← The Digital Executive
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- [00:00]
A
Foreign welcome to Coruscant Technologies, home of the Digital Executive podcast. Do you work in emerging tech? Working on something innovative? Maybe an entrepreneur? Apply to be a guest at www.corazon.com brand welcome to the Digital Executive. Today's guest is Dr. Robert Kerstein. Dr. Robert B. Kerstein received his Doctor of Medicine and dentistry degree in 1983 and his prosthodontic certificate in 1985, both from Tufts University School of Dental Medicine. From 1985 to 1998, he maintained an active appointment at Tufts as a clinical professor teaching fixed and removable prosthodontics. And in 1984, Dr. Kirstein began studying the original T Scan 1 technology and and has since that time also studied T scan 2, T scan 3, 4, 8 and 9, and now the present day version which is the T scan 10 Novus technology. A pioneer and academic science advocate for digital occlusal technology, Dr. Kerstein teaches a measured system which greatly improves the success of bite related procedures commonplace in every dental practice. Digital measured occlusion provides predictable rapid bite comfort for most patients while lessening prosthesis breakage and remakes and shortening treatment times. Well, good afternoon, Dr. Kirstein. Welcome to the show.
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B
Thank you for having me.
- [01:34]
A
Absolutely. I appreciate it. You're hailing out of the Boston area. I'm in Kansas City just an hour apart, so I appreciate you making the time. Sometimes it is challenging to get calendars aligned, but I appreciate that. And jumping into Your first question, Dr. Kirsting, you began your journey with the first generation T scan in 1984 and have now seen it evolve through the T scan 10 Novus version. What first drew you to occlusal analysis? And how did you realize that traditional tools like articulating paper, visual inspection, et cetera weren't enough?
- [02:08]
B
Well, it's a great question. What drew me to computerized occlusal analysis was that it was the first time you had the ability as a dentist to measure occlusal forces across time as they change in a dynamic way. And that was not possible with articulating paper and ink, which actually don't measure the bite. They don't have bite capability measurements at all. And although they were at the time in 1984 being used in dentistry and taught as if they did measure the bite in a number of different ways, studies clearly show that the ink and paper weren't capable of measuring anything about someone's bite, essentially, except where like top and bottom teeth would touch each other. So in 1984, suddenly there was this ability to detect and visualize bite forces changing across time. And that because of that, you could see forces evolve unevenly around the arch. You could see teeth hitting before other teeth and areas of teeth with high pressure that were occurring way too early in someone's bite. And none of these things could be visualized by paper and ink. And so that's when I actually realized that the traditional tools were really ineffective despite what had been taught. And that really became apparent when I began comparing bite forces measured by the T scan to the paper markings. And that was really telling. But what's unfortunate for patient care and more importantly for patient well being even today, is that worldwide those same principles around paper mark size and bite forces are constantly being taught, incorrectly taught. And this, the principles actually violate physics and we don't have to go into the specifics, but essentially the idea that paper mark size could show you bite force is completely backwards. It's actually pressure is worse when the marks are small and you get high pressures when you have small surface areas. So dentistry was teaching big marks of forceful light, small marks of light force. And it just isn't true. And the T scan can differentiate them. And so the T scan was a major Advance Even in 1984, where you could finally see which contacts really were forceful and you had a method of detecting them. So you really clarified which articulating paper marks mattered and which ones didn't. And that alone was a major advance at the time. So that makes T scan a minimally invasive technology. It actually protects patients well being from these essentially outdated and incorrect patients paper mock principles that dentists use every day still, even though it really doesn't work.
- [04:37]
A
Thank you, I appreciate that. Really. Do we get experts on the show all the time like you, Dr. Christine, to kind of walk us through? And I appreciate that you were drawn to this T scan technology with that promise of visualizing that bite force and the changes over time. And what I took away from it as well is this, it's a minimally invasive procedure, it does better for patient care, and it actually tells the true story versus the articulating paper. So I really appreciate that. And Dr. Kirstein, the next question I have, you use T scan in many clinical and research settings due to guide adjustments. How do you translate the raw data, like the force curves, timing graphs, into practical decisions in a dental practice, say for a crown implant or patient with TMD symptoms?
- [05:24]
B
Well, essentially in simple terms, you record the information you're trying to capture with the T scan itself, the sensor that goes between the teeth. And that can be a multitude of different things. You can have patients bite down, you can have them clench and grind, you can have them chew on the sensor. So it depends on what you're trying to capture and what you're trying to measure or manage, like installing an implant crown or finishing an orthodontic case after invisalign. And when you detect the data, the data detects high force, low force, medium force, changing forces, as I said. And then you can isolate very clearly the problematic contacts where there's excess bite force. And then essentially you mark the teeth with articulating paper. But instead of trying to look at the paper and say, well, I think it's this one because it's big, or I think it's not consequential because this one's small, you don't do that at all. Essentially, the T scan data tells you which locations to target, and then you treat those problem contacts, only leaving many healthy low force contacts alone. And as I said, it's very minimally invasive because it's highly targeted. So that targeting process of using the paper to mark the places that are problematic can be applied to an implant column, can be applied to a TMJ patient's bite, can be applied to installing veneers and smile designs and even more complex things like fancy implant prostheses made of all kinds of crowns and bridges and implants. So the bite correction outcomes then become highly refined and predictably better for patients by using these T scan metrics that are in the force graphs and the software entities you were asking me about. And so essentially it's computer guided occlusal adjusting, which is far more accurate and it definitely speeds up treatment and it takes away all this subjectivity. I mean, the papermark method has been shown in studies to only be 14% accurate. And what that means is essentially a big mark is big force 14% of the time and a little mark is light force essentially 14% of the time. And that means if a dentist chooses big marks all the time, they're going to be wrong 86% of the time. And this is where many dental problems arise after patients get new dentistry. So this, this method, it puts patients at risk for bite complications that the T scan mitigates and controls far, far better simply by knowing which paper marks to treat. So that's the, the essence of how you apply the information to control the outcomes.
- [07:56]
A
Amazing. Thank you again for unpacking that. Dr. Christine, what I really like, I'm going to just give you Some that repeat back. The highlights here is you're really with this T scan recording the information you're trying to capture, measure based on the type of procedure. Obviously that varies. But this is a highly targeted process that's very efficient and obviously beneficial for the patient. And we see this technology as a major improvement over the paper process. And the bite outcomes become highly defined, as you mentioned, and again, better for patient care. I appreciate that. And Dr. Kirstein, from a business viewpoint, how does a dental practice justify investing in the technology and training associated with T scan and digital occlusal analysis? What metrics or outcomes, reduced remakes, fewer patient visits, etc. Should they track?
- [08:45]
B
Well, it's exactly what you were just talking about. So the, the justification, investing in both the technology itself and in the training required for a dentist to become a competent T scan clinician because nobody buys it and can't, you can't really use it unless you're trained well. And that's a skill set that you just don't have when you purchase a T scan. But the, the justification comes from the time it saves the practice in so many different ways. And the three, I would say the three biggest time savers are a very common problem in dentistry, is that patients leave the office with new dentistry, a few crowns and billings are changed. Maybe they got a couple of implants installed and then they develop bite problems afterwards. That even happens after invisalign, smile corrections, orthodontic corrections. And the dentists unfortunately struggle to install these cases with paper and ink because they really don't measure anything that the dentist can use to treat the patient. And what happens often is that the patients return for many visits. And it's actually a sort of a common pitfall of using the articulating paper. And it goes on all over the world. I was actually contacted today by a patient in Maryland, I live in Boston, who was struggling with her bite after some dentistry was installed. I was recently lecturing in India and one of the fellow dentists, his aunt went to get a crown installed two weeks ago and she developed bite problems afterwards and now has to travel across India to find a T scan expert. So this is a really common problem that's sort of hidden from the patients there. The papermark method puts people at risk. And the fascinating thing about this from the patient standpoint is when I was seeing these kinds of patients, I was sought out by many from many different countries. Over the years of being a clinician, I was able to fix this issue that was bothering them in most of the time in one visit. And they were really surprised because their dentist spent many visits, sometimes months, without succeeding. And maybe making it a little bit better, maybe making the bite a little bit more tolerable, but not resolving the problem that suddenly, you know, not suddenly, but they're in my office three years later, two years later, six months later. And so they were really surprised that I was able to essentially treat them in one appointment. So the, the, the reality of that is when you're not using the T scan, there's a huge time loss in dental practices because there's often struggles with bite problems after patients get their new teeth and the dentist can't charge the patient for extra bite visits because they can't get the bite Right. Right. So that's a huge loss leader. And it's so common. And the stories, as I said, I was contacted in the last two weeks, I already found two people from different parts of the world with the same issue. So that's a huge improvement. In terms of justifying the investment then along the lines of what you mentioned at the beginning, treatment times in general can be reduced. So in other words, delivering an implant case with the T scan, you don't have all those extra visits that arise if you do a good job with the T scan and computer guided bite adjusting. It controls the outcomes. And I can speak to that because I had patients coming into my practice every week or certainly every month with these problems, post insertion bite problems. But I was a prosthodontist, a bridge reconstructionist, and I was installing the same kinds of things that were bothering these patients that were in my practice. And the only difference was that I was using the T scan to install them all. And the dentist that they came from wasn't using the T scan. And this was a huge problem for the patient and for the practice. So speeding up treatment, resolving TMJ directly without needing Botox or splints or appliances. For example, there's very sophisticated bite adjustment procedure called exclusion time reduction. It's a T scan application and it stops TMJ and in one to three months and you don't have to wear a nightguard, you don't have to keep going for Botox. And it actually does resolve the symptoms. And this is something we've been studying since the late 1980s. So exclusion time reduction is extremely powerful and resolves the problem in a matter of months. That's bothers people for years. But that kind of speed can't be obtained in the appliance, splint, Botox, TMJ world nothing like what the T scan could do. And the last investment incentive might be that in published studies, the T scan has been able to preserve dental materials, preserve bone around implants statistically less than breakage complications and fracture complications of dental restorations. Crowns, bridges implants. So as far as a business model goes, the faster treatment times, many less bite uncomfortable patients, no longer wasting chairs, spare time and the installation of more lasting and comfortable restorations really ramps up office dental efficiency. And that's the main driver of what is really worth the investment.
- [13:32]
A
Thank you a lot to unpack there. Big highlight here is investing in the technology. Obviously it's going to save time in that treatment procedure. That's going to mitigate longer term bite issues with the procedure. Of course, in multiple future visits preserves bone loss, many other benefits, but again, it's more preventative. And when, whenever a patient spends less time in the chair, they're more apt to be coming back and coming back as a happy patient. So I appreciate that. And Dr. Kirstein, the last question I have today, looking ahead, we talk about emerging tech here in the future. How do you see the future of occlusion evolving with technologies like intraoral scanners, AI driven bite analysis and digital workflows? What role do you see for measured occlusion in the next five to 10 years? And how should new practitioners prepare?
- [14:25]
B
Well, it's a very interesting question. Of course, all of dentistry is going digital with what's known as the digital workflow. And it's become essentially the standard of care, greatly improving the mechanical fabrication of prosthetic teeth and implanted teeth. But with scanners and with the digital workflow and milling machines and CAD cam and sophisticated imaging like cbct, none of those things can control the bite function. You need a patient for that and you need their new restorations on their teeth or in their jaws of the implant patients. And the patient has to be biting down and chewing around on a T scan sensor in order to control the forces on the new dentistry. So the future of measured digital occlusion is very exciting because it's the last frontier of the digital workflow and it's the only step that's still not computer driven in a widespread way. So there's a huge need for the T scan technology in dental medicine simply because articulating paper and ink can't control the bite forces on all this new digital dental work. And again, the things we talked about in the last question about saving time and all of that, but there's really a dramatic need to improve the outcomes. And, and so, in that vein, there certainly could be AI enhancements that would help isolate unique insights into what might be wrong with the patient's occlusion and pass them on to the dentist. But regardless, dentistry can only propel itself forward in the quality of patient bite care and certainly patient well being by widely adopting the T scan and treating with the principles of measured digital occlusion. And as far as how should a new practitioner prepare? Well, the answer is obvious. They should buy a T scan and they should train properly to learn how to use it. And to do that, they really have to recognize the value of measuring the occlusion with the technology, rather than subjectively assessing the occlusion with ink and paper. Doesn't matter what method of building the bite or moving the teeth or creating a new prosthesis is accomplished with the digital workflow. The bite function can't be controlled with paper and ink. So practitioners have to really be open to learning that this is a problem. Not only thinking about adopting the T scan for the greater good of the dental patient's well being, but understanding that the papermark method is actually problematic and coming to face the truth about it, that science has proven now many times that it's just ineffective. And the T scan obviously is the solution. So that's essentially what a young practitioner needs to face and then adopt the technology and learn how to use it.
- [17:01]
A
Amazing. Thank you. And you talked about that standard of care moving in the digital age into digital dentistry, which a lot of different areas in dentistry are doing. But you hold a lot of hope and promise in that. The future of measured digital occlusion, obviously the need for better measurements, and they only get better over time. And you even talked about how AI may even make that a little bit more accurate. So I appreciate your insights. That's great for our audience. And Dr. Kirstein, it was such a pleasure having you on today and I look forward to speaking with you real soon.
- [17:35]
B
Well, thank you for having me. I'm grateful for the opportunity to help educate your listeners to the benefits of digital measured occlusion and using T scan metrics to treat patients safely and improving their well being. It's really the main driver of my interest in talking to important podcasts like yours. The public understand there is a much better way for them to have their, their bite issues dealt with, and dentistry needs to understand it as well. So thank you for the opportunity.
- [18:03]
A
Absolutely. For helping improve humanity. Bye for.