In the old days as a dentist it was fine, there were limited treated modalities, very limited equipment, possibilities and pretty much an unlimited supply of disease.
This meant you could set your practice up, provide a mediocre level of service with a mediocre level of clinical skill using mediocre equipment and just occupy the mediocre end of the market. A few people would try to be really good with the materials and equipment that was available, provide a bit better service and then they would be at the top earning a bit more money. Generally the rest could not be arsed. The ‘not be arsed’ guys could survive in that middle ground, work until their pension and then get out. It was a safe format, very little changed and it existed for a few decades.
We don’t live in that world anymore. We live in a high tech, consumer aware, heavy consumption environment and this has affected dentistry dramatically as it has the rest of the world.
Let’s just take the example of the ballooning market of intraoral scanners. You can read a paper here which looked at the six best selling scanners in the world and their accuracy on an analogue model.
Clinician A buys CEREC by Sirona and runs the scanner in their practice, they have undergone an enormous consumer experience, paying a lot of money (£80 - £90,000 for scanner and mill) and that is the system they have chosen and that is the one they run.
Clinician B buys TRIOS, a different system altogether and runs that system in their practice.
Here’s the problem, Clinician A will tell you that CEREC is the best because he has spent a huge amount of money and isn’t going to tell you it’s crap; if he tells you it’s crap that is to say that he made a bad choice, he’s wasted a lot of money and wishes he would have bought another system. Clinician B will do the same with the system she has bought. So we enter into this ever fulfilling prophecy of people saying the stuff they have bought is the best and depending upon their influence, other people will but that stuff assuming that it is the best and nobody ever knows the difference.
This situation is ok when you are buying cars because really nobody gets hurt. So if you buy a Porsche instead of a fancy Audi then nobody minds if you say a Porsche is better than Audi. Maybe your friend buys a Porsche as well but nobody gets hurt. If you have a massive marketing operation though that sells a piece of kit which is worse than the other piece of kit and there is no proper comparison then this becomes a problem.
In effect randomised, controlled trials and the scientific community were supposed to sort this but they simply cannot keep up with consumerism. There is not enough money in dental research and not enough time in the day to keep up, analyse and appraise the new products properly before they come to market. We are researching in the market every single day. The solution to this is for the big guys in practice to have more than one system, to run both systems in good faith and then to tell honestly which is the best system or even better, to talk about the deficiencies of the system they invested heavily in.
Take the Sirona system for example… eighteen months ago I invested heavily in that system and spent well into six figures for CEREC, a milling machine and a 3D scanner. The integration of the system is really pretty good but the quality of the scans is not as good as the scanner I have previously (the CS9000). In terms of build quality, the Sirona XG 3D is fantastic, it comes with a five year warranty and is built like a tank. The CS9000 rattled when it scanned, had various mechanical difficulties associated with it but the images were clearer.
As part of the digital revolution let’s have a philosophical revolution regarding discussion of the products together. Let’s be open about what we have and suggest to the manufacturers how they might improve them. At the moment the manufacturers have us over a barrel because they can sell us extraordinarily expensive pieces of kit which we then justify because we are scared to say we made a mistake. Things are opening up though and it’s time for consumers to bite back. What we want is manufacturers to produce the best piece of kit with the longest warranty on an open platform so that we can do what we like.
The first one to do that gets my vote.
Blog Post Number: 812
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