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  • Dr. David Alfaro

Is digital technology reducing independent thinking?

When I was a kid, I knew every single one of my friends' telephone numbers off by heart. I had dozens of 7 digit sequences accessible to me whenever I needed. Then came the smart phone. Do you think I know anyone's number other than my own? No. My mom is momcell. My brother is brocell. I could probably give you the area code, but any more than that and I am stumped.

Is digital technology doing the same to dentistry?

Let us talk digital advancements.

I am a big proponent of digital dentistry and have researched it quite a bit. My masters thesis looked at digital impression technologies and computer guided design/manufacturing for dental crowns. It is pretty clear, there are some amazing advantages to the incorporation of digital impressions into the everyday dental practice, and dental labs are performing most, if not all of their work, with at least some component being completed on a computer. The results are consistent, accurate, faster and better for the environment.

But.....what is it doing to our knowledge of the process? Most of my professors had to wax and cast their dental work. Yes, this is antiquated, full of errors, and not really cost effective, but they learned key aspects of dental anatomy and biomaterials properties. Now, we take a couple of pictures with a camera, send things to a lab where a computer tech drop a stock tooth design onto the file from a catalogue, touches it up and a machine mills it. There is no need to know about dental anatomy or biomaterials because the computer does it all for you.

Technological advances are not limited to general dentistry; it has also affected procedures that were once quite specialized. "Guided" implant surgery, for example, is a heavily marketed treatment in modern dentistry. Again, pioneers in implantology had to learn to assess bone and soft tissue, learn how to manage flaps, how to make intraoperative decisions, and ultimately how to place properly positioned implants without the hand holding of a computer guide.

Now, we take some models, the lab guys can throw in a couple of implants in the CT scan file (although most people do plan it on their own) and they send us a guide, and then theoretically we just pop the implants in. It is simple and easy so someone without surgical or implant experience can do it.

And orthodontics......oh man. Dentists do not need to know a thing about ortho anymore. The dental assitant takes a model, sends it to a company who sets everything up for you, and you give the patient some trays every two weeks. Yea, you might have to file some teeth down, but the computer tells you where. The best part is, if you are getting off track, you just take some new impressions and reboot the treatment. Sounds great, right?

No. This is horrible. We are unlearning critical thinking skills.

Computer guided dentistry is a tool that can be very useful, but dentists need to know the background procedures first in order to truly understand the pros and cons of these new gadgets.

Guided implant surgery has its limitations, so sometimes the guide has to come off and you go old school. What if you only do implant surgery a couple of times a year and primarily rely on a guide, and then you run into a complication? A 45 minute appointment can quickly turn into a 4 hour mess.

Clear plastic tray tooth aligners have even more limitations, so to truly get a comparable result to traditional orthodontics, real braces are often required to properly "finish" the case. If a dentist does not know how to work with real braces, in many cases they are not giving the patient as complete of a treatment as possible. I have seen lots of people who have had these clear braces on for way longer than expected, and yes, their front teeth look great, but they complain about their bite. (We can talk about why another day)

I want to believe that everyone providing clear braces has a good background in traditional orthodontics before they start providing those treatments, and that they participate in continuing education and study clubs, and more importantly that they properly explain both the pros and cons to the patient before selecting this treatment over traditional braces.

I also want to believe that people who are providing dental implant surgery have taken more than a weekend course where they slap a couple of implants in a pig jaw the morning after an open bar sponsored by an implant company, before they venture into this field on real humans.

Yes, many of my colleagues are responsible and do this. In fact, Vancouver has some of the best and longest standing continuing education programs in North America, which are geared to both general and specialist dentists. But is it realistic to hope that in today's competitive market that all people are training properly before jumping right in?

I dunno......what do you think?

Thanks for reading!

Dr. Dave

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