Microscope operative dentistry?

Discussion in 'Dental Residents and Practicing Dentists' started by studentdent00, Jun 9, 2018.

  1. studentdent00

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    What's everyone's thought on using a microscope for routine restorative dentistry for the sake of career longevity (i.e. neck and back injury prevention) and as a marketing strategy targeting high-end patients? I reckon that it will be initially more costly with a steep learning curve in addition to increased operation time, but then again the quality of procedures and career longevity will probably increase at the same time, enabling the dentist to attract more fee-for-service patients and elevating his/her lifetime income. Perhaps it can also be used to justify increased pricing model. Thoughts? I doubt it will work with mill type offices and most of the PPO based offices but see it as a viable model for 100% FFS offices.
     
    #1 studentdent00, Jun 9, 2018
    Last edited: Jun 9, 2018
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  3. Rainee

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    No. Just no. Is this a joke post? Even the gps that I know that have microscopes for endo wouldn’t do one for operative. This has to be a joke post.

    FFS patients are unicorns now and patients care about the experience if they like or dislike you or if they like the hygienist. They could care less if you still use equipment from the 70s and they def wouldn’t justify paying more for treatment. It’s a bottom sum game bro. If they can go down the street for a private in office financing for 50$ filling versus your cash microscope 200$ fill they will always choose the cheaper option. If anything they would be be like ahh that’s why you charge so much for fillings, and then they go home and see flyer for 49$ exam free cleaning and fillings from local PPO mill.

    Once you own a business you will understand the word overhead and the implications of a useless 40000 microscope. It take me 15 min to bust out a filling. With microscope you go way slower. So in the end you decrease your productivity. Nothing in this post makes sense. Sorry.

    Last edit: you will learn to find out that FFS patients tend to be the cheapest patients there are, because dentistry without insurance is damn expensive. They don’t want X-ray/exam/build-up/ they will negotiate for cheaper price and also try to bargain with deals. There’s no way the cheapest patients will be willing to pay more for a microscope fill.
     
    #2 Rainee, Jun 9, 2018
    Last edited: Jun 9, 2018
  4. studentdent00

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    Used microscopes cost considerably less than 40k. It is true that microscope dentistry is slower than "loupe" dentistry, but slower speed is made up in a sense with a higher treatment cost (justified via increased meticulousness). It's true that FFS patients can be "cheap," but at least they can afford the service and some are willing to pay the premium for VIP experience and quality dentistry. It's about confidently projecting the value of the proposed treatment and communicating effectively.
     
  5. Rainee

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    Still nope.
     
  6. vellnueve

    Dentist

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    Patients aren’t going to pay more for that. And it’s not practical anyways.
     
  7. ModifiedBass

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    One of our faculty in the city who is extremely successful in private practice performs microscope restorative and heavily advertises it. So yes, there are patients that will pay for it and pony up the premium for it. They even implemented two days worth of seminar/practice for us to try it out during our fourth year. After using it, and what I’ve gathered from most of the classmates I spoke with, it just seems impractical for most. So yes there is a patient base that can make the investment worth it out there, you just have to be a very strong advertiser, but I would never do it myself.
     
  8. shendo

    shendo UCSF/NYU Lutheran AEGD La Clinica Site Director

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    OP- if you are interested in learning more about microscope operative dentistry, I would recommend checking out the dentaltown website where there is a forum dedicated to talking about microscopes and how general dentists are incorporating it into their everyday clinical use. You can also check out the AMED organization (Academy of Microscope Enhanced Dentistry). I've talked with reps from the major microscope companies, and they have noticed a trend in the recent years of more and more GP's buying microscopes to use for general dentistry, not just endo. That is why Zeiss came out with a new microscope last year that is catered more for general dentists. Microsopes nowadays have come down in price as there is more competition, you can find a decently equipped microscope around $15,000-$20,000.
    There is definitely a steep learning curve in the beginning especially if you are trying to learn how to use it on your own, and the issue is that most dentists who give up during the initial learning phase are the ones who say it is not practical and not worth it.
    Let me dispel the myth that microscope operative dentistry is only for high end general dentists- I have been a general dentist working in a community clinic setting for the past 10 years and I use the microscope on a daily basis not just for endo cases but for 60-70% of my routine general dentistry procedures (fillings, crown preps...). Obviously, I don't cater to high end clients or FFS patients and I am still able to make it productive doing quadrant dentistry with the microscope for a majority of my procedures. Yes, in the beginning during the learning phase, it did slow me down and it was very frustrating at times, but now it takes just as long for me to do a filling with the microscope vs loupes and in some cases, it cuts down my time with the microscope because I can visualize better.
    Also for young dentists who are starting out in their career, you won't appreciate the benefits of the ergonomics using a microscope for your neck and back, but once you are further in your career, this is something that becomes much more appreciable. When I talk with the microscope reps, they mention that a good percentage of the general dentists that buy scopes are not buying it because they want to do high end dentistry per say, but more it is for the ergonomics since they have developed back and neck issues.
    Anyways, just wanted to give you a perspective from the other end and encourage you to research more if you are interested in incorporating microscope into your practice later on.
     
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  9. Rainee

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    You can also use a cbct for endo... blood infusion bone particle mix into ext sites... rubber dam for all fills, laser for all class 5 lesions/impressions, all great options that are miles ahead more practical cheaper (can be debated) and produce quality results then what the original poster is suggesting.

    Could I use a microscope a filling? Yes. Could I use a rubber dam for extraction? Yes. Could I use a cbct for a filling to make sure all decay gone? Yes. Is that unpractical? Yes.

    Spend on your time on practical things rather then unpractical. The secret of a successful practice is keeping overhead low, being productive and keeping patients happy.
     
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  10. TanMan

    TanMan New Member
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    +1... what he said, I'd totally agree with (even though we don't always see eye to eye).
    Remember to ask yourself this question: Does it increase quality and/or improve profitability?
    If you set yourself up with all this technology and advertise it, patients expectations will go up. If and when things fail (and they do...), those high expectations will bite you in the ass.

    A heavy FFS(not pure FFS) office closed near me recently and OMG, these are some of the highest maintenance patients ever that I've been seeing. If you really want to do FFS, you really have to make sure that you make every patient count (high prod/pt). They will drain your time, question you a lot, and talking doesn't pay the bills. I sense you are trying to carve a niche FFS market, and it's something that's possible, but difficult. I wouldn't have the answer since I don't have a pure/mostly FFS practice, but FFS patients are not the same everywhere. A high end FFS patient from San Francisco would be different from a high end FFS patient from Baton Rouge. If you know where you want to setup, you can probably get more customized responses. However, trying to sell yourself as a high technology practice sets up high expectations. Technology makes sense if it increases quality and/or increases profitability. Relying on the idea of "high technology" alone is quite a gamble IMO.
     
  11. ProspectivePostPreDent

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    How much is your back worth to you? The answer might not be the same for everyone.
     
  12. DocJL

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    My endodontist (friend) tells me that his back hurts just like mine does.

    He says you end up twisting around the microscope to look around it for some things, several times during every procedure.

    Dentistry is hard on the body, period.

    Loupes or microscope, and not seeing too many patients, while paying attention to your posture, help, but doesn't change the basic fact that you are working in a small confined space and doing procedures most of the day.
     
  13. oralcare123

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    I have been lucky to witness someone who is very good at the microscope dentistry. The quality of his work is incomparable to any Loupe one. It was not at all longer, but the opposite
    He said it is easier on his eyes and back - he used the chair with elbow support
    Glenn A. van As, BSc, DMD, Dental Education
     
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  14. oralcare123

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    It is a real thing. There are people in this country, who are willing to pay double to be treated by one of those specialists. Don't be so fast to judge something you know very little about
     
  15. DocJL

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    Perhaps he is just gifted.

    Just as we all learned in dental school, some people are naturally gifted with their hands.

    If someone has average or below average hands, even though they can learn, as dentistry is a skill, IMO they will never be as smooth or good with their hands as someone who is gifted. Seeing the image in 10x on a microscope, vs 3 to 5x with quality loupes isn't going to be the determining factor here, in operative or pros.
     
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  17. Rainee

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    I like to keep things real. If the OP posted something to the extent of rubber dam dentistry only and marketing with transfusion platelets after ext with cbct for FFS patients, I would def say go for it. But giving someone the ridiculous false hope of doing class 1 and class 2s with a microscope is just plain silly. I’m sure there are 1-2 dentists doing this but there are more practical things to market. Just keeping it real.
     
  18. oralcare123

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    It might sound like an overkill, but even during fillings microscope is helpful. Mostly during endo and prosthodontics cases. I never asked how he started, but said it will allow him to practice longer easier
     
  19. oralcare123

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    Maybe try his course and you will see the difference and the potential
     
  20. ysrebob

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    There's a dichotomy here between the folks who truly love dentistry and are excited about it, VS the dentists who are just trying to make a living in a tough profession, provide honest good service to their patients, and go home at the end of the day. It's hard for one to comprehend the other.

    Most of us fell into the first category (idealistic and excited) coming into dental school, at least I hope so. A few years out in the world of hard knocks and I bet a majority find themselves in the second camp. I certainly have. Don't knock Rainee for not being at all interested in adding complexity to his procedures without a proportionate benefit in outcomes. A few years out there paying the bills and dealing with the public day in and day out, and you may feel exactly the same way. It's not the same thing as being casual about quality of care.
     
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  21. DocJL

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    Once again, Bob nails it.
     
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  22. studentdent00

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    Just to reiterate, I think the main rationale behind incorporating a microscope into day-to-day dentistry should be to prevent back and neck injuries or at the very least to decrease the risk of sustaining them. Obviously without adequate training and other ergonomics improvement measures including a better office design and more comfortable dental chair with armrests, one may not reap the full benefits of having a microscope. Improvement in quality of care as a result of improved ergonomics is a secondary effect and not the primary objective in obtaining a microscope.
     
    #20 studentdent00, Jun 13, 2018
    Last edited: Jun 13, 2018
  23. Rainee

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    In the end it’s all a crapshoot. My best advice is to live a healthy life/lift weights/swim/yoga. Even the best maintained people that I have met have come down with problems with back or hands. You can’t predict what will happen 5-10-20 years from now on. You are better off getting a personal trainer/gym membership to prolomg your career over a microscope.
     
  24. setdoc7

    Dentist

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    I use a scope in my GP practice. Got it used for cheap and wall mounted it. After using it for endo a lot, I tried it one day for some crown preps when my loupes ended up at home and not in my briefcase. Been using it ever since. It is a useful adjunct, but like anything else, there is a learning curve using it. I am at the end of my career, not the beginning, so not trying to build up a practice I have been running for 32 years, but trying to enjoy the profession I have been a part of for 35 years. I definitely see more than with my loupes, the lighting is excellent, and the maintenance is low. If I had a young family, student loan debt, and high overhead, I would probably forego the scope.
     

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