Dentistry has evolved – and continues to do so at an extraordinary pace.
Not long ago – even just 20 years back – the vast majority of dentists worked in a very personal, hands-on way. One clinician, one assistant, one patient at a time. It was intimate, precise, and deeply human. These dentists were often pillars of their communities, caring for generations of families with a sense of trust and connection that remains the beating heart of our profession.
This kind of dentistry still exists today – and it should. There will always be a place for the skilled hands and compassionate eyes that tend to one tooth, one emergency at a time. It’s essential, it’s meaningful, and it’s deeply appreciated. I do this too and so do many on my team when we have to.
But something is changing. The landscape is shifting.
For those moving into an era of full-arch rehabilitation, complex reconstructions, and interdisciplinary treatment, the demands on our thinking – not just our technique – have grown. We are being called not only to treat teeth, but to design smiles, to restore function, to harmonize aesthetics with biology and make it all last forever.
And at the same time, technology has rewritten the rules.
We now diagnose, plan, communicate, and execute treatment in ways that would’ve sounded like science fiction just a generation ago. CBCTs, IOS, facial scans, AI-assisted planning, cloud-based lab integration, dynamic smile design – these aren’t dreams of the future. They’re tools we can access today. I am having a lot of fun with these tools and it truly is a paradigm shift.
But with all this power, we must ask ourselves:
Are we truly thinking differently? Are we leveraging these tools in a way that honors their full potential – especially when managing complex, multi-phase treatments?
Because when dentistry becomes more than one tooth at a time – when we are rebuilding form, function, and beauty across a full arch or even a full mouth – we need to shift our mindset.
Much like planting a bush in your garden versus redesigning the entire landscape, the complexity and responsibility change. One is personal, manageable, and intuitive. The other requires a broader vision – a landscape architect who understands irrigation, sustainability, sunlight, soil health, and how everything works together over time.
Or imagine the difference between repainting a room and building a home from the ground up. The latter demands an architect, an engineer, and a builder – each bringing their unique expertise at the right moment.
In dentistry, we are now stepping into that same triad of responsibility.
Sadly, dentists are not paid to think and plan. Only to execute. That must change.
Here’s the problem: in our current system, dentists are primarily remunerated for what they produce not how they think, or how much effort goes into planning. Procedures are billable. Planning, thinking, collaborating, and sequencing? Not so much.
This means that many times, planning is rushed. Or skipped. Or folded into the treatment fee with little time allocated for it. But when you’re dealing with complex care, planning is everything. Without it, even the most skilled work can unravel.
We need to change this model. We need to help both dentists and patients understand that great outcomes start long before a handpiece is picked up.
Patients Must Learn to Pay for the Architecture
If patients want extraordinary, long-lasting results, they must understand the value of the planning phase – the architecture of a smile.
This is where vision, design, and diagnostics come into play. It’s the foundation of everything.
And today’s technology gives us the most advanced tools we’ve ever had to “design before we drill”:
- Intraoral Scanning (IOS) for high-resolution, accurate impressions,
- CBCT for detailed 3D understanding of bone, root, and sinus anatomy,
- Facial Scanning and Dynamic Tracking to integrate function in motion.
And much like Digital Smile Design (DSD) – pioneered by Christian Coachman – this planning methodology has now become widespread and integrated into most advanced lab and design software. The DSD legacy is profound: it taught the profession to think like architects.
The beauty of this evolution is that even smaller clinics can outsource this phase to specialized planning teams or labs. This allows clinicians to elevate their cases with high-end architecture without needing all the technology or expertise in-house – and importantly, this fee can and should be passed on to the patient. After all, you wouldn’t expect an architect to design your home for free.
I jokingly call dentition with extensive work done over the years without a plan, “Favela Dentistry”, because the Favelas of Rio de Janeiro are beautiful from a distance but close up, clearly the result of budget do-it-yourself building.
Engineering: The Foundation Beneath the Surface
Once the architecture is complete, we move into engineering – the often invisible but critically important step that ensures everything works.
This is where we decide:
- Which implant systems, sizes, platforms, and configurations to use,
- What biomaterials will deliver the best strength, biocompatibility, and longevity,
- What type of ceramics or lab materials to use,
- How to sequence surgeries, orthodontics, soft tissue work, and restorative phases.
But engineering is also where clinical ethics and biological respect must guide our decisions.
We must always think minimally invasive. Our default should be to preserve natural tissue, not replace it. Whenever possible, we should consider orthodontics to improve the baseline position of teeth before considering more aggressive intervention when grinding off healthy enamel for esthetics.
We should aim to shave off the least amount of enamel, save every viable tooth, and avoid extracting healthy teeth in order to perform full-mouth reconstructions or conversions to systems like All-on-4. These decisions are not just clinical – they are engineering choices with long-term biological consequences.
Patients have the right to understand their options clearly – and those options should be presented in the architecture phase, based not on trends or commercial pressure, but on biology and legitimate, peer-reviewed evidence. This is one of the cornerstones of Slow Dentistry. Explaining the risks and rewards of the treatment to the patient.
A thoughtful engineering plan doesn’t just solve problems – it protects what is still healthy and truly invites the patient into the decision-making process.
Sequencing: The Unsung Hero of Success
One of the most overlooked aspects of engineering is sequencing.
- Should we start with orthodontics to align roots and create space before placing implants?
- Should we change the shape of teeth when they’re too small before or after aligners?
- When to raise the bite?
- Should we do bone or soft tissue grafting first?
- Do we place implants early and restore later – or stage them after initial restorative work?
Every case is different, and the sequence matters. A lot.
Great sequencing reduces visits. It minimizes healing phases. It improves communication across disciplines. It creates momentum, trust, and consistency – for both patient and clinician.
Bad sequencing, on the other hand, leads to chaos. More appointments. Missed deadlines. Compromised results. Financial or reputational loss.
Only Then Do We Start to Build
Once the architecture and engineering are solid, we can finally begin to build.
This is the phase most patients are familiar with – and the one dentists are most often trained and paid for. But when we approach it only as builders, without the strategic phases that came before, we’re working without a blueprint.
With digital workflows, guided surgery, CAD/CAM, 3D printing, and high-performance ceramics, we now have extraordinary tools to build with precision and predictability. But technology is only as good as the plan behind it.
When everything is aligned – from diagnosis to execution – this phase becomes smooth, fast, and deeply rewarding. The results feel almost effortless. Healing is faster. Outcomes are more predictable. The patient experience is transformed.
Moreover, it can be executed by different doctors and easily monitored by the team that are simply following a plan. This is critical for big clinics with a lot of work.
Quality Control: Dentistry’s Missing Layer
In construction, every phase must be signed off by an inspector before the next begins. You don’t pour the foundation and start building walls until it’s been checked. You don’t put on the roof until the frame is sound.
Dentistry rarely operates this way. But it could – and should.
With modern scanning, radiography, and photography, we can document each step. We can create a digital record that not only proves quality, but helps educate the patient, reduce errors, and even allow for external peer-review when needed.
Imagine a future where dentists are only paid when each phase meets pre-agreed standards. Where outcomes, not procedures, define value. That future may be closer than we think – and it will elevate the entire profession.
Many won’t welcome this thinking, but those that suffer when things go wrong and have to pay for the clean-up most certainly will appreciate it.
A New Model for Dentistry
So, what are we really talking about here?
We’re talking about a mindset shift.
The modern dentist – particularly when managing complex cases – must step fully into three roles:
- Architect – who imagines and maps the destination. The vision.
- Engineer – who plans the systems, selects the tools, and sequences the journey.
- Builder – who brings it all to life with skill, care, and precision.
Each of these roles is essential. Each deserves time, respect, and remuneration. And each contributes to a standard of care that reflects the very best of what dentistry can be.
You can be all three, or part of the system. That’s fine.
Final Thoughts
If you’re a patient, ask your dentist how much time they spend planning your treatment before beginning. If the answer is “not much,” you may be investing in something built on shaky ground. Ask how they plan and who are the “players” in the entire ecosystem. What thought they have put into sequencing, materials and outcomes?
This is more important than the classic, “what’s the guarantee?”
If you’re a dentist, give yourself permission to think deeply. To charge for your thinking. To collaborate more. And to use every tool at your disposal to deliver extraordinary results even if that means outsourcing.
And if you’re a young clinician, remember that speed isn’t the goal – strategy is. Mastering the roles of architect, engineer, and builder will not only make you a better dentist – it will allow you to do your best work for the people who trust you most.
This is what the future of dentistry looks like.
Thoughtful. Strategic. Ethical.
Built to last.
