Advances in dentistry: At what cost and … worth it?
There have been many advances in dentistry during the past 10 years. Some can be considered improvements for the betterment of patient services, others are marketing techniques disguised as improvements. For example, the field of implant dentistry has seen some significant improvements in implant design. In fact, it is one of the true areas of dental sciences in which improvements and needs were based on retroactive analyses justifying the direction of the sciences.
There was a need for simplification of product design and use. There was a need for changes in the implant macro- and micro-topographical design to speed up osseointegration, improve patient management and provide a more stable long-term osseointegrated implant. There was a need to design changes to abutment connections to create a predictable, long-term, stable connection to allow the use of cemented restorations. All of these advancements were achieved with scientific support and rationale.
On the other hand, some changes in dentistry may not have been well supported by scientific rationale. Every year new bonding agents come on the market. Many of them don’t stay on the market long enough to be tested for long-term results. Some don’t undergo rigorous wet chemistry, long-term testing (a standard testing format for bonding agents) because they don’t stay on the market long enough to substantiate the research funding.
In dentistry, new products imply new and improved formulas. With bonding agents on their ninth to 10th generation, the science still shows us that the fourth generation (two-bottle) generated the best bonding results. So what has been improved? Not the bonding efficacy, but the handling of the products. Many formulas today are single-bottle, and some exhibit self-etching to speed up use. Simplification of use appears to be a more important marketing variable than product efficacy. That’s often a reality in today’s competitive product fields.
There has also been an explosion of marketing of CAD/CAM (computer-aided design and manufacturing) technologies. Every company is marketing its version of this technology. The CEREC machine (CEramic REConstruction) uses CAD/CAM to enable dentists to provide crowns and/or inlays in their office in one visit.
There is no doubt patients love the concept of having to spend only one appointment without all the fuss to have a crown fabricated and inserted. Though if we critically compare it to our “conventional existing technologies and methods,” some aspects of the technology still fall short The esthetics can limit in-office use to posterior teeth.
In contrast, we have clearly seen the benefit of CAD/CAM machines in laboratory use. Previous methods of casting large substructures had many limitations, such as distortion aspect, cost and alloy weakness, to mention just a few. Today the use of this technology seems to be able to avoid such limitations and create a superior framework without the shortcomings of the previous technologies. They can also fabricate a superior framework for the same or lesser cost.
Another example of this convenience-versus-performance improvement confusion involves lasers and instant chairside bleaching. One independent study (Clinical Research Association) showed a chairside approach not performing as well as two “take-home” bleaching systems. The tested in-office laser-bleaching session produced significantly fewer desirable color changes than did the tested “take home” bleaching protocols. Apparently the in-office system dehydrated the teeth, making them look whiter, but for a shorter period.
So why are dentists buying such systems? It appears to have more to do with advertising and marketing than with product efficacy.
That raises this question: Is dentistry swinging more toward a profit-based model instead of a health-based model?
There are clinical advantages created by many of our new technologies, but are they being exploited for other reasons? Are the benefits worth the changes in clinical approaches? Are the “new-and- improved” technologies a clinical benefit or just a marketing ploy?
The best guideline remains “patient benefit.” If the new technology produces an improved product, greater success rates, reduced costs and quicker, simpler patient treatment, then you have your answer. If not, then it’s worth questioning the philosophy of a practice that uses those expensive marketing toys.