Future of Dentistry?

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OU2010

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So about a week ago a Dentist who practices in the city my undergrad is located in dropped into a pre-dent meeting and held a very informal question and answer session. And some hot topics came up about, Implants, invisalign, healthcare and other issues and I felt it was a very informative meeting. However, I understand that this is just one person’s perspective about the future of dentistry and I was wondering what you guys thought about some of his thoughts.

Here are a few things Dr.X said that didn’t sit too well with me...

Implants are a haphazard way of treating patients, because there are so many different companies who make implants, an implant put in today will be out of date and too unfamiliar for another dentist 5 years from now to treat.

He compared implants to putting in landscaping. If there is a gap in your yard, just put a tree there.

Invisalign is the wave of the future for orthodontics. Invasline can treat 85% of all orthodontics cases and most orthodontics offices are slowing down because GP’s can use invisalign.

What do you guys things about these statements?

I don’t want this thread to cause any controversy, and this isn’t the type of thread similar to “ What specialty should I go into to maximize my profits, so I can overcompensate for my small pp.”

Thanks for your responses.
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OU2010 said:
Implants are a haphazard way of treating patients, because there are so many different companies who make implants, an implant put in today will be out of date and too unfamiliar for another dentist 5 years from now to treat.
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LOL, what, he doesn't keep pt records?


OU2010 said:
Invisalign is the wave of the future for orthodontics. Invasline can treat 85% of all orthodontics cases and most orthodontics offices are slowing down because GP’s can use invisalign.
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There will always be cases for brackets and wires, but now many 'simple' cases can be done via invisalign in the dental office. At Temple we get certified in invisalign so I don't see why it would stop many of us from doing it in private practice vs. referring.
 
1992Corolla said:
LOL, what, he doesn't keep pt records?



There will always be cases for brackets and wires, but now many 'simple' cases can be done via invisalign in the dental office. At Temple we get certified in invisalign so I don't see why it would stop many of us from doing it in private practice vs. referring.
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Invisalign has placed a new requirement for dentists and orthodontists to do at least 10 invisalign cases per yr and a certain amt of CE in Invisalign to maintain certification. This has been tough for many private practice GPs to accomplish esp in a slow market. As a result many dentists have been barred from doing invisalign.
 
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Haha, thats why it didn't sit well with me. It isn't like the implants are coming from mars. However his overall attitude about implants was negative, he also said most dentist don't "load" ( make the implants completely functional) which will cause too much strain on the surrounding teeth.

I don't want it to seem like I'm bashing this dentist though, he was very helpful.
 
KlingonDentist said:
Invisalign has placed a new requirement for dentists and orthodontists to do at least 10 invisalign cases per yr and a certain amt of CE in Invisalign to maintain certification. This has been tough for many private practice GPs to accomplish esp in a slow market. As a result many dentists have been barred from doing invisalign.
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I didn't know this. Thanks for the great input.
 
OU2010 said:
Implants are a haphazard way of treating patients, because there are so many different companies who make implants, an implant put in today will be out of date and too unfamiliar for another dentist 5 years from now to treat.

He compared implants to putting in landscaping. If there is a gap in your yard, just put a tree there.

.
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This is a ridiculous statement. Yes there are many companies out there. So stick to the largest companies so they'll still have parts if you ever need to replace them. Implant these days are more reliable and stable then the ones in the past.
 
IMO,

the future of dentistry is one of regeneration and stem cells.
This doctor may be right that the implant is not a perfect replacement for a tooth. But it is the best option compared to a bridge or partial denture or no treatment.

The future is one where a missing tooth can be regenerated from a stem cell into a fully functional morphogenetically correct tooth within the arch. At that point we won't be needing implants as much.

Until then I wouldn't hesitate doing implants even on a family member.
 
Dentistry looks pretty good right now. I think it's mainly going to be supported for a while by the baby boomers. That being said, most of the new disease is being concentrated in those who don't have $$$.

An issue that might come up: Dentistry becomes more and more boutique as they spend billions on better veneering porcelain while the disease burden of the have-nots flows in on a river of pus into the ER's. Politicians summarily lay the smack down on dental licensees.

BTW, anyone that said implants are haphazard treatment needs to have their dental license revoked for stupidity.
 
OU2010 said:
... so I can overcompensate for my small pp."
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:laugh:

I think this should be a great title for a letter of intent to study dentistry.:D

Seriously though, the dentist who was "doing you a favor" wasn't really doing you a favor. Maybe there are too many dentists around his/her area and they focus upon PPO nonsense.

Dentistry is wonderful, implants have and will continue to revolutionize prosthodontics as we know it. While stem cells are currently in fairy-tale land, titanium and titanium alloy implants are here and are great options for patients!
 
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MRSA said:
anybody have thoughts on the effects a caries vaccine could have on the profession?

http://www.nidcr.nih.gov/Research/R...ientificOpportunities/PanelOnCariesVacine.htm

http://www3.interscience.wiley.com/journal/119080127/abstract?CRETRY=1&SRETRY=0
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What may work, rather than immunity, is another idea based in the idea of probiotics. (www.oragenics.com). I went to dental school where this was developed. Basically the boss man (Dr. Hillman) found a strain of S. mutans in nature (someone's mouth) that excludes all other strains via production of an antibiotic, much the same way our good friend Penicillium did for many years. This strain still caused decay just like everyone else.

He knocked out the gene producing lactate and filled the metabolic defect with ethanol as the end product instead. Inoculate people with this, and the host/wild type S. mutans is driven off with a non lactate producing strain------> no caries. Dentists should worry unless the FDA is too chicken **** to approve..... which it looks like that may be the case.
 
GoGatorsDMD said:
He knocked out the gene producing lactate and filled the metabolic defect with ethanol as the end product instead. Inoculate people with this, and the host/wild type S. mutans is driven off with a non lactate producing strain------> no caries. Dentists should worry unless the FDA is too chicken **** to approve..... which it looks like that may be the case.
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is his paper published? if so, i'd love to read it.

so how would this be administered? would it be a probiotic? is it in phase 1 or 2 clinicals or anything?
 
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GoGatorsDMD said:
What may work, rather than immunity, is another idea based in the idea of probiotics. (www.oragenics.com). I went to dental school where this was developed. Basically the boss man (Dr. Hillman) found a strain of S. mutans in nature (someone's mouth) that excludes all other strains via production of an antibiotic, much the same way our good friend Penicillium did for many years. This strain still caused decay just like everyone else.

He knocked out the gene producing lactate and filled the metabolic defect with ethanol as the end product instead. Inoculate people with this, and the host/wild type S. mutans is driven off with a non lactate producing strain------> no caries. Dentists should worry unless the FDA is too chicken **** to approve..... which it looks like that may be the case.
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Until that strain of Strep causes a rare incurable type of necrotizing fascitis/menigitis/other deadly disesase and lawyers jump all over that shi* like seagulls on bread. There is a reason the FDA is very cautious of these things. It's great that scientists are doing stuff like this, but geez, one mistake or small problem and you'll get your pants sued off.

Have you watched TV from 10-3 PM in the day? "Has a doctor looked at you the wrong way? Did he give you the evil eye? If so, call the law offices of such and such and we'll get you the money you deserve!"
 
OU2010 said:
Invisalign is the wave of the future for orthodontics. Invasline can treat 85% of all orthodontics cases and most orthodontics offices are slowing down because GP's can use invisalign.
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So far, Invisalign has been primarily marketed to adults. The great thing about adults is: they COMPLY. In other words, they wear what you ask them to wear. They're motivated.

The great thing about braces? They force compliance. Kids won't wear their rubber bands or retainers; what will make them wear their Invisalign Teen trays? How many parents will get fed up with Invisalign trays eaten by dogs, thrown in the trash after meals, run over by the car, even after they've accepted the higher sticker price of Invisalign? Sounds like a nightmare to me. Sure, maybe you can use Invisalign to try treating 85% of cases, but not up to the standards that you can treat to with fixed appliances.
 
OG1 said:
So far, Invisalign has been primarily marketed to adults. The great thing about adults is: they COMPLY. In other words, they wear what you ask them to wear. They're motivated.

The great thing about braces? They force compliance. Kids won't wear their rubber bands or retainers; what will make them wear their Invisalign Teen trays? How many parents will get fed up with Invisalign trays eaten by dogs, thrown in the trash after meals, run over by the car, even after they've accepted the higher sticker price of Invisalign? Sounds like a nightmare to me. Sure, maybe you can use Invisalign to try treating 85% of cases, but not up to the standards that you can treat to with fixed appliances.
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Thats why you pick and choose your cases. Some adults wouldnt work well either. One of my teens is probably the most compliant.

I dont think you can say the standards are always worse. Again, its about picking and choosing cases.
 
OceanDMD said:
Thats why you pick and choose your cases. Some adults wouldnt work well either. One of my teens is probably the most compliant.

I dont think you can say the standards are always worse. Again, its about picking and choosing cases.
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Well said! Pick your cases correctly.

In General, adults are more compliant than teens.
Having said that it is safe to say that more than 95% of teens will be non-compliant and 20-40% of adults are compliant.
I have numerous adults who were non-compliant and didn't finish invisalign trays that were prescribed.

This is the real world frustration with Invisalign. Unless the pt is adamant about being compliant it is a lose lose situation between the pt and you. the pt won't get results and you won't see results.

This is however not true for large chain dental clinics who are only after $. They are probably don't care if pt complies or not as long as they are already paid in full.
That is why the local dental chain gets hundreds of cases easily in a yr and invisalign is happy with these dental chains and don't care if they lose business with solo dentists who can't make 10 cases a yr.
 
OU2010 said:
Invisalign is the wave of the future for orthodontics. Invasline can treat 85% of all orthodontics cases and most orthodontics offices are slowing down because GP’s can use invisalign.
Click to expand...
False. Most orthodontic problems have to be corrected with the brackets and wires.

As an orthodontist, I am not too worried about invisalign. Invisalign is too expensive for most patients. A lot of the patients choose to see me for conventional braces treatment because I charge them a lot less than the cost of getting invisalign treatment.

I don’t do invisalign for a couple of reasons:

- The net profit is higher for convention braces. I pay less than $250 for 20 brackets + 4 bands + wires +ties + assistant salary ($20/hour salary….each RDA spends about 10-15 minutes per patient x 24 ortho visits). I believe the lab fee for invisalign is about $1000-1500:eek:.
- I don’t have to constantly explain to the referring dentists why the teeth are not perfectly aligned and the occlusion is not ideal with invisalign tx.
- I don’t have to spend additional $$$ to put braces on to correct the problems that invisalign fails to correct.

I would not use invisalign on my 2 kids.
 
OceanDMD said:
Thats why you pick and choose your cases. Some adults wouldnt work well either. One of my teens is probably the most compliant.

I dont think you can say the standards are always worse. Again, its about picking and choosing cases.
Click to expand...

Right, exceptions to every rule. I didn't say the standards are always worse, I said that if you try to treat 85% of ortho cases with Invisalign it won't be up to the standards of fixed appliances. Some might be better or the same - exceptions to every rule - but the majority probably won't.

Picking and choosing cases, yes, but the OP's dentist speaker is claiming 85% of ortho cases can be treated with Invisalign.
 
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charlestweed said:
False. Most orthodontic problems have to be corrected with the brackets and wires.

As an orthodontist, I am not too worried about invisalign. Invisalign is too expensive for most patients. A lot of the patients choose to see me for conventional braces treatment because I charge them a lot less than the cost of getting invisalign treatment.

I don’t do invisalign for a couple of reasons:

- The net profit is higher for convention braces. I pay less than $250 for 20 brackets + 4 bands + wires +ties + assistant salary ($20/hour salary….each RDA spends about 10-15 minutes per patient x 24 ortho visits). I believe the lab fee for invisalign is about $1000-1500:eek:.
- I don’t have to constantly explain to the referring dentists why the teeth are not perfectly aligned and the occlusion is not ideal with invisalign tx.
- I don’t have to spend additional $$$ to put braces on to correct the problems that invisalign fails to correct.

I would not use invisalign on my 2 kids.
Click to expand...


Typical response from an orthodontist. When you have an adult who has relapse, and absolutely will not go back into the railroad tracks, its perfect. Sure the return is less, but when you work out the hourly production based on fee-lab fee its still lucrative. Im not saying specialists are in trouble, Im just saying my teenagers who are class I skeletal and dental with mild to moderate crowding or spacing can be treated successfully with invisalign. And they are happy not to wear the train tracks.
 
OceanDMD said:
Typical response from an orthodontist. When you have an adult who has relapse, and absolutely will not go back into the railroad tracks, its perfect.
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Not so perfect for their pocket. A lot of my adult patients don’t mind wearing braces again for 6-12 months for the relapse….and they only have to pay ½ as much as invisalign. For braces, the patient can put a small down payment and make monthly payments (zero interest). For invisalign, the patients have to pay a huge amount of $$$ up front due to the high lab fees. Therefore, it is a lot easier for my tx coordinator to sell the traditional braces case than to sell the invisalign case.

OceanDMD said:
Im not saying specialists are in trouble, Im just saying my teenagers who are class I skeletal and dental with mild to moderate crowding or spacing can be treated successfully with invisalign. And they are happy not to wear the train tracks.
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In my opinion, even for the skeletal and dental class I maloclusion cases (majority of the cases at my practice), they should be treated with brackets and wires. A lot of kids actually like the train tracks and colorful ties. Many of them beg their parents to get braces soon as I left the consult room.
 
charlestweed said:
Not so perfect for their pocket. A lot of my adult patients don't mind wearing braces again for 6-12 months for the relapse….and they only have to pay ½ as much as invisalign. For braces, the patient can put a small down payment and make monthly payments (zero interest). For invisalign, the patients have to pay a huge amount of $$$ up front due to the high lab fees. Therefore, it is a lot easier for my tx coordinator to sell the traditional braces case than to sell the invisalign case.


In my opinion, even for the skeletal and dental class I maloclusion cases (majority of the cases at my practice), they should be treated with brackets and wires. A lot of kids actually like the train tracks and colorful ties. Many of them beg their parents to get braces soon as I left the consult room.
Click to expand...



Again, typical responce for an orthodontist. Listen and learn, 30-50 year old women(and men for that matter) that have relapse/crowding/spacing, and want nothing to do with brackets, are perfect for invisalign. I dont finance. For every student out there, dont EVER finance your patients. Chase finances AT 0% FOR INVISALIGN FOR 2 YEARS. No brainer. How is that not selling point. My average case is 4-5 hours of chair time, my fee 5-6k (depending on how difficult the case is or questions on compliance), after lab bill when you break down the production its $700/hour. Now, I dont think a GP, OMFS, ENDO, is going to bitch about that kind of hourly production.

Your comment about selling braces over invisalign because of finances does not hold water. In my area, orthodontists are charging 7-10k to treat. I pick simple cases for plastic ortho, and charge anywhere from 3-6k. Once again, the adults JUMP ALL OVER IT. Your missing the boat. I have parents that dont want their kids to have brackets. Have you seen the decalcification marks brackets can leave? How about the buccal decay around the band on the sixes. It gets old hearing the ortho specialists poo poo plastic ortho. There is a place for it when you pick the right cases. You need to accept it, and maybe incorporate it. The number one provider in my area, and he is in the top 5% in the country is an orthodontist. I've seen his work. Its solid, never compromised.


Another point on financing, on average half of my cases have paid everything up front. Its the excitement of "clear braces". Its the marketing that invisalign has done. It make patients excited, "want dentistry". Dont get me wrong, the new rules as far as yearly cases and CE pissed me off, and I use the other options out there for simple cases. However, people come in and consistently ask about Invisalign. 2 cases a month, 50k in my pocket.
 
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OceanDMD said:
Again, typical responce for an orthodontist. Listen and learn, 30-50 year old women(and men for that matter) that have relapse/crowding/spacing, and want nothing to do with brackets, are perfect for invisalign. I dont finance. For every student out there, dont EVER finance your patients. Chase finances AT 0% FOR INVISALIGN FOR 2 YEARS. No brainer. How is that not selling point. My average case is 4-5 hours of chair time, my fee 5-6k (depending on how difficult the case is or questions on compliance), after lab bill when you break down the production its $700/hour. Now, I dont think a GP, OMFS, ENDO, is going to bitch about that kind of hourly production.

Your comment about selling braces over invisalign because of finances does not hold water. In my area, orthodontists are charging 7-10k to treat. I pick simple cases for plastic ortho, and charge anywhere from 3-6k. Once again, the adults JUMP ALL OVER IT. Your missing the boat. I have parents that dont want their kids to have brackets. Have you seen the decalcification marks brackets can leave? How about the buccal decay around the band on the sixes. It gets old hearing the ortho specialists poo poo plastic ortho. There is a place for it when you pick the right cases. You need to accept it, and maybe incorporate it. The number one provider in my area, and he is in the top 5% in the country is an orthodontist. I've seen his work. Its solid, never compromised.


Another point on financing, on average half of my cases have paid everything up front. Its the excitement of "clear braces". Its the marketing that invisalign has done. It make patients excited, "want dentistry". Dont get me wrong, the new rules as far as yearly cases and CE pissed me off, and I use the other options out there for simple cases. However, people come in and consistently ask about Invisalign. 2 cases a month, 50k in my pocket.
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$5-6k for an invisalign case….good for you. No, I don't need to learn. I do what I think is best for my patients. If a patient doesn't want to get brackets at my practice, then he/she needs to go see a doctor who does invisalign….and I don't feel bad about losing that patient. I am 38 years old but I think like an old fashioned dentist. I believe every posterior filling should be restored with amalgam. If the patient doesn't like the metal framework RPD, it doesn't mean that it is OK to give him/her the flimsy valplast RPD. If the patient doesn't want to waste 2 appointments for a crown, it is not ok to use the ugly, poor margin Cerec crown. Again, this is just my opinion.
 
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charlestweed said:
$5-6k for an invisalign case….good for you. No, I don’t need to learn. I do what I think is best for my patients. If a patient doesn’t want to get brackets at my practice, then they need to go see a doctor who does invisalign….and I don’t feel bad about losing that patient. I am 38 years old but I think like an old fashioned dentist. I believe every posterior filling should be restored with amalgam. If the patient doesn’t like the metal framework RPD, it doesn’t mean that it is OK to give him/her a flimsy valplast RPD. If the patient doesn’t want to waste 2 appointments for a crown, it is not ok to use the ugly, poor margin Cerec crown. Again, this is just my opinion.
Click to expand...


I apologize for the snarky "learn" comment. But you have to understand how old it is to hear specialists poo poo GPs and the stuff they do that specialist dont. I have learned that sometimes what is the best choice, and what the patient wants or will pay for is often different. As long as the patient is informed, given ample time to make sure about their decision, the valplast POS partial may be the treatment. As far as amalgams, I dont place them(unless its a moisture issure or wizzie). If I cant place a posterior resin, if I can isolate the tooth with a dam its a bonded onlay, inlay, or a crown. Thats what I would want on my teeth, not the hunk of old school metal. I dont use cerec now, but, for what its worth, I made myself a cerec crown that I am still wearing on #18 with no problems (7 years). If done right, the margins are solid. By the way, I thought you were an orthodontist?
 
OceanDMD said:
I apologize for the snarky "learn" comment. But you have to understand how old it is to hear specialists poo poo GPs and the stuff they do that specialist dont. I have learned that sometimes what is the best choice, and what the patient wants or will pay for is often different. As long as the patient is informed, given ample time to make sure about their decision, the valplast POS partial may be the treatment. As far as amalgams, I dont place them(unless its a moisture issure or wizzie). If I cant place a posterior resin, if I can isolate the tooth with a dam its a bonded onlay, inlay, or a crown. Thats what I would want on my teeth, not the hunk of old school metal. I dont use cerec now, but, for what its worth, I made myself a cerec crown that I am still wearing on #18 with no problems (7 years). If done right, the margins are solid. By the way, I thought you were an orthodontist?
Click to expand...
Hey Ocean, no need to apologize. I know you are trying to help. We just have different opinions on this "invisalign" topic....that's all.
 
OceanDMD said:
As far as amalgams, I dont place them(unless its a moisture issure or wizzie). If I cant place a posterior resin, if I can isolate the tooth with a dam its a bonded onlay, inlay, or a crown. Thats what I would want on my teeth, not the hunk of old school metal.
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:thumbup:

Amalgam is outdated, period. It's not about the mercury, it's about the prep destruction required for amalgam and the wedge-effect it leads to.

Bond a tooth back together, don't create a splitting tooth. Don't like composite? Use bonded amalgam at least, or better yet, use gold. Concerned about splitting teeth with amalgam or gold? - use ceramic inlays/onlays for bigger cases.

I must validate this comment also. I have practiced in public health and IHS and high-end practice. I love large amalgams with amalgambond, they work GREAT and I have seen 40+ year results come back (obviously not from me but from similar treatment) and still holding okay. But nowadays, putting a MOD amalgam into a tooth is asking for that tooth to crack. It also has to do with bruxing and occlusal forces teeth are subjected to.
 
mike3kgt said:
:thumbup:

Amalgam is outdated, period. It's not about the mercury, it's about the prep destruction required for amalgam and the wedge-effect it leads to.

Bond a tooth back together, don't create a splitting tooth. Don't like composite? Use bonded amalgam at least, or better yet, use gold. Concerned about splitting teeth with amalgam or gold? - use ceramic inlays/onlays for bigger cases.

I must validate this comment also. I have practiced in public health and IHS and high-end practice. I love large amalgams with amalgambond, they work GREAT and I have seen 40+ year results come back (obviously not from me but from similar treatment) and still holding okay. But nowadays, putting a MOD amalgam into a tooth is asking for that tooth to crack. It also has to do with bruxing and occlusal forces teeth are subjected to.
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If the tooth is prepared properly and the functional cusp largely intact, the chance of having a tooth fracture caused by Ag restoration should be very small……a lot less than the chance of having recurrent decay caused by shrinkage of the composite restoration. If a 20+ year old MOD almagam filling on my tooth fails, I have no problem letting my dentist replacing it with another amalgam restoration. What do I know…..am only an orthodontist.
 
OceanDMD said:
Typical response from an orthodontist. When you have an adult who has relapse, and absolutely will not go back into the railroad tracks, its perfect. Sure the return is less, but when you work out the hourly production based on fee-lab fee its still lucrative. Im not saying specialists are in trouble, Im just saying my teenagers who are class I skeletal and dental with mild to moderate crowding or spacing can be treated successfully with invisalign. And they are happy not to wear the train tracks.
Click to expand...

this study did not show very good results

http://www.ncbi.nlm.nih.gov/pubmed/19121497
 
OceanDMD said:
Dont get me wrong, the new rules as far as yearly cases and CE pissed me off, and I use the other options out there for simple cases. However, people come in and consistently ask about Invisalign. 2 cases a month, 50k in my pocket.
Click to expand...

My wife just got notification from invisalign yesterday that they were dropping their minimum 10 cases a year requirement + lessening the amount of yearly CE for a doc to remain "invisalign certified"
 
DrJeff said:
My wife just got notification from invisalign yesterday that they were dropping their minimum 10 cases a year requirement + lessening the amount of yearly CE for a doc to remain "invisalign certified"
Click to expand...

Looks like it bit them in the ass. Sure stirred up a brushfire in the dentaltown forum.
 
runfast520 said:
this study did not show very good results

http://www.ncbi.nlm.nih.gov/pubmed/19121497
Click to expand...

The clincheck is theoretical. All cases often require "refinements" and/or other tweaks to get a desired result. I am certainly not saying its better than braces at moving teeth (or the accuracy), Im saying its a nice alternative IN SOME INSTANCES, and their marketing has patients aware of the product. Now Im sounding like a pitch man, If you dont want or believe in the product, dont incorpoate into your practice. I was skeptical at first.
 
DrJeff said:
My wife is real curious to hear what they're going to say (both on and off the record) at the AAO meeting in DC next weekend
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If you wouldn't mind, PM me any inside info. The rep in my area is really nice, but I just dont trust her. She has been pushing these damn vivera retainers (lab cost like $175 which is ridiculous) when I can make essix retainers for like $1. Drives me crazy.
 
OceanDMD said:
If you wouldn't mind, PM me any inside info. The rep in my area is really nice, but I just dont trust her. She has been pushing these damn vivera retainers (lab cost like $175 which is ridiculous) when I can make essix retainers for like $1. Drives me crazy.
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No problem there Ocean. My wife is good friends from her residency program with both one of invisalign's case review docs and also one of their bone biology research orthodontists, so if there's any unofficial info, she'll probably find out about it at one of the various parties at AAO and/or one of the various bars in the DC area next week

:D
 
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