By Dr. Anthony M. Puntillo, DDS, MSD
When I first graduated from my orthodontic residency, now more than 23 years ago, a standard set of initial records included plaster models, facial and intraoral photographs taken with film, developed, then trimmed and placed into mounts and panoramic and lateral cephalometric radiographs taken with film and developed in darkrooms. The digitization of our society has made the process of gathering and storing this important diagnostic information much more efficient for most orthodontists. In fact, more than four years ago (November 2012) I wrote a Tech Blog article on digital retainers and the impressionless orthodontic practice. Since then the use of intraoral scanners and 3D printing in our profession has grown exponentially. It is now not hard to imagine a day in the near future when impressions will disappear completely from the practice of dentistry. As I near the end of my 8 year term on the CTECH committee, I can’t help but wonder what is next. Where else can we use technology to eliminate inefficient processes from our practices?
The most obvious next step for me is the elimination of intraoral photographs. All of those 
intraoral scanners, now used by most orthodontists, take multiple photographs of our patients’ teeth to create the 3D digital images. Several of these scanners can capture images in true, or close to true color. It can’t be long before we come to the realization that digital images taken with a good intraoral scanner are a better alternative to the standard set of 5-7 intraoral 2D photos we have been taking for decades. The 3D digital image is not only a better diagnostic record of the patient’s current dental state, it also is more versatile in that it can also be used to create and fabricate appliances (i.e. clear aligners, indirect bonding setups, retainers, etc.). If a good intraoral scan can consistently be completed in less than 10 minutes, aren’t we wasting our time and that of our patients’ taking 2D photos. I concede that we are all very accustomed to diagnosing our patients with these 2D photographic images. However, it was not that long ago when most thought that multiple radiographic exposures were necessary on the majority of our patients. Now most of our patients are diagnosed with a single, quick radiograph taken on a CBCT machine and from that single exposure we derive a much higher level of diagnostic information.
To be honest, I am not yet ready to mothball our cameras. For starters, I still think that facial 2D photos are necessary. I know that there are 3D cameras available that will someday eliminate the need for our extraoral series of facial photos. However, for whatever reason (I believe primarily cost) these have not yet caught on. So for now we will still be taking a series of three 2D digital photos of our patients’ faces. Additionally, 2D intraoral pictures still play a significant role in our new patient consultations. We have not yet found the best way to display and share the captured 3D dental images (STL files) to educate our patients. I anticipate that this last hurdle will be overcome in 2017 and when that happens our DSLRs are going to see much less action and our IOSs are going to play an even larger role in our new patient process.
Moving your office to a new location is a tedious process involving many tasks and some headaches. A critical moment during the move is the transfer of your main phone number to the new location. Unfortunately not all numbers can be transferred to certain areas. Phone carriers have rules regarding the assignment of specific numbers to defined geographical areas that are beyond the purpose of this blog. Luckily there are solutions to this problem.
Indirect bonding was first introduced to orthodontics over 20 years ago and has become an integral part of many orthodontic practices and orthodontic labs worldwide. The four reasons/advantages for its inception are: 1) Indirect bonding has been widely viewed as giving the orthodontist the ability to achieve more accurate bracket placement on a static model and not having to deal with the clinical challenges with direct bonding on a patient, 2) The doctor can perform the final check for bracket placement at his/her own leisure and not under a set clinical schedule, 3) To improve clinical efficiency with decreased doctor chair time at the full bonding appointment, and 4) Finally, for improved patient comfort due to decreased time which the patient is in cheek retractors.
Augmented reality is the integration of digital information with our physical senses, (e.g., touch, smell, sight). This technology is far from new and has multiple uses in the commercial market but has struggled to find a foothold in the consumer market – that is until recently. On July 6th, 2016 Niantic released the Pokemon Go game app and within 20 days it had already been downloaded 75 million times while producing $10 million in revenue a day for Niantic. The popularity of this augmented reality game is not relegated to kids, as you may find adults as well as young patients playing Pokemon Go in your waiting room or clinic. It’s still to be determined if it will simply be a fad or a long-term success, but regardless, there are several things we as orthodontists can be doing to leverage this augmented reality app for the benefit of us and our patients.
PokeStops present a unique opportunity to orthodontists and other savvy marketers. One of the items available for purchase at a PokeStop is a lure. Lures can be purchased and activated at a PokeStop to attract Pokemon. The lure lasts for 30 minutes and attracts Pokemon to gather at that particular PokeStop for easy capture. For example, I once stumbled upon a crowd of 60 people sitting in an amphitheater by the Willamette River in downtown Portland. I assumed they were awaiting the start of a performance and asked a nearby vendor what show it was. He explained there was no scheduled show and there were simply two PokeStops located side-by-side which both had active lures. The crowd had congregated to take advantage of the lures to easily capture Pokemon.
Google my Business is another way Google has made it easy for us to let prospective patients know about the level of care we offer. It complements your website by giving your practice an identity and presence on Google. If you previously used Google Places for Business or Google+ Pages Dashboard, you may not have noticed it, but your account has already been automatically upgraded to Google My Business. The information you provide about your practice in Google My Business will appear on Google Search, Google Maps, and Google+ to those searching for an orthodontist. And if you had multiple Google+ Pages they will all show up on the Google My Business Dashboard as long as they are associated with the same email address.
It was not that long ago when we all relied upon our friendly postmen and postwomen for the delivery of our letters. Today the United States Postal service is scaling back mail operations in favor of package delivery, and the majority of our written communication is transmitted electronically. Is the delivery of healthcare, and particularly orthodontic care, headed for a similar fate? A Computerworld article, cited research by Deloitte, which projected 75 million of 600 million appointments in 2014 with general practitioners would involve electronic or eVisits¹. “Electronic visits or telemedicine are comprised of electronic document exchanges, telephone consultations, email or texting, and videoconferencing between physicians and patients. The vast majority of eVisits, according to Deloitte, are likely to focus on capturing patient information through electronic forms, questionnaires and photos.” In the state of Texas, new legislation has opened the door for physicians to be compensated for remotely providing care to children through a video connection to the school nurses’ office². Market forces including an expansion of access to care, increased efficiency, and financial incentives are driving all of these changes. Just as eMail though has not completely eliminated the need for our postal service, eVisits are not likely to eliminate the need for all direct patient to physician interaction. However, there can be no denying that technology is changing the manner in which healthcare is delivered and our specialty will not be immune.
Microsoft has recently released the latest version of its operating system (OS) for PCs – Windows 10 (let’s call it WinX).
Many of you may have seen a little notifier popping up on your PCs prompting you to reserve or upgrade to your free copy of WinX now. With great joy and vigor many of you have done just so. But is this a good idea? Staff clicking on it can trigger a disaster if this isn’t thought through.
My stance is typically to wait out the initial release and let others debug the 1.0 version. At the time of this writing 
Nowadays almost all of us have a smartphone and we use it hundreds of times during the day checking incoming e-mails, surfing through the web and sharing our thoughts and pictures online within our social communities. This is the “permanently online” era and our patients ask for immediate information supply and assistance request satisfaction.