Burn the Ships: Why I Embraced Digital Dentistry and Never Looked Back

You're listening to the Phil Klein Dental Podcast Up until a year ago, Dr. Miles Cone has been doing things pretty much the same way for decades, producing beautiful prostheses with long-term clinical success. But with his very hands-on approach and his passion for perfection, he and his wife often found themselves working late hours in the office. Over time, this added a lot of stress to the practice and the family, and Dr. Cone was grappling with burnout. So about a year ago, he made this big leap from analog to digital. And very quickly, everything changed. To tell us about his journey into digital dentistry and how it completely transformed his life is our guest, Dr. Miles Cone. In addition to achieving board certification within his specialty of prosthodontics, Dr. Cone is also a certified dental technician. He currently has a boutique practice in Portland, Maine, where he works closely with his wife, Cornelia, who is the office manager, as well as his close advisor regarding many aspects of the practice. We're going to be talking to Dr. Cone in a second, but first, if you're looking to raise the bar with your adhesive dental procedures, you should definitely be looking into Bisco. Bisco is a great company that has an unparalleled track record. I can unequivocally say... Adhesion is their passion. They are genuinely dedicated to understanding and improving the ability to bond dental restorations. Bisco is a company that places tremendous value on research and scientific knowledge to benefit you and your practice. Being an endodontist myself, my favorite Bisco product is Theracal LC, which hands down is one of the best materials to use for direct and indirect pulp capping procedures. It not only seals the dentin, but offers significant calcium release, which stimulates hydroxyapatite and secondary bridge formation, which is exactly what we're looking for in these kind of procedures. So check out their entire product line of premium adhesive products at bisco.com. Dr. Cone, thanks for joining us on the show. Thank you, Phil. Pleasure to be back. So we've spoken before on various topics, and I know for all remembered time, you have been all about handmade prosthetics, traditional dentistry, doing it the analog way. So what made you suddenly change to digital? Yeah, that's a great question. You know, as I've been on the lecture circuit, a lot of folks have approached me asking me this, saying the exact same thing. They followed me on social media. They followed me, you know, for the last 10 years, and they knew that For a long time, I was that guy that would say, CAD scam. You'll never get good restorations using this technology. When I was in my residency, we always joked that using an intraoral scanner and the milling machines, the restorations we would get, the fit was something akin to socks on a rooster. We hated doing it. I wanted nothing. I wanted no part of the digital technology. And, you know, there was a point in time where I was starting to get really, really burned out. You know, and I think every clinician's been there where they're just getting compassion burnout. They're feeling tired all the time. You know, you start getting overworked. You've got more patients. The patients are more demanding. And everything in our practice, as you mentioned, was just all about analog, handmade. And because I'm a lab technician too, you know, I took... The brunt of that right on the chin, I was doing a lot of that work, you know, completely on my own. And so my wife, she's our practice manager. And of the two of us in our office, we have a very small clinic. And I think we've talked about this before. We have a very small boutique clinic. She's the practice manager. She does everything that requires the real thought in the office. And I do kind of the grunt work. And she was recognizing that, you know, I'd wake up in the morning, my nose was running, my throat was sore. And she's just like, you know, we got to do. something different something has to change and so she would accompany me to a lot of my lectures when we'd go you know overseas when we you know lecture nationally and so she's seen all the cases that I present so while I was doing my my speech my presentation she'd be out you know in the in the hallways you know chatting with with the vendors at the booth seeing what was kind of new and up and coming and that was something I usually was not a part of so she would see all this stuff and i remember sitting there on the plane you know the ride home and she'd say hey is there something to this digital you know you know speaking to some of these folks it seems like you know the technology has come a long way maybe this is something that we should consider and so before i knew it i didn't realize that she did this um kind of behind my back she made a few phone calls to uh a few companies you know i won't get into the specifics but we had several folks come in Several reps come in. They brought their intraoral scanners and we went through probably a half dozen or so different intraoral scanners. And that kind of began our process with making the transition from the analog to digital. And then we were kind of off to the races from there. Yeah. So it seems like. The more I talk to dentists, I'm finding that the digital scanner is like the entry piece of equipment for dentists to begin the journey. They scan digitally, but then after that, the file goes off to the lab and everything goes back to normal. Is that how the journey begins? Yeah, you know, for us, that's kind of how it began. For us in the very beginning, the digital dentists, you're just doing the intraoral scans. And this is something I'd recommend for anybody who wants to get into it. Just the... The sheer volume of alginate impressions that scanning replaced for us, that was a huge component of this digital journey. You know, just that was the very first thing right out of the gate. Like, I'm not going to worry about scanning implants. And, you know, I'm a prosthodontist. So a big part of our practice is implant dentistry, dentures, big full mouth crown and bridge cases. So I didn't even start there. I was just doing the baby steps. And anybody that knows me, they know that I'm. awful i when it comes to the the ifu the instructions for use i don't go through the instructions for use i like to try to figure things out of my own and pretty much right out of the box you know the scanner that we had i was able to to troubleshoot and figure things out and surprisingly the user experience was much better than what i had recalled from again the days in my residency um you know and it was enlightening to see just how far that technology had come and I had to, you know, eat a little crow and admit to my wife that she was in fact, correct. And that, you know, maybe that there was something new to us. So that's kind of how we got started was doing just entry level stuff, just replacing the diagnostic casts and, you know, screenshotting those images, sending the STL files to the labs, but not only the technicians, but the other providers, the, you know, the periodontists, the oral surgeons, the endodontists, all the folks we were working with, And my gosh, it was so the convenience of it saved us hours. I mean, hours every day. And then, you know, that became extrapolated over weeks, months. And now here we are nearly a year into this journey. And I can't begin. I mean, if I had to calculate the number of hours, I mean, it would be it'd be difficult to do, but it's a lot. We'll be getting back to our guest in a second, but first, if you're a dentist who understands the importance of diagnostic accuracy and treatment planning, then you're probably thinking about CBCT for your practice. With the advent of CBCT, the limitations of 2D imaging and the clinical guesswork that goes with it are now things of the past. So the question is, which unit should you buy? Of course, you do your research, ask your colleagues, and talk to different companies. But before you make your final decision, check out the models by Merida. As one of the first companies to market in CBCT, Merida has refined its features for simple, accurate positioning. and provides multiple acquisition modes and fields of view. Well known for remarkable image clarity, their technology will help you diagnose apical lesions, root fractures, cysts, TMJ, and so much more. So when you're ready to embrace the transformative power of CBCT, check out the state-of-the-art equipment by Merida. To learn more, visit merida.com slash USA. So your wife was instrumental in encouraging you, and hats off to your wife. for her being so astute to realize what the benefits are. What was it that was holding you back before that? And maybe that's the same situation for many other dentists that are out there. Was it the part of your career you were in? Was it the fact that it's just difficult to change your workflow? What was the main thing holding you back? Yeah, that's a great question. I think that's probably the question I get asked the most is, I think everybody assumed that at some point I probably would. make the transition to digital. And then, yeah, the big looming question was, yeah, so why didn't you do it sooner? Like, what was the big issue? And I think, I think for me, you know, there's, it's a, you know, multifaceted question. But I mean, we run a very small, very boutique dental clinic focused on aesthetics. And I, for a long time, I thought, well, this technology, it's reserved for bigger practices, you know, multi-op. offices that are seeing high volume um you know and so if i had to start thinking about the roi for something like that i'm like okay i'm seeing like four or five people a day you know max on a busy day i might see five people like i'll never be able to to recoup my investment you know and that was the other thing i thought the technology would be way too expensive and i think if you look at it you know maybe five or six years ago maybe it was quite expensive and a little bit more out of reach but now The cost of, you know, an entry-level scanner, I mean, I've seen scanners on the market for, you know, 10, 12 grand. It's almost, there's really no excuse for not getting into it. And, you know, for me, again, being a specialist, to go back to being a novice again, you know, and everybody that knows me, you know, I tend to be a subject matter expert in the, you know, the isolated fields that I talk about, whether it's dentures or ceramics or implants. Like, I don't want to be brand new. I don't want to be, you know, the green guy now that doesn't know, you know, which end of the scanner to use or, you know, how to even turn on my milling machine and, you know, all these new files. And it's almost like learning a new language. And the handcrafted, you know, the artisanship of, you know, that side of dentistry that I was a part of, that was such a huge, tremendous part of my identity. And for years, you know, like I said, I'd been yelling from the rooftops, like how great handmade is and just how bad digital was. You know, how do I face the dental community in the profession? How do I backtrack on that now and say, oh, you know what? Just kidding. So there was those if I have to be honest with you, I didn't know how to reframe my new systems and protocols to be like, OK, I'm actually on board now. But it became so overwhelming and such an impactful part of our practice that. I got to the point where I was like, I just, I don't even care now. This is where I'm at. And I'm not too, my ego isn't too big now to say, hey, I was wrong. The fact that you have mastered analog dentistry, the aesthetic dentistry that you've done, the lab work that you understand, and the anatomy of the teeth that you have mastered. New dentists that are coming out that are getting trained on digital and the wax ups are days of the past. How will that affect? their ability to use digital dentistry, not having the background and the knowledge and experience that you had in analog? Yeah, that's a fantastic question. To be very honest with you, I'm not sure. I don't really know how that's going to impact people going forward. What I suspect, and here's, again, this is me just off the cuff here, what I think is going to happen, and I know that this is already starting to take a foothold, is many of these digital companies have an artificial intelligence component to their software. So for example, when I scan, say a tooth prep, say I'm doing tooth number 30, I'm doing a molar, and I prep that molar and I submit it to the laboratory, I have the option now to have... intelligence design that crown for me and so i think with a lot of things this is going to divorce um the newer clinicians the younger dentists away from you know really doing a deep dive into the morphology into the anatomy into all of those things that i really loved and so there is a part of me that's kind of sad for that but you know for if i have to really think about it i think the majority of dentists i don't know that that's like super important. You know, I don't know that that's going to make or break their practice. And I, I feel that in, you know, five to 10 years time, there's not going to be anything that are these machines can do that, like we couldn't do better, you know, I think they're gonna really take over. So yeah, it's a good question. And maybe one that requires a little bit more, you know, deep thought, but I think time will tell, it'll be interesting to see for sure. Yeah, no, I think you answered that quite well. And I don't know of any part of our life that's not being somewhat quote unquote taken over by the digital revolution. You know, I don't know how many people are going to be able to write essays or poetry or books for that matter with chat GPT. You know, these kids are writing. Yeah, I mean, they're writing their papers. using chat gpt and some people are saying it's fine it's just like the calculator it didn't mean that we wouldn't understand math we use the calculator but i personally disagree a little bit on that i think that having chat gpt write a paper for a high school kid is not helping that kid out um but that's my opinion absolutely and you know i guess my big thing is i just hope that this new level of efficiency doesn't become a shortcut do you know what i mean it's one thing to have artificial intelligence design you a night guard design you a crown but you still need a human mind on the other side of that to interpret that you know and i think that's one thing that the machines will never be able to to understand is how does that crown feel in a patient's mouth right how does the how do the how does the texture you know reflect the light and look you know how is that how are the aesthetics and so i think you know phil i think there's always going to be a small percentage of clinicians and technicians that will always seek out something better more knowledge right and then there's the people that you know they just want to they just want to work a nine to five and they just want to pay off their student loans right i think that's i think that's fine um you know but like i said it'll be it'll be interesting to see how this how it all pans out you know and perhaps you know we're having a we're doing a podcast five years from now and we reflect back on this and i say hey gosh AI can make a crown better than any technician. You'd be mad not to have AI make it. Why would you ever try to make it yourself? There's a friend of mine here in Austin, Texas. His name is Byron Reese. He wrote a book called The Fourth Age. Great book. It's about AI. He's an expert on AI. And he talks about artificial intelligence and whether or not robots can become sentient or can they actually have feelings. And it's debatable. to where the future is going to be with this. And you mentioned that the dentist has to interpret the data, which we do now, and understand what a crown feels like and get a very good understanding of occlusion and what's best for the patient. But this book is interesting. It's really... well written. I've heard this guy speak. It's called The Fourth Age. You can get it on Amazon for our audience if you're interested. Let me ask you this. So you started with the scanner and that obviously had a significant impact on your new love for digital dentistry. Tell us about the workflow after the scanner. What was the time period where you said, okay, I'm good with the scanner, but I want more. And you kept progressing through your digital workflow into your day-to -day activities. Yeah. And, you know, that's a great question, too. And, you know, one of the things when I'm when I'm speaking is, you know, people always ask me, was the scanner like the very first thing? And for a little while, I thought it was. And then I started to look back and I said, well, you know what? Actually, we've been using digital photography for a long time. You know, nobody I haven't used film in forever. And same with our radiographs. We've been taking digital x -rays. We've been using, you know, cone beam technology with our implant planning. Our patient records are all. digital now and i started looking back and i was like hey you know what we're almost kind of we're already in the mix a little bit this isn't quite as scary maybe as i thought and sure enough that scanner interacts seamlessly with the digital photographs with the the dicom files from the you know the cbct and the laboratories and working with a great laboratory was key to all of this because they take all of that data and they stitch it together, and then they work with you. And this is, you know, something I wanted to mention too, is that I know a lot of people are going to go with the AI option because it's less expensive and you can have it now, right? You can have the crown now. But I highly encourage anybody who's getting into the digital realm to find a great laboratory to help sort of chaperone you down this path when you first get started. And so that's exactly what we did. We paired up. with a great digital lab and then i remember you know driving home and they said okay we had we had an emergency patient come in and they said hey miles um you know we got the scan from you we'll just shoot it right back to you uh you know my team did the digital wax up and i know your patient's coming in two days we'll just send you over you know rather than like overnighting this case to you we'll just send you back the stl file and you just print it out and you'll have it ready there and i thought well gosh i can't i can't do that i don't have a printer you know and they were like well you got to get one man that's that's the next step and so it became sort of this organic you know workflow where you go from like okay i'm gonna start with a scanner and then maybe you get like a printer and then if you decide that you want to take on that role of being you know a lab technician and i think there's something cathartic about doing some of your own lab work. Again, I'm biased, but you know, then maybe you get a milling machine and, you know, with the milling machine, you know, comes with, you might have to get a centering oven or a furnace, you know, if you want to add, if you want to glaze it. So that was sort of our, I felt, well, it felt natural. It felt organic to me. And what I see very often is, you know, and especially when I'm lecturing to different groups is these young dentists are graduating and they've taken out a massive massive healthcare professions loan, several million dollars. It's definitely in the seven figures. And they will go and they'll drop $150,000, $200,000 on all these great toys. They'll get the intraoral scanner. They'll get the milling unit. They'll get the 3D printer. They'll get the cone beam. They'll get the face scanner. They'll get the colorimeter, the spectrophotometer. They'll get all of this stuff. And they've got that kind of shiny toy syndrome, right? Where it looks great. They were inspired by somebody. Maybe it was even me, you know, at one of the lectures where they buy all this stuff and then they get home and now they've got that. I think what my wife calls, you know, the effort dip where they've kind of bought all this stuff. They're in it. They use it for a week and then it just kind of drops off. You know, they get kind of burned out. with all of this new stuff it was just too overwhelming it was too much at once and then that scanner becomes the coat rack you know the milling unit becomes the paperweight you know for for all of your like stuff that you're doing in the office and so i i think that there should be a natural progression and again i'm i'm biased because that's the way that we did it and we had great success um but i think that people should you know start by just dipping your toe in the water and i i think for most people the intraoral scanner that will be that that's what it would be for them, you know, without the intro scanner, maybe having a 3d printer doesn't make too much sense or having a million unit might not make too much sense without the, without the scanner. So that's where I feel like you should start. And also I think the scanners in terms of the cost, that's the best bang for the buck, because like I said, you could get a, I mean, I've seen scanners and I'm not saying I recommend the scanner that's $10,000, but they're, they're out there, you know, for, um, $20,000 easily, you could get a top of the line scanner. And I think that's significantly less than what you're going to spend on some of these other machines. And I think you just have to figure out what's going to be right for your practice. You know, if you're a multi-op practice, you've got assistance, you know, maybe you've got an in -house lab. These things definitely make sense, but I think it's best to just sort of scale it up. What my wife likes to say is she calls it a throttle. You know, she's like, it's not a switch. You shouldn't just like one day you're analog, the next day you're digital. You know, you kind of need to ramp it up progressively. So if we can look into a crystal ball, do you see five to seven years from now, mostly all dentists using intraoral scanners? And it's similar in a lot of ways to the way we moved into digital radiography. Absolutely. Yeah, I think that's another great question. And I'll tell you just from, this is anecdotal, of course, but when I, you know, go to these presentations and give my speeches and... there's like say there's like 200 people in the room and I always like to keep it interactive I'll say you know show of hands who's got a scanner I would say probably only maybe 35 to 40 percent of the people raise their hand um and it's not for you know because the people are shy I think you know there's just not nearly as many dentists that have scanners out there um as you'd think and I what I found is that many of the people that own a scanner have multiple scanners it's not just one so i wonder if those numbers that you know the ada puts out there where they're like oh 65 of dentists have i'm like i don't know if they do i think they just i think multiple docs at the same office have a scanner but i think there's still a lot of folks out there who are And I know, you know, speaking with some of these companies who are, you know, develop the scanners, develop the milling units, develop the 3D printers, there is still a big push to get, you know, a large percentage of dentists on board with digital. And I thought incorrectly for a while that, you know, it'd be the guys who are in their, you know, maybe late 60s, early 70s, who are looking at retirement in five years. Oh, they're the ones that haven't gone digital. That's not it at all. There's a lot of there's a lot of apprehension out there. And so I guess my. Big part of what I'm hoping to do is to encourage people, enlighten people, you know, show them the air of my ways and that, you know, digital dentistry, you hear this all the time, digital dentistry is the future. No, no, no, digital dentistry is now. It's now. And if you aren't doing it in three years, I think you'll be that guy who's still... about the virtues of having a landline, you know, and, and like bemoaning all of the problems that we have with smartphones, you know, Oh, the battery doesn't last. Oh, the reception, Oh, the screen could break. You know, what you need is a good solid landline. Like nobody does that anymore. Right. And I think that, yeah, in three years, most likely five years, almost certainly, I think the percentage of people who do not own a scanner will be probably under, you know, 20%, I would say. That's my prediction. Again, we'll see. Let's chat again in five years time, Phil, and we'll see if that has come to pass. For sure, for sure. So as we end this podcast, is there a way of our audience to check your lecture? schedule should they just google miles cone cone to find you do you have something posted well you know in today's age of social media i think one of the the best and fastest ways that people have to to find me is just on my my instagram account which is miles cone dmd and typically there i'm posting you know little stories updates on when I'm lecturing, where I'm lecturing, follow me and check that out. You know, and I've been asked multiple times to put together YouTube videos and things like that. So, you know, never say never. Again, I said never to digital and yet here we are. So, so stay tuned. I know there's a lot of desire for the content. So I'm eager to, you know, I'm eager to please. So we'll see. And I encourage all of our listeners to visit VivaLearning.com. Type in Miles, M-I-L-E-S. Cone , C-O-N-E, and you'll see all of his content. Dr. Cone , thank you so much as always. Great podcast, and we'll see you on future ones. Have a good one. Appreciate it. If you're enjoying this podcast, please leave a review or follow us on your favorite podcast platform. It's a great way to support our program and spread the word to others. Thanks so much for listening. See you in the next episode.