The impact AI is having on dentistry and especially in DSOs where it is being rapidly implemented is significant.
For Amol Nirgudkar, interviewing his friend, Ophir Tanz, at Dykema’s Definitive DSO Conference 2022, was exciting. Both are CEOs in AI technology companies they founded to meet the challenges of providing the highest level of service to dental patients and unburdening dental teams as they work towards achieving more comprehensive care. In the case of Pearl, the promise of AI is diagnostic support in a comprehensive manner for all patients.
To start the interview, Amol Nirgudkar (co-founder and CEO of Patient Prism) asks Ophir Tanz (founder and CEO of Pearl) about his career.
“My interest in AI goes all the way back to my days at college when I was at Carnegie Mellon,” says Tanz. “Prior to Pearl, I ran a computer-vision-oriented AI company called GumGum.”
Here's an abridged history of his role in AI computer vision applications:
- Tanz was the founder and CEO of GumGum from 2008 until 2019. Starting in 2008, GumGum was on the leading edge of using AI computer vision to unlock the value of images and videos produced every day across the internet.
- Since 2008, the company has applied its patented capabilities to serve a variety of industries from advertising to professional sports.
- Starting in 2015, Tanz began the process of collecting what is to his knowledge the largest collection of labeled dental radiography in the world.
- GumGum started to take this seriously and spin off a separate company in 2019, which became Pearl.
“I stepped down as CEO of GumGum to become CEO of Pearl because I was so excited about it. AI is a very powerful technology that I believe has the ability to dramatically improve lives, and in this case, patient lives. Our goal, as an organization, is to improve the lives of billions of patients worldwide.” – Ophir Tanz, Founder & CEO of Pearl
9 FDA clearances in 3 years
Pearl has obtained nine FDA clearances within three years. That’s more than any other AI computer vision company providing AI dental radiologic interpretation for supporting diagnosis and treatment planning.
Currently, Pearl has been regulatorily approved in 90 countries and has the most FDA approvals in the United States.
Nirgudkar asks, “What made Pearl so far ahead of everyone else?”
Tanz reports they believed that to fulfill the promise of AI they needed to invest early in FDA clearances and do it as comprehensively as they could from the start.
"The promise of AI is diagnostic support in a comprehensive manner for all patients. To fulfill that promise the AI needs to be able to identify all diseases from small interproximal caries to early bone loss to periapical lesions that should be discovered early, even calculus." – Ophir Tanz, Founder & CEO of Pearl
“If you look at the market today, there are three companies with FDA clearances of any sort. From a disease detection perspective, which is really the most consequential kind of detection that exists, the only clearances that exist for two of these other companies are for caries for patients between the ages of 18 and 22 and for bitewing radiography'" says Tanz.
"Our FDA clearances are for nine separate conditions--comprehensive pathology detection, like periapical radiolucency and calculus and caries, and a whole list of other detections. We also sought approval for patients aged 12 and above for periapical and bitewing radiography.”
This was a major undertaking, requiring multiple statistical models, three years, and millions of dollars.
“Instead of applying for FDA clearance in a stepwise manner over years, we wanted to be able to deliver on that vision right out of the gates,” says Tanz.
Why does FDA clearance matter?
“The FDA exists to effectively protect patients and also practitioners,” says Tanz. “If you are using a medical device that has not been FDA cleared to identify disease, then you are doing something that's highly illegal. If a detection device has not passed clinical trials and therefore is not vetted, there is a possibility that your diagnosis could be detrimental to the patient…I want to enable people to make the most functional use of our AI as possible—to realize the promise of AI. FDA clearance clears the way.”
Pearl products were designed for ease of use
Nirgudkar remarks, “You’ve done a great job at Sage and many other DSOs in enabling their people to fully use your AI platform. The platform itself facilitates usage, and you have operationalized it so people are able to find and help patients accept the treatments they need that might have been missed. Your customers are generating more revenue and profits.”
Tanz credits Pearl’s product development team for making it highly functional and easy to use. “You have this powerful, exciting core technology, but if you're not wrapping it appropriately and presenting it appropriately to practitioners and patients, then you have an issue because people aren't going to use it. It needs to be low touch. It needs to be high yield. And I think what we've learned over time is how to maneuver the product in a way such that it is low-touch and high-yield. We're able to really take control on our end of the change of management process and not burden our DSO partners with this, because we know the best practices.”
As software developers, "we have to take the burden on,” says Nirgudkar. “And we have done that at Patient Prism. We have taken on the burden because change is hard. A lot of technology has been added to DSOs and they have the challenge of implementing it fully. But it’s essential for us to make it easy for customers to learn and fully utilize the technology.”
AI surfaces undiagnosed opportunities for treatment
Tanz reports that when a DSO onboards with Pearl and the AI reviews patient x-rays of the last 18 months, the AI typically surfaces up undiagnosed opportunities for treatment on a scale of at least one million dollars, often much more.
“The AI is a probabilistic engine,” says Tanz. “It's highly consistent and measurable. [Upon recalling patients,] you might find some false positives and vice versa. This is also why the clinical trials exist with the FDA, to show that you're able to provide results that are commensurate to or much better than a human level of performance.”
On Instagram, dentists daily tell Pearl about their diagnosis and case acceptance success with the AI. Not only can dentists find and treat more diseases but “we are unburdening them,” says Tanz, “by offering them a second set of eyes when they already have so much on their plate.”
Pearl (www.hellopearl.com) has two products, which were recently reviewed on Patient Prism’s blog:
- Practice Intelligence -- Practice Intelligence is a clinical management platform, which merges AI x-ray analysis and patient treatment data. When the AI assesses the radiologic data of a patient and detects a potential condition or combination of conditions that may require treatment, it flags the patient and condition(s) as a potential treatment opportunity. Practice Intelligence also checks the PMS to see if the patient has treatment planned, scheduled, or completed for the flagged condition(s).
- Second Opinion -- a computer vision aid for real-time x-ray evaluation that is currently available to dentists across the United States, Canada, Europe, Australia, and several other territories. In March of 2022, the United States Food and Drug Administration (FDA) cleared this pathology detection solution to help dentists accurately identify a broad range of common dental conditions in patient x-rays.
Pearl’s Practice Intelligence predicts the following treatment opportunity types:
- Restoration Replacement
Pearl's Second Opinion AI radiologic detection system is trained to detect the following conditions:
- Bone Loss
- Notable Margins
- Root Canals
- Edentulous Regions
- Periapical Radiolucency
- Widened Periodontal Ligament
What kind of ROI can be expected in implementing Pearl?
Pearl enables doctors to provide more comprehensive care, and two principal types of ROI occur. One is the elevated standard of care associated with using Pearl. The other is the superior financial outcome. Because of its efficiency and how it facilitates case presentation, it is also reducing stress for not just doctors but also hygienists, treatment coordinators, and team members who explain the financial aspects of care.
“We ran a case study across ten practices in one of our DSO partners. We were able to show upwards of $11,000 incremental revenue generation per week. It was wild,” says Tanz.
The $11,000 include $3,000 from restorative, $6,000 from specialty, and another $2,000 from recalling unscheduled patients and scheduling them to review their needs. Due to its retail pricing, the Pearl platform is an immensely powerful ROI-oriented tool.
The gift of health
Nirgudkar is so excited about Pearl’s technology that he confesses, “I am fascinated by this amazing technology. It makes me want to buy dental offices and implement Pearl to help patients get the care they need. From an investment cost-benefit analysis perspective, the cost is meaningless, and it's not just the quantitative benefit; it's the qualitative benefit of elevating the standard of care."
Thanking Tanz, Nirgudkar adds, “There is no other company today besides Pearl that can deliver the entire promise to you. As of now, you're the best choice. And I'm delighted to know you as a friend and as somebody who has paved the way for all of us to follow in the dental AI business.”
Tanz also appreciates the advances Patient Prism has made in AI natural language processing to record dental calls and track call intelligence.
“I'm a big fan of Patient Prism, and we're really looking forward to what the future holds. I think AI in dentistry has really taken hold. It's become a hot topic because it represents a paradigm-shifting moment where we are going to see an elevation of the standard of care. Every few decades we have seen a new technology that is able to do that in a field of medicine, and I think this is the one now.”
– Ophir Tanz, Founder & CEO of Pearl