost constant pace of innovation. I think we are approaching an incredible “next phase” of our profession.

I think this next phase will build upon the constant growth of 3D in the profession. We can already merge digital impressions into CBCT data sets, and this will lead to a constantly updated 3D patient record. That will combine with the almost unfathomable abilities of AI platforms to create, not only being able to “hold a patient’s head in the palm of your hand” but to also be better informed with objective third-party data on potential pathologies. Imagine a patient with a large edentulous space. You are virtually treatment planning 2 implants and being told “occlusal forces are calculated to be X on 2 implants and Y on 3 implants,” which will allow you to treatment plan with a more favorable clinical outcome.

That scenario is much closer to reality than you might think. Buckle up. The ride is going to get much more exciting.

Chief Dental Editor and Technology Editor John Flucke, DDS, reviews his favorite dental product test drives of 2022, and shares what he is looking forward to in 2023. 

Top 5 (plus 1) Test Drives of 2022

As a general dentist who loves a good challenge, I absolutely love endodontics. Don’t get me wrong, I truly love all the procedures I get to do; however, endodontics is my favorite.

When you think about it, endo is one of the few medical procedures done almost exclusively by feel. Now I know microscopes can help. If you ever do a Google search on endodontics, the images that show up will often show the view seen through a microscope, and they are impressive. However, even with all the magnification we have available, there is no current technique that lets us truly see what we are doing.

That’s what makes endodontics so fascinating to me. Each case is unique and as such requires the doctor to have a “feel” for the case and the instrumentation. Performing endodontic therapy is like a puzzle, and it is so much fun to decipher the canal anatomy every time. Our choice of instrumentation is so important, which is why I’m excited to let you know about a product test drive I recently completed on the Channels® Flex line of endodontic instruments, which are exclusively available by Henry Schein.

Anytime I evaluate endodontic files, I bench test them first. I have a big supply of acrylic practice blocks, and I like to use them to push files to their limits and see what it takes to make a mistake. I’d much rather discover file limitations in an acrylic block than a patient’s first molar. What I have discovered in both acrylic blocks and patient procedures is that the Channels® Flex files perform very well.

The files come in 2 taper choices: .04 and .06. In most cases, I have found that is all that is needed. They are made of industry-leading nickel titanium. Nitinol, as it is known in metallurgy, is an amazing metal that was originally discovered in 1959 at the Naval Ordnance Laboratory as part of research into making better missile nose cones. When someone tells you these endodontic files are “space age,” they mean it. Interestingly, the technology to easily manufacture the material was not developed until the 1980s.

The flute design and taper of a rotary file have a distinct effect on how a file handles the confined spaces of the canal system. And in my hands, the Channels® Flex instruments have exhibited superior strength and an amazing amount of flexibility.

There is a Zen quality to correct endodontic instrumentation. The doctor needs files that cut efficiently but are not overly aggressive, along with files that are flexible but resistant to fracture. No one, doctor or patient, wants root canals to take longer; however, files that work quickly can’t remove too much tooth structure or they will be weakening the tooth in the process of treating. I felt the Channels® Flex files were correctly located in the “Goldilocks zone” of being just right.

When testing on acrylic blocks, I like to really force a file to see whether I can find its weaknesses. And I am happy to say that, despite my best efforts at trying to do so, not 1 file broke. This is a tremendous testament to the strength and durability of these instruments. One of the cardinal rules of endodontic instrumentation is to never force a file. However, during testing, that is exactly what I do to understand just how much abuse a file can take before a catastrophic failure occurs. I’m not saying these files won’t break, but I am saying you must try to do so.

One of the great things about the flexibility of these files is that they allow you to navigate a canal’s natural shape without concerns for bounce back, which is common with some other systems on the market. The company claims the files can negotiate 90º curves, and although I did not have the opportunity to see that firsthand, my experience has given me no reason to doubt those claims.

The .04 taper is available in sizes 15 to 60, and the .06 taper is available in sizes 15 to 50. They are also color coded to match the colors of ISO hand files to make them easily identifiable and easy to sequence. The taper is easy to determine by stripes on the instrument handle. Two stripes indicate .04 taper, and 3 stripes indicate .06 taper.

In my opinion, one of the best developments we’ve seen in obturation in the past few years is the creation of precisely molded gutta-percha cones that correspond to file diameter and taper. Channels® Flex files take advantage of this enhanced manufacturing technique to supply their corresponding gutta-percha points that are created to fit perfectly into the canal after instrumentation. There are also perfectly sized paper points to use.

The Channels® Flex files performed very well in my hands. They were easy to use, negotiated tricky canal anatomy reliably, and removed dentin efficiently without being overly aggressive. I liked that these files were designed to help the doctor successfully instrument most cases without forcing the user to learn an entirely new instrumentation technique. After my normal bench testing, I began clinical implementation with no concerns about how the files would perform.

As a general dentist who performs a lot of endodontic treatments, I’ve found the Channels® Flex complete line of files, paper points, and gutta-percha points to be easy and reliable to use. If you are looking for a way to improve your endodontic outcomes or to just make the procedure easier, you must check them out. They are available to order from Henry Schein.

[Sponsored] Find out what John Flucke, DDS thinks of the Channels® Flex endodontic files from Henry Schein.

Test Drive: This New Endo File System Is Ready for Any Challenge a Root Canal May Present

Let’s start this month’s column with a walk down memory lane. Do you remember the Sony Memory Stick? I’m not talking about a USB flash drive, which some people refer to as a memory stick. No, I’m talking about the Memory Stick that was made by Sony. If you weren’t like me, geeking out over all things techy in the very early 2000s, you probably have no idea what I’m talking about.

Back then, there were only a couple of types of portable flash memory cards. One was CF cards. They were about the size of a book of matches. And then there was the sleek Sony Memory Stick, which was thin, purple, and the size of a stick of gum.

Being an electronics company, Sony was hoping to corner the market on flash memory by making the Memory Stick the de facto standard. They made lots of electronics that utilized the Memory Stick. In fact, I still have an old 3.2-megapixel pocket camera with a Memory Stick slot.

Sony was hoping that if all of their high-end electronics only used Memory Sticks, that would lock users into buying lots of them. Alas, by the end of the decade competitors chose to use CF cards or the smaller SD cards that were made by a variety of manufacturers. Sony soon discovered that consumers wanted cards they could use in multiple devices, not 1 type for their Sony devices and something else for other electronics. So, the Memory Stick never really took off.

Today we buy memory cards and don’t really think about it. You buy a card and put it in the appropriate slot in your device and it just works. The cards are device agnostic, not caring what device they are inserted into. And that, my friends, is the gist of open architecture—hardware that connects and works with other hardware regardless of the manufacturer.

In the early days of in-office milling, doctors had 2 options. There was CEREC and their competitor, E4D. Both systems sold an intraoral scanner, sometimes called an acquisition unit, and a mill. The scanner had design software built into it. The doctor would create a digital impression, design the restoration, and then send the restoration to the milling unit.

If you were a doctor who wanted to do in-house restorations, you had to buy one of those systems in their entirety. The good news was that the system worked. Since it was all created by a single company, you knew that everything communicated, and you had an efficient workflow. The main barriers were the cost of the systems and deciding which one to purchase. Both systems were sold exclusively through dealers. Patterson sold CEREC and Henry Schein sold E4D. Some doctors were hesitant about spending a large amount of money with a dealer that they didn’t buy from regularly.

The cost factor was significant. Both systems were more than $100,000, and there were rarely such things as discounts or deals. Doctors who invested in these systems needed to do a decent number of restorations every month to make sure their costs were covered. Some doctors didn’t like the idea of the need to stain and glaze restorations that were in the esthetic zone. For those doctors, these devices were posterior-only, and many chose not to invest in a machine with those limitations.

In the early 2000s I had a meeting with some of the folks from Sirona. At that meeting, internet connections were still mainly dial up. I suggested they build a modem into the system to allow the doctor to send the digital data to a lab. The lab could take the data, create a restoration, and then send the case to the doctor. I told them I could see a real market developing for digital impressions. In response I was told that the system was designed for same-day dentistry and that I just “didn’t get it.” I wish I had patented that idea.

I invested in a CEREC 2 unit from Sirona in the late 1990s. This was followed by a trade-in and upgrade to a CEREC 3, which was later upgraded to a CEREC 3D system. Although the upgrades worked and the system continued to improve, the upgrades were very costly. I got a little burned out by what I started calling “the upgrade treadmill.” I began to feel that as soon as I paid for an upgrade, I needed to start putting significant dollars in the budget for the next upgrade. Right or not, I grew tired of spending 10s of thousands of dollars to keep up. There was also the threat of obsolescence as companies would remind you that without upgrades you were soon out of luck with support.

That is one of the drawbacks to working with any closed system, not just with CAD/CAM. When any consumer is beholden to a single manufacturer there is the inherent temptation for the company to overcharge and underdeliver. This is not an indictment of the companies I’ve mentioned here. It is a fairly common occurrence in any business endeavor. Humans are humans and can be expected to act accordingly, especially when large amounts of money are involved.

As my CEREC 3D aged, I began to phase same-day restorations out of my practice. I was a doctor who still was using a lab in addition to CAD/CAM, so my lab cases increased.

I wasn’t out of the game for long. I still believed in CAD/CAM, and in doing many cases in house. At the 2006 American Dental Association meeting in Las Vegas, Nevada, as I wandered the aisles of the exhibit hall looking for new and exciting things to write and lecture about, I came across a small booth for Cadent, a company selling a digital impression system called iTero.

The device brought to life my idea of doing impressions digitally, but then sending the digital info to your lab and letting the technician create the prosthesis. Shortly after meeting the folks from Cadent, I had an iTero 1.0 system in my office. It wasn’t long before my team got really good at digital impressions. The iTero was built on a platform of open architecture, which I was thrilled about.

Open architecture means hardware and/or software that connects to hardware/software from other manufacturers. Closed systems work only with other components from that system, whereas open systems will work no matter who the manufacturer is.

Here is a great example of what this all means for dentistry. Not too long after mastering the iTero, I was contacted by a company that was developing a mill for dental offices. They wanted to know if I would be interested in testing their device that was in beta.

When the mill arrived, we installed it, powered it on, and were ready to go. We scanned a case with our iTero, exported the file to a jump drive, and then put the jump drive into a computer that contained the mill’s design software. That design software opened the iTero file, and there was the digital impression on the screen in all its glory.

We quickly designed the case and sent it to the mill. Everything connected and everything worked. It was as though we had been doing that for years, only it had happened in less than an hour.

And that, my friends, is the essence of open architecture.

Recently, the team and I decided to get back into milling restorations in-house. I knew there were some materials on the horizon that would offer a lot of advantages, and I felt we had a decent grip on things.

The joy of open architecture is that you can pick what you want and make it work the way you want. Your choices are not dictated by a manufacturer that holds you to a specific model.

As we moved forward, we were already using 2 different iTero models in our office. Every member of the clinical team, including hygienists, could pick one up and use it immediately. We then looked at design software platforms. We didn’t need to worry about whether it would interface with our iTero—all digital impression systems create their files in a standard format that can be read by any design software on the market. Because of that, we explored ease of use, cost, support, etc., for different companies’ products. We settled on exocad because it did what we wanted it to. It was our choice and no one else’s.

We then began to evaluate mills. Once again, we were not limited by what would work with exocad. The design software outputs to a standard file format that can be used by any mill on the market. After doing our due diligence on mills, we selected the DGShape DWX-42W. Our choice was based on the needs of our office. There are lots of mills on the market. As with cars, there is no 1 model that is perfect for every customer.

Today, even formerly closed systems are now open architecture. The market spoke, and every company that I’m aware of moved in that direction. This is great news. Now you can pick and choose what best fits your office and its unique workflows and patient base.

This also means that if you buy a digital impression system today and in 2 years a better one comes along from another source, you can sell your current one and buy the new one. All the pieces of this workflow—impression scanner, design software, and mill—are interchangeable now.

You can arrange and rearrange these parts as you see fit. The workflow is custom tailored to your exact fit. In the not-too-distant future I’ll be writing a more detailed column about my journey. For now, though, remember that in-office milling is ready for primetime, and it will continue to evolve and get even better. However, since you can replace the parts whenever you like, the time to get involved with this is right now.

Oh, and did I mention that all that design output also goes to my SprintRay Pro 3D printer? That’s right, I have the option to mill or print things. That brings even more of this control into my office. That means it’s not just same-day crowns, it is same-day occlusal guards, study models, surgical guides, and anything else you can print.

This facet of our profession is exploding right now, and the biggest reason is open architecture. Embrace the change!

The market has moved toward open architecture CAD/CAM, but the industry did not always operate that way. 

Open Architecture and the Journey to CAD/CAM

When I was young, my grandfather’s office had a sign with a quote from English philosopher John Ruskin: “It’s unwise to pay too much, but it’s worse to pay too little. When you pay too much, you lose a little money—that is all. When you pay too little, you sometimes lose everything, because the thing you bought was incapable of doing the thing it was bought to do.”

That quote has stuck with me for my entire life. My grandfather, like John Ruskin, was a bit of a philosopher as well as a small business owner. He knew how to run a successful business. He taught me a lot, and I am frequently amazed at how much of his advice I apply to my own small business daily. Dentistry is a profession that requires precise and durable equipment, but as we all know, that equipment comes with a price tag. This even applies to your hygiene department.

When viewed from the perspective of the patient, the hygiene department is the practice’s gateway to clinical dentistry. For most patients, they spend more time with members of the hygiene team than they do with the doctor. You simply cannot understate the importance of the patient experience with the hygiene team. If a new patient with minimal restorative needs comes to a practice, their patient experience is principally linked to what they experience at their semiannual cleanings. They develop a relationship with their hygienist and that relationship leads to trust.

The trust factor is huge when it comes to clinical restorative diagnoses. When a patient builds a relationship with the hygienist, they are much more likely to follow treatment recommendations. That’s why codiagnosis between the doctor, the hygienist, and the patient is so important. Trust is not only built from the time the patient and hygienist spend together, but also from what the patient experiences during that time.

A patient approaches their hygiene visit with certain expectations, which may include getting questions answered, having concerns or fears allayed, and having a comfortable experience. However, for many patients, their No. 1 concern is leaving that visit with the wonderful feeling of their teeth and mouth being clean and fresh.

A large part of that hygiene experience comes from the ultrasonic scaler. As anyone who practices clinical dentistry can attest, the profession takes its toll on the human body. The art and science of performing quality prophylaxis is responsible for repetitive stress injuries to the hands, wrists, and fingers, which is why a quality ultrasonic scaler is one of the best purchases a doctor can make for the hygiene department. The hygienist benefits because they put less stress on their upper extremities, and the patient benefits because the ultrasonic scaler is more efficient, induces less sensitivity, and the energy helps lyse the cell wall of pathogens.

Ultrasonic scalers are valuable pieces of the hygiene armamentarium; however, they come with a price. That’s when John Ruskin comes to the rescue. It is unwise to pay too much, so how about paying less and getting all the quality you want and need? That is what my team has experienced as we have worked with the TurboSensor®+ Ultrasonic Scaler from Parkell.

I’ll gladly admit I have a penchant for top-of-the-line hardware, which transfers over to my purchases for the hygiene team. We’ve used the most expensive ultrasonic scalers on the market, and the team has been happy with them. However, they also understand me pretty well, and they know that if I get a chance to try something out, we are going to do that. So, we brought in the TurboSensor+ Ultrasonic Scaler and put it through its paces.

I have 6 hygienists on staff, and they have tons of experience. Many of them have been practicing for over 20 years, whereas my least experienced team member graduated in 2016. My point is that these women have seen and done it all. They also understand that when I am testing products, I need honest and critical answers.

One of the nice things about the TurboSensor+ is its small size. This unit will not require you to sacrifice a lot of your counter space. Its small size also means it is easy to move. For a doctor on a budget, that means transferring the unit from one room to another is simple, so you can buy 1, then purchase more as the need arises. For my team, it meant we could easily move it to give every hygienist ample time to use and experiment with it—and use it they did!

The unit is impressive. Designed for use with 30 KHz tips, it is compatible with inserts from all major manufacturers. The device features a new IntelliSense™ processor that delivers consistent performance with any 30 KHz tip.

The detachable handpieces are autoclavable, which eliminates the need for sleeves and allows the entire handpiece to be sterilized. The handpieces have held up well throughout cycle upon cycle in our autoclaves, and the quick-lock connector makes it simple to attach and detach them from the unit. Their texture allows for a good grip and tactile feedback, which has also remained throughout our testing range.

The TurboSensor+ also makes purging of the unit simple and efficient with safeguards that help prioritize infection control best practices. The unit will not start purging unless the handpiece is disconnected in order to make sure a sterilized handpiece isn’t contaminated during the purge. The entire process can be started and controlled with the foot pedal as well.

One of the handiest features is the quick, easy jump to turbo mode. It is not uncommon during treatment for the operator to come across an area with particularly tenacious calculus. For those instances, rather than stopping and performing manual adjustment of the power settings, the device allows the operator to do a hard press of the rheostat, which ramps up the power to turbo mode. This not only makes treatment easier but also makes the operator more efficient. The hard press feature allows the hygienist to keep their eyes on the target, which is better for everyone. Looking away, making the necessary power adjustment, getting repositioned to the treatment site, removing the tenacious calculus, then repeating the process in reverse is inefficient and time-consuming. No one wants a dental appointment to last longer than necessary.

During standard procedures, the unit allows for full customization of the power to the tip, as well as the water delivery. This allows the hygienist to get things dialed in to their favorite and desired parameters while providing the patient with a comfortable appointment.

The other highly desirable feature is, of course, the price. As a company, Parkell has existed since 1948—and a business doesn’t survive that long unless it does things the right way. Dentistry is a close-knit community in both the clinical and business sides of the industry. The profession demands quality goods for the benefit of our patients. Parkell has developed a reputation of not only quality goods but also of delivering that quality at a very reasonable price. The TurboSensor+ Ultrasonic Scaler is just another example of that. The company initially brought their line of ultrasonic scalers to the market in 2003. This line of products has a long history of innovation and dependability. In my office, we expect a lot from an ultrasonic scaler, and the TurboSensor+ unit has delivered. My team loves it, and I’m confident yours will, as well.

[SPONSORED] In this Test Drive, John Flucke, DDS, shares the experience he and his team had using the latest ultrasonic scaler from Parkell.

Test Drive: This Affordable Ultrasonic Unit Offers High-End Performance, Features 

As a technology lover and former psychology major, I have always been fascinated by what technology can do for us but also why we accept or reject things with the potential to change our world. History is full of examples of individuals who rejected new ideas and discoveries. One of my favorites is a quote from Alfred Loomis, MD, an accomplished clinician and luminary in medical education who served as president of the New York Academy of Medicine and the Association of American Physicians in the late 1800s.

The story goes that in 1882, Dr Loomis was told about Robert Koch’s discovery of tubercle bacillus as the cause of tuberculosis. A few days later, Dr Loomis was giving a lecture when he stated, to the delight and laughter of the students present, “People say there are bacteria in the air, but I cannot see them.”

Dr Loomis’ belief system was too strong to allow him to see the truth. This happens often in business, too. In the early days of computing, Ken Olsen, the CEO of Digital Equipment Corporation (DEC), told colleagues, “There is no reason anyone would want a computer in their home.” DEC made mainframe computers that were, at their smallest, the size of a refrigerator. A couple decades later, his company was bought by home computer manufacturer Compaq. Olsen was so entrenched in his world of giant computers that he was blind to the concept of smaller ones.

My point is even experts make mistakes regarding the future. If that mistake is made by a business, it can be the end of the business. This is especially true for a company comfortably entrenched in an industry, which brings me to the point of this column.

Whip Mix Corporation began back in 1919. The name comes from a machine they licensed from a dentist that easily and consistently mixed water and gypsum investment powder into the perfect consistency to pour around a wax pattern. That means Whip Mix has been involved in making cutting-edge products to make the creation of fixed dental prosthetics easier since 1919. That is an amazing and admirable mission!

Back when Whip Mix was founded, the lost-wax technique was the common fabrication method for gold prosthetics. The technique still works and is used today, but the profession has evolved. The use of nonesthetic materials such as gold has decreased significantly, and the need to mix investment material decreased with it.

I mentioned resistance to change because it is a common occurrence. A company develops something amazing and new, and the once tiny company has amazing success. However, instead of scanning the horizon for new and better things, the now large company, spends huge amounts of energy and capital to maintain the status quo.

Whip Mix did not do that. They embraced the future and kept on the cutting edge. As Technology Evangelist, I salute them! The company saw the market and profession changing and changed right along with it.

In the past 10 years, dentistry has made an evolutionary jump into the world of 3D. We are now seeing the incorporation of 3D impression/acquisition units (which some call scanners) and the pairing of those devices with 3D printers. This allows offices to print models, surgical guides, occlusal guards, dentures, orthodontic aligners, and even permanent crowns. This market is exploding with potential.

Doctors in today’s high-tech practices are working on ways to develop the best digital workflows. The snag is they only have a deep understanding of half the process. They know dental impressions, and this familiarity helps in choosing the 3D impression system that best fits an office. However, 3D printing is unknown to many doctors. Left to find their own answers, doctors must often work with new and unfamiliar companies because many 3D printer manufacturers are newer brands in the dental industry.

The other piece of expanding an office’s hardware footprint is the concept of compatibility. As a diehard technology lover, I am passionate about the concept of open architecture software and the interoperability that comes with it. Basically, it means every scanner will output to a file type that can be used by every 3D printer. It’s a great concept for mixing and matching hardware, but it also means a doctor has to be absolutely sure of their purchasing decisions.

There are many snags that can pop up that you don’t think about until you use a piece of hardware. As my grandfather used to say, “Son, experience is what you get 5 minutes after you needed it in the first place.”

Enter Whip Mix with their VeriONE line of digital workflow products. Combined they present a turnkey 3D concept I truly love. The company offers the full range of 3Shape TRIOS intraoral scanners, VeriEKO 3D printer, VeriLUX 3D model-curing station, and the VeriWHIRL 3D model-washing/processing station, which can all be purchased together.

3D in dentistry is moving past the early adopter phase. Doctors do not want to spend valuable time figuring out technology. They want to buy it and use it. That is what Whip Mix delivers.

The company allows the doctor to purchase with confidence. Whip Mix has looked at its product line from every angle. Not only does the doctor get state-of-the-art hardware but also state-of-the-art software as well. As an authorized dealer for 3Shape, Whip Mix gives the doctor access to this incredible design platform. But it goes 1 step further than that. If the office sees the benefits of 3D printing but doesn’t want to do their own design?, 3Shape offers their own offsite design services that create necessary files and email them to be printed with office hardware. Problem solved!

The mind trust at Whip Mix analyzed the industry, saw the changes coming, and looked at the solutions for how offices could integrate these amazing technologies. They then took it 1 step further and said, “Where are the potential problems?” They identified those problems and built solutions into their turnkey system.

An established company could have easily pointed out the risks of change and encouraged doctors to stay with the status quo. That is what many companies do. Instead, Whip Mix saw the future, saw the benefits, and embraced them. They went the extra step to make their customers’ experience less stressful.

I am impressed with Whip Mix and the system they designed for predictable digital dentistry. Doctors can now buy digital solutions from a company with more than 100 years of experience. Whip Mix began as a company of 4 brothers who worked together and saw the future. Today the company still maintains a culture of seeing and embracing the future.

If you want to reap the benefits of digital workflows, bring Whip Mix into your practice. They have done the hard work for you, and this means you can enjoy digital workflows while knowing you have a partner who has done everything to ensure your success. My time and experience working with their products has made me a strong believer in Whip Mix. I am confident you can benefit from their efforts as much as I have.

[SPONSORED] John Flucke, DDS, shares his impression of the new turnkey chairside 3D printing solution from Whip Mix.

Test Drive: Embracing a Changing Industry, Whip Mix’s VeriONE Turnkey Digital Solution Makes 3D Printing Accessible to Any Dental Practice

I’ve been doing this technology thing for quite a while now. I consider myself lucky to have been practicing when computers got a toehold into the industry. I managed to catch the wave just as it started to swell, and I have been riding that wave ever since. One of the better things my history in technology has given me is perspective. When I started with tech, older colleagues teased me about how I’d survive “when the computer quits working.” I would just smile and say, “There are ways around that,” and leave it at that.

The early days of the tech influx saw new, amazing high-tech devices come to dentistry, even before the computer became commonplace. The original intraoral cameras were on carts that were wheeled in when needed and connected to big electronic boxes that converted the camera signal into something readable, then that box was connected to a big monitor to display the image.

There was no way to save the images. You just showed the picture to the patient, then went on about treatment. You could print them if you desired, but that required expensive photo paper, and you had to then put the photos into a paper chart. It wasn’t worth the hassle.

Early digital radiography was a tad more sophisticated. It still required a cart, but at least it used a laptop. You could store the images in a digital patient file for later retrieval, but the process and the sensors were bulky. Plus, when you wanted to see the radiographs, you had to get the laptop and then open the files.

Suddenly the computer became the hub of the tech wheel, whereas the intraoral camera and the digital x-ray sensor became the spokes. The operatory computer was where everything connected. Suddenly and efficiency surged when we didn’t have all these separate pieces that we brought in to use.

A History Lesson: Cloudy With a Chance of Electrons

In 1982, a young and bright 28-year-old, Scott McNealy, helped found a company called Sun Microsystems. His statement in 1982 was: “The Network is the Computer.” We are now seeing this statement proven out time and time again.

The reason I bring this up is because, when translated to today’s environment, what he really meant was: “The Cloud is the Computer.” As a profession, we are already turning a large amount of our practice data over to the cloud, and that is only going to increase. Thanks to a near ubiquitous penetration of broadband internet, we are moving data around the planet like Marilyn Monroe’s skirt over a subway grate.

The computer in the operatory is not going away anytime soon, but it will function more and more as a gateway for the operatory to access information that all our connected devices will store.

The next big jump we will see is cloud storage of imaging, including our cone beam computed tomography data. Companies are putting the finishing touches on a single access point for extraoral photos, intraoral photos, intraoral radiographs, and cone beam.

Now let’s think about the Internet of Things (IoT) for a bit. Think of things like Ring doorbells, Nest thermostats, garage door openers, and, of course, the Amazon Echo that brings Alexa into your life. All the types of things that are connected and make your life easier without being connected to your computer. In most instances, the first time you plug them in, they ask you for your Wi-Fi username and password, and that’s it. They will automatically connect to your network, then they sit there in the background.

The biggest reason we haven’t seen tons of IoT in our offices yet is that we don’t often have to change our equipment. Sure, you might have an IoT thermostat currently, but that is a low-dollar item. I am talking about chairs, dental units, autoclaves, and the expensive things we use every day. We don’t often replace them, but as we do, you’ll see many devices that want to connect.

One of the first devices I saw with this ability is my SciCan STATIM 2000 G4 cassette autoclave. I purchased the device a couple years ago and was able to connect it to my network. It sends emails to me about every cycle it runs and warns me and my equipment support team at Goetze Dental if there is a problem.

Then there is Planmeca’s Romexis system. This software connects every piece of Planmeca equipment in the office and does cloud image storage that I mentioned above—all in 1 system.

Imagine devices that notify service when they break down or, better yet, 

they break down. It costs a lot of money to equip a service van from your equipment repair team. I’ve been told each van can cost a company well over $100,000 because they are full of the most needed parts, but they don’t carry every part. Often, a tech comes to the office, diagnoses the problem, then needs to go pick up the necessary part (or, heaven forbid, needs to order it). Until the repair is completed, an office is not functioning at peak efficiency. IoT technology will allow a device to contact service and say, “I need part XYZ or I will not work in X number of hours” or “I need part XYZ, and I am broken and not functioning.” Either scenario allows your service team to bring the necessary part on the first trip and minimize your downtime. Doesn’t that sound amazing? It is!

Being so dependent on things outside our control is scary for a lot of us. Dentists are almost all strictly type A personalities, and we love control. Some of the things we are going to deal with are going to be difficult for some of us, whereas some of these have things that need to be worked out.

Ransomware is a huge problem, and I don’t have the solution. The criminals that run those groups are well aware of what targets can be hit to maximize the chances that a target will pay. I often wonder what would happen if one of these groups knocked a digital impression system offline. Sure, we could all start using impression material, but that would create major problems for the industry. What if someone took a cloud imaging platform down? What if there were no radiographs for a certain percentage of dental offices? That would be a disaster for the industry.

In the past year or two, we have seen a lot of healthcare systems get hit with this problem. The crooks know hospitals need to run, which puts a tremendous amount of pressure on hospitals to pay to get access to their data. We’ve also seen a few dental systems get hit with this. One of the largest was when ransomware compromised a dental information technology company, then used that company’s access to their clients to freeze the clients.

Dental companies that are providing things like practice management and image storage need to put security at a premium. Every company I’ve spoken with has assured me they are locking things as tightly as they can, but there is always room for improvement. There are HIPAA requirements, but it’s also just the right thing to do both ethically and for the good of our businesses. Ransomware had been around for a very long time, and it’s not going away anytime soon.

There is also the problem of the connection itself. If your business is going to rely on offsite services, will you be able to go offsite? We recently lost our internet connection for 2 hours and our VoIP phones went down.

My office is still running a server, so our data were accessible, and our VoIP provider was able to quickly route our phone lines over to our cell phones, so the problem was minimized. I was lucky. If I was running cloud-based practice management or image management, we’d have been in a much deeper hole. Even with digital impressions, our scanners just queued up the scans, then sent them out when the connection came back, but it could have been a lot worse. Even though the internet in my office is not mission-critical to every operation, it soon will be, which means we must have connections and vendors we can rely on.

We are all becoming so dependent on our digital tools that in the very near future, losing 1 (or the connection to them all) will mean everything will come to a screeching halt. This also means these services and the internet connection that powers them must be as reliable as our other utilities like electricity. Things are incredibly more stable and reliable than in the past, but they need to be even more so.

As anyone who knows me will tell you, I’m bullish on technology. The problems I’ve discussed here aren’t problems we all deal with every day, but that doesn’t mean we can ignore them. In the past year or two, we have seen what can happen when a

Cloud-based software is the way of the future for dental practices, but what implications does that have on the evolution of technology in the industry?