Orthodontists and new technology: Techies or Luddites?
We are all aware of the rapid pace of change that our speciality has seen in recent years. The maelstrom of new brackets, wires, aligner systems, intra-oral scanners, 3D imaging, 3D printers and remote monitoring systems are just some of the newer systems that we have to grapple with.
Change and the advent of new technologies have some rubbing hands with glee, while others (like Kevin) often caution us to ‘sit it out while supportive evidence emerges. I’m sure we all have colleagues who are happy to jump on the bandwagon and ‘alpha-test’ new technologies. But, equally, we all know of others whose decision-making, practice and mechanics have changed little for decades. But what proportion of us fall into each category? And crucially, what factors make us adopt these newer technologies?
A team from North Carolina and Boston, USA did this study.
Laura Anne Jacox, Clare Bocklage, Teresa Edwards, Paul Mihas, Feng-Chang Lin, and Ching-Chang Kod
Am J Orthod Dentofacial Orthop 2022;161:364-74. DOI:https://doi.org/10.1016/j.ajodo.2018.08.018
What did they do?
They conducted an online survey as a follow-up to an earlier qualitative study to identify critical factors influencing the adoption of new technology among orthodontists in the United States. Their previous qualitative work explored factors including cost, performance, and ease of use. The survey included a decision tree based on technologies that respondents had either adopted or forgone. They, therefore, based the survey on their history of adopting various technologies. They e-mailed the survey to 4,600 AAO members.
Participants and Interventions:
Participants included AAO members based either in private or corporate clinics with current residents, newer graduates (less than 2 years), retired clinicians, full-time academics, and those based outside the U.S. excluded. They obtained responses from 343 clinicians (7.4%). They categorized the respondents as early, middle, or late adopters based on screening questions.
What did they find?
The results were many and somewhat disparate. I have tried to summarise the more pertinent findings. These were:
- Technology adoption was not related to orthodontists’ age, gender, ethnicity, time in practice, residency program, or practice setting (e.g. rural or suburban).
- Most orthodontists (72%) first hear about new technologies from peers.
- Company representatives were the second most common source (42%) of information, with the effect of conferences and continuing education also prominent (41%). All other sources were cited by less than one-third of respondents.
- Around one-quarter of orthodontists learned about technologies from journals, with social media reaching almost as many orthodontists as published literature.
- Earlier adopters began more patients per year than other groups and charged higher fees. They were more likely to use self-ligating brackets, CAD-CAM wires and brackets, CBCT and clear aligners. They also seem to focus mainly on patient preference.
In terms of technology adoption, the cost, ease of integration, and impact on efficiency seemed to outweigh any possible effect on outcomes. Patient preferences also motivated the adoption of aesthetic treatment modalities and intraoral scanning.
The respondents believed that intraoral scanners and 3D printers improved efficiency and workflow while also being preferred by patients. Both technologies provided a marketing advantage, while the intraoral scanner helped by reducing the need for plaster models. CBCT increased operating costs for most doctors, whereas intraoral scanning did not.
They also felt that CAD-CAM brackets offered a marketing advantage. Laboratory-produced clear aligners were thought to reduce office visits, provide an aesthetic option and assist with marketing. In-house aligners led to lower costs while satisfying esthetic demands, although, unlike laboratory-produced aligners, a reduction in in-office visits was not thought to arise. Orthodontists did not feel that aligners influenced either outcomes or treatment time.
What did I think?
I think that this was a fascinating study. From a methodological perspective, I liked that the fact that the authors built the study from first principles, having undertaken and published an earlier qualitative element. Fundamentally, however, this is a piece of research that makes me think about my practice- what I do and don’t embrace, whether I procrastinate too much and whether I should be more or less adventurous. It also makes me reflect on the adjuncts that I have bought into to a greater or lesser extent over the years (the boxes of unused micro-osteoperforation devices in my surgery being a constant reminder). Equally, it makes me think about the techniques I have embraced less than I could and perhaps should.
The finding that early adopters value digital workflows and CAD-CAM systems and seem to be more proactive in developing in-house aligners is interesting. But, equally, the fact that technology may be valued more as a means of broadening patient choice, changing workflows, and offering marketing appeal is telling. These advantages are considered more pivotal than any possible effect on treatment outcome.
What can we conclude?
Clearly, further research evaluating the accuracy of orthodontists’ beliefs on the effect of technological advances would be helpful. This type of research is undoubtedly happening. Nevertheless, based on some of the findings from the present study, I can’t help feeling that our inherent tendencies around technology might mean that human nature will trump these findings. And the early-adopting techies will continue to embrace, while the Luddites will procrastinate and ignore.
Professor of Orthodontics, Trinity College Dublin, The University of Dublin, Ireland