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Nov/Dec 2013
Volume 34, Issue 10

Overcoming Barriers to Implementing New Technologies in the Dental Practice

Edward J. Zuckerberg, DDS, FAGD

One of the biggest challenges dentists face today is the need to sort through the available technologies that can assist with both clinical and front office tasks to deliver high-quality care in a cost-effective manner. Among these technologies are clinical tools for digital radiography, CAD/CAM restorations, air abrasion and lasers for hard- and soft-tissue removal, microscopes for better visualization, lights for easier recognition of suspicious lesions, caries detection devices, vibrating injection aids, and various photographic tools for intra- and extraoral documentation. For the business office, practice management systems are now routine, but adoption of systems that allow complete integration of tasks such as replacing written and paper charts, e-claims and e-benefits for insurance, third-party financing, patient information intake via computer tablets, and the use of social media and web services for marketing to replace print advertising campaigns is lagging.

The challenges can be daunting, but a closer look at these technologies can remove many impediments to the implementation of the ones that may be useful for a given office. Apparent financial barriers fall away under close inspection, as the return on investment (ROI) often means not just the ability to afford a given technology, but increased efficiency in performing tasks and, in almost all cases, increased profitability.

Digital Systems: Good Economics

Digital radiography has been available since the late 1990s, yet utilization today in the United States stands at only around 50%. (This estimate is based on the author’s personal interviews with management personnel from Dexis and Schick, two of the largest digital radiography equipment providers to dentists. Also, Du Molin1 stated anecdotally that while 66% of dentists he interviewed responded that they used digital radiography, he cited a Yale study that indicated the usage may be only 30%.) Cost of a system can range from $20,000 to $40,000 for a typical dental office with three to five operatories, including a sensor for each treatment room. Some offices opt to share sensors between rooms to reduce cost, but this can actually lead to a greater rate of sensor damage from extra handling and can cost more in the long run. The typical annual expense for an office using film and exposing 50 images a day for 200 days a year will be $5,000 per year for film costs alone. After adding the costs for developing chemicals, automatic film developer, and depreciation, one can easily see how a basic digital system can pay for itself on costs alone in less than 4 years.

The true benefit of digital radiography technology, however, has nothing to do with recovering the cost of the system via actual supply savings. For as long as dentistry has been a profession, one of the most difficult aspects of practice has been gaining case acceptance for needed treatment. Patients often put off treatment due to other expenses, such as a new car, a vacation, or other more basic needs; this is often the result of the dentist’s inability to communicate the urgency of the treatment. The ability to display pathology on a large screen during case presentation allows for a higher acceptance of treatment2 and may pay for the investment in this technology many times over.

Similarly, for dentists who dismiss the $150,000 price tag of a CAD/CAM system as an insurmountable expense, it may be time to re-examine the ROI. Section 179 of the tax code, one of the few breaks left intact for dentists by last year’s tax overhaul, allows for full write-off in the year of purchase. This deduction can be worth as much as $70,000 initially for dentists who are already taxed in the top bracket by the federal and state governments where they practice. In addition, with an average savings of $300 per restoration compared to laboratory-fabricated restorations, a practice doing as few as 20 restorations per month can save an additional $70,000 in lab and supply costs the first year using this technology and can basically recover the entire cost of the equipment in that period. Going forward, the technology can produce $70,000 in savings each year and can potentially raise patient awareness of the practice’s utilization of high-tech devices. While one cannot definitively claim that dentists need to use these technologies to deliver an extremely high level of care, polls and focus groups of the general population indicate that patients’ perceptions are that dentists who utilize the latest technologies are delivering a higher level of care than those who do not.3

Automating the Business

Perception of cost may also deter many dentists from automating the business tasks performed in the office. Again, the ROI of replacing an antiquated chart system with a digital one might not be immediately obvious. However, from facilitating referrals, to easier transmission of claims and attachments, to analyzing the profitability of the practice, the benefits of digitizing patient records are numerous. Moreover, natural disasters such as floods, fires, tornadoes, and earthquakes can wipe out a dental office along with the paper records in it. While insurance can replace the hard assets of a practice, the records that are on paper are irreplaceable.

Marketing via print advertisements such as telephone directories and newspaper ads is costly and largely ineffective.4,5 Patients attracted by these means may be bargain hunters, and it may require extensive effort to establish trust with them. Conversely, the “word of mouth” type of referral has always been a desirable means of obtaining new patients due to the inherent trust established prior to the first visit; however, it has often been difficult to obtain these types of patients. Today’s savvy dental practices market using social media sites like Facebook, which allows them to attract subscribers and market to the networks of their subscribers, thereby harnessing many more trusted referrals at a significantly reduced cost versus a high-level telephone directory program. Traditionally, dentists might budget as much as $20,000 to $40,000 per year for a print campaign that fails to generate any trusted referrals. Costs of an effective internet and social media campaign are significantly lower and potential patients are more efficiently educated about the dentist’s services. Furthermore, social media can even show potential patients which of their friends already use that dentist’s office.

Securing the Future

Finally, one of the greatest advantages of having a high-technology office will surface if and when the practice is sold. Prospective buyers will be attracted to those offices with both clinical and efficient business technologies already in place, as they will not only be assured of the future smooth functioning of the business, but will also be able to accurately assess the value of the practice.

Converting to new technologies is no doubt challenging. However, when reconsidering ROI, increased efficiencies, and improved profitability, now may be the time to make the conversion.


Edward J. Zuckerberg, DDS, FAGD
Dr. Zuckerberg lectures nationally and internationally on technology integration and social media marketing for dentists, in addition to treating patients part-time in Palo Alto, California. The father of Facebook founder Mark Zuckerberg, he maintains a Facebook page,, with tips for promoting dental practices using social media, as well as a page for his patients,


1. Du Molin J. Dental practice technology: 66% of dentists use digital x-rays. Dental Practice Marketing and Management Web site. September 27, 2011. Accessed October 9, 2013.

2. The future of dentistry is digital – don’t be left behind. Schick by Sirona Web site. Accessed October 9, 2013.

3. Technology impacts patient perceptions, according to new study on doctor-patient relationships [press release]. Seattle, WA: Marketwire; December 2, 2008.

4. McCarthy B. Print advertising vs. online advertising. McCarthy and King Marketing, Inc. Web site. April 25, 2013. Accessed on October 9, 2013.

5. Stringfellow A. Print vs. digital: where should you spend your ad dollars? American Express Open Forum Web site. March 21, 2012. Accessed October 9, 2013.

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