Technology—An Old Guy's View

I was recently at a party with a friend ofmany years. He was a dental supply representative when we first met and has continued to be very successful in his career of more than 30 years. We hadn't seen each other for nearly a decade, so we caught up on our families and the upcoming marriages of our daughters. Our conversation inevitably moved to our common bond of dentistry. I talked about my practice and he spoke of the evolution of the services that he provides for his clients.

And then the questions began. He asked, “Do you have a CAD-CAMmachine?” I responded no, then gave him some reasons, both technical and philosophical. Clearly, the technology has arrived, and, no doubt, it is the future. However, I have not yet made the decision that the technology fits into my small, single-doctor, low-volume practice. I also voiced my concerns about the commitment to excellence that is required to bond adhesively-retained restorations in molar regions. Not totally satisfied with my response, he next asked if I owned a laser. I answered, yes, but that I use it on a limited basis in my practice. I mentioned that the laser is a wonderful adjunct in many areas of soft tissue therapy but that I am concerned about the marketing of lasers for some applications, such as closed flap crown lengthening. He just smiled and asked, “Well, how about a digital impressioning system?”My answer was again no, but I must admit, I do have a significant degree of enthusiasm for this new technology; I just haven't jumped into it, yet. A little more encouraged with that answer, he then asked about digital radiography. I was relieved to be able to answer yes with enthusiasm to this one. He sensed that he wasn't going to enlightenme on the virtues of technology, so he wisely chose to cease the questioning on an up beat.

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As I reflected on our time together over the next few days, I realized that there had been a disconnect in our conversation. My friend was both interested in and excited about the current wave of technology, and his questions reflected that enthusiasm. In retrospect, my answers to his questions were primarily philosophical, rather than technical. We were viewing our common interests through very different lenses. His view of technological advances was wholly positive, while my view was clouded with philosophical concerns. This disconnect between the old and the new has played out in the same way over many generations. However, this time it is different, because, for the first time in my life, I reflect the old. This realization forced me to look deeper into my dinosaur world view. I have come to realize that it isn't the technology that concerns me; it is the hype that accompanies the innovations and the dentist's ability to be discriminating when making technology decisions. It's not the technology, but rather the hands and minds that drive the technology that concern me. For me, it is ultimately about excellence. I have been most fortunate to have mentors in my life who have modeled excellence for me. Never has the discussion been about faster, quicker, cheaper. It has always been about the best interest of the patient and how to optimize the longevity of the result.

In recent years, the extreme makeover movement has had a significant impact on dentistry. On the one hand, it has raised the consciousness of the public to the potential benefits of esthetic dentistry. However, it has also given the false perception that the expedient way is the best way. The use and, in some cases, the misuse of new technology, has been a driving force in the quest for immediate dental gratification. So, how does a dentist approach the issue of how and when to incorporate new technology into the practice? Clearly, the issue of technology and excellence shouldn't be an either/or conundrum. Rather, it should be about which of the new technologies, when used correctly, can make excellent dentistry more affordable for the patient and less difficult for the dentist. When the technology decision is made based on excellence, rather than hype, both the dentist and the patient benefit. So, where does the thoughtful dentist go to get help with these decisions? The primary source of information is the refereed dental literature. Journals, such as Operative Dentistry, provide unbiased information that should be the starting point in our discovery process.

A second venue is study clubs. Study club opportunities abound. In addition to many local study clubs, there are several study club networks that provide wonderful opportunities for professional growth on a continuing basis. The Seattle Study Club network was founded in 1977 by Dr Michael Cohen. The emphasis in these clubs is interdisciplinary treatment planning. In a much different vein, Dr Richard V Tucker founded a network of study clubs more than 35 years ago, which emphasizes cast gold and direct gold restorations. Although the emphasis is very different in these two study club networks, the goal is the same—excellence through education and practice.

Finally, continuing education opportunities for learning about materials, techniques and new technologies are legion. However, the dentist must be discriminating when choosing with which star to tie his/her wagon. Many continuing education courses are sponsored by companies. There is certainly nothing inherently wrong with this relationship; however, full disclosure is essential and the attendees must be discriminating when evaluating the information gleaned from sponsored courses. Additionally, annual meetings of dental organizations, such as the Academy of Operative Dentistry, provide excellent opportunities for unbiased continuing education.

This is clearly the best time in history to be practicing dentistry. To a significant degree, our good fortune is due to the wonderful technology that is currently available. However, we must remember that technology is ephemeral, while a commitment to excellence is a constant. When contemplating the acquisition of new technologies for our practices, the decision must be based on excellence rather than expediency. As Aristotle reminded us more than 2,300 years ago, “We are what we repeatedly do. Excellence, then, is not an act, but a habit.”