The inverted pyramid of CEREC

Rogers (1995) described the four main elements in diffusion as being the innovation itself, communication channels, time and the social system.

There seems to be a lot of buzz in dentistry right now about AI, scanning, printing and how technology is going to impact the profession.

There’s a lot of competition for dentists’ eyes and money.

Will some things take off quicker than others?

As you may remember, I've been a ‘CEREC dentist’ for more than seven years. It transformed me, as a dentist, for the better.

If we look at the diffusion of the innovation curve as applied to CEREC, then we are moving  more towards the middle.

I’d say it’s in the ‘early majority’ phase

CEREC has been around for more than 20 years. I remember hearing dentists talk about poor margins, chipping margins and cumbersome processes. I was at a course once and the endodontist lecturing asked those with a CEREC machine to put their hands up. He then went on to instruct us to put a “proper restoration on the tooth, not a CEREC”. Needless to say, I never referred a patient to him! Maybe he needed to read more widely or just stick to his lane!

The interesting thing is that the adoption of CEREC has largely been driven by general dentists, rather than research emminating from universities. 

Most dental paradigms are driven by research, academics and diffusion down to general practice.

CEREC is different and I wonder whether this is a sign of the times for developers of new technology.

GP dentists are looking to do things better, to deliver service in a more convenient manner to their patients and are willing to invest time and money to do this. Well, the innovators and early adopters are!

The GP dentist’s  experience drives the refinement of the product, since the manufacturers want to have their product be successful.

So why this inversion of the tradiational pyramid of diffusion? There's a number of reasons.

Once upon a time, in the 80s and 90s, CPD was mostly delivered by the universities or the ADA branches. With the advent of compulsory CPD the floodgates opened to knowledgeable non academics sharing their skills and experience, often in a more practical hands-on way, facilitating implementation. Essentially, they were acting as translators for the academics.

Then came digital and social media. There are so many places we can access information, clinical tips, education, and read about new technology as it becomes available. It's a minefield in some ways but a treasure chest in others. You just need to be discerning and do some research about ideas proposed.

During this time the CEREC product has improved and is becoming easier to use. The bar has been set by Airbnb who had a design goal with their software to be no more than three clicks from booking. That's now the standard for any technology.

The tables are turning for academics. I have witnessed the evolution in the thinking and information shared by prosthodontists such as Prof Markus Blatz. In the past two years he has expanded his restorative paradigm to include non retentive preps. Similarly Dr Miguel Ortiz shares day to day CEREC preps regularly. Promoting the preservation of tooth structure that can be achieved with modern ceramics and conservative preps on his CEREC machine. 

The specialists and educators are getting on board. Some cashed up universities now have digital facilities preparing their students for the future; or is it the present? 

Scanners are everywhere, printers are common, digital workflow is normal. The academics in their ivory towers have to get on board or be left behind.

There's a need for clinicians to look at technology and say to themselves, “how can I use that to help me deliver better care to my patients?”, whether it is more accessible care due to reduced cost, less appointments, less travel, or improved safety and quality.

So will this be the same with AI radiography? I've seen and heard the “but how accurate is it?” Well, how accurate is the new graduate dentist or OHT reviewing the indistinct PA radiograph or OPG? Can we all put our hands on our hearts and say we haven’t missed something on a radiograph? That a second pair of digital eyes wouldn’t help?

I think that the time taken to progress along the x-axis of the diffusion curve will be shorter since the amount of social proof has accelerated exponentially, communication is rapid and there has been a major shift in the social system of dentistry. It’s being driven bottom up rather than top down.

So the CEREC Bluecam came out in 2009 and now we have the Primescan  from 2020. Fourteen years to reach the early majority.

The world is a different place now so we need to strap in for the next 10 years.

Oh and by the way here’s a photo of a CEREC one of my final year student’s did. (That looks like a sharp corner but it’s the fisure from this angle)

Have a great day

Rosie