Technology and the cosmetic dental practice

Aug. 1, 2009
Your car senses an impending crash and automatically applies the brakes, thereby avoiding an accident.

By Jack Ringer, DDS Accredited member, AACD

For more on this topic, go to www.dentaleconomics.com and search using the following key words: American Academy of Cosmetic Dentistry, technology, communication, Dr. Jack Ringer.

Your car senses an impending crash and automatically applies the brakes, thereby avoiding an accident. Your phone instantly recognizes that you have entered a different time zone and resets. Your computer turns on your oven while you are still at work, thus ensuring a perfectly roasted chicken for dinner. Technology is changing our lives. Likewise, dentistry is a beneficiary of technological innovations. Here are just a few examples:

Communication

Success in correcting an esthetic disability requires complete and accurate communication between parties (patients, dentists, specialists, and lab technicians). The diagnostic process has been forever changed with the development of more sophisticated digital X-rays, digital photography, and computer simulations. Digital X-rays give the dentist many advantages compared to conventional radiographs by eliminating chemicals. This allows for a greener office, provides cost and time savings, and makes the process instantaneous and accurate.

Since the advent of digital cameras (e.g., Nikon D300), an accurate and inexpensive communication tool is now available to allow the dentist and patient to instantly view any smile aspect. These images can be digitally manipulated to change the color, contrast, and brightness, along with a realistic simulation of a desired smile. There are two options. Dentists create a simulation with image simulation software (e.g., Photoshop by Adobe or AlterImage by Seattle Software Design), or they send images to an outside computer simulation service such as Virtual-Smiles.com.

Equipment

Modern technology helps reduce human error, inefficiency, and productivity drain in many areas of the dental practice. Conventional impressions require several steps, each of which introduces the possibility of human error. But new digital technology, such as Digital 3-D video impressions (Lava Chairside Oral Scanner by 3M ESPE), has produced results that are as good or better than conventional impressions.

In doing so, digital impressions make the procedure more efficient, more comfortable, and less costly. A computer-generated resin model, from which restorations are built, is then manufactured based on the digital impression, and the digital impression and resin model demonstrate accuracy that equals or surpasses conventional methods.

CAD/CAM (computer assisted design/computer assisted manufacture) is the process in which an item is digitally designed and manufactured by integrating a computer to machinery. While this technology has been available in dentistry for several years (CEREC by Sirona), recent advances in computer software and industry demand have seen more companies enter the field. This is good since the competition will bring technological and financial advantages. CAD/CAM devices can be situated either solely in a dental practice or in the laboratory (Lava Milling Centers by 3M ESPE).

In the dental practice, the dentist digitally scans the tooth preparation, designs the final restoration, and imports this data into the manufacturing element of the device where the final restoration is milled to exacting specifications (CEREC or E4D by D4D Technologies, LLC).

The milling device uses various types of ceramic blocks (pressed ceramics), which typically are monochromatic or possibly polychromatic. As long as the operator creates an accurate scan and design, the restoration's marginal fit is fine. Esthetically, these restorations are acceptable for inlays and onlays and full coverage crowns that are not in a primary esthetic zone.

Lasers are another area of technology that has become popular. Lasers can assist dentists in many areas, and have shown promise in soft-tissue therapy. They can be used to incise tissue accurately with little or no bleeding. Though lasers, to date, have been developed to remove hard tissue (enamel and dentin), they still cannot compete with the air turbine or electric drills in terms of time and cost.

Light wavelengths and the energy produced by lasers also have been used to assist in dental office bleaching techniques, to accelerate the process in caries detection devices (DIAGNOdent by KaVo), and in soft-tissue cancer detection devices (VELscope by LED Dental, Inc.). Unfortunately, no single laser is currently available to accommodate all these treatments.

Another device is electronic anesthesia (Compudent STA by Milestone). This device is computer-controlled for administering local anesthetic. There are many advantages with this device. In many cases, it helps to reduce patient anxiety simply due to its high-tech appearance. There is less discomfort because the device administers virtually one drop of anesthetic at a time. This eliminates the pain caused by the pressure of manually injecting the anesthetic. Palatal injections also can be given almost painlessly. This lower dose is beneficial to the dentist when evaluating esthetics immediately after a cosmetic procedure, and beneficial to the patient who experiences less of a numbing sensation.

Materials

Technological advances in materials have added dramatically to today's practice. The demand for metal-free restorations has fueled advances in composite resins and ceramic restorations. Newer composite resins have little shrinkage upon curing because they are comprised of nanometer-sized particles. The optical properties that closely mimic those of a natural tooth have made them the restoration of choice for conventional fillings. When placed correctly following the principles of adhesion, these restorations have become predictable, long-lasting, and have little or no postoperative sensitivity.

Many ceramic developments have become available, particularly core-strengthened ceramics such as the zirconia products (Lava by 3M ESPE). The zirconias continually prove to be comparable or superior to metal as the coping material for full-coverage restorations and abutments for implants. Since they are machine-made, their accuracy, esthetics, and physical properties generally either meet or surpass those that are necessary when constructing crown and bridge restorations.

Finally, with the advent of self-etching adhesives (Solo by Kerr) and cements (Unicem by 3M ESPE), dentists can bond restorations with little or no postoperative sensitivity and in less chairtime. This benefits the patient and dentist.

Communication within the Academy — a benefit of membership

For a dentist to remain competitive and on the cutting edge, continual learning and implementing new technology is imperative. The American Academy of Cosmetic Dentistry is committed to incorporating new technology. Therefore, it is only logical that dentists who seek to elevate their cosmetic proficiency should consider alignment with this organization.

As a result of new technology, dramatic improvements in the quality of restorations and services dentists provide for patients have been commonplace, and provide the dentist with an improved quality of life professionally. I urge you to jump on the technology bandwagon. I think it is here to stay, and will continue to advance in our profession!

Jack Ringer, DDS, an accredited member of the American Academy of Cosmetic Dentistry, has been in private practice for more than 25 years in Anaheim Hills, Calif. He has taught contemporary esthetic dentistry at various institutions the last 14 years. Reach him at [email protected].

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