May 2009, Volume 5, Issue 5
Published by AEGIS Communications
Dental Inventors and the Greatest Innovations in Dental History
Allison DiMatteo, BA, MPS
From floss to fluoride in toothpaste, the dental drill to ergonomic dental chairs, someone in dentistry somewhere had an idea to make the profession better. As a result, dental professionals and their patients can enjoy more comfortable office visits, more efficient and effective treatments and procedures, and better oral health in general. The inventors of many of these products were themselves dentists.
“It is invariably a natural trait of dentists to be natural inventors. We invent every day,” observes Steve Brattesani, DDS, a practicing dentist for the past 22 years who holds somewhere in the range of 27 United States and international patents for his inventions. “Even though the procedures might become tedious and monotonous and we do things over and over, every tooth is different. Every tooth has a different truth to it, and every patient is different. Therefore, we invent how to handle our patients. We invent how to fix the teeth. We invent new techniques. In our heads, we’re always creating.”
This month’s feature offers just a glimpse of the many professionals in dentistry who have turned their attention during the past 30 years to inventing products, materials, and equipment used in the dental office, at home by consumers, and otherwise now taken for granted by the greater dental profession or industry at large. This presentation also explores what it takes to invent what dentistry needs and have it seriously considered by a manufacturer. Some of these product ideas will be successful. Throughout the development process, having confidence and a concept that solves a specific problem in a unique way are key.
A Global Oral Care Leader Recalls His Beginnings
The impetus for creating his first invention and the catalyst for starting his company were connected together, but not as one might think, recalls Dan Fischer, DDS, the founder and president of Ultradent Products, Inc. He had the need, with his love and passion for full-mouth reconstruction, to find better ways for controlling bleeding. It was based on that passion that the successful hemostatic solution called Astringedent®, the precursor to Viscostat, was invented in 1979. Astringedent set the pace for a succession of products that would soon exceed expectations in the dental industry.
“To really turbo charge it and bring it to the level it needed to be, the Dento-Infusor was developed, a device that goes onto a syringe and actually infuses this coagulating hemostatic,” explains Fischer. “Now at the time, my desire, my goal, was not to start a dental company. I was perfectly content with my dentistry. But upon discovering that no dental company really could see the value or at least was willing to pay for the value, that’s when I realized that if this was to reach dentists, we’d have to do it as a family. So, Ultradent was formed simply as the vehicle to get this new technology out and available to dentists.”
But getting the technology to clinicians also required education, Fischer says, and it was necessary to teach dentists to do things differently than what was in their mindset. Ultradent taught them to rub areas that were bleeding to promote hemostasis, which runs counter-intuitive to what dentists knew to do. Therefore, it became necessary to work directly with their customers, not go through lines of distribution, Fischer says, and that’s the model that Ultradent has stayed with over the years.
The business that began on a kitchen table and moved into a 40’ x 60’ hay barn which was converted into an FDA-inspected facility grew rapidly. Within a 12-year period Ultradent expanded from a home operation to a 220,000 square-foot facility that today houses more than 900 employees. Ultradent now manufactures and packages more than 500 materials, devices, and instruments that are used worldwide by dentists, group practices, dental and veterinary labs, government agencies, and universities.
“It took blood, sweat, and tears. Yes, we made mistakes. We had to learn as fast as we could about FDA guidelines and requirements. We cobbled together equipment that was not off the shelf because it wasn’t available off the shelf, simply to save money,” Fischer says. “I was working in the dental office as many hours a day as I could to generate income to funnel into Ultradent. We borrowed on the house three or four times, which meant that if at any one of those times we’d failed, all 14 kids would be living in a tent.”
Fischer’s fondest memory of a product invention is of Opalescence, noting that he can remember being up all night full of exhilaration, knowing that it was a breakthrough. The combination of a sticky, viscous bleaching glue and a soft, thin tray was going to be a standard, he says, one that required two inventions coming together that were counter to existing products. Opalescence enabled Ultradent to bring comfort to the whitening procedure so that patients could even bleach through the night if they desired, or for 1 to 2 hours a day, Fischer recalls.
The Start of a Conservative Spirit
Following years of dissatisfaction with the dental materials available on the market, Robert Ibsen, DDS, founded Den-Mat Corporation in 1974. He began formulating his own bonding materials and porcelain laminates in order to preserve, restore, and enhance a patient’s smile. Today, a majority interest in Den-Mat Holdings, LLC, is owned by DLJ Merchant Banking, a division of Credit Suisse.
“The catalyst for inventing the products that I have I think goes back to when I was in my late teens, getting ready to go to college and choosing a career, and I think it’s pretty typical of a lot of dentists—I wanted to help people,” recalls Ibsen. “Dentistry was a profession where there were educated people helping patients.”
As he moved from direct composite bonding into porcelain restorations, Ibsen recalls observing the effects that traditional over-the-counter dentifrices were having on the restorations he placed. That was the impetus for him to develop a toothpaste that would continuously polish the teeth, and Rembrandt Toothpaste was born. “We were solving a problem that needed a solution, and we just grew by making improvements—helping people get rid of and prevent canker sores and the like,” Ibsen says. To this day, the Rembrandt brand invented by Ibsen remains a well-known staple in dentistry, despite a long string of hand changes (eg, Ibsen sold the product to Gillette, after which that company was bought by Proctor & Gamble, who later had to sell the brand to Johnson & Johnson).
Ibsen also applied the knowledge he’d acquired to the development of the contact-lens thin and strong LUMINEERS by Cerinate porcelain laminates. Based on clinical studies, Ibsen says he advertised to the public about finding a dentist who uses this product in order to find out more about its advantages, including the elimination of preparing sensitive tooth structure and no need for anesthetic injections. Patients responded positively to the advertisements, and the company now manufactures more than 150 cosmetic and restorative dental products.
“Marketing is a transfer of information and knowledge to people who may benefit from a product or a procedure. If they know about it, they want it,” says Ibsen, adding that the company he founded now serves more than 86,000 dentists nationwide, with its products available in more than 68 foreign countries. “That’s been my formula for creating products that people really want, not that they have to have. I only do that which is highly beneficial for people—dentists and patients alike.
From Post and Core Materials To Online Corporate Education and Training
Philip Klein, DMD, is the president and chief executive officer of Learn HealthSci, Inc. (doing business as DenTrek), a company he founded in 1999 to create software applications for the development, delivery, and management of online multimedia training modules. But before that, he was also the founder of Dental Logics, Inc., a company he founded in 1994 and sold in 1998 to Premier Dental Products Company; its chief offering was the IntegraPost, a titanium alloy post with a flow-through head and micro-knurled shank specifically designed for syringeable core materials and resin cement.
“I guess it was through my frustration of not finding the post that I wanted from my dental distributor that led me to design one myself. I was fortunate to have a friend that was using one of the first 3D design software applications for architectural design,” Klein recalls. “His computer skills allowed me to transfer my conceptual design to the computer, and I was able to simulate the post and core procedure in a virtual 3D environment. This was probably the most exciting part of the invention process, and it was critical in allowing me to take my idea to reality.”
Within a few months, the initial design was complete. The entire process, from idea to a working prototype, took almost 2 years. Add another year for laboratory and clinical testing, and then Klein was ready to bring his invention to market. During the testing phase, he was working with the United States Patent Office, hoping to get three US patents covering different components of the post and core system. “I have to admit, I had no idea what I was in for when I started,” Klein says. “Dentists are not trained on the process of bringing new products to market. It’s something you learn along the way, and it can be a very expensive lesson if it doesn’t pan out.”
After selling the IntegraPost System, Klein was hired by the acquiring company to lecture on the product and set up hands-on training programs. It didn’t take long to figure out that traveling around the country lecturing to small groups was inefficient, expensive, and unbearably tedious. In 1999, while surfing the Web, he came across a medical site that delivered pre-recorded audio presentations synchronized with PowerPoint slides. The presentations were very basic and the quality was poor, but he immediately realized the potential of the Internet for online training. After a few months of research, which included asking a lot of questions, Klein hired a part-time programmer and multimedia artist. Within 6 months, they developed a pilot e-learning Web site and a process to produce online presentations using audio and slides.
“At that time, e-learning was relatively new, and I realized I was entering uncharted territory. There were very few people that understood the technological challenges of Internet-based learning, and that made it more difficult for us, but also allowed us to establish ourselves in the dental industry,” Klein says of those early days with his second company and invention. “Our company was one of the first in the world to use Flash for Web-based training. We have since integrated 2D and 3D animations, vastly improving the learning experience through more compelling instructional design elements.”
By 2005, for the first time, there was a cost-efficient, standardized way of training dental sales reps on new products and services. Currently, over 85 dental manufacturers and 16 dental dealers participate in the DenTrek Online Sales Rep Network. Klein says his company delivers more than 9,000 sales rep module viewings per month and trains over 7,500 sales reps in 8 different countries. Four new sales rep modules are added to the network every month. Recently the Dental Trade Alliance (DTA) hired DenTrek to create an online training site, Introduction to Dentistry. The site offers 17 modules, ideal for employees who are new to the dental industry. Companies like 3M ESPE and Colgate use the DTA site for global training of their employees, Klein says.
Recollections from an Implant Inventor
The needs of patients were the catalysts for the implants invented by Gerald Niznick, DMD, MSD, president of Implant Direct, LLC. He started placing dental implants in 1971 and found that the implants available in those days were unpredictable. They helped some patients, but for others, the implants didn’t work as well as they’d hoped.
By the end of the 1970s, Niznick started thinking of better ways to develop dental implants to help his patients. As a prosthodontist, his biggest problem was stabilizing a lower denture. He developed the Core-Vent Implant System designed for a procedure in which two freestanding implants were placed in the edentulous patient to stabilize an overdenture, along with another invention of his, called the Core-Vent Attachment.
“That’s really what got me going—trying to help that particular type of patient. I found that when I put these implants in using a certain surgical technique that avoided over-heating of the bone and early loading, they became firmly anchored to the bone, which we were calling ankylosis at the time. Later, it became known as osseointegration,” Niznick recalls of his early days of inventing dental implant systems. “From there I thought of ways to attach different kinds of abutments to these implants for different clinical applications. This laid the basis for modern implantology with freestanding implants and versatile prosthetics.”
The field of implantology developed rapidly throughout the 1980s, with competition pushing the introduction of new products. By the end of the 1980s, Niznick had developed four different implant designs, each with a unique way for an abutment to connect the internal hex-thread connection, which became the main patent in the implant industry, he says. Niznick licensed the idea to 10 different companies, and it’s considered by many as the cornerstone of modern implant designs, he says. At the time of its introduction, Niznick recalls that the popular Brånemark implants had external hex connections, which demonstrated problems with screw loosening.
Other product developments followed for Niznick, from sterile packaging to fixture-mount packaging (ie, an implant suspended on an insertion tool), and from prosthetic abutments (eg, angled abutments, screw-receiving abutments) to dual transition surface treatments. Core-Vent Corporation’s name was changed to Paragon Implant Company in 1997 and was sold to Sulzer Medica (Zimmer Dental) in 2001, at which point Dr. Niznick had 26 US patents to his credit. Today, after moving back into a factory he built in 1994 and leased to Zimmer Dental until the end of 2004, Niznick is back in business with Implants Direct International. He has 10 new implant designs covered by nine new patents, some of which are still pending.
“In the 1980s and 1990s, my company offered a variety of abutment options for different clinical cases. Implant Direct’s approach is to offer a variety of one- and two-piece implants with all-in-one packaging, including the transfer and abutment specific for the particular type of clinical application,” Niznick explains. “The other thing that is different today is that we make maximum use of the Internet for marketing, technical support, and online purchases. It has allowed Implant Direct to market on a global basis without the expenses of the major implant companies, thereby creating a price-point shift in the implant that ultimately is benefiting dentists and their patients around the world.”
Respected and Revered Inventor Continues to Target Dentistry’s Specific Needs
Bernard Weissman’s first inventions date back to the mid-1960s and include devices and instruments used in dental technology. With a well-rounded technical expertise and broad knowledge of dentists’ clinical needs, he designed products that became quickly accepted and used in practical, everyday dentistry. His inventions created more predictable, accurate, and precise positions for single- and large-unit bridges, Weissman says. The more broadly known product was the Tach-EZ spring attachment that’s still used today for retaining partial removables without the need for unsightly clasps or external retainers.
Weissman founded his first company, Whaledent® International, in 1965, and it earned a reputation for producing distinctive products and systems while enabling him to join the highly respected ranks of academia and practicing dentists. He recalls that he enjoyed the great honor of being recognized and appointed by the late dean of New York University College of Dentistry, Dr. Edward G. Kaufman, to the position of assistant clinical professor. Although he has given up this honored position, Weissman remains closely connected to the NYU dental school educational activities.
“The distinctiveness of our products really spoke for themselves. These were products, not merely trimmings or additions, but totally new concepts. They could have been considered strange at times, but they made great contributions to dentistry,” Weissman says. “Having created these innovations and by being in contact throughout the development process with academia and high-level practitioners, I and my company became known for our work, and we experienced unstinting support from outstanding and distinguished international practitioners of the art.”
In 1970, Weissman sold his interest in Whaledent and retained the position of vice president of the Ipco Holding Company until 1987, with responsibility for developing highly productive products, with a cumulative total of more than 100 patents for products that continue to be used and sold by the current Coltène/Whaledent® company. In 1987, he acquired the interests of the renown Swedish company Dentatus AB, located in the suburbs of Stockholm, and developed more than 20 additional patents for products such as the Profin® Reciprocating Handpiece, an instrument designed for fine, detailed finishing of the interproximal areas where rotating instruments really cannot be used. Dentatus AB Sweden sells products internationally, and Dentatus USA Ltd distributes these products in the United States and Canada.
“All of our products are manufactured at Dentatus AB Sweden, in compliance with the strict regulatory requirements and highest standards that are recognized in worldwide dentistry,” explains Weissman. “Our 50 Dentatus employees, with our Swedish management team of engineers, designers, and manufacturing personnel, enjoy the benefits and high respect for their dedicated efforts.”
Weissman’s innovative spirit has continued with the development of the first light-transmitting Luminex® post that polymerizes light-curing composites within the entire root canal, as well as the Luscent Anchors® fiberglass resin post. He says his latest and likely the most important of his inventions are the Dentatus Narrow-Body MTI Monorail®, and Anew™ and Atlas™ Implants for fixed and removable overdentures, which dentists can use more broadly on patients who have inadequate bone, narrow ridges, and restrictive spaces.
“While I continue to be involved at a lower pace in creating my dental toys, our international team is involved in all other related activities,” Weissman explains. “Our Swedish managing director, Tomas Skeppmark, reports to our Dentatus USA, Ltd, chief executive officer, Thomas Murphy. The combined US and international market devel-opment and sales activities are coordinated by our vice president, Nita Weissman-Okamoto, from our facility in New York.”
“I will offer the advice given to me by my first patent attorney, which is that inventions may be the most costly enterprise you may encounter in life. You have to be able to follow through with their development, testing, and making them known to customers who may want to use them,” Weissman says. “Anyone deeply committed to a particular product must also be able to undertake a wide array of issues surrounding it (eg, how it’s used, how it may be paid for, how it will be perceived, how it will be distributed). Inventing is a very rewarding enterprise, but it carries a great risk for the faint of heart.”
What Companies Look for in New Inventions
According to Andrew Lichkus, PhD, vice president and chief technology officer for DENTSPLY, as a company, DENTSPLY is focused on providing better dentistry. Regardless of the capabilities that companies have internally, they know there are substantially greater resources and expertise available outside of the company to drive innovation, he says.
“We are always interested in making sure that inventions can be translated into a superior product or service that benefits patients or makes providing clinical care easier for dental professionals,” Lichkus says. “Once we [DENTSPLY] determine that the clinical need exists, we can use our research and development capabilities to commercialize the invention sooner, and our worldwide sales presence to bring the invention to the global market more effectively than can be done by an individual inventor.”
Therefore, at DENTSPLY, the first thing the company looks at when considering an idea or an invention is whether it meets a clinical need, fits with the company’s core competencies, and aligns with the company’s strategic plan, Lichkus says. Lichkus says they’ll also consider whether the company’s strategic plan is comprehensive enough.
With a more than 100-year combined history of 3M Dental and ESPE AG, 3M ESPE has had many opportunities for individuals to send the company their ideas, notes Keith Haig, marketing operations manager for 3M ESPE. Being such a large company, 3M developed a process for the submission of ideas and inventions for consideration that is outlined in a small, pocket-sized book called About Your Idea. The book, which is sent to inventors, dentists, or anyone that might have an idea, addresses all aspects of what is necessary to protect both the inventor and 3M, Haig says.
“The first stage in the process is really for inventors who have an idea to submit to read this book,” Haig emphasizes. Next steps then include conducting a preliminary test of the idea to ensure it fits with the strategic goals of 3M ESPE (ie, that it is aligned with its current big businesses such as healthcare, automotive, chemical, consumer, traffic and safety, industrial). If it does, then one of two routes can be taken depending upon whether the idea is patented or not, Haig says.
If the idea or invention falls in line strategically with the company, then the next consideration at DENTSPLY focuses on how the concept contributes to the profession. For example, Lichkus notes that the company will consider if the invention makes patient care better or helps the dental professional provide clinical care more effectively.
“We’re also looking to see if the idea or invention speeds up the process of providing a service or product to the patient, or the practice of dentistry itself,” Lichkus explains. “Does it make [dentistry] less expensive, more effective, or more reliable? Those are the key criteria that we’re looking at.”
Klein says that from his experience in the industry, he knows firsthand that many of the larger dental manufacturing companies receive numerous phone calls from dentists with an idea for the “next big product” in the dental industry. Although it’s important for an inventor to exhibit eagerness and enthusiasm about their product, it’s also very important to have a viable and carefully thought-out business plan and presentation ready.
Advice from Inventors and Manufacturers
According to Lichkus, inventors should look at companies as very good opportunities to commercialize their invention, and the first step in that process is to ensure that the link between the invention and the commercial outcome is well established. He explains that DENTSPLY is fortunate to have several invention opportunities brought to its attention. Unfortunately, not all of them can be commercialized at the same time and, in some cases, they must be staged.
“If you don’t participate in the process, you can’t benefit from it,” Lichkus encourages. “Dentists and all dental healthcare professionals should be encouraged by the fact that many of DENTSPLY’s products originate from outside the company. A substantial proportion of our products and services are based on inventions from people around the world serving in a variety of different settings, from practice to universities. The linkage between research and innovation led DENTSPLY and the American Dental Association in 1959 to initiate the Student Clinician Research Program. This program fosters scientific inquiry, innovation, and research among dental students and their faculty mentors. Now celebrating its 50th Anniversary in 2009, dental students from 36 countries now participate in the global DENTSPLY Student Clinician Research Program. In the course of their careers, these students may see their research efforts result in new products, techniques, or technology that benefit patients.”
Haig from 3M ESPE says that his company is always on the lookout for that next big idea, adding that the company has a strong history of firsts. Therefore, dabbling in product invention really isn’t an option because there is a huge amount of work that goes into the creation of a product, especially one that’s going to be valuable to the market, he says. The ideation phase is only the first part.
In fact, with 3M ESPE and perhaps many other large companies, Haig says there are six stages in the process of product commercialization. It starts with an idea and, following ideation and a filter that is applied to the idea, the process moves on to concept development and testing, after which feasibility assessment takes place. Next come development, scaled up production, and full commercialization.
“Most dentists probably aren’t set up to go through this type of rigorous process of fully developing and commercializing a product in a FDA-regulated environment,” Haig surmises. “This is where picking the right partner to help commercialize an idea is critical.”
Klein says that if dentists have a great new idea and they strongly believe it can change dentistry for the better, then they owe it to themselves and the profession to pursue it. He says this doesn’t mean that they have to develop, manufacture, market, and sell the product to the industry; taking a product from an idea to market, conservatively, could cost hundreds of thousands of dollars, or even more.
“It requires a great deal of time and an experienced, knowledgeable team of people to help you. But you certainly can play a role in taking it to market,” Klein asserts. “Keep in mind, most dental companies don’t breed innovation internally. They get many of their ideas and products from the profession—from the chairside clinician that sees a need that directly applies to a dental procedure.”
Fischer strongly suggests that dentists take their ideas beyond only ideas and at least get them to a prototype stage. This is an important exercise, he believes, and it even can be a fabulous education for them in coming to understand more about what a manufacturer may be up against when manufacturing their idea.
“It’s one thing to draw and create something in the dimensions as large as a napkin or a piece of paper. It’s another thing to create them at the sizes that may be needed to enter inside of a canal or inside of a cavity preparation,” Fischer says. “So, I encourage dentists and inventors to go as far as a prototype, if at all possible.”
From there, Brattesani explains that what’s involved in determining feasibility includes the cost factors, white papers on the unit, what’s required for its manufacturing (eg, injection molding device or stamp press), and what the cost efficiencies are. He notes that the best idea in the world won’t sell if it costs too much.
“You don’t know the final price point until you have the final prototype approved by everybody,” Brattesani says. “When you’re dealing with a corporate structure, that could be a tedious process, since you’ve got many different cells and divisions that have to sign off on it. So, an invention can take months to years to come to fruition, and sometimes it comes to fruition and the market for it has already passed.”
Fischer also encourages potential inventors to study and realize what the dental marketplace really is going to be like for the proposed product. He cautions that early inventors can start doing multiplication, without ever subtracting or dividing.
“We’re usually multiplying, and we’re multiplying how many units we feel are going to be bought by how many dentists who are going to use them. How many times a day will be multiplied by how many patients in a year,” Fischer calculates. “We can come up with tens of millions of dollars of projected successes. If we’re not careful, the numbers become so tantalizing in our brains that it’s difficult for us to accept a small start that may be required first. It’s that human nature thing that can run away with us if we’re not careful.”
Fischer says you don’t always win. There are times that you can lose; you just have to pick yourself up, dust yourself off, and keep swinging where you can.
“I think the greatest learning experience through my years of developing products has been learning how to pick yourself up when you crashed and to listen better next time, even listening to others better, and to keep swinging,” believes Fischer. “In the path to being successful, it’s not a straight line. It entails ups and downs.”
Brattesani remembers that one of his biggest inventions—an educational device to show patients how a sonic toothbrush is superior to all other brushes by using a method that stops the brush in midstream so its movements and strokes can be observed—was actually turned down six times before finally being accepted. So he created a prototype, and it wasn’t until he presented it in a different meeting with fresh eyes that it was perceived as a great idea, he says.
“I love the inventive individual who is driven to raise the bar—the dentist out there who is willing to put in the hours, pay their dues, invent and create, develop the prototype, prove it out, and so to be able to demonstrate not only to themselves but others that this is superior to other things out there,” shares Fischer. “Dentistry needs such individuals. Our patients need such individuals.”
Not surprisingly, Fischer encourages those who have ideas that they feel can go places to roll up their sleeves, jump in, give it their level best, and take it as high as they can. Then, when they feel they have something, to find entities they feel they can trust with whom to share it.
“I encourage them to take that on, to live that progression and that developmental process,” Fischer emphasizes. “It helps broaden them. It helps them grow, and it’s good for the profession.”
According to Niznick, the hardest thing about inventing is cultivating the idea that you can really do it. He says that once a person can say, “Hey, I can come up with an idea for such-and-such,” that’s when the creative juices start flowing and they can develop the confidence to recognize what the problem is.
“I’ve got 35 patents, but it all started with one idea to make a better implant,” Niznick says. “If there’s an area in which you think you’ve got an idea that’s better, then have the confidence to go forward and develop the prototypes. Then test it clinically, have some of your friends try it, and try and get on lectures and programs to talk about it and try and generate some interest for it.”
How an invention is used determines if it’s good or bad, Brattesani believes. In dentistry, hopefully inventors and professionals can make things better for everyone, and that’s why he’s passionate about dentistry.
“My goal is to leave dentistry better than when I entered the profession, and when I pass away, I want people to be able to say that I made a difference by making dentistry a more pleasant, efficient, and better environment,” Brattesani says. “If I can help dentists do things better, faster, and cheaper, and their patients enjoy those benefits by not having to be in the chair for as long—or to have something done with less pain or discomfort, then I’ve done something good for my industry.”