5 molars in a row

To start thinking about how the so-called “disruptive innovation” affects the dental marketplace and how industry trends could possibly influence the way we practice dentistry, it’s important to point out how our behavior and consumption habits fluctuate based on the “generation” we identify with.

The focus of this series of Spear Digest articles is to examine how new technologies, shifting business models and evolving patient behaviors impact our dentistry. I’ll begin in this Part 1 by addressing some generational differences as they relate to clinicians and patients.

As a proud Generation X member, I grew up watching a bunch of TV series with futuristic narratives, including “Get Smart,” which featured an extremely sophisticated counterespionage agent who had the ability to use his shoe as a “mobile” phone. When I started dental school in 1980s (I’m almost scared to admit this) the available dental materials and technology, as well as many of the concepts we were taught back then as being “state of the art,” had very little to do with what we use and teach today.

The dental world was pretty “analog” back then. Clinical photography and radiography were strictly analog, and I am almost ashamed to say this, but we were not even required to utilize gloves in the clinic during my first couple of years in dental school. The most popular restorative dental materials for operative dentistry back then were amalgam and gold restorations, and when doing amalgams some schools were still teaching G.V. Black’s principles like “extension for prevention.”

Back then, it was unthinkable that a restorative practice in the “civilized world” could routinely employ digital photography or radiology, not to mention CBCT units as conventional diagnostic tools. Moreover, dental amalgams are hardly utilized today, and modern adhesive dentistry principles evolve around being as minimally invasive as possible. Lastly the use of chairside scanners and milling machines, such as those pioneered by CDOCS, are swiftly becoming fixtures in the dental armamentarium.

In their 2013 book “The App Generation,” Howard Gardner and Katie Davis explained that Baby Boomers and Gen X members like me are essentially considered immigrants to the digital era, whereas millennials and Gen Z dentists are natives to technology.

This heavily influences the way we think about technology, hence younger dentists are much more receptive to early adoption.

The impact of ‘sustaining’ and ‘disruptive’ innovation

In an article I wrote last year, I described the complexity of communication with our patients in this information age and how it stems from information overload, confirmation bias and patients’ desire for immediate gratification.

Patients today are strongly enthused by the latest and greatest technology and products, which makes communication challenging at best.

Conversely, medical knowledge rate of expansion increases exponentially. Whereas the doubling time was an estimated 50 years back in 1950, it accelerated to seven years in 1980 and 3.5 years in 2010. But it could soon be within a few months, according to some estimates.

Innovation can be classified as “sustaining” and “disruptive.” Meanwhile, sustaining innovation can be “evolutionary” or “revolutionary.”

Evolutionary innovation is a linear process. It means that an existing product or technology is progressively or slightly improved, whereas revolutionary innovation implies a more radical, discontinuous process that does not yet have a significant impact on existing markets.

On the other hand, when disruptive innovation exists, it creates a new market by essentially providing a different set of “values.”

Around 2007, the global marketplace saw the birth of some of the most outstanding disruptive examples with technology. The Apple iPhone was introduced and companies like Facebook, Twitter, Uber, Netflix, Airbnb and Amazon transformed society’s consumption habits.

However, according to Harvard University professor Clayton Christensen – who coined the term “disruptive innovation” – the disruption displaces an existing market, industry or technology to produce something new that is more “efficient and worthwhile.” But the term also states that in business theory the true disruptors are “business models, and not necessarily the products.”

Positive disruption in dental, health care industries

If we look at disruption in health care, and even more specifically in cardiology, one can easily argue that drugs that lower cholesterol are disruptive to angioplasty – just as angioplasty was disruptive to open heart surgery.

There are, however, numerous other disruptive innovations that are continuously “threatening to reshape the traditional medical business model landscape,” such as:

1. Retail clinics
They operate outside of conventional physician offices, disrupting existing business models of primary care. The technology driving their acceptance is the electronic medical record (EMR), with computerized physician order entry and sometimes e-prescribing applications embedded in the EMR.

2. Telemedicine
Several merging technologies allow us to move patient care from physician offices to less-expensive sites. These include advances in network bandwidth, software development, medical devices, advanced telephony and video conferences. The business model is to deliver care conveniently to patients, often at home.

3. Medical tourism
The business model relies on wage and medical product price differentials, along with a new breed of brokers who create comprehensive international travel packages that make having surgery away from home nearly 30% less expensive than in the U.S.

4. Personalized medicine
In personalized medicine, patients are classified into subpopulations according to their susceptibility to diseases or their responses to certain drugs or treatments. This allows for the use of the most appropriate therapies for individual patients, as well as whole populations.

Disruptive models shaping the dental industry

5 molars in a row

If you think about it, all these different possibilities translate into business models that are cheaper and, in many instances, perceived by the patient as better than the conventional model.

Each of these models is likely to grow and be assimilated by the system, if the establishment permits. But that is based on conflicting political and socioeconomic moving parts, each of which add layers of complexity to potential outcomes.

Our dental marketplace has most definitively not been a stranger to innovation in the last 30 years that I have been around practicing.

Sustaining innovation, both evolutionary and revolutionary, has literally become a constant. Breakthroughs in conventional restorative dentistry, implant dentistry, biomaterials, CAD/CAM technology and digital design software continuously emerge and evolve. Hence, they renew our clinical interdisciplinary possibilities, as well as help us to manage and optimize workflows in our practices.

From a stricter disruptive innovation perspective, there are quite a few technologies and business models that have surfaced and are unquestionably shaping the dental marketplace. We should single out:

  • Artificial intelligence
  • 3D printing
  • Virtual/augmented reality
  • Internet of things
  • DSOs (dental service organizations)
  • Direct-to-consumer dentistry

In the second part of this article we will discuss each one of these in greater depth, since they are technologies and business models that are here to stay and most definitively will influence the way we care for our patients.

Ricardo Mitrani, D.D.S., M.S.D., is a member of Spear Resident Faculty.