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Conversation with Dr. Michael Miller

July 1, 2007
I recently had the chance to talk with Dr. Michael Miller who runs REALITY Publishing.

by Dr. Michael DiTolla

I recently had the chance to talk with Dr. Michael Miller who runs REALITY Publishing. Michael has long been one of my mentors because of his unique combination of knowledge pertaining to research and clinical techniques. To me, REALITY has led the dental field in educating dentists about esthetic dental products and techniques. This month I will share some excerpts from our conversation.

Dr. DiTolla: Michael, you see a lot of new products. I am sure some live up to their promises while some probably do not. If you had to name a few of the most exciting products you have seen in recent years, what would they be?

Dr. Miller: One certainly is the advent of electronic caries detectors, starting with DIAGNOdent. About 20 years ago, there was an electrical conductance device manufactured by a small company out of the Northeast that had a little smile and frown on its LCD screen. Although this happened 20 years ago, the product was way ahead of its time. It was one of the first of these types of instruments that we evaluated when we started REALITY in the mid-1980s.

Then, for another 15 years, it seemed nothing significant came on the scene until the arrival of DIAGNOdent. Today there is another instrument, the D-Carie Mini, which is manufactured by Neks Technology in Canada. In a way, this product takes electronic caries diagnosis to another level since it also diagnoses interproximal caries. I think this is one area in which patients always have been suspicious, particularly when they see a dentist who says, “85 cavities.”

While these electronic caries detectors are not 100 percent accurate, they add to our ability to assist, not only from a diagnosis standpoint, but to help patients understand the “numbers game.” A physician can give you a cholesterol score or your (level of) triglycerides. Everyone wants a score, and electronic caries detectors definitely can give you one.

Laboratories have looked into CAD/CAM. This is an exciting area. We did a full evaluation of the CEREC 3D last year. We concluded that, for computer-proficient dentists who have a large practice, the CEREC 3D is definitely a good addition. Now the CEREC 3D has been superceded by another generation. I think this part of dentistry has seen tremendous advances. Even some lab systems, such as Lava by 3M ESPE, have made a major impact on dental restorations in terms of metal-free dentistry.

I think the third most exciting area in recent years is ergonomics. Traditionally, dentists work in a bent-over posture. Thus they tend to have musculoskeletal problems and repetitive-use injuries. But the advent of better loupes, operating microscopes, and headlights has definitely made practicing dentistry much easier and more ergonomic for many practitioners.

Dr. DiTolla: Michael, I am surprised that ergonomics was one of your answers. I can’t believe I asked you about the most exciting areas in dentistry and composites and you did not mention bonding agents. This shows me that you keep an open mind and are not completely focused on just esthetic dentistry. I think when REALITY started, the perception was that it was all about esthetic dentistry - how to do it, and what products to use.

Dr. Miller: Recently, I wrote an article about the “nano trend.” Today there are “nano trends” in society. Everything is smaller. We see it in dentistry with nanohybrids and nanoadhesives, etc. The reason I did not mention composites is because I don’t think there have been any revolutionary advances in composites in the last 20 years. There have been small, incremental advances but certainly nothing - in my estimation - that just grabs us. The same is true with adhesives.

I have a favorite slide in my lecture programs about self-etching adhesives. The slide says: “Just because it doesn’t hurt doesn’t mean that it is a better adhesive.” This is what clinicians need to know. Self-etching adhesives have their place in modern practice, but they are not the “be-all, end- all” that many people think they are.

Dr. Michael DiTolla is the Director of Clinical Research and Education at Glidewell Laboratories in Newport Beach, Calif. He lectures nationwide on both restorative and cosmetic dentistry. Dr. DiTolla has several free clinical programs available online or on DVD at www.glidewell-lab.com. For more information on this article or his seminars, please contact him at www.drditolla.com.

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