“Digital does not improve mistakes, it highlights them.”

“Digital does not improve mistakes, it highlights them.”

Miguel Stanley, director of the White Clinic and vice-president of the Digital Dentistry Society

“I don’t believe that technology makes a dentist a better dentist.” These words belong to Miguel Stanley, founder and director of White Clinic, recognised as a pioneer in clinical implementation in various areas of advanced technologies, and for whom the idea of technology without training “is useless”. In his opinion, each time this area is contemplated, it is imperative to “make an equal investment in a capable and well-trained human resource”. In an interview with Maxillaris, the vice-president of the Digital Dentistry Society – and member of several international scientific and academic institutions – predicts that in the future “it will be the patient who will be making more conscious decisions, assisted by artificial intelligence”. Miguel Stanley, who was recently named one of the 100 best dentists in the world by his peers and considered one of the “32 Most Influential People in Dentistry” (by Incisal Edge magazine), is adamant that the golden age of the industry “is yet to come”.

In general, what is your comment on the evolution of digital tools in the dental industry?

It is obvious that the new digital tools in dentistry have been “invading” our profession in a positive way. I personally think that it’s important to calibrate our language when we use the term digital dentistry. I say this because all it takes is for a dentist to communicate with his lab technician via video through a social platform, such as WhatsApp, and he is already using a digital tool. Therefore, I think it’s important to place each different digital tool into distinct segments. There are clinical management technologies, which have been in use for many years, like the digital X-ray, which I have been using in the clinic for over 22 years, and these already exist in almost all national clinics.

However, we have the most advanced technologies, such as intraoral and facial scanners, and technologies that analyse jaw movements, integrating this information with the intraoral scanners. In addition, we have the latest generation software that can be used by the dentist, as well as by the dental technician, which I would say is a universal communication platform today. These technologies are already more expensive and require more specific training, and are truly indispensable for the dentist of the future.

There are still many professionals who aren’t taking full advantage of these new technologies and, in some cases, the technological factor may even represent a delay in the consultation or treatment. How can this reality be reversed?

First of all, I don’t believe that technology makes a dentist a better dentist. The factors that truly make a dentist excellent are experience, good clinical protocol, great materials, adequate time to work, a great team, a good laboratory, among others. Technology only aids in communication and acquisition of information. I know many dentists who can do amazing things without technology. However, younger people have a lot to benefit from using technology because it really helps in terms of communication between teams, in asking for help from others, and in the detailed analysis of work, as well as how work is designed. It is not only an incredible tool for the execution of work, but also in how we think about work. As such, it is crucial that big dental groups invest in technology and training for the younger generation because it will go a long way in mitigating the lack of experience.

In addition, I believe that technology helps a great deal in integrating the patient into the treatment plan and avoiding complications. We know that today colleagues share a large number of patients and the only way to control the entire sequence and make sure that nothing is lacking or is forgotten, is through technology. So, if a dentist is doing everything from start to finish, they often don’t need that much technology, but in interdisciplinary dentistry, technology is indeed indispensable.

Do you think that training in this field, regarding diagnostic and treatment devices, has been corresponding to the needs (and pace) of the ongoing digitalisation process?

I am unaware of the reality of training in this area in Portugal. I am very connected at an international level, but I have never been invited to participate in training at an academic level in Portugal. I would be delighted to do so. Nevertheless, I believe that big brand names, and I say this because I know the CEOs of most of these technology companies, are incredibly focused on increasing the educational offer around the world, not only in person through conferences, but also online.

How long will this digital adaptation process take?

The adaptation process happens at the same speed as the implementation. In other words, as technology is acquired, the teams learn how to integrate it into their daily workflow. For some years now, I have been warning clinic owners who make investments in technology that they should be extremely aware of the time this requires. For example, integrating an intraoral scanner into a clinic is not as straightforward, nor is it always faster than silicone impression, for example. Software training is necessary, because when it comes to new scanners the technique itself is not as complicated and the learning curve is relatively fast. Clinics that do not allocate adequate time to prepare the patient – launch the computer, open each patient’s medical record, prepare the technology so it can correctly scan and then process this information correctly, requires close to 30 minutes – will find it difficult to integrate this technology.

As the founder of the Slow Dentistry Global Network, we have been studying the timing of things in depth, and for practices that prefer to do things faster, and have the illusion that these technologies are much faster than traditional techniques, that’s not quite right. It’s true that they allow you to do so much more, but in the beginning you need time and you need to change your strategies.

Regarding all clinics at a national level having a 100% digital workflow, that depends on the economy of the country itself. This transformation is costly and I believe not everyone will be able to do it. Unfortunately, like everything in life, those who can work with the best brands and with the right integration time will win this race to the future. So that’s why I’ve said it right at the onset – you don’t need technology to be a fantastic dentist.

Is the intraoral scanner currently a full scale replacement for conventional moulding?

That’s a complex question. I have been working with this technology since 2015 and have all the brands and their latest versions in the clinic. We have a lot of experience in this matter.

I can say that in some cases nothing replaces a good polyether impression. I am talking about very complex full mouth cases.

However, for the vast majority of individual and small treatments like orthodontics with aligners, I would say that nowadays a good scanner can replace an impression. But, here it’s important to have an excellent dental technician who understands how to interpret these images and also the use of high-quality 3D printers. Digital does not improve mistakes, on the contrary, it highlights them.

The software industry is also growing rapidly. In your opinion, what criteria should be followed before choosing a certain software?

I would say that the main criterion is to work with a software that is “open source”. That is, one that can receive STL and DICOM from every source. The future lies in platforms that integrate all sources of information. Some companies try to create closed circuits, they rarely succeed. Obviously, there are some amazing cases, but they are usually more expensive. I love systems that are open and that allow us to adapt and integrate things we may already have without having to sell or upgrade them at a great cost to the company.

Is using digital technology synonymous with a better final result in the treatment provided to the patient?

As I have already said, no! The experienced, well-trained dentist working analogically may, in many circumstances, obtain even better results than someone who has no experience or knowledge and is working with the best digital technologies. Technology helps and enhances, it does not correct or improve a poor treatment. I often say that a bad dentist should run from digital technologies! It is very easy to catch a bad treatment through these means, because everyone can see it. In the past, a bad impression was only known by the dentist and the dental technician. Today, by using digital technologies this information is shared very quickly. I believe it’s an incredible way to see who’s who.

But I’ll say it again, we can’t forget that in the past dentists were able to do amazing things with great quality and without any kind of technology. But they had more training, more time and great dental technicians.

Is investing in digitalisation a sure bet? Does it mean reducing clinical costs in the medium or long-term?

That is not always true. I think it is much more important to invest in good, well-trained professionals and give them adequate time to work in an ethical and responsible way. I have a very dim view of these new large groups entering the market, hiring young dentists and not giving them enough time to work in a controlled and safe manner. We have to be incredibly vigilant about this.

But obviously, any clinic that invests in the fundamental technologies that comprise the digital universe, such as CBCT, intraoral scanners, milling machines, etc. will have greater and better production capacity. But as a reminder once again, it is imperative that every time you invest in a new technology you should be making the same investment in a capable and well-trained human resource to work with it. Technology without training is useless.

Which dentistry disciplines have benefited most from the ongoing digitalisation process?

Without a doubt, where we have seen the greatest transformation is in dental laboratories. The capacity and quality of production has completely changed. I say this because in the last five years we have invested heavily in our in-house laboratory, and I am very aware of this.

Obviously, these technological advances have also been accompanied by the industry, which is creating new materials that are also very interesting. Today, and thanks to digital technologies, we are able to do things with monolithic ceramics that used to be unthinkable.

And then, obviously, we have orthodontics with aligners that can now also integrate CBCT, creating conditions for a much more serious diagnosis at the periodontal level. And then, finally, surgical guides, which are definitely being used more and more in our profession.

How do you see the future of these technologies and how will they influence the profession in the next 10 or 20 years?

I’ve been thinking a lot about this, and I believe that the virtual patient is coming. What does that mean? It means that in the future it will be possible to digitise all of the patient’s information and put it on the Cloud, and it will be the patient who will decide, in a more conscious manner, making decisions assisted by artificial intelligence. In addition, there will be so much more control over the materials placed inside the mouth, which today simply doesn’t exist. I believe that technology is going to fundamentally revolutionise the way dentists work and how patients consume dentistry. It’s going to be much harder in the future to “cheat” the patient or perform poor work. It’s a great time to start investing in training and professional ethics, and maybe focus more on doing things right because technology is going to catch all the “bad actors” that are doing things wrong without any kind of control.

And that’s why I’ve been saying for a few years now that the golden age of dentistry is yet to come.

*Originally published in Maxillaris.

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