When is it appropriate to integrate a new device, technique, or material into clinical dentistry?
James Bahcall, DMD, MS; David Cohen, DDS, MS; Rena Vakay, DDS
The advancements in science and technology within the field of dentistry over the past 10 years have been significant. These innovations have helped to elevate the standard of clinical dental treatment that practitioners provide to their patients. The question for practitioners, however, is how and when to make the professional decision to integrate the advancement of a new device, technique, and/or material into everyday dental practice.
Unfortunately, for many dentists, when it came to performing procedures in dental school, their clinical training often may have been interspersed with varying, inconsistent, and sometimes contradictory faculty opinions. In addition, many students were taught to search for expert opinions and learn from their clinical experiences.1 Often upon completion of dental school, practitioners may hear a lecture or read an article in the literature that is compelling enough to prompt them to try a new instrument, material, or technique in their practices.
Oral healthcare providers are continually lured by or attracted to new devices, techniques, and materials in hopes of providing their patients with better treatment outcomes. With any new technology, there is an adoption lifecycle. This lifecycle is a bell curve that divides users into "early adopters," "early majority," "late majority," or "laggards" of new technology.2 Therefore, among dentists there is a wide spectrum of individuals in regard to who tends to jump on the "latest and greatest" instruments and clinical techniques (early adopters) versus those who wait until a device, technique, or material has been proven in evidence-based research (early/late majority), and those who will never change from their current treatment techniques (laggards). In reality, though, it is debatable as to exactly how many clinical trials need to be reported in the literature to confirm the significance (ie, evidence-based) of a new technology, technique, or material.
The problem is that research is a double-edged sword. On one hand, research can take many years, causing the average cycle for majority adoption of a new device, technique, or material in dentistry to be 5 to 10 years or more. On the other hand, without research there would be no proper benchtop and/or clinical testing required to evaluate a device, technique, or material effective for usage in dentistry.
The American Dental Association defines evidence-based dentistry (EBD) as "an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences."1 Therefore, personal experience should not be the sole source of decision-making in dentistry. Rather, a dentist should use EBD because it provides the least biased, best-validated information on which to base clinical decisions. EBD helps close the gap between clinical research and real-world dental practice.3
As a full-time practicing periodontist, it is important to stay current with trends in periodontal and implant treatments. Unfortunately, sometimes new technology and materials may be marketed by manufacturers as the next great treatment modality without significant research backing these claims. Therefore, it is prudent for clinicians to rely on peer-reviewed literature to stay updated on significant advancements within the field of periodontology. I personally am an early majority adopter to new technology. This allows me to take the time to read periodicals and let the new technology evolve past the beta or "1.0 stage" of product development.
When a new device, technique, or material is marketed for use within the field of periodontology, clinicians should ask themselves the following questions: (1) Will this new technology improve my current patient treatment outcomes? (2) Will this new technology reduce my patient treatment time? (3) Will this new device, technique, or material safely meet either of the above goals at a cost that will not outweigh the benefits of using this new technology?
Oral healthcare providers cannot approach the use of new devices, techniques, or materials in their professional lives the same way they might in their personal lives. An example of this is when a new cell phone comes to market. Some people may love new gadgets and are impulse buyers who do not want to wait for long-term studies regarding the benefits of the new cell phone model. Purchasing a new phone without this information is not going to really hurt anything; the worst-case scenario is that the phone fails to perform up to the buyer's expectations. This is a chance, however, that a professional cannot afford to take on his or her patients.
Before jumping into new technology too early, oral healthcare professionals may benefit from being patient and seeing what the evidence-based research published in the periodicals says, rather than finding out the hard way that the long-term patient benefits are less than ideal.
As a restorative dentist, there are five objective reasons for integrating a new device, technique, or material:
1. to improve clinical diagnoses and treatment planning, eg, adding cone-beam imaging for implants
2. to increase predictability of better outcomes, eg, using a new curing light with a better depth of cure
3. to increase efficiency, eg, using a digital scanner instead of traditional impressions
4. to improve profit margins by reducing costly "remakes" of crowns, which involves staff time and materials
5. to prevent "routine-itis"-doing something because you have always done it that way
However, there are two subjective reasons for the timing of incorporating changes that, in my experience, are as important as the objective reasons but are not often discussed.
The first subjective reason to implement change is when the team is struggling with a material, device, or technique. The system may also be part of the problem, as it may be cumbersome, difficult, or unpredictable to use. Maybe the depth of the team's clinical skills or training is lacking. They, therefore, may be unsure and uncomfortable. Sometimes poor attitude, poor-quality dentistry, and lack of follow-up result. This can have a domino effect on the entire practice, leading to bad experiences for patients (and staff) and possibly patients leaving the practice (and writing a poor review online!). If such a chain of events is occurring, the timing of change becomes urgent, and the change must support a better workflow, an improved experience for the patient, and better-quality dentistry.
Staff members who are mature and self-aware can provide invaluable feedback on what changes will help them improve. If listened to and acted upon, this "bottom-up" feedback can empower the team. A team that is empowered will more readily implement a new technique or device without resisting, because now they see a direct benefit to patients and themselves. To incorporate something new, the clinician should introduce it to the team early so there will be ample time for them to be part of the decision-making, training, and implementation. Clinicians all have had the experience of returning from a course and receiving resistance from the team when trying to implement a new product, device, or other technological advancement.
The second subjective reason for when to implement a change is psychological. Bringing in a new, fresh approach or device provides a lift to the patients, staff, and doctor. It creates excitement and a buzz for the practice. For example, with digital scanners, patients no longer need to dread impressions, and both doctor and dental assistants may get more enjoyment from practice. Additionally, the practice sets itself apart from other dental practices with the new technology, enhancing the patient experience.
There is never a "perfect" time to implement new techniques, materials, or devices because change is difficult. However, approaching change as a benefit to all and implementing it in small increments may help the dental team be more inclined to embrace it with open arms.
1. Ismail AI, Bader JD, et al. Evidence-based dentistry in clinical practice. J Am Dent Assoc. 2004;135(1):78-83.
2. Moore GA. Crossing the Chasm: Marketing and Selling High-Tech Products to Mainstream Customers. New York, NY: Harper Collins; 1991:9-25.
3. Kishore M, Panat SR, Aggarwal A, et al. Evidence based dental care: integrating clinical expertise with systemic research. J Clin Diagn Res. 2014;8(2):259-262.