Author: Terry

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Uncategorized

Open Formats and Protocols in Dentistry

Open formats and protocols in dentistry first appeared in the 2000s. They grew from the need of dental laboratories to integrate equipment for digitizing study models, designing dental prosthesis,  and manufacturing those products. Many software systems are “walled gardens”, where everything inside the walls are manicured but there is no way to access other gardens.  Of course, outside the walls the landscape is *not* manicured, so a robust integration method is needed. The “gardens” in this case were the Dental CAD/CAM systems of the 1990s.

Dental laboratories pressed for open integrations so they could make effective outsourcing decisions about how to manufacture these products.  Dental CAD customers demanded ways to manufacture their products using the tools or partners they determined was best for their business. Performance tuning for specific equipment may still be needed, however the issue of connectivity between different vendor’s CAD and CAM is no longer an issue.

The same market forces that drove open formats and protocols between digital dentistry tools are now coming to bear on dental imaging and business software.  Some dentists are demanding it in the pages if Inside Dentistry:

Dentists should not be beholden to any company for the ability to access and use their data in the manner that they see fit. (Jablow, 2019)

Improving patient care while meeting the demands of the dental insurance industry will drive this move to open connectivity. For the patient that would be portability of dental records and image.   If market forces are expected to be efficient, then artificial barriers to patient choice need to be reduced.

The application of machine learning algorithms to dental imaging improve the accuracy of diagnosis, which could create demand for earlier interventions as well as reduce unnecessary ones [1].

Lastly, open formats and protocols will lower integration costs for the dentist [2]. Administrative costs are one of the largest drivers of dental (and overall healthcare) costs. In this way the dental industry will take a lead from dental lab owners in demanding  connectivity to improve patient outcomes.

How is open connectivity impacting your business? Tell me about it in the comments!

References

[1] Shah, Agam, AI Can Lead to Lower Dentist Bills, Wall Street Journal (July, 16, 2019) https://www.wsj.com/articles/ai-can-lead-to-lower-dentist-bills-11563269400 Accessed 2019-07-19

[2] Jablow, DMD, Martin, Digital Dentistry Data, Inside Dentistry (July 2019) https://www.aegisdentalnetwork.com/id/2019/07/digital-dentistry-data Accessed 2019-07-19

 

 

Categories
dental-lab manufacturing

Terry Lorber mentioned on IDT Weekly

Metatooth’s Terry Lorber is mentioned in Episode 26 of IDT Weekly. IDT Weekly highlights articles in the peer-reviewed Inside Dental Technology publication. IDT is a resource and learning tool for dental laboratory owners and managers. This month’s issue (July 2019) includes a Continuing Education article entitled “Does it Scale?”, by Terry Lorber.

The article covers a range of topics, from the mundane (for example, network topology) to the more philosophical (for example, lean manufacturing). The aim is provide concrete examples on a number of ways to bring the latest business technology to the dental lab. For inspiration, the author looks to examples from his experience in dental startups, where the growth expected by investors must be supported by robust and reliable information systems.

Need help with integrating dental & business technologies? Contact us to find out more. Do you have examples of scaling information systems for dental manufacturing? Tell me about it in the comments!

 

Categories
manufacturing

Lean Manufacturing and Kaizen

Lean manufacturing is a term and concept that grew from the heralded Toyota Production System of the 1970s. Toyota was able to up-end the North American car market by becoming efficient at building high-quality cars (Roos, et al., 1991). Lean manufacturing encompasses many practices for identifying and removing waste from the manufacturing process. These concepts are beneficial to startups, small businesses, and large manufacturers.

A kaizen event is a 2 to 5 day effort focused on one business process or workstation. The kaizen team should be made up primarily of the team members who conduct the process under scrutiny. You may start with 5S: Sort, Set in Order, Shine, Standardize, Sustain. Safety is job one! After the workstation is in order, document the process. Make note of every step. Measure the process. The goal is to remove waste, not to speed-up the value added steps.

Look for repetitive tasks that don’t add value. Can they be automated? An example of waste is duplicated data entry. Strive to enter data only once into your master database or lab management system. Look for ways to export/import to downstream workstations as needed. Traceability is not just a requirement the FDA places on medical device manufacturers, it is valuable on it’s own as a tool to reduce errors and improve quality.

Make a change and re-measure. Repeat as necessary. Celebrate your team and their improvements at the end of the kaizen event.

Interested in learning more about how to hold a kaizen event? Contact us for more information. Have you held a kaizen-like event? Tell me about in the comments!

References

Roos, Daniel, Ph.D.; Womack, James P., Ph.D.; Jones, Daniel T.: The Machine That Changed the World : The Story of Lean Production, Harper Perennial (November 1991), ISBN 0060974176, ISBN 978-0060974176

Categories
dentistry review

Teeth and Oral Health in America

Teeth and oral health in America is a complex issue, which invariably means class is involved. The mouth is part of the body, but for reasons that remain unclear, dental colleges were created separately from medical colleges. This silo-ed approach to education has been mirrored in the way dentistry is delivered, separate from physical care. The real economic pressures that have created our current healthcare crisis are also shaping the way oral healthcare is delivered. Mary Otto has authored a book investigating the oral healthcare landscape.

TEETH
The Story of Beauty, Inequality, and the Struggle for Oral Health in America
By Mary Otto
291 pp. The New Press. $26.95.

This book was brought to my attention by a recent article on dentistry in The Atlantic. Otto covered oral health for the Washington Post and is now the oral health topic leader for the Association of Health Care Journalists.  She’s contributed to drbicuspid.com and while Teeth is a scholarly work supported by ample notes, it remains highly readable. It was reviewed in the NY Times Sunday Book Review after it’s publication in  2017. The topics it covers are just as relevant in 2019!

The state of one’s teeth says a lot about one’s economic status. The same economic forces that have driven the uptake of cosmetic dentistry also make it harder for oral healthcare to be delivered to under-served populations. Initiatives that could help deliver oral healthcare face opposition from dental associations. These initiatives typically involve allowing dental hygienists to provide (unsupervised by a dentist) cleanings to school children in “dental deserts” or expanded licensing for dental therapists.  These are policy changes that can and do work, but push back from organized dentistry has been hard.

One example given is in the case of Deamonte Driver, whose death from an infected tooth drove the State Children’s Health Insurance Program debates of the aughts and the Affordable Health Care debates of the teens. It seems like the simplest solution to providing access to oral healthcare is expand the pool of practitioners who can provide these services, but the fear that dental hygienists could threaten the dentist’s business model is a powerful block to these kinds of changes.

What role does technology play?  I offer two avenues:

1. Technology providers need to continue to innovate with new products and therapies. Advancements in endodontics, implantology, and (yes!) prosthetic therapies provide avenues for dentists to provider better and more effective care for their patients.

2. Technology must continue to reduce costs. Not only is cost reduction attractive to technology providers, it also creates the margin space for therapies that were first developed for the premium market to be made available to the value market.

What role do providers have in improving teeth and oral health for under-served populations? Tell me about it in the comments!

Categories
coding

LAMP Ubuntu 19.04

LAMP on Ubuntu 19.04 should be a snap, and it is. If you install all the packages! I was missing libapache2-mod-php and php-mysql. Here’s the blog post that helped me out.

How To Install Linux, Apache, MySQL, PHP (LAMP) stack on Ubuntu 16.04

LAMP starts with Linux

Ubuntu 19.04 also provides a meta-package for this.
sudo apt-get install lamp-server^ will install all dependencies, and give instructions for enabling PHP under Apache2. Mind the trailing caret (^)! This meta-package selects MySQL 5.7 over MariaDB 10.3. A brief search indicates this is the best choice.

Why am I doing this? In order to have a development environment for this WordPress 5 website. WordPress is widely used, but is not this developer’s cup of tea. However, it does have a strong community and it’s development is ongoing, so time to get on the bandwagon. Or at least use a staging methodology to push changes to www.metatooth.com.

My first website was of the LAMP variety. I guess 20 years is not that long for a platform’s life-cycle. What platform’s longevity surprises you? Tell me about it in the comments!

Categories
startup

SCORE

SCORE offers free business counseling. For those near Lynn, MA you can find them at the Lynn Area Chamber of Commerce on Thursdays. I’ve been going since January. They’ve answered all my questions: finance, marketing, sales, strategy. You name it, they’ve seen it!

It’s been a great journey so far and I am learning new skills (for example, the sales pitch, marketing collateral). The SCORE counselors have a variety of backgrounds and are eager to brainstorm ideas. Business patterns are similar across industries, for example, Customer service is always about… the customer. For a startup or small business owner who has done 80% of the work, getting sound advice is crucial to completing the next 20%.

A session is 1 hour with whichever 2-3 counselors on hand. I treat it a bit like a project review meeting and a bit like a board of directors meeting. It’s a great tool to keep one honest with the schedule and plan. I keep up my project planning and communication chops by preparing the bi-weekly summary. I have developed KPIs to help understand how my efforts are paying off. For someone used to working in organizations, it is a familiar routine.

But it’s also a way to weed through all the potential ideas and keep focus. Taking an idea from conception to sustainability is a challenge.  Having others involved in the narrative makes it possible to connect tactics with the overall strategy.

One needs to prepare for overnight success and the best method for me to prepare is to practice. The counselors provide a process within which I can operate.  There is also a bit of encouragement, which is helpful, too.

Have you used SCORE or a mentoring program? Tell me about it in the comments!

SCORE business counseling notes
My notes from a SCORE counseling session.
Categories
marketing

Postcard 4×6

Categories
research

3D Printed Epithelial Cells

I was recently reminded about this technological advancement! Epithelial cells are part of the Periodontum, which includes the Periodontal Ligament. Being able to print these biological materials (and a scaffold) opens up new possibilities in functionality for regenerative and prosthetic products.

How far away could a 3D printed gingiva implant be? Hazard a guess in the comments!

https://3dprint.com/237289/korea-researchers-3d-printing-tracheas-epithelia-cells-chondrocytes/

Categories
programming

The Most Amazing

The most amazing product I developed was a scan body & detection algorithm for dental implant procedures. The scan body’s design is patented[1] and the algorithm is proprietary.

scan body
Image © Dentsply Sirona

What is a scan body for dental implant procedures? It’s a device attached to a patient’s dental implant and recorded in a dental impression. The implant’s location with respect to the patient’s anatomy can then be determined from the impression. Knowing the location, a prosthetic tooth can be fabricated.

I developed the algorithm in an iterative way using well-known techniques. I also needed to collaborate with other software engineers who had a deeper knowledge of the domain. It was a C++ application built with CMake and deployed as part of a data processing pipeline. It did not have a 100% detection rate, but it served a vital business need.

The algorithm was part of a larger project that involved the design and supply of the device to clinicians. It was a cross-functional and trans-national team. A great challenge but one of the most amazing projects I’ve worked on, too.

This post inspired by the idea of being a “top 3%” developer in C++, thanks to toptal. What was your most amazing product or project? Tell me about it in the comments!

1. US Patent #D787,061S SCAN BODY FOR DENTAL IMPLANT PROCEDURES