ACOMS Letter From an Editor: Reflecting on 20 Years of Practice Transformation

Greetings from the Pacific Northwest! I am Libby Kutcipal, an oral and maxillofacial surgeon (OMS) from Seattle, and I have recently become an ACOMS Review editorial advisor. I grew up in Northern Michigan, but did my OMS training in Seattle, where I have been pretty much ever since. Currently, I live in a houseboat — think Sleepless in Seattle — and enjoy my free time in the mountains, both skiing and hiking.

The theme of our June issue of ACOMS Review is “transformation.” When I think about this topic, what first comes to mind is the routine transitions of life, like summer to fall or a vice president becoming president. These times can be transformational, but I see the biggest change when looking back at the scope of my life and career.

Especially since I began my practice nearly 20 years ago, I’ve seen our profession transform in so many ways:

• Documentation: My first years in practice had paper charts. I can’t even imagine writing everything by hand now. Then, I had a hybrid of handwritten notes and dictation. Now, I feel behind the times with a cloud-based EMR, where I still have to type! Voice recognition and AI-based documentation are here.
• Imaging: My first images were developed in a dark room with recycling for the little foils around the film! I had one shot; then, it took about five minutes to develop. If any image had to be repeated, it slowed down the whole appointment! Now, it’s all digital — and fast! Repeating an image is done in seconds. If a cone beam computed tomography scan (CBCT) is needed, no special trip is required, we can take one in about 16 seconds. CBCT technology has also changed — improvement in image capture time, image quality, and movement tolerance. We can all look at that third molar with the roots surrounding the inferior alveolar canal and discuss those risks with our patient. We can locate supernumerary teeth and better assess intra-bony pathology. We can precisely plan implant size and placement.
• Orthognathic surgery: I had pads of tracing paper, pencils, protractors, scissors, rulers, and tape all over back in the day. Then, there was the articulator, plaster, acrylic, and pressure pot; the list goes on! Now, much of the planning is digital —with VSP meetings and surgical guides to match. Bending plates could be time consuming, but now, pre-bent surgical plates are available for the most complex cases.
• Implants: I trained on Branemark implants — need I say more? We would plan the case using a panoramic image (knowing the magnification) and with a transparent overlay for the implant length. I hand-made surgical guides with models and denture teeth. Fast forward to today, we have virtual positioning of implants and custom surgical guides and intra-op navigation for precise positioning.

As I am writing this, I can think of more and more innovations that have changed the way we practice. This not only encompasses clinical practice, but now scheduling, billing, and the administrative side of OMS practice. While many of us practice in smaller practices, it is easy to stick with the status quo. We need to stay up to date on the latest technological advances, or we will be left behind

Libby Kutcipal, DDS

Dr. Libby Kutcipal practices oral and maxillofacial surgery in Seattle. She worked at Seattle Children's Hospital for several years after residency/fellowship, then went into private practice. She currently owns a practice in the Ballard neighborhood of Seattle. She lives in a houseboat in the middle of Seattle, with her big goofy yellow lab. They enjoy spending the weekends in the mountains on the trails or in the snow.