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LIGHTS OUT?

Ideas with the potential to transform dentistry, such as the ones nominated for this year’s Edison Awards, don’t spark to life every day. When they do, it increasingly seems that high-tech products are the only ones with a prayer of breaking into a hidebound marketplace. Experts are divided on a question fundamental to the future of our profession: Has true dental innovation ground to a halt—or are we in the middle of a golden age?

By Elizabeth Dilts

LEA ELLERMEIER IS chief executive of the U.S.-German company Replicate Dental Technologies. She has developed a nifty product, elegant in its deceptive simplicity, that she maintains might well represent the first major innovation the world of dental implants has seen in more than five decades.

Replicate, as its name suggests, is a system that crafts implants that are exact duplicates of patients’ original teeth. A dentist can insert one immediately after a problematic tooth is extracted, like putting a piece of a jigsaw puzzle into place.

There’s no post. No coming back three months after surgical placement of that post to get a crown glued on. No filing down and perhaps damaging adjacent choppers so that the new, mass-produced implant can fit in the patient’s mouth.

For roughly the cost of a current implant, Replicate Immediate Tooth Replacement System can eliminate the standard two-stage procedure with a perfect copy—100 percent anatomically precise, as if out of a Xerox machine or a cloning laboratory—that pops right into place without difficulty or pain.

“The first dental implant was placed more than 50 years ago. Where has the innovation been [since] beyond changing some surface coating and shape?” Ellermeier says, speaking by phone from Replicate’s Berlin headquarters. “I want to replace my tooth with a tooth.”

The fact that Ellermeier is speaking from the German capital gives the game away just a bit. The Replicate System is not yet available in the United States. It’s readily accessible in Germany and throughout the European Union. Ellermeier and her cofounder, Ruedger Rubbert, formed the company in Dallas in 2006. They began work in earnest in 2009, investing their own money, and they had certainly hoped to be able to enter the American market by now.

Despite solid implant-market growth of about 5 percent last year, raising additional funds to undergird the Replicate System has been a slog. Regulatory hurdles have proved difficult, too: It has taken Ellermeier the entire 12 years of Replicate’s existence to complete the necessary research, studies and evaluations merely to submit the product for approval from the U.S. Food and Drug Administration.

John Andersen and his brother, James D. “Doug” Andersen, haven’t yet faced the daunting obstacle of trying to secure FDA approval for their innovation, which unlike an implant is not, at the moment, considered a medical device. But they’ve also spent the last dozen years trying to get market traction for their product, Periogen Oral Rinse. The Andersens founded The Periogen Company in San Diego in 2006 when Doug concocted (after substantial trial and error) a mouth rinse that claims to prevent tartar buildup twice as well as brushing alone. It’s garnering some attention—it’s nominated for an Edison Award this year, after all—but the Andersens say getting practitioners to mention, much less recommend, the rinse to their patients has been tough. “Getting dentists to adopt new innovations,” John says, choosing his words advisedly, “is like pulling teeth.”

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IS IT REALLY? Dentistry has certainly never been known for its embrace of disruptive innovation, a tendency that arguably begins in the classroom. Years ago, one noted academic in charge of a commission to overhaul education lesson plans famously observed that “it’s easier to move a cemetery than to change a [dental school] curriculum.”

It also just feels as though measurable advances in the common products that clinicians use every day—loupes, chairs, imaging software, practice-management tools—have been slowing. By at least one significant metric of innovation, that sensibility stands up to scrutiny: patents. The number of patents for dental ideas filed in the last two years is among the lowest over the last three decades. Anecdotally, too, experts say the industry’s manufacturers and financing organizations have shifted focus, turning their attention instead to developments in the dental- technology sector.

It’s not true that innovation in dentistry has simply halted, of course. In many respects, this is a golden age of innovation—in some aspects of our profession, at any rate. Over the 30 years beginning January 1, 1988, more than 684,000 patents containing the words “dental” and/or “oral” have been filed to the U.S. Patent and Trademark Office, according to Google Patents, an exhaustive database of some 87 million patents and applications from 17 offices worldwide.

Nearly 65 percent of those 684,000 were filed for dentistry apparatuses—the former a broad category most of whose patents have to do with implants, followed by restorations and auxiliary equipment such as lights and chairs.

Almost 29 percent of all dental and oral patents filed between 1988 and the start of this year concerned preparations for medical and specifically dental purposes: soaps, bandages, disinfectants and the like. The next three most common categories for which patents were filed were cosmetics, apparel and diagnostic instruments. The numbers (and the developers) have varied over the years.

The most prolific American dental inventor over the last 30 years is Dr. Dan Fischer, chief executive of the Utah-based manufacturer Ultradent, whose name appears on 1.5 percent of all dental and oral patents over that period. (He did not respond to interview requests.) The company that has topped the patent ranks in that time, with 2.5 percent, is 3M.

The fattest three-year period for dental patents over the last three decades was January 1, 1995, through January 1, 1998. There were, in fact, about five times as many patents filed then as were filed between 2013 and 2016, the most recent three-year period for which data are available.

Or consider the last decade: From January 1, 2007 (six months or so before the earliest inklings of the financial crisis) to the first day of 2018, the number of dental and oral patent filings and patent applications—just to give us a more complete view of the state of innovation in that period—has steadily dwindled. From 2007 to 2010, some 224,000 such patents were filed. From 2010 to 2013, 150,000 were. From 2013 to 2016: 88,000. And since January 1, 2016, just 24,000 have been—a three-year projected total of just 36,000.

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THE FLOOD OF new ideas and products, then, is indeed slowing, if not exactly to a trickle. Is there some larger force at work here—a financing bias, perhaps, that’s unwittingly preventing products from achieving escape velocity into the marketplace? Replicate’s Lea Ellermeier and Periogen’s John Andersen, both of whom patented their ideas more than a decade ago, both feel that the inertia of the highly profitable status quo initially kept them from being able to disrupt the dental industry nearly as much as they would have liked.

For Ellermeier, that manifested itself in major implant companies exerting marketplace control and continuing to supply (admittedly satisfied) customers with the same old (admittedly effective) products. For Andersen, it meant running into the brick wall of an industry business model that values—or financially rewards, at least, which is presumably a good proxy—treatment, not prevention.

Ellermeier is also convinced that an innate lack of specific expertise on the part of investors contributes to the struggles of dental startups. These products concern unsexy dentistry, after all—not cancer or the “gig economy” or social media. “Not a lot of investors are experienced in . . . dentistry from a medical-device standpoint,” she says. (A successful entrepreneur, Ellermeier previously founded Lingualcare, an orthodontics-technology company, which she sold to 3M in 2007.) “Investors may have invested in cardiology inventions before, or diabetes, or orthopedics. So they know stents and hearts and knees. Dentistry? Not so much.”

The American Dental Association has noticed. In an effort to help dental startups combat financing difficulties, last October the ADA announced a partnership with Matter, a Chicago-based health-care-technology incubator that provides equipment and support to around 200 health-tech startups. Matter also works with 11 hospitals, five universities and 40 health-care companies to foster ties between institutional players and startups in need of assistance of numerous kinds. “As we look toward the future, improvement in the delivery of dental care becomes more and more dependent on rapid innovation,” ADA president Dr. Joseph Crowley said when the two organizations announced the partnership. (The ADA has not disclosed the terms of its partnership with Matter, and did not respond to requests for comment.)

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BY FOCUSING SQUARELY on the development and promotion of innovative dental technology, the pairing of Matter and the ADA highlights what some professionals say is something of an industry fissure: Innovation is occurring, yes, but to an inordinate degree it’s happening in the technology space.

Dr. Edward Shellard, chief dental officer of the imaging and software company Carestream Dental, headquartered in Atlanta, is one industry pro who sees innovation in most areas of dentistry “plateauing,” as he puts it, while technology-specific aspects—particularly how to parse the information offered by so-called “Big Data,” as well as how to store and retrieve it—advance rapidly. This is rightfully so, he says: Dentistry in general has significant information-technology needs, and the entire profession stands to benefit mightily if they’re addressed in innovative ways.

“The next growth spurt is how we use all this data, understand this data,” Dr. Shellard says. “The use of long- term clinical data to make better-informed decisions is where we’re going to end up. The image resolution may be slowing. But the next step is really the management of that data, leveraging that, using it and analyzing it.”

A cursory look around helps make the case that Dr. Shellard is probably correct. Many dentists are now cresting a decade or so of the mostly or fully digital practice. The industry has experienced widespread adoption of CAD/CAM technology, CBCT data, intraoral scans and plenty more. It therefore follows that the amount of digital information— words and images alike—in the custody of the average practice is swelling by the day.

To remain useful, all that data will have to be migrated to higher-tech, broad-based storage solutions, such as the cloud, to ensure that doctors can retain the information (as they’re required to by law) and quickly access and make sense of it. That’s not necessarily new to anyone in dentistry, Dr. Shellard observes. But the technology that will help dentists complete those tasks certainly is.

“The management of large data sets, particularly images, is really going to require technological breakthroughs,” he says. “It will be an important piece to get in place because without it, it’s going to force us to have a local server to maintain, and that creates storage issues and vulnerability.”

Not everyone, meanwhile, agrees that dental innovation is slowing overall. Dentist, author, educator and Dentaltown.com founder Dr. Howard Farran (a 2014 inductee into the Incisal Edge Hall of Fame) in many ways occupies a perfect perch from which to observe industry trends and technology firsthand. And he’s ebullient about the profession’s prospects.

“Dentistry is advancing at 10x,” he says. “There is no sign of stagnation.” As evidence, he points to the ways in which manufacturers have improved the longevity of restorative materials—an area that is technological, but only nominally, and in which thousands of patents have been filed in recent decades. He urges dentists and others not to fall prey to pessimism about the pace of dental innovation. “In 1900, health care was 1 percent of gross domestic product. By 2000 it was 14 percent of GDP, and there were nine dental specialties alone,” he says. “Now, to be a family dentist who can do root canals, crowns, fillings and other things, you’re not even number one in your area. As a dentist, you can’t even stay up on the innovations in bone-grafting techniques, let alone placement of an implant.”

Consider this year’s—or any year’s—nominees for the Edison Awards, for example. Financing is never a certainty or easy to secure, of course, but the sheer brainpower being brought to bear on a thousand and one aspects of dentistry will ensure that the profession keeps chugging along. And in any case, as the gregarious Dr. Farran observes, trying to forecast medical innovation is something of a fool’s game. “I think this is a perfect storm,” he says. “Predicting where dentistry will be in 10 or 20 years is like predicting where the stock market will be.”

ELIZABETH DILTS is a staff writer for Incisal Edge.

 

CRYPTO GETS ITS TEETH CLEANED

Bitcoin for dentistry: crafty, or just plain crazy?

THERE’S HANDPIECE INNOVATION. There’s practice-management innovation. There’s image-capture innovation. And then there’s Dentacoin.

Cryptocurrency, the often baffling agglomeration of decentralized digital money backed by no government, has rocketed to prominence of late thanks to its nausea-inducing market volatility. Among far-better-known crypto examples—Ethereum, Ripple and of course Bitcoin—is Dentacoin, introduced last year. Its intended purposes: to remove all middlemen between patients and doctors; to increase cost transparency and lower prices; and, laudably, to help bring dental care to those with no ready access to it.

That’s the idea, anyway. Blockchain, the technology behind cryptocurrencies, is unquestionably here to stay, offering a secure, encrypted transaction ledger that promises (someday) to revolutionize global supply networks and much else. As it matures, meanwhile, untold millions of people are developing so-called alt-coins to grease the skids of commerce, ostensibly solve some societal problems and maybe even get rich. (Maybe. As of press time, an individual Dentacoin was worth just over one-tenth of one cent.)

How Dentacoin would work is murky. In theory, it’s a reward system enabling doctors to offer them as chits or credits to patients who rate procedures, review their practice and more; recipients could then exchange their Denta- coins for a prophy, X-ray, root canal or other menu item.

Unanswered as yet is how Dentacoin might first come to be seen as an asset with inherent value. It’s not clear why someone would trade, say, U.S. currency—legal tender, can be used to buy anything—for a vaporous exchange credit redeemable for nothing but dentistry.

Blockchain is in its infancy, and conundrums abound. In the words of Jon Martindale, who covers cryptocurrencies for DigitalTrends.com, “[Dentacoin] is likely to be volatile. . . . [M]any factors outside the market itself can have an impact on a cryptocurrency’s implicit value, which could destroy collections overnight, or create potential Dentacoin millionaires—who would then have few avenues for spending the currency. There’s a limit to how many cavities you need filled.”

Intrigued? Comfortable with risk? Visit the Dentacoin Foundation, the currency’s creator, at Dentacoin.com, where you’ll find a 34-page prospectus. Perhaps Dentacoin is a harbinger of the future. Or maybe it’s just an elaborate Ponzi scheme. Caveat emptor. —BRIAN DAWSON