Interview: Dr. Milan Madhavji

“Many of the functions currently performed via 3D printing (surgical guides being one example) will be rendered obsolete once augmented reality for surgeries reaches a certain point.”

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Dr. Madhavji graduated from the University of Manitoba in 2006 with an honours DMD and a concurrent B.Sc in Dentistry. He worked as a general dentist serving Northern Manitoban communities for a year before attending the oral and maxillofacial radiology specialty program at the University of Toronto until July 2010. He has exclusively practiced oral radiology at Canaray for the past 5 years and has reported over 30,000 CBCT scans. His current interests are CAD/CAM guided surgery and digital communication. He is a co-developer of the Accuplant guided surgeryinstrumentation system, which has been designed to enable all clinicians to utilize guided surgery with minimal instrumentation costs. Dr. Madhavji will be presenting at 3DHEALS2017.

Q: What is your vision on the intersection of 3D Printing and healthcare?

A: As an oral radiologist, I find that the most straightforward application of 3D printing is the translation of planning data from CBCT and other 3D modalities from the computer to the patient intra-operatively. 3D printing is really just one tool in the larger concept of moving to 3D computer-based planning of surgeries. Many of the functions currently performed via 3D printing (surgical guides being one example) will be rendered obsolete once augmented reality for surgeries reaches a certain point. 3D printing in the future would therefore be most likely applied to the manufacture of customized biological and biocompatible materials for surgical use.

Q: What do you specialize in? What is your passion?

A: I am a dentist that has specialized in oral radiology. My passion is tinkering with computer hardware and software to enable the repetitive tasks to be automated, which leaves more time available to pursue things that are more difficult or fun.

Q: What inspired you to do what you do?

A: I would say curiosity about how things work and a desire to try to communicate more effectively, along with the ability to not give up even when people think what I’m doing is a waste of time or seems trivial or silly at first glance.

Q: What is the biggest potential impact you see 3D printing having on the healthcare industry? Dentistry?

A: For dentistry, I feel that the biggest impact will be to encourage dentists to move from a 2D world of plain films and flat charts to a 3D world of planning and charting. 3D printing is what enables people to translate their ideas and plans from computers to the surgical suite in the most accessible and straightforward way at the moment, so it is a crucial component of the transition away from 2D planning.

Q: What challenges do you see arising in implementing 3D printing in healthcare sector in the next 5 years? Esp in dentistry?

A: The major challenge in dentistry specifically is metal artifacts in CBCT scans, which prevents effective segmentation of 3D data in the region we are interested in producing 3D printed objects, which means that we need to acquire other 3D data (digitize a stone model or take a digital impression of the dental arch) to compensate for the scatter. At the moment, digital impression systems that perform this task intraorally are the exception, not the norm, as they are between $15,000 and $35,000 per unit, but this should change over the next few years as the price of these units comes down.

The other challenge is the cost of introducing 3D printing into a workflow. Most dentists are used to dental implant surgeries costing a certain amount (whatever it is for each dentist). No matter what, the introduction of 3D printing into this implant workflow would increase the base fee by a few hundred dollars. For dentists in competitive markets, the increase in the fee makes some dentists feel that they would be at a competitive disadvantage, given that patients generally cannot tell the difference between a dentist that utilizes 3D planning from a dentist that utilizes 2D planning. Unless the patient and/or dentist understand the value of the 3D planning/printing process, and feel that it is worth it, the 3D workflow does not become the default technique.

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Q: What is the best business lesson you have learned?

A: Everything costs way more to implement than you are expecting. Also, as far as 3D printing and any other investment with an uncertain business model goes, only invest as much in it as you are willing to lose.

Q: What is the biggest business risk you have taken?

A: Becoming an oral radiologist back when it was considered a dead-end no-future specialty would be the biggest, at the time the decision was made (2006). Big risks are basically par for the course for me, because I am comfortable with the idea of “you win some, you lose some”. Most recently, I started a 3D printing-related offshoot in November 2016 that essentially promised to consume most of our future clinic revenue, and has also incurred a sizable debt for a business of our size, but the regret of not having tried when the opportunity arose would surely outweigh the potential loss of investment.

Q: What were the biggest challenges you had to overcome on your innovative journey?

A: Being able to ensure that my radiographic reporting duties are not neglected while trying to do programming. There is a shortage of Canadian oral radiologists, and the work is increasing in a linear fashion, so every month we have to come up with new innovations to save a few minutes here and there in order to keep up with the workload. I have really seen a huge nosedive in the amount of sleep I am getting lately, from reporting by day and programming at night, and it is unsustainable, but I can manage it in bursts for now.

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