Interview Dr Miguel Stanley, exocad Insights 2024

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Dr Miguel Stanley shares his view of the future of digital dentistry at exocad Insights 2024

Dr Miguel Stanley, director of the White Clinic in Lisbon, Portugal, during the exocad insights 2024 in Palma de Mallorca in Spain. (Image: Akira Schüttler, exocad)

Staying at the forefront of innovation and patient care requires passion, dedication and a commitment to learning and mentorship. During exocad Insights 2024, Dr Miguel Stanley, the director of the White Clinic in Lisbon in Portugal, not only highlighted his personal evolution in dentistry—navigating through challenges and embracing technological advancements such as digital diagnostics—but also reflected his deep-seated desire to inspire the next generation. Based on an unyielding pursuit of quality and a thoughtful approach to patient care, his journey resonates with many, having a profound impact on how dentistry is practised and perceived. In this interview at the event, he delved into the transformative potential of digital dentistry, including how he is using technology to reintegrate dentistry into medicine, and he shared principles and practices of stress management to support dentists.

Dr Stanley, you are a key opinion leader and a sought-after speaker, and patients come from all over the world to the White Clinic for treatment. In many ways, you are a pioneer in dentistry and overall healthcare. What important influences have made you who you are?
Looking back, there have been many different influences over the years. My father was a profoundly honest man. He valued principles and ethics above anything else. I think your values should always come before business and money. I had a strong Catholic upbringing; we were taught to have moral values. I am not talking about religion but about having a code of ethics. I come from a very conservative background, so that too has influenced the way I see the world.

I would say that some of my greatest mentors in dentistry have been Drs Maurice Salama and David Garber. Almost 20 years ago, I saw a lecture by Dr Sascha Jovanovic, and he disrupted my thinking. I hope I can do the same for new generations of dentists and inspire them.

My experiences, including traumas, failures and negative influences, have shaped me significantly. I’ve encountered many industry trends not supported by science, and this taught me the importance of adhering to core principles. This is partly why I chose not to expand into a network of clinics; I prefer to maintain control to ensure the highest quality of care for my patients. At the White Clinic, it’s the dedicated people, not the brand, that define our success.

Why do you feel the need to share your knowledge and what you feel is important in dentistry? Is this driven by your passion for what you do or is it more than that?
Everybody likes to be recognised for what they do, to be valued and appreciated. I gave my first lecture in 2002. Back then, when you got invited to give a lecture, there was no social media. It was an opportunity to talk about science and share an idea, and of course, you felt appreciated. I’m a musician at heart, and I have always enjoyed entertaining and feel comfortable in a crowd. I guess public speaking triggered my love for being on stage and entertaining other people.

Nowadays, I am so privileged to have this platform, but still every time I finish my presentation, I get off the stage and begin beating myself up about what I’d forgotten to say. I don’t take this privilege for granted, and I put a lot of time and thought into my lectures.

In a way, it feels like being a mountain climber in that each summit is a challenge or a surfer for whom every wave is different. Every lecture is unique because the audience is unique and the feedback is unique. It is, to me, an art in itself to keep an audience engaged. By keeping the audience engaged, I hope to inspire them and have a deep impact on the lives of their patients. Therefore, it is a responsibility I take on with huge accountability and with a strong sense of ethics and principles because of my values. I do it nowadays because if I can inspire just one dentist to do something better, to go back and improve on his or her skills, the way that he or she does things, then the lives of his or her patients will also be affected by that. I think I have had a little bit of an impact in my industry that way, and I am happy about that.

Given your expertise and the focus of your exocad Insights lecture on the power of virtual patient representations—avatars you called them—in dentistry, could you elaborate on how digital tools are transforming the diagnostic and treatment planning processes in dentistry?
For younger dentists accustomed to digital tools, the transition might seem straightforward. However, for Gen X and baby boomer dentists raised on analogue techniques—like taking moulds, shipping them off and waiting for the finished dental work—there was often little communication with the lab. This lack of control over the process could lead to significant frustration due to the reliance on external factors that were difficult to manage.

Companies like exocad developed this extraordinary tool that allows you to see the future. Everybody knows that AutoCAD is one of the top tools for architectural design. Similarly, exocad is the software for designing teeth. There is an absolute similarity between building a house and building a new smile. You need to establish the foundation first, and that requires a survey of the site, which in dentistry translates to the intra-oral scan, the CBCT scan, the facial scan and dynamic motion tracking. Exocad aggregates the content of all these files to create an avatar. Patients and clinicians can see all this, and it allows you to avoid treatment complications virtually even before you start.

When aligners first emerged in the late 1990s, the concept was to straighten teeth with an extraordinary treatment modality! Almost three decades later, we have the capacity to design smiles, involving very complex thought processes, virtually. We carefully select the appropriate materials, determine the optimal sequence for each phase, understand the precise timing for each step, and then seamlessly integrate everything to achieve the desired results. The beauty of the software is that you can monitor each phase, you can do quality checks, and you can communicate and interact with everybody who is able to see the same thing.

Your lecture at exocad Insights 2024 focused on the intersection of technology, patient engagement and clinical outcomes. How do you see events like exocad Insights contributing to the advancement of digital dentistry and enhancing collaboration among dental professionals?
Well, the beauty about exocad is that it is an open-platform. It works no matter what scanner you have, what CBCT device you have, what kinds of materials you work with, what 3D printer you use or what milling machine you work with. That open-platform mindset is beautiful; it is universal—and for that, I have a great deal of respect. It is the most democratic software available. The patient is also able to engage with his or her treatment thanks to this software. It is a tool for the patient, for the dentist, for the lab, for the practice or business owner and even for the manufacturer; it is an industry connector.

Meetings like exocad Insights, where you can collaborate and connect, are important because trade companies can attend and showcase their software, hardware, solutions and products. It is open to everybody because everybody can work with everything on offer, and it allows dentists from all walks of life to share and engage with their way of doing things at their own speed and within their own budget.

Any dentist looking to gain insights into the industry’s future over the next three to four years, especially those considering major decisions or investments, should attend this event. It’s not just another dental congress; it’s a crucial educational opportunity that brings together some of the brightest minds in the field. This is a really, really good meeting for dentists, lab technicians and business owners to come together, and I recommend it to everybody.

As a pioneer in clinical implementation of advanced technology, you’ve probably witnessed significant shifts in dental practice over the years. How do you envision the role of digital tools evolving in the near future, and what impact do you anticipate these advancements will have on patient care?
In my exocad Insights presentation, I showed a video of an interview I had with Dr Howard Farran in 2015 in New York, where I started by saying that, in the future, it would be the patient who decides. Consumer-led revolutions have been a long-standing trend in most industries. Imagine this happening in dentistry. Of course, patients can’t treat themselves, but what if we gave patients tools to make better-informed decisions?

Currently, patients choose dentists based on location, cost, accessibility and recommendations—criteria that lack a scientific basis. Yet, everyone is seeking the best care. I envision a future where patients don’t go to dentists for initial check-ups; instead, they visit scanning centres. There, they will be able to get comprehensive scans, like CBCT, panoramic and facial scanning, integrated with dynamic motion tracking. After the visit, the data will be uploaded to the cloud, where an ethically designed biological treatment plan will be created. The patient will then receive recommendations for a dentist based on clinician experience, technology available to the dentist and user feedback. This approach will revolutionise patient acquisition, moving beyond traditional referrals to a system driven by artificial intelligence (AI) feedback.

Many lab technicians globally face a common issue: they receive poor-quality scans from dentists, but are expected to work with them regardless, as there’s little hope for improved scans. This situation isn’t ideal, and patients deserve to be aware of this. I foresee a shift driven by patients themselves, revolutionising how they choose their dentists. With advancements in technology and AI, this change is imminent. I am eager to lead this revolution, empowering consumers to make informed decisions about their dental care.

Your work with the Slow Dentistry Global Network emphasises the patient experience and safety during dental visits. How do you see the integration of digital dentistry aligning with the principles of Slow Dentistry and improving the overall patient journey in dental care?
People may believe that Slow Dentistry is about working very slowly. It is not. It is about having time in your daily workflow to do things properly. If you are seeing 20–30 patients a day, you will not have time to properly disinfect the room, for example. Taking an intra-oral scan properly can take 15 or 20 minutes, depending on the case, whereas a traditional silicone impression can take 5 minutes, so technically, it is faster to take a silicone impression than an intra-oral scan. It takes, let’s say, 5–8 minutes to take a CBCT scan and 30 minutes to interpret it. A facial scan can take seconds, but it takes you an hour to fuse it in exocad. You must have time in your workflow to use these technologies. Time is a very under-appreciated commodity in dental care, and we are not paid for it. We are paid for the result, not for the thought process behind the result. Why aren’t dentists or lab technicians valued for their time to think? I think that that’s another consumer change that must happen. We should get paid for the time we need to get the best results, just like doctors are. Slow Dentistry endorses and supports dentists.

Being a digital dentist involves significant data acquisition and processing. For example, creating an avatar requires an intra-oral scanning file, a CBCT scanning file, a facial scanning file and a dynamic motion file, and it can take around an hour and a half just for data collection. Afterwards, you must integrate these files on the exocad platform and analyse the data, further extending the process by a few hours. Given these time-intensive requirements, rushing is not advisable. Embracing Slow Dentistry is essential for any dentist aiming to excel in the digital realm, and this may necessitate hiring additional staff or allocating more time per patient.

What drives you to take on a new project, to embark on a new adventure, in dentistry?
This is my hobby. You know the saying “Find something you love to do and never work another day in your life.”? Take Cristiano Ronaldo, a person I have had the privilege of knowing for many years. He has all the money in the world. Why does he still play football? Because when he plays, he loves it. It is as simple as that. What drives me is that I want to change the world. Nobody asked me to do it. I am under no obligation to do it. It would be a lot easier for me to stay in my lane and just work at my clinic and focus on my business. I like to connect the dots, and so it upsets me to hear “You are not a doctor; you are just a dentist.”

The medical industry looks at dentists as mechanics, and dentists, unfortunately, may inadvertently give support to this by focusing on tooth alignment, tooth whiteness, and their shape and function. I thought about what we could do to change that. During the pandemic, I understood the importance of inflammation. People were dying of inflammation, and I started studying all of this with my team. I have a brilliant dentist on my team, Dr Ana Paz, who does a lot of research into this. We were always challenging each other and inspiring and learning and researching and then testing, going to some of the top minds in the world and looking at this connection. Then it just hit us one day: the jawbone is part of the immune system, and the teeth as well are connected to the brain. It is therefore not just a question of having a healthy smile; it is about healthy teeth.

We also must consider a healthy bone marrow. “Bone marrow”, “jawbone”, “inflammation” and “cytokines” are terms that immunologists and doctors understand. I asked myself if this could be a way to connect with the medical industry and have doctors prescribe dental treatments—because they typically do not. A patient can have cancer, and his or her physician may not know that it might be linked to an oral cyst. I decided to use my platform to get dentistry back into mainstream medicine.

That leads to a question I wanted to ask you, relating to your new passion, biological dentistry, and its impact on systemic health. Is it your goal then to reconnect dentistry with medicine?
I am so passionate about this, and frustrated at the same time, that I developed an AI-based program called Missing Link. The goal is to use an existing panoramic X-ray, which many people have, to support doctors and patients who are looking for answers and not getting them. We know that most doctors are overwhelmed with work and that healthcare systems are overburdened. Even in rich countries, it is difficult to get a good doctor to spend time with you. What if the missing link in healthcare is dentistry? The doctor can scan the patient’s panoramic X-ray very quickly using Missing Link to detect any inflammation in the jaw. The patient might not be aware of low-grade inflammation, especially if he or she has no pain, which is not always the first symptom of a problem. Missing Link provides screening and not a diagnosis.

So Missing Link is directed at medical doctors not at dentists?
Yes, it is aimed at medical doctors. Based on the findings of Missing Link, the doctor will refer the patient to a dentist for proper diagnosis and treatment. In that way, Missing Link will generate a whole new set of patients for the dental community. The dentist too might want to use Missing Link for his or her patients to confirm his or her findings.

We developed this platform for the medical community to provide a clear rationale for dental visits. Using AI, it helps doctors demonstrate the necessity of specific diagnostics like CT scans, enhancing patient understanding and cooperation. Traditionally, radiologists use similar processes to identify fractures that require surgery. Our tool fills a crucial gap in healthcare communication by facilitating requests for detailed diagnosis and follow-ups between dentists and other medical professionals.

How do you manage all you do and stay sane and have a good work–life balance and the time to take good care of yourself? In short, what is a day in the life of Miguel Stanley like?
Firstly, I have a very stable family life. Secondly, I have a very limited social life. Thirdly, I have an incredible team of people working with me. I have 48 people at the White Clinic, and we only have seven treatment rooms and do not work on weekends.

I only attend about 12 international conferences a year and carefully pick the ones I want to go to. I make sure I go to events where I can have a huge impact and change people’s lives or at least give them new perspectives.

My day starts at 6:00 a.m. Because I am a surgeon, I do not smoke and I do not drink alcohol. The level of focus I need for my surgeries is like that of a chess player or an athlete. I need to be incredibly focused for a long period. I started fasting about seven years ago. One of the keys to longevity is fasting. We’ve known that since Hippocrates. I never have breakfast and two to three times a week, I only have dinner. This allows the body to go into ketosis and gives you an extraordinary amount of focus and clarity. I use ancient integrative knowledge to keep my body very healthy. I sleep well and monitor my sleep.

I treat my job like a religious duty; it is a very sacred thing to me. When I show up to work in the morning, I need to be focused and rested and ready for my commitment to help my patients heal. It is not just a job; it is a mission.

The older I get, the more I am committed to having a healthy mind in a healthy body. So, when I go home, my phone is off, and it is family time. I need to really focus on what matters. I can also say, even if people don’t really believe this, that I am where I want to be, it is my luxury to be able to decide this, and I do not try to please anybody.

You have previously said that dentistry is one of the most stressful professions. How do you manage stress personally?
Managing stress in dentistry requires discipline and a dependable team, which I’m fortunate to have. I don’t handle everything on my own; I rely heavily on my trusted colleagues. We maintain constant communication and share responsibilities. For instance, my orthodontist has been with me for 22 years, and my cosmetic restorative dentist for 18 years. These long-standing relationships contribute to a solid support system. Additionally, by focusing solely on one clinic and selectively accepting only 30%–40% of potential patients, I ensure that we never overextend ourselves, and that helps keep our work environment manageable and stress at bay.

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