Scott T. Keys, DDS
Thinking back over 23-plus years of practice, there have been many instances in dentistry that could be described as game changers. If we asked 10 different dentists for their top five game changers, we would likely get 10 different answers.
The purpose of this article is not to define all of the different techniques that have made a difference, but to review some of the top game changers in recent years, as well as highlight up-and-coming products and procedures that may prove to have major impacts in our practices.
Recent game changers
Rotary endodontic files
How many dentists’ hands have been saved by the efficiency and predictability of nickel titanium rotary files? Many young practitioners don’t know or cannot appreciate the effort it takes to complete molar endodontic therapy from start to finish with hand files.
Clear aligner therapy
While not a replacement for conventional orthodontics that use bands, brackets, and wires to realign teeth, clear aligner therapy has made a huge improvement in case acceptance and compliance with many adult patients. It leads to better occlusion, improved esthetics, and healthier periodontium.
Guided implant surgery and cone-beam technology
The surgical placement of implants using guides and cone-beam computed tomography (CBCT) has greatly decreased the time and effort it takes to predictably place dental implants. This results in better treatment options, less pain, and more predictable treatment outcomes for our patients.
There has been incredible progress during the last 20 years to improve the delivery of crown and bridge restorations to patients in a manner that is both efficient and predictable. The results are comparable if not superior to most lab-fabricated full-coverage restorations, they can be done in a fraction of the time, and in some instances done at a considerable reduction in the cost of fabrication.
Lithium disilicate and full-contour zirconia restorations
In most instances, lithium disilicate and zirconia materials have eliminated full-coverage metal restorations and porcelain-fused-to-metal restorations from general dental practices. They’ve also greatly improved the esthetics and strength of natural-looking, full-coverage restorations.
Up-and-coming game changers
Versah Densah implant burs and osseodensification
This is a product and procedure that could very well change the way dental implant surgeries are performed, regardless of the brand of implant used in the replacement of the missing tooth or teeth.
Densah implant burs were created by Salah Huwais, DDS, in an effort to optimize osteotomy form and maximize initial implant stability. Dr. Huwais developed the drill system based on the concept of using osteotomes during the preparation of the osteotomy site. Unlike traditional dental implant drilling techniques, Densah burs do not remove bone from the osteotomy. Instead, the bone from the osteotomy site is simultaneously compressed and grafted outwardly into the walls of the osteotomy.1 This action creates dense compacted bone in the osteotomy walls. This results in a stronger, more stable purchase for any dental implant system and may actually facilitate faster healing and maintain higher initial torque values.2
In many instances, this can lead to earlier restoration of the implant, which benefits patients as well as the growth of the practice. Ridge expansion techniques, vertical sinus lifts, as well as conventional implant placement can all be accomplished with one osteotomy drill system. These innovations in drill design and sequence could truly revolutionize implant dentistry.
Exparel (bupivacaine liposome injectable suspension)
We can all agree that our society is experiencing an opioid epidemic. Our profession can help address this growing problem. Most dentists have encountered patients who either exhibited drug-seeking behavior or showed signs of a potential dependency on pain medications.
This product has the potential to not only change the way post-operative pain is managed in major dental surgeries, but also effectively decrease patients’ dependence on post-operative opioid analgesics. Exparel (Pacira Pharmaceuticals Inc.) is a lipid-encased (depafoam) bupivacaine delivery system that is designed to block pain receptors for up to 96 hours. As the lipid capsule is dissolved naturally by the body, the bupivacaine molecule is released at the surgical site for continued analgesic affects.
First developed for orthopedic surgery cases to control postoperative pain, it has recently shown great benefits for dental surgery. In cases of third-molar extractions, full-mouth extraction, periodontal surgery, and implants, the use of Exparel has decreased, if not eliminated, the amount of opioid prescriptions that are being written postoperatively.
Studies show that 99% of surgical patients receive opioids to manage postsurgical pain.3 Ninety-two percent of surgical patients who receive opioids have side effects consisting of nausea, vomiting, and constipation.3 Other side effects can include drowsiness or confusion. The more alarming consequence of postoperative opioid use is that 1 in 15 people become long-term users.3 Some even develop tolerance to the opioids and need higher doses over time.
Unlike opioids, which affect the whole body, Exparel works directly at the surgical site. In clinical trials, patients who received Exparel had less need for opioids or did not take opioids at all. The use of Exparel post-operatively could make an extraordinary difference in the way dentists manage postoperative discomfort for all of their patients in the future. It could also greatly decrease the number of opioid prescriptions that are written and the potential for patients to inadvertently develop dependency on the medication.
The list of game-changing tools and procedures in dentistry is endless. It is an exciting time to be in dentistry, but a concept/creed created by my friend and colleague could be the biggest game changer of all for many young dentists just starting practice: “Grit trumps talent, structure trumps strategy, and luck trumps them all, but don’t count on it.”
Slow and steady wins the race. There is almost never one big game changer that makes a successful dentist. Dentistry is filled with small, smart decisions that are repeated over and over again and mixed with hard work, and this leads to successful and financially independent dentists.
1. An Interview with Versah. Inside Dentistry. 2015;11(2).
2. Trisi P, et al. New Osseodensification Implant Site Preparation Method to Increase Bone Density in Low-Density Bone: In Vivo Evaluation in Sheep. Implant Dent. 2016;25(1):24–31.
3. Carroll I, et al. A pilot cohort study of the determinants of longitudinal opioid use after surgery. Anesth Analg. 2012;115(3):694-702.
Scott T. Keys, DDS, is a graduate of Louisiana State University School of Dentistry and an owner-dentist supported by Pacific Dental Services in New Braunfels, Texas. He currently serves as a faculty member of the PDS University—Institute of Dentistry.