Second Opinion

Second opinions are common in healthcare; whether a doctor is sorting out a difficult
case or a patient is not sure what to do next. In the context of our magazine, the first
opinion will always belong to the reader. This feature will allow fellow dentists to share
their opinions on various topics, providing you with a “Second Opinion.” Perhaps some of
these dentists’ observations will change your mind; while others will solidify your position.
In the end, our goal is to create discussion and debate to enrich our profession.
–– Thomas Giacobbi, DDS, FAGD, Dentaltown Editorial Director

Innovation and the Dentist

William B. Dragan, DDS

Centrix CEO

Much of the progress occurring in the everyday practice of den-
tistry comes from those who involve themselves in it on a daily
basis. Dentists are a very innovative group because there are many
times we encounter problems that are not in any textbook. What do
we do? We all have to innovate in order to solve some of these out-
of-the-ordinary situations.
Four years of dental school gives us the most basic of ideas about
what dentistry is. It isn’t until we are out in the world actually prac-
ticing dentistry that, if we are lucky, we realize how little we actu-
ally know. I was one of those who, after school, thought they knew
it all. For nine years I was ignorant of all the potential dentistry had
to offer. Slowly, I became disenchanted and depressed with my prac-
tice. I finally decided I could not go on the same way I had been
going. I had to change. I decided to sell my practice, get out of the
area and become associated with another dentist. I lost money on
the sale of my practice, but I never looked back. I never regretted
the monetary loss because if I didn’t change I think I would have
just given up dentistry.
My dental associateship gave me a new life. The dentist I
worked with was a constant student, starting study clubs, going to
courses and always buying and trying the newest products and
devices. Dr. Jack Buckman was my inspiration and mentor, open-
ing my eyes to all the developing possibilities that started to emerge
in the late 1960s and early 1970s.
I had graduated from Temple Dental School in 1958. We had
been taught in, what I would call, the Stone Age of Dentistry. Some
of the few basic changes I saw in dentistry started with the high-
speed air rotor and disposable needles. It is hard to believe now, but
in dental school the anesthetic needles were cleaned, sharpened,
resterilized and reused. Synthetic impression materials were not
heard of in school. We used compound, alginate, wax and plaster of
Paris as our major impression materials in school. Changes, such as
the introduction of composites and VPS silicone impression mate-
rials, have occurred to make our lives, and those of our patients, eas-
ier. When I finally realized all the potential that existed, I became
excited with dentistry again. My association with Jack’s dynamic
practice was opening my potential and career possibilities.
Jack, as I said, would buy anything new. I was very fortunate to
be there when the first practical composite was introduced to the
profession. That composite was sold by Johnson & Johnson and
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I became an entrepreneur, but then again,
every dentist is an entrepreneur in one form or another.
called Adaptic. It was a paste/paste material that was mixed in equal
parts and placed into a cavity preparation with a spatula. Not an
ideal method, filling with a spatula, it many times incorporated air
into your restoration. Air in my restorations was a problem for me
that became an opportunity and the start of my odyssey into inven-
tion. I became an entrepreneur, but then again, every dentist is an
entrepreneur in one form or another.
My entrepreneurial exploits started when I became interested in
the problems I was having when I filled class III cavities. Many
times, I ended up with voids at the surface. I had to redo the restora-
tion and hope I would not – again – incorporate more air. My redos
began taking too much time in my schedule. To regain control, I
thought and came up with several composite placement concepts
that were impractical. Finally, I thought I had the right idea to cure
problem of voids in my composites. If I could syringe the compos-
ite directly into the cavity preparation from the bottom out, I would
eliminate or at least minimize the incorporation of air. There was
not a device on the market to do this, so I made my first two syringe
prototypes. This was only part one of the concept. To test out the
whole concept, I had to design and invest in a prototype injection
mold to make a disposable plastic tube, which would be the reser-
voir for holding and expelling the composite. This is where you
have to separate the men from the boys. In 1969, the mold cost was
$6,000; all the savings I had in the bank. I had no guarantee this
concept would work. I made the leap of faith and invested to make
my first syringe with a tube and a plug. The moment of truth came
when I first tried the prototypes and the system worked! I had
solved my problem, but what to do next?
To protect myself, I decided to spend more money and file for
a patent. To reassure myself that my syringe technique was good and
I was not blinded by my genius, I gave my other prototype to a fel-
low dentist I had known since dental school. He liked it. Now what
do I do? I was totally convinced that placing composites with a
syringe system was the way to go.
We dentists are not taught manufacturing, so I decided to intro-
duce Johnson & Johnson to the concept of using a syringe system
to place composites into cavity preparations. Johnson & Johnson, as
did other large manufactures, refused even to look at my concept.
This is a crossroad that any independent inventor must consider:
Do I invest my own money and form a company? Or, do I just for-
get the whole thing and write off my losses as experience? I decided
to form a company. I called my company “Centrix,” taking the
name from centric relation. I truly believed the idea of syringing
composites would take off and my fortune was made. (A delusion
many inventors have is that a good idea will make you rich over
night. There are exceptions, but it would be like hitting the lottery.)
For me, I found my road to success was a long and very hard road.
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That was then. Now, I see all the new, unlimited possibilities
that are open to all the wet-gloved dentists today. Because there are
so many products and techniques that are exciting, I am sorry I can-
not physically practice dentistry today. Opportunity exists everyday
for all dentists to be on the lookout for different uses for technol-
ogy. Maybe there are ways to improve what you are doing and using
today. Every problem, new product and/or technique create oppor-
tunities for those who are inquisitive and want to make their lives,
and those of their colleagues, easier or more efficient.
Centrix and I have always looked for simple products that can
help the dentist; and therefore, help make the patient’s visit less
traumatic. I believe that, for the most part, we do accomplish our
goal. It amazes me how long it can be before a simple product is
accepted and becomes standard in everyone’s dental office. My first
product took over 10 years to became the accepted method of plac-
ing composite resins and this was a simple disposable tube and plug.
I would like to challenge all dentists, young and not so young,
to keep your eyes open and be always looking, and especially think-
ing, how they might solve the everyday problems that you have or
will have. Don’t be afraid to say there may be a better way for both
you and your patients.
A suggestion to all dentists with an idea for a product or idea:
Don’t quit you day job. During my time trying to build Centrix, I
was a full-time dentist and practiced for 40 plus years. Keeping your
practice doesn’t mean you should forget developing your ideas. It
means you may have to work at night and weekends. The dentist is
the only one truly able to improve the techniques and products that
are and will be necessary. If the dentist does not innovate, the large
companies will give you good chemistry and large items like digital
x-rays, milling machines and other big-ticket items; but it is up to
you to make them work and work efficiently in your practice.
Unfortunately, I have found that it is easy to innovate, but very dif-
ficult to get the story across to our colleagues. That doesn’t mean
you should be discouraged, it means that you have to believe in your
ideas and persevere.
Though it can be a difficult road, there is nothing more reward-
ing than seeing an idea go from the drawing board to actuality, and
finally, become accepted by the profession worldwide. There are
many dentists who have created products dentists use every day. Just
a few of these men are Drs. Bob Ibsen of Den-Mat; Dan Fisher of
Ultradent; Josh Friedman, who started Demetron; as well as Barry
Musikant and Allan Deutsch of EDS. Some other innovators are
Drs. Raphael Bowen, who discovered modern composites, and
Angelo Buonocore, who developed bonding resins and preventive
sealants. There are many more people who should be on the list, but
I haven’t the space to name them all. It’s time for you to join this
list. Centrix’s motto is “Making Dentistry Easier.” I challenge you
to keep thinking and dreaming, some dreams do come true.