Digital revolution elevates Milwaukee VA Dental Service

“Our dental service has been on this journey since 2013,” said Dr. Ankur Patel, chief of dental services at the Milwaukee VA. “As far as I know, we are the first VA dental service across the enterprise to have navigated the hard work and processes to arrive to this unique digital environment.”

Patel said the result is “an ecosystem” that allows the dental service to employ cutting-edge technology “to provide dental care that is more accurate, quicker and efficient.”

Dr. Jesse Smith, head of the Milwaukee VA’s prosthodontics program, who has teamed with Patel for the past 13 years to bring the dream to reality, agreed.

“I feel like the floodgates have opened,” he said. “It’s been an absolute game-changer for us.”

Digital technology plus unfettered internet

There are two key components to the initiative:

• Fully incorporating digital technology into Milwaukee VA dentistry.
• A customized, specialized air gap computer network which connects that technology with leading dentistry manufacturers, experts and resources around the world.

The technology portion has been ongoing for 13 years. It started with the acquisition of computer-aided design software and a milling machine and has grown from there to include 3-D printing.

The days of making impressions, creating ceramic models and then using those to manufacture dental implants are waning. Now, mouths can be scanned electronically, and that information fed into computers where the prosthetics are created. What used to take weeks can now be accomplished in days — or even hours.

“We’re building prototypes that allow us to bypass a lot of these analog steps that would take so much time to do,” Smith said. “This whole digital revolution has allowed us to become more efficient without sacrificing quality.”

It also saves money: Smith said a crown that used to cost $180 to manufacture and take weeks to deliver can now be designed and created in-house for about $66 in a matter of hours.

“We keep a tremendous amount (of our manufacturing) in-house at a significant cost avoidance,” Patel said. “Across the board, with any type of dental deliverable — crowns, bridges, implant crowns, dentures — we have the technology in place to provide that digitally rather than analog.

“At some VAs, the turn-around time for a crown is months. We can turn something around in a day if needed, which is just mind blowing. It’s come such a long way.”

Overcoming networking obstacles

But for those efficiencies to be realized, the design systems must be able to talk to the manufacturing systems in a seamless way. Unfortunately, that has not been the case across VA dentistry.

“Networking obstacles had created inefficiencies to processes related to digital manufacturing, which did not allow us to use the equipment as intended or efficiently,” Patel said. 

For example: Smith said the Milwaukee VA has implant software that is FDA-approved. However, that software needs to connect with the FDA regularly for updates and bug fixes. On the VA network, that was not possible.

“The only solution we really saw was to have a customized air gap network, that would allow us to have all this equipment that could freely talk and validate whatever needed to be validated,” Smith said. “It’s allowed us to work much more efficiently.”

Creation of this network began about three years ago and was finally realized this spring. It involved a host of VA departments and experts, including Health Technology Management, Information Technology, Facilities Management and Supply Chain Management.

Without their committed and comprehensive support, Patel said this would have been a pipe dream and impossible to achieve.

The result: a digital manufacturing network, independent of the VA network, “which really allows us to leverage the equipment and technology in the way it's intended,” Patel said.

“We've essentially modernized our digital dental practice to be not only consistent with what you'd find in a private office … but to be the envy of any practice,” Patel said. “With the technology we have, and now the ability to network it and create workflows, we are so far ahead.”

Embracing the future

Patel said the Milwaukee VA is now set to embrace the digital future, which means the best of care for Veterans.

“The digital dentistry environment … is the pinnacle of technological efficiency and the gold standard of digital workflows and capabilities to treat Veterans,” he said. “It’s a groundbreaking thing. I’ll look back on this one of the greatest accomplishments that really set us up for success moving forward.”

Smith agreed, noting that the accomplishment belies the hard work behind it.

“No one understands what it took to get to this point and what it actually means now,” he said. “To someone on the outside, it sounds like no big deal. But it is a big deal for us who have lived and breathed within the VA for as long as we have. … It’s allowed us to become 10 times more efficient.

“Anything that comes in the future, we now have the ability to seamlessly integrate that without jumping through hoops or being told, ‘We can’t do that in the VA.’” Patel said. “We’ve created sustainability of growth to accommodate for new innovation. We are very well postured to evolve with whatever dentistry does moving forward.

“We can stand at the top of the mountain and say, when you come to the Milwaukee VA dental clinic … you’re going to experience technology and dental deliverables that far and away exceed what we see in the private sector and across the VA enterprise.”

“It’s taken 13 years, but I think we now have the best digital program of any VA in the country.” Smith said.