CAD/CAM—Must-Ask Questions to Ask Before You Buy
Scott D. Benjamin, DDS
If and when you are in the market for new technology, you will be faced with a difficult decision-making process. You may not have extensive hands-on experience with the technology you are considering, yet, depending on who you talk to, you can get abundant, and often contradicting, information.
While you will likely find opposing views on almost every product out there, and while it is rather easy to check out for yourself which impression material works best in your hands, or which bonding agent you like best, or even which handpiece feels best in your hands by just trying it, when it comes to major technology (such as digital imaging, computer assisted design/computer assisted manufacturing [CAD/CAM] units, hard tissue lasers), “just trying it” is difficult for a number of reasons.
First, cost is a factor. Many newer technologies are expensive, although clinicians who incorporate these new technologies into their practice eventually rave about the overall economics and the return that they get on their investment. But more important, there is a learning curve, and just putting a system into your practice without any guidance from someone with experience will most certainly yield unsatisfactory results.
Therefore, exploring new technologies yourself should be a structured process, and you should be aware of what is important to you and what is not. You may get overwhelmed with technical data that is really not relevant, or return-on-investment (ROI) calculations that are based on scenarios that do not apply to your specific situation.
At one time or another, unfortunately, we have all fallen under the impression that sales reps always tell us that the system they are offering at this very moment is the latest and greatest and heads and shoulders above any possible alternative. While many reps do have their customers’ best interest in mind when recommending investments in new technologies because they are interested in creating a sustainable business relationship, there is some truth to the fact that they will not be completely neutral when comparing what they have to offer to what their competition has to offer. So what can you do about that? Where can you turn in order to get the right information? What are the right questions to ask? And what do you need to consider to make the right choice?
First and foremost, as a potential buyer you need to look at the complete picture. This author has found that one of the best ways to go about doing this is to talk to your colleagues who already own the technology you are considering purchasing to see if and how it works for them. Ideally, find colleagues who share your treatment philosophy and are thus comparable with your style.
In addition to that, there are several questions outlined in this article that you should be asking when you are deciding on incorporating a new technology into your practice.
More often than not, dentists evaluate the clinical performance of a system by a few cases they have come across without any knowledge about the dentist using it, the clinical situation at the time of the treatment, the type of consent between patient and dentist at the time, the available technology at the time of the treatment, etc. Using CAD/CAM as an example, the system is sometimes judged on a restoration milled by a salesperson who may not have any idea about what is important clinically, but was trained to push a few buttons in a certain sequence in order to close the sale. With digital imaging, the image quality is often judged by the example images provided by the manufacturer.
Is that really the way to go? Probably not. The best and most objective way to evaluate the clinical performance of any type of system is through extensive examination by independent researchers. While a lack of research does not automatically disqualify a technology, especially when it is new and no long-term results can be presented, it is definitely a plus if sound research can back up the clinical claims made about the technology. With that in mind, presented here are some questions to consider asking your sales rep to help you learn about a new technology’s clinical performance.
Can you show me some clinical studies on the product/technology that confirm the clinical benefits that this system claims?
It is common for manufacturers to do some type of research to confirm the validity of their approach before they launch a product. Keep in mind, though, that the real proof comes with additional studies from various independent and objective sources. Longevity studies are the real thing when it comes to restorative techniques.
How many cases have been done with this technology?
Generally speaking, the answer should be: the more the better. If a technology is used routinely, chances are that you would have heard about any major failures.
How many of my peers work with such a system?
Again, the answer you want to hear is the more, the better. Not that the majority is always right, but if you look at competing technologies, there is often a good reason for one being used more than the other. And there will be more resources available for a widespread system than there will be for a rarely used system.
The Learning Curve
Integrating a new technology or technique into a practice always requires new learning. Do not expect any major change in technology to go 100% smoothly—it will slow you down initially. Just think about the first crown preparation you cut at dental school. How long did that take you? And how fast and how much better can you do it now?
The same principle applies here. While there is never a general answer for “How long will it take me to learn it?” there are some key things you should check that will make your odds for a smooth transition into any new technology much higher
Is training included in the purchase or do I have to find it on my own?
In general, when training is included it is likely to be a more standardized and quality-controlled process that has been improved and refined over time and represents a good and tested route to efficiency with the system. If you have to find training on your own, there can be a huge variance in quality out there, and you cannot really tell before you get there.
Are qualified clinical trainersavailable, or is the training done by company representatives who focus on selling the technology rather than teaching the overall clinical process?
The more complex a technology gets, the more we see manufacturers and distributors teaching to the various “buttons.” However, it is imperative to seek out training conducted by actual clinicians who will teach the clinical applications of the technology rather than just teach the bells and whistles of the technology. Think about the difference for a moment. To use a simple analogy, how to change the speed of a handpiece can be taught very well. That is technology training. However, that does not really help you unless you are fully aware which speeds are indicated for what type of procedures. This would be taught in a clinical type of training.
Is training available on a regional or local facility, or is it all done at a centralized location?
While this question is not very important for the training content/quality itself, it is beneficial to have some local resources that you can seek out when questions come up or some “memory refresh” is needed after the formal training has ended. Generally speaking, the closer you are to your trainer, the easier you will be able to contact him or her when you have questions.
Are there other support systems that can be helpful?
A lot of technologies have caused the creation of grassroots networks of users—for example, study clubs, academic teams, Internet discussion groups, etc, where users can exchange ideas, tips, and tricks that can be very helpful in daily clinical practice. Ask your colleagues about local user groups they may be in if you are interested in learning directly from your peers.
What Happens if Things Go Wrong?
Nobody is perfect, and no technology lasts forever. And while no sales rep likes talking about troubleshooting before the sale closes because it might scare you away, this is a factor you still need to consider before buying.
While most of the major full-service dental distributors usually do a good job on repairs on core equipment, newer and more complex technology sometimes can overwhelm even the most experienced technicians unless they have been thoroughly trained on the specifics of that technology. You want them to have completed a very product-oriented technical training, preferably provided by the manufacturer. Questions to consider for what happens after the sale include:
What type of warranty comes with the technology?
Obviously, longer is better. While this does not guarantee you a flawless performance, at least you are covered if something goes wrong.
Can I get good service in reasonable time if needed?
Ideally, ask your dealer questions such as: “How many of your technicians have been trained on this technology?” “Do you have a guaranteed time to get me back up and running in case something happens?” and “Can I get a loaner while my unit is out for repair?”
Is there any immediate support (such as a telephone hotline or help desk) available if I have a problem?
This is an important factor to consider in case something goes wrong outside of normal business hours and you find yourself in a situation where you need immediate assistance.
Another big issue when it comes to purchasing a new technology is the fear buyers have that it will quickly become obsolete. Everyone is afraid that the manufacturer will release the next generation the very week after he or she makes the commitment and signs the purchase contract/lease. And the rate at which technology is evolving today, that may be a very valid concern.
However, this kind of thinking is not always rational. For example, “outdated” computers that are only a year or so old can still do what they were meant to do, so for most people they have not yet really lost value at all. The newer generation of computers might be fancier and better looking, and maybe games and other extraneous applications can run faster and with better graphics, but can it make you type any faster? Not really. So sometimes, the fact that a new generation is out does not automatically mean that you will need to upgrade your own version of the technology. However, sometimes the new technology really does offer significant advantages and it would be a good move to upgrade.
There are some further questions that can help you to develop a feeling for what you can expect in case the technology changes:
- With the technology’s manufacturer, is there a history of new generations and, if so, how were platform changes handled for existing owners?
- Did the dealer offer a trade-in program for the older technology?
- Can the system be upgraded or does it need to be replaced completely?
When it comes to incorporating new, and possibly expensive, technology into a practice, many dentists are scared away by the initial price, which they perceive to be too high cost. As a business decision, however, new technology should be viewed as an investment, and what should be looked at more than the initial cost is the technology’s potential ROI. Doing the ROI analysis is more important than comparing purchase prices. What the prudent clinician should do is to make sure that the analysis is customized to his or her specific situation. All too often sales reps work with ROI examples that might work in some broad cases, but may or may not have anything to do with a particular dentist’s individual case. Here are things to do/ask:
- Ask for a cost/ROI analysis based on the intended use of the technology.
- Compare it to any available alternatives.
- Seek the advice of a practice management consultant or CPA if applicable. These professionals are very well trained in analyzing and crunching the numbers.
Hopefully this article will help you to make the right decision when you consider a major new technology purchase in the future. With any class of products, especially those with competition, there are usually pros and cons for each individual product. More often than not the decision comes down to the overall infrastructure on training, support, and available resources, which will likely have more impact on your success with the technology than many of the technical details.
About the Author
Scott D. Benjamin, DDS
Sidney, New York