Cutting through the Gordian Knot: Where and How to Start your Digital Dentistry Adventure

For those of us who have kind of sat on the sideline up until now and have not quite jumped into the world of digital dentistry, you're probably constantly thinking about when should I make the move? Am I ready to buy the intraoral scanner? What kind of scanner do I need? Should I buy a 3D printer along with it? Do I design my own restorations? What kind of lab do I work with? There's a lot of questions that are spinning around in your mind, justifiably so. And you could learn about these things on CE webinars, going to CE courses, talking to your colleagues, watching YouTube videos, and so forth. But Dr. Miles Cone has gone through this, and he actually only up until about a year ago was doing no digital dentistry at all, strictly analog. He lectures a great deal, and he's very happy to share his story. And there are some pitfalls that have... emerged among dentists who are making the move, and he talks about those in this episode. So sit back, enjoy the episode, and we're very happy to introduce our guest, Dr. Miles Cone. He is a laboratory technician. He's also a prosthodontist, board certified, and he has a lot to share with us. He has a boutique practice in Portland, Maine. We're going to be talking to Dr. Conein a second, but first, are you looking for an air-driven handpiece that rivals the power and torque of electric? Well, I have good news. It's finally here. It's called the T-Mac Z and it's from NSK, a company we all know and trust as a world leader in dental handpieces. In addition to being lightweight and ergonomic, this revolutionary air-driven handpiece delivers unprecedented 44 watts of power, allowing it to cut through tough zirconia smoothly and quickly. In fact, the T-Mac Z reduces overall cutting time by 30%. That means less chair time, reducing the burden on you and your patient. Take a test drive of the TMAX Z air-driven handpiece from NSK. For a free 10-day trial, go to nskdental.com and find your local rep to inquire. Experience the power and excitement of the TMAX Z series. Dr. Cone, thanks for joining us on our show. Thank you, Phil. Pleasure to be back yet again. Yes, absolutely. So the digital dental landscape, it can be totally overwhelming. There's no question about that. There's a lot of gadgets out there. Dentists are excited to get on board. So tell me a little bit about the process you went through in selecting new technology for your office. How did you start and how did you make sure or get the confidence to know you were purchasing the right stuff to start this journey? It wasn't my idea. I had gotten a violent shove towards digital from, you know, a loved one who saw me burning out and putting in most of my time towards tasks that, you know, really needed to be delegated to somebody that doesn't have, you know, multiple letters after their name. And not to put down anybody that's, you know, not a clinician, you know, there's tasks and jobs that need to be done. But I was doing. much of the the grunt work that was taking me late into the night and I think my wife was tired of hearing me say you know I gotta miss one more soccer game or one more piano recital and I just you know sitting at the office pouring casts trimming casts mailing out the you know I think she had just gotten really really sick of it and after listening to her you know kind of go on and on for a while and you know listening to the pros and cons of what she thought because she did a lot of the research I think the the initial mindset shift to go digital was the first hurdle. And looking back on it, I mean, it's easy to say now, but looking back on it now, I think that was, I think that might've been actually the easy part, you know, shifting over. And as I'd mentioned before, you know, she was the first one to point out, she's like, you know, I don't know why, you know, this digital dentistry thing is such a, such a scary thing for you. Like half of our practice is digital. She's like, when was the last time you did a film x-ray? She's like, that was. dental school in 2004 you know and same thing with the patient records she's like you haven't physically written a patient record in a while and she goes you for crying out loud you teach digital dental photography she's like you're pretty much there she's like isn't it isn't an intro scanner pretty much just a digital camera you know slightly tweaked out and so i said yeah yeah true you know and you nobody wants to have to confront all their demons and especially when it's your spouse who you know brings it up to you and you have to admit that they're right So we we made that switch. And the big part then after was kind of navigating the digital dental landscape. And if for anybody that's been to, you know, the ADA meetings or the Chicago midwinter meeting, you know, just to name a few and you walk through, you know, the vendor booths. It's funny, like six, seven years ago, I remember looking at, you know, all the different gypsums and, you know, the the. resins and the things like that you know to pour models and you know the the smart boxes that would auto dispense you know the water and the plastic you know and i was like oh wow this is great and you know the articulators and everything else all of those great things that i'd been trained up on you know so meticulously in my residency but now everything is is digital everything is like it's a 3d printer it's a face scanner it's an intraoral scanner it's um you know, just new ways of creating a 3D patient, you know, long after they've left the office and using that information to communicate with the laboratory technician, to communicate with, you know, the surgeon, and then to have sort of a three-way interaction between all of the, you know, the meeting of the minds to essentially do something that's going to help the patient in the end. 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And so, you know, I think the intro oil scanner, and I'd mentioned this before, I think that seemed like the obvious place to start. And so that's what we did. It was it didn't cost nearly as much. And we had, you know, numerous reps come in and we tried them all out. And my journey is going to be different from everybody else's, you know, and I can't I don't like to mention one scanner over the other in my lectures. Everybody knows, you know, the scanners that I use. I don't think this is the venue to go into that because. certain scanners have different needs for different people like i don't do ortho in my office and without mentioning any brands everybody knows which scanner is supposed to be really good for doing ortho cases and invisalign cases um you know and then there's other scanners that cost a lot more and they've got a lot of bells and whistles and they do you know they do this that and the other thing and that's great but i didn't feel like we really needed that you know and then there's some really low-end scanners that you know are probably like good enough for most people and so Finding the right scanner for us really just came down to the user experience. It came down to customer service, which was huge for us. Like I said, we're a small dental clinic. If something goes down, our entire day is shot. So I needed a company. that was going to be Johnny on the spa. And I wanted to work with a brand that had good social media presence and had a lot of videos out there and tutorials and things like that. So that's kind of how we got started with it. And I think that digital scanner was like our ticket to play and our entry into that realm. So as a recommendation to our audience, would you say the most important part of deciding which scanner to purchase would be the research on the side of the clinician? Or would you say talking to sales reps? Yeah, that's a good question. And I don't want to, again, I don't want to like make any, any, for any of the companies that listen to me, of course, they're gonna be like, talk to the rep, talk to the rep. Here's, so here's what we did. And again, this was Cornelia. This is her thought. She said, of course, the reps are going to tell you all of the pros, few of the cons. And of course, what you know, the other companies have that, you know, doesn't quite stack up to their version or their model. So it was important for me to try it out for myself and to do it in a way where I had no outside influence, you know. But what we also did was we spoke to other folks that were in, that were deep into digital. When it came to your final decision to purchase the scanner, what influenced you the most? Was it your research? beforehand? Was it the sales rep? Was it your colleagues? What do you think was the big factor in influencing your purchase decision? Yeah, it's a great question. So of course, and you know, I think this goes without saying that the sales reps are going to give you all of the advantages and tell you all the great things about their scanner, and then possibly tell you a few of the things about the competition scanner that doesn't quite stack up to theirs. Of course, there's going to be bias in that. And I take everything that the rep said with a grain of salt, which is why it was very important for me to have my own hands -on training. And I know there's a lot of people that will go to the meetings, to their local study clubs, and you sit there at the booth and you sit down and you try it. But of course, you're rushed because you got to get to the next presentation. So I don't think you're going to get the true experience out of sitting down at a booth, at a meeting for five minutes. I think it's really important. to get the scanner in the office, try it on an actual patient. For me, having my wife there was very convenient. You know, it wasn't just scanning on a typodon. I wanted to see what it was like in the mouth, of course. And so after we had, you know, a half dozen or so different scanners in the office and I had, you know, real actual live hands-on experience, I started to form my own conclusions about which one I thought was probably the one that I was going to go with. And to kind of... you know, put a bow on that at the end, I have, you know, the advantage of having many lab technicians in the profession that I'm very, very close with who have gone, you know, they're doing digital, they work with a lot of docs that are digital. And so that hack for me was to contact not only the local technicians, but many of the folks that I knew worldwide, you know, and social media is great for this too. You could reach out to folks, you know, on Instagram or Facebook or. any of the other platforms and i would go out and ask the technicians like hey with all the scans that you get in which ones do you find are the most accurate which ones are the cleanest which ones are the best and for us it just happened to be that the scanner that i was already leaning towards which fit my budget fit our needs um for our office it turned out that that was the one that consistently came up that many of the technicians um the ceramists and the dentures were saying hey this one has Very consistently clean margins. The resolution is great. The accuracy is on point. It's easy to work with. So that for me, Phil, I think was one of the biggest things that if I had to give one piece of advice that if the folks listening only take one thing away, reach out to the laboratory technicians and ask them, right? Because, you know, reach out to your friends, of course, you know, your other, your colleagues who have scanners already. But that was the thing for me that kind of... the deal. Yeah. And having a company that has the support available is so critical, right? Because when that if that scanner, unfortunately, would go down, you can't work that day until it's repaired. So or if it's a software glitch or design problem, you want to make sure that companies are available with support staff. Yeah. And that was the other thing that, of course, my wife mentioned, you know, there was there were a few companies that The price point was, you know, slightly less, which was attractive. Again, we're a very small clinic, you know, so having a more affordable scanner, of course, was important. But then, you know, we started to look into it and we realized that their customer service base was not in the USA. It was in a completely different time zone. So I think my wife had mentioned that point. She's like, yeah, what happens? And I think it's going to be a when, not an if. When we have a glitch, when we need something resolved, who do we contact and how and what happens? So, you know, maybe spending a little bit extra for a company that had outstanding technical support and, you know, like live service, you know, that was really key in our decision as well. And so I would encourage folks who are going to get into the digital dental realm to consider that. And I, again, I realized the appeal of, you know, oh, well, I could get. two of these scanners for the cost of this one. But, you know, sometimes you get what you pay for. Yeah, many times. Without mentioning any companies, sometimes you get what you pay for. Yeah, without a doubt. So with all the great benefits digital dentistry offers clinicians, and there are many, tell us about the pitfalls or caveats you would caution against. Yeah, that's a great question. And this is something that I get asked. um by by many of the folks when i'm lecturing too they're like all right well what would you they're like yeah how do you recommend you know how do you recommend getting into this and i said you know i realize that there's a lot of glitz and glam with the digital i realize the how sexy it is that to say that you're a digital dentist because you get to put that on your web page and the patients love it and everybody wants to have the latest and greatest but it's it's definitely possible to go completely overboard. And I think I'd mentioned this before. It's easy to run up into the six-figure range tech. You can buy a cone beam that has a facial scanner and you can spend $75,000, $80,000 on that. You can buy a milling unit for another $55,000 and get a 3D printer for $35,000 and a scanner for $50,000. And the cart... and all of the ceramics that come with it and the, you know, the service plan for the two years. And it's very easy to run these numbers through the roof. And when you're just starting out and you've got like a brand new loan and you, you don't realize that at some point you got to pay that money off. Right. And so that's the thing that I, that I always mention is that don't create a prison for yourself. And this is something my wife said, again, Cornelia mentioned this because she was doing, office tours and she was looking around you know when we were like looking into setting up our office and she's like oh this guy has you know this and that and the other thing and my gosh i can't imagine the number of hours he's gonna have to work to like pay all of this stuff back he hasn't you know he's fresh out of school um the dust hasn't even settled on the construction at his new office yet you know he's like two million dollars in the red he hasn't prepped a tooth So, you know, our big thing is like, you know, don't don't spend outside your means. And this is how we are just with life in general. You know, that's a that's a good rule to follow is, you know, stay within stay within your budget, do what's comfortable. let the process grow organically, you know, have a scanner for a little bit before you get the printer, you know, have a printer for a little bit before you decide to get a milling machine, you know, these things should come incrementally, you know, and I realized that there's a lot of people out there that kind of went overboard. And they kind of again, they had a rep come in, I won't mention companies that set up offices, but they had them come in, of course, they sold them on the one that was the most because they wanted to make the commission. And now they're stuck with a lot of debt. And very limited knowledge of how to maximize these tools to their advantage. Yeah, for sure. And I think dentists need to really think about the financial plan of their practice. Where am I going to be in a year? You know, why am I purchasing all this equipment? And, you know, the scanner is one thing, $10,000 to $20,000, that's affordable. And that, as you mentioned in a previous podcast, it brings great efficiency to the practice. The ROI is easily measurable. and quick, relatively quick, because you talked about your productivity boost on another podcast that we did. But when you get into CBCT and facial scanners and all those other bells and whistles, I mean, CBCT, that's becoming more and more necessary in a lot of ways. It's expensive, but the diagnostic benefit of that is incredible, incredible. So Cornelia, your wife, was very nice to join us. And she's your, you could say, office manager, although she does many other things and wears many other hats in the practice. And she was influential in getting you to really embrace digital dentistry, which is probably not the most common thing in the world for a dentist's wife to be pushing her husband into... digital dentistry. I think that sounds reasonable to say that, but we're really happy to have her on the show. And I have a question for her specifically as one that really kind of runs the practice on the back end. So Cornelia, this question is for you. What are your thoughts about what Dr. Cohn said about kind of a dangerous pitfall for general dentists to fall into regarding biting off more than they can chew with regard to accumulating too much digital equipment too fast, too quickly, without being able to integrate it properly. And that could lead to a chaotic situation in the office where the digital realm doesn't really help them and they may not be successful bringing in digital dentistry into their practice. Yeah. So yes, thank you for having me on as well. So I think what you're kind of describing is something that... pattern that i've seen that's all too common where people over commit and then they get overwhelmed and then they just kind of check out and there's there's a really interesting phenomena that i came across um a guy who speaks a lot about entrepreneurship and business his name is mike mccallowicz he introduced me to this concept of the effort dip And I think this really summarizes this pattern that you see with Dennis really well. So what the effort basically says is you see all of these, like this new technology, like all of the shiny toys, and it's easy to get swept up in that. And then you bring it back to your practice and now you need to start implementing it. And initially it's actually harder. You're doing twice as much work. It's difficult. You need to get your staff on board and you kind of go into what he calls this effort dip. With the amount of effort that you're putting into this, you're not really seeing the gains and the yield and the ROI yet. And most people get stuck in that dip. I think that's the biggest risk. What Miles was saying, too, is especially if you have this huge ballast of all of this date, and now you need to figure out, on top of that, how do you integrate this into your practice, into the workflow, and you've got all of these different pieces of technology, and you need to onboard your staff. A lot of people I've seen just get kind of stuck there. That's where Miles was saying, you know, the intraoral scanner becomes the really expensive coat rack or the milling unit becomes the really expensive paperweight. And so I think that is something that to be very weary of. And I think there's ways to get through that. You and I, I think, are going to have another podcast where I'll kind of go into a little bit more depth of how one can overcome that effort depth. and how you can avoid that but that's what i would say is one of the biggest pitfalls that kind of coincides with this over commitment to technology on the front end yeah and that concept is effort dip dip yes yes okay yeah i didn't i didn't pick that up you have a slight accent which is a beautiful accent but i did that that particular phrase uh is is being covered up in your accent for me, but maybe our audience picked up effort. Yeah. So the, the dip of, you know, the effort. So, and, and Miles was actually cautioning me against using certain words in this podcast. No, don't say that people won't be able to understand what you're saying, but we'll get there. So I think the moral of the story is here is that we as dentists, as dental practice owners, as with any. business owner, we have to be mindful of our financial situation, fully aware of what our staff can be trained to do at the current time, and our workflow and everything else. I mean, there's a lot of factors involved before just accumulating equipment that obviously is very useful in the digital workflow, but we just have to make sure we could utilize it appropriately at the right time. And this will help us ensure that down the road, we have a very successful digital workflow integration. So with that, I would like to thank both of you for spending the time with us today. Thank you, Dr. Miles Cone, and thank you, Cornelia, for your insight. And we look forward to having you on future programs. Yeah, thank you. It was a pleasure. Thanks, Phil. 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.