"We cannot be dictated by digital technology"

Dental Tribune Online: Dr Chatoo, as a regular user of digital technology in your practice, where do you stand in the digital debate?
Dr Asif Chatoo: Digital technologies have been around for almost 25 years, when clinicians first started to use computers to help them manage their practices. Since then, there has been a revolution with the introduction of digital photography and later radiography. Now, we have things like digital intra-oral scanning, which means that we do not need to take impressions and keep physical models. The pictorial representations that one gets from photographs are all real and can be analysed so that they provide true representations of the patients.

With all of this technology, we have to be very careful though. Part of the counter-argument is that we are being led by the market and there are questions as to whether this is true progress. There are so many things on offer, however, and hopefully as professionals we can recognise what is beneficial and what is not.

Is the argument of the digital revolution being led primarily by manufacturers valid?
I think in the sense of making orthodontics available to everyone to treat patients with orthodontic appliances, yes. There is a steep learning curve with digital technology and one needs to ask questions when the manufacturer’s guidelines say that if one does it a certain way everything will be fine. Some might be tempted to believe that if one follows the manufacturer’s guidelines then one can throw out the rulebooks of orthodontics, but that is not true.

One still has to apply sound orthodontic principles to tooth movement. Take, for example, something like Invisalign. Despite being around for so long, there is no evidence that accuracy and predictability of tooth movement are anything better than about 15 per cent. If one looks at it like that one will say 15 per cent predictability on tooth movement is terrible. However, orthodontists are very smart people and they are cutting trays and modifying the aligners and making it the way they want the appliance to work. I think that is how we have to go forward because we cannot be dictated to by digital technology. We have to be able to control it and then we can see the value and make it work for us in a way that is constructive. The technology is there to facilitate treatment and not to take over.

Does the use of digital technology benefit the patient, in your opinion?
With digital technology, it is possible to explain to the patient what is going to happen with the digital plan in front of one. One can show the patient how his or her teeth are going to move and gain the patient’s input as one goes along. As a tool for communication, it is excellent.

The next thing is how effective it is, and whether it is better or faster. There are no studies at the moment that show that there is a significant difference. From the patient’s perspective, there is an overall benefit because it is faster and cost-effective.

As long as there is no harm inflicted on the patient, I do not think there is a problem. If one is looking for the silver bullet that is going to change one’s working life, then unfortunately it comes very slowly with digital technology. One has to learn it and master it. One has to go through 100 cases to really know how it works and whether it is good in this or that environment.

What are the main considerations for clinicians who want to start working with digital technology?
I think they have to have a great deal of patience and be willing to learn. One cannot simply close one’s eyes and rely on the fact that one knows how to move a tooth. There may be problems in the beginning and they have to learn how to overcome those problems by successfully using the technology. I would consider it a completely new way of thinking.

It does work and can be beneficial to one’s practice, but it has to be in a controlled environment and dentists should expect a steep learning curve.

Thank you very much for the interview