Damon Adams, DDS, editor-in-chief of Dentistry Today, speaks with Gary Kaye, DDS, MS, about how he got started in digital dentistry and briefly discusses, from Dr. Kaye’s own experience, some key points related to building a successful digitally based practice.
When did you start your involvement with digital dentistry?
Dr. Kaye: I first started on my journey in digital dentistry in 2001, when I acquired a CEREC 3D chairside CAD/CAM system (Dentsply Sirona) for my office.
What originally sparked your interest in technology and, specifically, digital dentistry?
Dr. Kaye: Prior to attending dental school, I had spent time in the medical technology industry working with ultrasonic imaging and early surgical laser devices. Within a few years of graduating from the Columbia College of Dental Medicine in 1993, I was able to observe one of the early CEREC machines in clinical use. I went to observe—over the shoulder—a single-visit ceramic inlay being designed, manufactured, and delivered to the patient. I was fascinated that everything we had learned to do by hand to create a restoration could be done by a machine. The procedure took more than a few hours, and the resulting restoration required a good amount of adjustment by hand at that time. I was amazed by the technology and immediately realized what the limitations were. At this stage of the development in this technology, the restoration was, in my opinion, sub-optimal. But I understood from seeing the all-around progress in technology that this would translate to a different way of practicing dentistry, and I knew that it would be just a matter of time until this is how dentistry is practiced.
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At this time in my life, I had the benefit of being at the beginning of my career as a practicing dentist. As many of us do, I invested heavily in postdoctoral education and made it a priority to become a better dentist. As I evolved over the years, so did the technology. I’ve been fortunate that these 2 paths have run parallel, and, through my involvement in the digitization of dentistry, I am proud to have played even a small part in changing how the profession of dentistry is practiced.
At the outset, what strategies and which concepts interested you the most? Has that changed over the years as you’ve expanded your role in digital dentistry?
Dr. Kaye: Prior to attending dental school, I had seen technologies in medicine improve the diagnostic and therapeutic capabilities for both doctors and patients. On the diagnostic side, I had been involved in the early ultrasound imaging devices and in surgical laser technology. Coming straight from that environment, it was natural for me to think about how technology could be used in dentistry. In dental school, I explored how ultrasonic imaging could be used to measure periodontal bone loss. I also understood the challenges of taking an idea or concept and creating a viable, functionally useful product from it. Over the years I have—and continue to—worked with innovative companies in developing and refining their products. So the concept of taking advantage of technological innovations in clinical practice has always been the key for me. In particular, restorative digital dentistry seemed to me a logical progression of where the technology was going.
Since you took such an early interest in the emerging field, what were the primary limitations you encountered? You mentioned the viability and functionality of the budding digital dental technology. Could you expand on that?
Dr. Kaye: The challenges seemed to be focused primarily around the design (CAD) and manufacturing (CAM) of the restorations. The image capture or scanning process was restricted to just a few teeth—a quadrant at best—and the process was very technique-sensitive, requiring a thin layer of contrast medium on the teeth, often in the form of a powder. Since then, technology has advanced to the point that a full arch can now be scanned in about 1 to 2 minutes. In addition, the capture of the patient’s occlusion—the bite record—can be done very efficiently and with great precision. Next, there have been exciting advances in dental materials. The earlier all-ceramics, while useful in the development of CAD/CAM, lacked the appropriate properties for widespread use. It took some time, but now there are many options to choose from, including the highly touted lithium disilicate and zirconia materials.
As the years have passed, and those advancements have been made, how has your thinking about digital dentistry changed?
Dr. Kaye: At the outset, the technology was for single-tooth restorations done at the chair. As things continued to advance, we were eventually able to do multiple restorations with a single intraoral scan. As new materials became available, it expanded the kind of restorations that could be done. Once we are able to scan the dentition and send those virtual models to a laboratory team, it became apparent to me (and many others) that physical impressions would be giving way to digital scans, just like radiographic film gave way to digital radiographic sensors. And now I can’t imagine practicing any other way!
With all of these changes happening at such a rapid pace, has there been any noticeable impact on your patients? Do they accept or reject digital dentistry from your point of view?
Dr. Kaye: In general, I have noticed that our patients have accepted the technology. Many of them, particularly those who have grown up with high-speed computers and smartphones, tend to equate new technology with cleanliness and competency. It actually helps to put them more at ease seeing some of the things that we can do with intraoral scanning and 3-D capture technology.
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What about your team? Has the evolution of digital dentistry posed any challenges from an organizational standpoint?
Dr. Kaye: Introducing new technology to the team often takes them out of their comfort zones, so I found resistance in the beginning. The way we got over that hurdle was to include the team in the buying and implementation discussions and decisions involving any new technology. Now, any time we look at a new piece of technology, we have the team involved in the research and justification to add it to the process. It makes a noticeable difference in morale and allows everyone to be included in the development and growth of the practice.
Were there any specific challenges that you found yourself confronting when adopting new technologies? If so, how did you manage to get through them?
Dr. Kaye: When I started, my goal was to do certain restorations in a single visit. I had to adapt the workflow to match that strategy. Appointments took longer, but there were fewer of them. Initially, I was the only one who could operate and maintain the equipment in my office. The efficiency that I gained from the technology was lost because I was doing tasks that did not require my expertise and training as a dentist. In addition, while the restoration was being designed or fabricated, the patients would have to sit and wait. Once I realized this, I started to train my auxiliary team members to understand the process from start to finish. That allowed us to approach the workflow in a more measured way and really take advantage of a proper routine. Also, and importantly, I could once again use my diagnostic expertise and clinical skills where they were needed most.
Given that you’ve gone through the technology adoption process numerous times, would you say that it’s important to think about the service and support available from the manufacturer?
Dr. Kaye: Yes, absolutely! I believe that this is one of the most overlooked aspects when dentists make buying decisions related to equipment, especially in the realm of digital dentistry. Focusing on pricing and features is obviously important, but considering the need for support after the purchase should never be overlooked. It should count for more in a buying decision than many clinicians realize. Scanners, mills, printers, and imaging devices are all run by very sophisticated computers, even though the user may only see a relatively straightforward interface. Such high levels of technology require professional, specialized experts, and, in the dental office setting, any fixes have to be done very promptly. The nightmare scenario of having a patient in the chair and a vital piece of technology shut down is one that we can all understand, so having the proper support to minimize downtime is absolutely vital. The best manufacturers provide the most expedient service and support to get us back up and running. Doing homework to figure out which purchases come with the best support is well worth the investment and the time. Consulting with experts, colleagues who have experience with different systems, and dental laboratory owners who work with different scanners and mills can be invaluable when adopting new technologies.
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How did digital dentistry relate to the mission and values of your practice?
Dr. Kaye: Digital dentistry allows us to provide better care for our patients, which is in direct alignment with our primary mission and our core values. Our patients are the center of everything that we do, and, if we can see to them more accurately, more efficiently, and with less discomfort—then we have met our biggest goals. Overall, digital technologies make us much more efficient, whether through shorter treatment times, fewer remakes, or better-fitting restorations. We all tend to think of efficiency as a benefit to the clinician and practice, but the real beneficiary is the patient. Improving the patient experience is what we are always trying to achieve!
Do you think digital dentistry enables better functional and aesthetic results?
Dr. Kaye: There’s no question. In my practice, the whole digital restorative revolution has made my job easier when it comes to restoring form and function to our patients. The technology allows us to visualize the restorative outcomes before anything is even tried into the patient’s mouth. This has led to much more predictable outcomes, and it improves our ability to deliver better functional and aesthetic results.
Do you think that one ever stops learning when on the digital dentistry path?
Dr. Kaye: No, never! And that is what makes it so exciting! Technologies, materials, and science are advancing so rapidly that we are compelled to stay updated and find a way to implement relevant technologies into our practices. This holds true to dentistry in general. We were taught in dental school that our degrees were just the beginning of a lifelong commitment to learning, and this is just a facet of that now.
So, what do you see as the future of digital dentistry?
Dr. Kaye: I believe that more dentists will adopt the technology as companies continue to innovate and work on driving costs down with improved functionality. Cost has been a barrier to adoption for many practitioners. Dental schools, while slow to adopt some of the new advances, are starting to include them in their curricula. This will give the graduates the skills to enter into practice, where the technology is much more ubiquitous. Digital dentistry has improved immensely over the past 2 decades, and it continues to change the ways that dentists and lab teams collaborate. Ultimately, as digital dentistry takes hold, I think that it will allow clinicians to further leverage technology to improve efficiency and provide better patient outcomes.
Thanks for taking the time, Gary, to share your experience and expertise with us! And congratulations on now being Dentistry Today’s digital dentistry editor! I, and my editorial team, look forward to working with you!
Dr. Kaye graduated from the Columbia University School of Dental Medicine, where he received awards in endodontics, prosthodontics, and geriatric dentistry. He has practiced comprehensive dentistry since 1993 and has built successful multispecialty group practices in and around New York. He is a graduate of the Dawson Academy of Comprehensive Dentistry and has published and lectured on ceramics, occlusion, and the adoption of digital dentistry. He consults with dentists, dental schools, and manufacturers on all aspects of digital dentistry. He can be reached at drgarykaye@nycdd.org.
Disclosure: Dr. Kaye is a founding member of Biodental Sciences Laboratory.
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