Focus On: Open Formats

Dr. Martin Jablow


Martin Jablow, DMD, discusses the benefits of open architecture and integration in a dental practice. 

Dentists have been sharing data between practices for as long as we can remember. It started with chart notes and the duplication of radiographic film, which was labor intensive and expensive. The advent of digital technologies has improved the ability to share patient data; however, proprietary data formats continue to present obstacles to collaborating on cases. These “closed system” formats may have been an advantage early on in the dental computer age but should no longer exist in 2020. Closed systems only assist companies in trying to sell their products and do not foster interoperability between offices using the same software, let alone other digital products at other practices.

The Rationale for Open Architecture 

Dental office data and e-services should be based on open standards so that software solutions will reduce the reliance on individual platforms and solutions. As clinicians, we should have the flexibility to decide what software is best for our dental offices and be able to migrate to and integrate with any other system in the future. Open-architecture or open-integration software prohibits the “lock-in” effect and achieves interoperability, allowing system heterogeneity and the freedom to choose device solutions from various providers.

What does this mean to your dental office? I recently merged my dental office with another practice. Even though we were using the same practice management software, the ability to merge our imaging databases was far from an easy task! The process took substantial planning and, even then, not everything could be successfully merged. This inability caused frustration and countless man hours trying to run 2 systems, and time—not the software—eventually allowed us to merge the data. Had the practice we merged with utilized an open-architecture solution with a standard imaging format, the process would have been much simpler. 

Issues Concerning Radiography and Imaging

Trying to get radiographs from another practice is usually a challenge. Most dental offices are inept in trying to share this important data. At best, we can get a JPEG file containing the desired radiograph and, at worst, a very poor copy printed on a laser printer. For radiography, there is an open standard called Digital Imaging and Communications in Medicine (DICOM). DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. If all dental offices were using the DICOM format, then any radiograph file could be viewed or enhanced in any other dental office using whatever software they were using. There would be no need to convert the files to send them to another dental office—just securely send the files via HIPAA-compliant email. The file can be dropped into the patient’s digital imaging chart, and all the data can be read at full resolution. The ability to enhance the image is also retained. Some imaging software programs do include optional DICOM support. The problem is since so few dental offices are using software capable of supporting DICOM imaging, the benefits are not worth the associated cost. 

Closed systems also may involve hardware integration. We should be able to select any sensor and plug it into a USB port and have the imaging software be able to recognize it and subsequently capture the images. Many imaging software packages don’t allow this to happen. They prefer to close their systems to other products; thus, the workaround for other companies is the use of TWAIN drivers. These drivers allow for integration but there are usually additional steps needed to capture an image compared to just one click from the host software/hardware solution. 

Digital Impression and CAD/CAM Systems

Digital impression systems initially were all closed systems, and that may have been a necessity in the early stages of development of these CAD/CAM systems. The marketplace has forced companies to create a more open environment. We have seen an evolution as the use of digital impression systems has necessitated an open architecture shift. In order to use different dental labs, the different impression systems must be able to communicate with all of the milling systems on the market. We now have STL (Stereolithography) files. These STL files are the standard for CAD software. No matter what digital impression system you use, there is the ability to send the file to the dental laboratory team and have the restoration made. However, as can be seen with the current issues involving every system and Invisalign (except iTero [Align Technologies]), you can still be held hostage because of corporate decisions if a company refuses to accept your files. One example of the contrary is that Align will accept STL files to fabricate aligners from outside North America.  

In a shorter period of time, digital impression and CAD/CAM systems have made the leap to an open architecture, while digital radiography and practice management software still languishes in their proprietary file formats, locking dental practices to both hardware and software choices.

Closing Comments

It is time for all dental companies to start converting their proprietary software systems into open formats. It will benefit all dentists and force companies to compete on the value of their products and development, and not by locking people into proprietary imaging device and software systems. With the speed of technological advancement, utilizing open-architecture solutions helps maintain a practice’s flexibility for future imaging investments without being locked into a specific technology provider.

Dr. Jablow received his dental degree from New Jersey Dental School in 1986 and practices in Woodbridge, NJ. He has received Fellowships from the AGD and the International Association of Dental-Facial Esthetics and holds memberships in the ADA, AGD, and NJ Dental Association. He can be reached at

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