For better or for worse, technology marches on, and it’s no different in the dental industry.  We have seen a number of imaging software platforms announce they will no longer be supported, and many offices are looking at options.  The challenge (and the opportunity) for an office is that, with a little bit of knowledge, they may be able to save quite a bit of money by avoiding a complete overhaul of all the hardware and software in the office.  

One of the biggest challenges that dental offices face is knowing whether things will work together.  For so many offices in this situation, they will hear high-priced imaging systems claim “nothing else will work”, while low-priced systems may claim “it will work with everything”.

The reality is usually somewhere in the middle depending not only on what systems are currently being used, but also what your needs and expectations are.  More and more, we are hearing from dental professionals who want to understand the tradeoffs more clearly so they can determine the best price without sacrificing image quality or workflow efficiency.   

With this goal in mind, we wanted to shed some light on some of the most common questions we hear from dental professionals so that an office can plan ahead and find the right solution for them.

Does my imaging software need to work with my practice management software?   The communication linkage between the imaging software and the practice management software is typically referred to as “bridging”.   Typically, the bridge offers two things:

1. The ability to open the imaging software directly from the Practice Management software, so that less clicks are required, and the patient being imaged will be automatically selected in the imaging software (i.e. no need to search for patient again in the imaging software after the patient was already looked up in the practice management system).

2. For new patients, the patient information that is entered into the Practice Management system is automatically updated into the imaging software thereby avoiding redundant data entry for new patients.

It’s worth mentioning that the imaging software can operate independently from the practice management system (i.e. without a bridge).  However, if they do work together, there are some workflow advantages to this.  The bridge will make the user feel like the practice management software and imaging software are one piece of software.  

If I change my imaging software, what should I do with all the images that are stored in my current software? Typically, the imaging software is what stores and manages all your digital x-ray images.  If you change your imaging software, new images will be stored and managed in the new imaging software.  Assuming the new software is not able to simply connect directly with the existing database of images, typically, you have two main options for what to do with the images in your old software.

Option one, is to simply keep a copy of the older software that you already have and use it to access the older images.  These images would also typically be archived and backed up as part of the normal IT best practices.   With this approach, there is usually a short period where comparing images taken at different times for a patient would require referring to different software. However, after a short period, the need to refer to older images becomes less and less frequent.

Option two applies if both the old software platform and the new software platform are compatible.  If they are, the images may be able to be “migrated” to the new software so that the old images would be available in the same place as the new images.  Typically, if migrating is possible between the two software platforms, it would be a separate service that may have an additional charge.

Will my current sensors work with my new imaging software? Frequently, the answer to this question depends not only on the system you are using, but also on what’s important to you. Typically, plugging a sensor into a PC that uses another imaging software results in one of three common scenarios:

Scenario One:  the imaging software cannot accept the image captured by the sensor.  The sensor will not work with the software.

Scenario Two:  the imaging software can capture the image, but the software will not offer any “capture automation” capabilities for that sensor.  For example, during a multi-image study, the user may have to click to accept each image in the software before moving to the next position.  Sometimes, the user may also have to manually rotate and place the images in the correct charting position.

Scenario Three:  the software can capture an image and apply the same automation capabilities that its own sensor would have.

Some offices may see Scenario Two as unacceptable, while other offices may be ok with this if they are saving money. To further complicate matters, sometimes either the imaging software or the sensor (or both) may have the potential to work together to achieve Scenario Two or Three above, but they may require additional pieces of software to do so.   In most cases, this additional software comes from the sensor provider, and is called a “driver”.  A “driver” is a generic term for a small piece of software that is provided by the hardware manufacturer to “handshake” with a larger software application (e.g. a “TWAIN” driver is a very common one).   

If you have any questions, or would like to better understand the tradeoffs of different options, please reach out to talk to one of our specialists.

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In order to assure that Dental Cone Beam CTs are being used safely and effectively, almost all states require that the Dental Cone Beam equipment have a mechanism to confirm it is operating properly year after year in a dental office.  This process can be confusing for a dental office because what’s required can vary between states, and the process can vary between manufacturers.  In fact, some first-time cone beam users may not be aware there is a requirement.

Typically, this procedure is generally referred to as “QA”, which is short for Quality Assurance.  For dental cone beam systems, this QA procedure across all manufacturers utilizes a tool referred to as the Quality Assurance, or QA, phantom.

To shed some light on this topic, we wanted to provide answers to some commonly asked questions about keeping your system compliant.

What is the QA phantom used for?

The QA phantom is a component that is scanned by the dental cone beam CT, and the resulting scan of this phantom is evaluated in specific ways.  If this evaluation passes a specific set of metrics, it serves as an indication that the cone beam CT is operating correctly.  This process is typically a core piece of the quality assurance, or QA, process.

Where do I get it?

Most commonly, this will come from the manufacturer of the cone beam.  However, there are independent companies that also provide dental cone beam CT phantoms.

Are they all the same?

No.  While there are many similarities, each one typically has its own unique characteristics.  It’s also important to know that each phantom provider has a unique process to use it, including what measurements to take.  

What does it look like?

While they are all different, they are typically cylindrical and made of a clear resin material.  They will typically also have different layers and some specific items embedded in them.  Here are a few examples:

I have a technician who services my office and my unit. Does my staff really need to know how to use this phantom?

It depends.  Some states require the office to perform the QA tests periodically (using the phantom), and sometimes an inspector will want to see evidence that this has been happening.  As an aside, performing this check is typically not that hard, and can be done fairly quickly.

How do I use the phantom?

This procedure on how to use it will come from the manufacturer, and the procedure is most commonly detailed in the User’s Manual.  While phantoms vary, there are some similarities.  Typically, it involves placing the phantom in the field of the view of the unit and taking a scan.  Then the QA process involves performing a number of simple measurements on the resulting image using the software.

These measurements will be looking at spatial accuracy, noise levels, contrast resolution, slice thickness and other parameters.  

I have a Dental Cone Beam and I don’t know where my QA phantom is.

You are not alone.  This is unfortunately an all too common occurrence as sometimes these items get lost in the office over time.  It’s highly recommended to designate a place to store this (and other maintenance accessories for the cone beam) and then inform the entire staff of this location. 

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I Place Implants, and I Outsource My CBCTs.  Would I See Higher Acceptance If I Absorbed the Initial CBCT Cost?

For most dental implant cases, one of the first steps is to perform an initial CBCT scan.  For those offices that do not have a CBCT in their office, this scan has a direct cost.  Depending on where the patient is scanned, the scanning facility may charge as little as $150 or as much as $300.  Charges for radiologist reviews may increase this charge further.

To cover this cost, most offices simply have the patient arrange the scan with the scanning facility, which the patient pays for directly out of pocket.  In many cases, they may tell the patient this cost will be “included” if they decide to move forward with the implant treatment.  This is a reasonable way to make sure the cost is covered.  Furthermore, many doctors see it as a valuable indicator to determine how committed the patient is to the treatment. 

However, some offices take the perspective that this initial CBCT payment may be serving as a hurdle that prevents many patients from even considering the procedure.  These offices take a different approach, and remove this barrier by agreeing to absorb this cost – independent of whether the patient decides to move forward with the full treatment plan.

With all the dental offices that utilized our digital imaging solutions, we have found that the latter approach is less common.  However, if done well, we have seen it be very effective in bringing implant treatment to more patients than would consider it otherwise.  One of the biggest benefits of this approach is that the CBCT arms the dental professional with a really powerful graphic to make the case to the patient how the treatment plan will improve their life.  These dental professionals prefer to remove barriers because once they have the cone beam scan, the patients can see the value for themselves.

However, this approach does come with risk.  It would be foolish and irresponsible to encourage patients to have CT scans performed when they will not accept the treatment.  So how is an office to decide the right strategy?

For those that are considering taking this approach, our recommendation is to run an experiment. 

As with any good experiment, it’s important to test the variable you are focused on and keep all other variables the same.  In this case, if you pick a reasonable time period — perhaps 3 months — then simply compare case acceptance during this period when patients are told that the initial scan is no charge to the acceptance rate when patient is told they will play for their scans.

Once this data is captured, it’s simple math.  The key datapoint is to evaluate how many more cases get accepted – and whether this additional income pays for the added costs of paying for scans on patients that do not move forward.  In this case, we will assume that in the standard operating procedure, the true cost does not change for patients that move forward with treatment – because in those cases the costs were absorbed in the broader treatment price.  

Here’s an example.  Let’s say that under normal operation (patient pays for their initial scan), the acceptance rate is 60%.  Let’s say that for this office that does implants, but not an enormous volume, they traditionally did 3 per month.

They then perform an experiment for 3 months, in which they offer to absorb the initial scan.  Let’s say that at the end of the three months, they find that they had 11 cases move forward on 15 recommendations, or an acceptance of 72%.

An increased acceptance is a good thing, but is this approach worthwhile?  We can’t be sure until we compare income vs. costs.

Let’s assume the cost of that initial scan is $300 and the incremental income for the implant case is $2000.  If we typically present the treatment to 15 patients in every 3 month period, then according to our experiment, changing our approach would result in about two additional cases every three months.   This means that:

Additional Cost:

Scans paid for patients that do not pursue treatment: 4

Cost per scan:  $300

Total Additional Cost:  $1200

Additional Income:

Additional Cases: 2

Income per case: $2000

Total Additional Income:  $4000

In this example, (assuming no other factors), it would be worth changing the policy to not charge the patients for that initial scan.

Of course, as with any calculation, the analysis is only as good as the inputs.  In addition, it should never be done in a vacuum without considering other soft factors.  For instance, perhaps there are other indicators that experience of the staff influence decisions about probability for case acceptance.  However, hopefully this provides on frameworks to decide if this approach makes sense for your practice. 

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The old saying “May you live in interesting times” never seems to get the old, and halfway through 2022, it’s as applicable as ever.    

Anyone who reads the paper is aware of the fears of inflation.  In June, the US Dept of Labor released their Consumer Price Index Report, and confirmed that the Consumer Price Index rose 9.1% in the trailing 12 months, which is that largest increase since 1981. 

However, more relevant to dental professionals, the index for Dental services increased 1.9% in June, the largest monthly change for those services “ever recorded” since the U.S. Bureau of Labor Statistics began tracking such numbers in 1995, according to the ADA.

This is mainly driven by price increases on materials and paying more to staff.

According to the ADA, a poll in November 2021 showed that personal protective equipment has drastically increased in price with more than half of dentists polled indicating that the price of surgical masks had at least doubled, and nearly 50% indicating that gloves had at least tripled in price.

In addition, “Eight out of 10 dentists reported issuing pay raises for their dental hygienists and dental assistants within the past year, which is reflective of a competitive job market across many industries, including health care,” said ADA President Cesar R. Sabates, D.D.S. 

As with many industries, the dental industry is also feeling the double-whammy of supply chain constraints along with higher competition for labor.  The goal for every dental office is to stay observant on these trends so that they can make the best decisions to navigate their practice through a changing landscape.

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