Annemarie Mannion

It’s an old joke that patients don’t like to visit the dentist. But new milling technologies mean both dentists and patients are saving time by not having to go for a second visit to place restorative elements.

Said to be the smallest 5-axis, smart milling machine, the PrograMill One combines high precision with industrial production quality. The self-contained system does not require any separate filtration or suction units. The PrograMill One can be operated via an app from a tablet or smartphone, while an LED light ring informs users about the current processing status. A camera within the unit captures all data on material and tool usage.

A second delivery visit is usually not required for dentists who use PrograMill® One® from Ivoclar Vivident®, a milling chamber that is billed as the smallest, five-axis, smart milling machine. With this chairside milling system, a restoration can usually be prescribed, designed, manufactured, and placed within a 2-hour window.

“Most patients are very excited because it saves them a second visit,” says David M. Juliani, DDS, owner of a family and cosmetic dentistry practice in Rochester Hills, Michigan. “The goal is to have your office as well-versed as possible in technology because your patients understand you’re doing the best for them.”

Dr Juliani was a beta user of the PrograMill One, which was introduced in 2017. Today, he uses it in his own practice and trains others in the technology. He says the mill has addressed many problems with milling systems he has used previously.

“My goal was to resolve some of the issues I’d had with other chairside milling systems, like marginal chipping and anatomical exactness,” he says. “I was looking to solve some problems that other systems didn’t.”

The PrograMill One is unique in that it is a self-contained milling system that does not require separate filtration or suction units. It features a wireless design enabling it to be placed anywhere within a practice, and it can be operated via an app on a tablet or smartphone. Additionally, an LED light ring visually informs the user about the current processing status.

“You can monitor it without having to physically be at the machine babysitting it,” he says.

One of the mill’s primary features is a block that moves around the tool, which improves fit and surface quality and shortens processing time.

“It protects the material and the structural integrity of the crown,” he says. “It’s going to be very good at ensuring that you have a great result.”

An innovative rotary grinding process and 5-axis turn-milling technology (5XT) offer minimal tool wear. A camera integrated within the mill automatically records all data on material and tool use, making material management convenient.

Dr Juliani estimates that about 20% to 25% of dental practices use on-site milling systems. But he believes the PrograMill One will benefit both large and small practices because it frees up dentists’ time and reduces other fixed costs, particularly for crown and bridgework.

If a practice does 40 crowns a month using an outside lab, Dr Juliani estimates that it will require 20 hours of delivery time (based on a 30-minute appointment). According to Clinical Research Associates, those 30 minutes generate no revenue and cost the practice laboratory fees for the crown, about $100 in staff costs, and the cost of disposables and room turn-over.

That adds up and could cost $8000 a month, not considering the lost productivity for a dentist and staff overseeing a patient’s second appointment—which could be an additional $7500 per month in lost revenue.

“Being able to finish a crown in one appointmentcan save 20 hours down the line where you can be more productive, not only from a dental standpoint but from an overhead perspective,” Dr Juliani says. “You’re saving on those overhead costs that go along with those 20 hours when you’re not generating any revenue.”

According to Dr Juliani, he still taps into the expertise of a laboratory for complex cases.

“In certain cases, I still send things to the lab, but I’m sending them digitally, not with analog impressions,” he says. “In certain cases, you’ll need a lab to finalize things, such as an occlusion or a bite problem.”

Dr Juliani says the on-site milling process has helped his interactions with labs. “I have probably a better relationship with the lab than ever because I have the ability to have immediate communication with them right away,” he adds, while the patient is still in-office.

Training a dentist and staff on the system takes about 2 days, Dr Juliani says. Usually, Ivoclar Vivadent would offer the training off-site, but due to SARS-CoV2 virus, other training methods are provided, such as video tutorials and Zoom meetings. Ivoclar Vivadent offers proactive post-sales support through a dedicated customer advocate, and the company also offers software updates as new features are needed.

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The PrograMill One from Ivoclar Vivadent is a milling machine that’s efficient for patients and clinicians.

Closer Look: Milling Made Simple

	Offering a more affordable clear aligner therapy for patients who want to straighten their teeth without breaking the bank has paid off for Dr. Gavin Miller, who operates La Jolla Dentistry in La Jolla, Calif. 

	Dr. Miller began working with OrthoFX in September to offer clear aligners at a set price of $3,950, which includes the aligners, one set of retainers, dental visits, replacement aligners if a patient loses or breaks one,  and a 3-year guarantee. 

	That price, compared to between $5,000 and $6,000 or more for other top name aligners, was appealing to this clinician, who believed it would also be attractive to his patients. He   has treated about 40 patients with OrthoFX aligners since September. 

	“I like being able to provide aligners at a more affordable price,” he says. “I also like that it’s a very innovative company.”

	OrthoFX was founded by two former Invisalign executives who saw problems in the tooth straightening world, including patients who were receiving poor results from mail order treatments. They started a company to emphasize clear, upfront pricing, face-to-face dentistry, and incorporate the latest in 3D printing and software technology. 

	OrthoFX uses 3D scanning technology to create a personalized aligner system that gently moves teeth into position. Made from a next generation polymer, they are designed to fit the teeth like a glove as they apply gentle pressure to each tooth and create movement over time. They are designed for comfort with three layers of material containing an elastomeric layer in the middle, and  also are stain resistant and nearly invisible. 

	“The aligners don’t look intrusive in the patient’s mouth. You wouldn’t even know they are there,” Dr. Miller  says. 

	OrthoFX’s partner dentists are carefully selected and must possess a current and valid state dental license. The company audits these records annually. 

	The process for a patient is very straightforward. A patient makes an appointment to meet with the doctor for an evaluation and a 3D scan is taken of their mouth and sent to OrthoFX. The first aligner is ready for the patient’s second visit. Once a treatment plan is finalized, the rest of the patient’s aligners are delivered chairside to the patient as treatment progresses. Treatments generally last between six and 18 months, during which the patient keeps regular appointments with their doctor. 

	Dr. Miller said he generally sees patients three to five times depending on the number of aligners. 

	Patients also have options to try out the aligners before committing to a plan. At no charge they can submit smiling selfies to the OrthoFX website and get a free 3D model of their finished smile. Then there’s a $95 “Try It Kit” option that includes a dental exam, an intraoral scan, and a custom set of passive aligners so patients can actually experience treatment.

	Patients who may not be good candidates for the treatment include those with periodontal disease, missing teeth or active dental decay. A doctor will evaluate their condition and make recommendations before they can begin treatment. 

	Dr. Miller has consulted on occasion with an OrthoFX orthodontist about the treatment plans and has been satisfied with the interactions. 

	He would advise any dentist considering working with clear aligners to do their homework. 

	“I wouldn’t just dip into it without having learned the therapies,” says Dr. Miller, who began to do CE with Invisalign in the early 2000s. 

	He classifies the types of cases he treats with OrthoFX and any other clear aligner treatment he uses as mild to moderate, but these aligners can be used for many complex case types as well.

	Dr. Miller has occasionally treated people who wanted to fix their smiles after treatment with mail order teeth straightening. “It worries me that they’re not getting the proper supervision and whether their teeth are safe to move,” he says. 

	OrthoFX also accepts insurance and payment plans and processes insurance claims. “It’s been beneficial to my practice as we have picked up restorative work to do as well for some of these patients,” Dr. Miller adds.


	A clear aligner service designed to make the process simple for both clinicians and patients, OrthoFX connects patients with its network of dentists in order to provide hands-on care at a single set price. In person, the single upfront price for the patient covers all office visits, the initial digital impression, customized treatment design, and the full series of aligners with free replacement aligners and follow-up retainers. 

OrthoFX is offering clear aligners at a set price, and helping this dentist grow his practice along the way. 

Clear aligner therapy at an attractive cost

	Not since the development of composites in the 1960s and the introduction of CAD/CAM in the 1980s has there been such an exciting time of innovation in dentistry. Researchers, manufacturers, scientists and practitioners are welcoming new and emerging technologies, from 3D printing and self-healing teeth to non-chemical disinfectants and digital scanning - all of which have the potential to transform in meaningful ways how dentistry is practiced.

	Call it the true science fiction of future dentistry. These new technologies are the wave of the future. They will not only change the way dentistry is performed and how dental practices are operated day to day but will dramatically improve outcomes for patients.

	“These new technologies are all about how to best interact with and treat the patient,” says 

, an incubator and accelerator for companies creating new dental technologies. “Instead of having to focus on all of the other aspects of running a practice, the dentist can automate certain tasks and concentrate on patient care. That’s what drives what we do at Cellerant; getting these companies and technologies out in the market in order to simplify the workflow and optimize the capabilities of the dental practice.”

 is the focus at Cellerant, many of their clients are leading the way in voice-activated technologies, automated practice management and marketing software, artificial intelligence and machine learning in caries detection, antibicrobial restoratives and chemical-free water disinfection, to name a few.

Read more: 6 emerging technologies that will change dentistry forever

	“Some of those new technologies utilize artificial intelligence and machine learning to make things easier for both dental professionals and patients alike,” Dr. Shuman says. “Others are focused on improving the materials used in the dental practice by either making them last longer or take on a more active role in the oral environment.”

 were developed by Dr. Ray Bowen nearly 60 years ago, they were a welcome alternative to the amalgam that had been used for more than 150 years to fill cavities. Amalgam leaves a lot to be desired. Made up a mixture of silver, mercury, tin and other metals, it has been found to contribute to higher mercury levels in patients’ blood, making finding alternatives to traditional amalgam fillings increasingly important. Esthetics are also a big concern for patients, especially since a study found that 90 percent of adults have at least one dental filling, and the average number of fillings per person is seven.

, is working with researchers to look for ways to improve composites and make them last longer. “Despite our numerous advances with composites, I think dentists are always looking for better dental materials,” Dr. Kim says.

	Researchers are also working on the development of composites with self-healing properties that would actually promote regeneration and healing in the affected tooth as well as increase restoration longevity. Dr. Kim is in year four of a five-year study funded by the National Institutes of Health that looks at how to improve treatment of Class V lesions to promote self-healing.

	“This is a really exciting time,” Dr. Kim says. “We’re changing the chemical properties of the traditional composite to a new composite that can better adapt to the Class V lesion. Since they’re right next to the gum and moisture control is a problem, they can be challenging. The new composite will address those issues. In addition, the composite will promote healing. If there are micro cracks, it can heal those tiny cracks, so the tooth doesn’t become a failure.”

 of the future will also mean being able to target a composite to a particular type of caries. Dr. Kim is currently submitting patents for his new composite technology and foresees companies picking up on his research and running with it to develop new products.

Trending article: The states with the best and worst oral health in 2018

 have been a big part of the conversation about the future of dentistry for a while. Researchers and dentists know that traditional hydrophobic materials will likely be phased out in the future and replaced with something that can actually interact with the living tissues around it.

	“Bioactive materials have the potential to solve the leading cause of failure in restorations and cementation: microleakage,” says Larry Clark, director of clinical affairs and marketing at 

. “Current resin technologies tend to be hydrophobic and passive in the moist oral environment. Hydrophobic materials do not allow for ion exchange with the tooth structure and can result in microleakage.”

	There’s now a focus on bioactive resin materials, which are hydrophilic and contain minerals that can interact with the tooth structure, helping to create a seal and prevent microleakage. While these materials are already available on the market, the future will offer more in terms of application and delivery.

	“You will begin to see bioactive products addressing white spot lesions in orthodontics, better coronal seals in endodontics and more,” Clark says. “Researchers will continue to find new applications for bioactive materials, from prevention and orthodontics to endodontics, restorative dentistry, bone cements, implants and materials that stimulate tissue regeneration. The ultimate goal of these advances will be to improve patient outcomes with less invasive procedures whenever possible.”

 is the primary cause of failures of composite restorations, researchers have also been looking into developing restoratives that are bacteria-resistant.

	One company on the forefront of this technology is Israel-based Nobio, which developed a line of dental restoratives that contain silica dioxide filler with quaternary ammonium (QA) residues that are covalently bonded to the surface. This is intended to reduce the number of bacteria that may remain in the cavity.

	“The idea was that none of the existing dental materials had any long-lasting anti-bacterial properties,” says Dr. Ervin Weiss, dean of the Goldschleger School of Dental Medicine at Tel Aviv University and chief technology officer at Nobio. Weiss and other scientists from the Hebrew University of Jerusalem and Hadassah Medical Center first came up with the idea to develop anti-bacterial restoratives 10 years ago.

Trending article: 5 things hygienists wish patients knew

	The idea was to create a composite with an antibacterial component that wouldn’t degrade or leak into the surrounding area, which is what they’ve created in the final product.

 has designed a line of light-cured restoratives, including a universal bonding agent, a flowable composite, a bulk fill flowable composite and a universal composite. All of these contain the QA filler intended to reduce the number of bacteria that may remain in the cavity and to maintain the functionality and integrity of the restoration.
	Weiss says the materials have been laboratory tested and shown to reduce bacteria dramatically. While the technology has applications outside of dentistry (such as for catheters or joint replacements), it has the potential to be a game changer for dentistry.

	“The potential is tremendous to be incorporated into nearly every single type of 

 on the market today,” Weiss says. “We have the beginning of a new class of materials. We’re on the verge of an era when we can go into the oral cavity with materials to address the major etiologies of diseases.”

	Dentists will not require additional training to use the company’s products, says Yoram Ashery, CEO of Nobio. He says the company has prioritized incorporating the disease-fighting agents at production. “Our whole approach is to keep every aspect of the procedure in the dentist’s office as is,” he says.

	While Nobio will soon seek clearance for its products from the FDA, researchers from the University of Toronto have also been exploring antibacterial filling materials.

 Utilizing mesoporous silica, a recent development in nanotechnology, the team was able to create a filling that self-assembled the antimicrobial drug octenidine dihydrochloride (OCT). The combination of silica glass and drugs maximized the drug’s density; it can pack over 50 times the amount into the material compared to others, allowing OCT to slowly diffuse over the course of years. It’s also important to note that OCT is an effective broad-spectrum antibiotic that has no known formation of resistance.

	The Toronto team’s next goal is to perform in vivo testing of its new material to observe how the harsh environment of saliva and bacteria will affect it.

	While composite advances target the restoration of existing problems, other companies are looking to prevent them altogether with sealants to strengthen enamel and add an extra line of defense against acid and bacteria.

Related reading: Using silver diamine fluoride as a new caries management solution

 is an example of such a product. “The technology is novel,” says Dr. Jason Goodchild, director of clinical affairs at 

. “It can help protect and repair. It’s the building block of other new products.”

	BioCoat, a sealant that features trademarked SmartCap Technology, was developed in partnership with Creighton University. The product utilizes patented semi-permeable resin microcapsules filled with fluoride, calcium and phosphate, which diffuse in and out of the sealant. Goodchild says studies have shown that even at six months, ion release continues at a significant rate. BioCoat also strengthens enamel and seals margins against microleakage to provide an extra line of defense during acid attacks.

	While still in its infancy, recent stem cell research recently posited that 

 Using embryonic tooth germ cells, researchers at Okayama University in Japan have reconstructed bioengineered tooth germ with a technique known as the organ germ method, a 3D cell manipulation technique.

	According to the study, micro-CT analysis showed that the developmental process of the bioengineered tooth’s formation was practically identical to that of a natural tooth.

Trending research: Are dentists getting greedy over X-rays?

	The researchers at Okayama University noted that immature wisdom tooth germ may be considered a potential candidate for reconstruction of bioengineered tooth germ.

	However, there are some limitations. For instance, elderly patients don’t have developing tooth germ that could be used for this process. Autologous transplantation of tooth germ is also limited by the number of available teeth and the size of a given tooth.

	In the end, the researchers concluded that additional evidence and testing will be required for the medical application of this process - but new developments could be coming down the road soon, which could have very interesting implications for the future roles and responsibilities of dentists.

	Another area in which breakthrough technology is poised to spark revolutionary change in dentistry is 

, particularly water disinfection. Dental unit waterlines provide the ideal environment for the growth of bacteria and biofilm, requiring dental practices to use a variety of chemicals, masks, cleaning procedures, distilled water and other practices to keep bacteria from harming both patients and staff.

 is one company taking the lead in dental unit waterline treatment. Toppen offers an inline water filter called

, which utilizes quantum disinfection technology to destroy bacteria and viruses in municipal tap water without adding chemicals.

	“It’s like a battery that puts out enough positive charge to destroy bacteria on contact,” says Owen Boyd, Toppen’s chief technical officer who has 25 years of water treatment experience.

Read more: OSHA violations that you're making - and don't even realize

	Unlike chemical approaches to water disinfection, such as silver, chlorine or iodine, which take from 30 to 90 minutes to kill bacteria, Toppen’s product kills bacteria on contact. Boyd explains that QDFx also is useful because it doesn’t promote the emergence of superbugs, as chemical applications can.

	“Bacteria are pretty smart,” he says. “They don’t like to be killed. They change their DNA to become resistant to the chemistries that are trying to kill them.”

	The company is also harnessing one of nature’s most potent natural disinfectants: ozone. Boyd notes that ozone is about 50 times more powerful than chlorine and kills bacteria and viruses three times as quickly, which results in superior disinfection response with very low concentrations.

	The company produces an ozone spray bottle for surface disinfection, as well as a range of other products that can help prevent ill health effects from using chemical cleaning products. Boyd says dentists need to become aware of the dangers of using harsh products multiple times a day.

	“If you’re using household cleaners every day, that’s the impact of smoking a pack of cigarettes a day,” he says. “This is a commonsense approach for the office environment. No more, ‘Let’s clean the office but leave behind the hazardous materials that could cause potential health problems.’”

	Al Dube, president and CEO of Toppen, says the company is committed to making dental practices safer by reducing the use of chemicals. “This is a mission to transform the thought process of dentistry,” he says.

	Technology is moving ahead for dental laboratories as well. 

 is working on the next generation of 3D printing for dental labs with r.Pod, a desktop 3D printer that’s versatile enough to digitize a lab.

	“Our approach is to take dental materials that have stood the test of time and to provide them in a format suitable for additive manufacturing,” says Justin Marks, president of Master-Touch Dental Lab and CEO of Arfona.

	Marks predicts dental labs will put their old injection systems aside as they make the switch to 

Related reading: Revolutionizing dentistry with 3D printing

	“You’ll be able to do more units and at less cost,” he says. “They’ll see faster turnaround, especially if they’re using intraoral scanners. It can be done in half the time than what’s done in traditional practice.”

	He adds that the potential benefits of 3D printing are enormous for patients.

	“When [3D printing] becomes widespread, it will have the potential to bring costs down and reach people who aren’t replacing teeth,” Marks says.

	Younger dentists have already been introduced to 3D printing during dental school or residency.

	“[During my residency], they brought in this 3D printer and showed us the software, the steps and the workflow to build a model from a scan,” says DPR Editorial Advisory Board member Tera Poole, who will graduate in June from a residency in orthodontics at the University of California, San Francisco.

	When she goes into private practice, Poole expects to eventually have a 3D printer in her office. She believes being able to create aligners, crowns and other prosthetic devices quickly and on demand will be an expectation of dentists and orthodontists of the future.

	“For my generation and the one after me, it’s how we’ve grown up,” Poole says. “We’ve grown up in a technological world. We definitely like convenience and the on-demand aspect.”

	Reaching existing and new patients remains a large concern for dentists - especially in the unknown landscape of an increasingly digital world. To stay on the forefront of the digital revolution, dentists need to be savvy about their web presence and online 

 or risk getting left behind. As marketing and practice management tools go online, automation will become the name of the game, streamlining processes and saving front office staff a lot of time and energy.

	What does this mean exactly? Think everything from voice-activated practice management systems to wearables to complete automation of patient reminders and marketing.

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	Several companies are already developing new technology and solutions to help dentists stay ahead of the curve. For example, 

 is focused on helping dentists grow their practices and their brand. Their system is an all-in-one practice marketing tool that manages a practice’s brand and optimizes visibility on various online platforms, including social media, local directories and search engines, and websites. It also addresses other critical aspects of practice management such as patient reminders, call conversion, online scheduling, marketing budgets and decisions.

	“This is the only system that has integrated all of those tasks into one product,” says Paul Intlekofer, CEO of 

. “More importantly, our new ChairFill product automatically optimizes your schedule to maximize growth.”

	ChairFill mines existing patient records and tracks the practice’s ROI for new patient acquisition, automatically monitoring how well the practice is increasing case acceptance and using that information to identify how much to spend on new patient acquisition. But even that step is automated. If the practice chooses, the MMG growth system can make those marketing decisions and take the appropriate marketing action on behalf of the practice, such as modifying your SEO spend when your internal ChairFill campaigns are filling your schedule.

 is also critical for practice success. Patients in a digital world will want to see new technology and gadgets - and the benefits gadgets have of getting patients out of the chair quicker. One simple way to streamline clinical workflows is through the use of smartphones and smartwatches.

 is taking advantage of this technology to make the dental practice workflow seamless. Founded by Ryan and Zach Hungate, HIPAA-compliant Simplifeye is a technology that allows dentists and dental team members to view patient information on an Apple Watch.

	The watch shows a quick overview of the current workflow, color-coding patient records on the watch face and detailing who the patient is, when their last appointment was, what services are needed, and - most importantly - what health conditions the dentist should know about. That allows dentists to utilize their time more effectively.  
	Simplifeye also allows the incorporation of voice technology, which Ryan Hungate, DDS, predicts will be a huge time saver for dentists. Instead of putting down a drill and removing gloves just to review an image, the dentist can complete the task with a simple voice command.

Read more: The future of artificial intelligence in dentistry

	“You don’t have to take your gloves off at all,” he says. “You can tilt your wrist toward you and say, ‘Show me the last panoramic X-ray.’ Because the technology is smart, we know which screen you are standing closest to and it will actually throw the image to that screen.”

	The Hungates think voice-command technology is the wave of the future in dental practices and elsewhere. “One of the things dentists do every single day is look at images. Going forward, it should always be hands-free,” Zach Hungate says.

	“The question isn’t where voice technology will be, but where it won’t be,” Ryan says. “Just imagine where this can go. Why should I ever have to touch another piece of technology again to move a chair up or down or to play music or a TV show for a patient?”

	The conversation about future tech in dentistry often ventures into the realm of 

 at some point. It’s already in medicine, so why not dentistry? IBM’s Watson is already using deep learning in cancer research, but Watson hasn’t donned a dental cap yet.

	However, there’s a deep-learning AI platform for detecting caries that’s in the late stages of clinical evaluation. 

 already demonstrates sensitivity and precision when analyzing bitewings and may be available in the next year or two. Where this could go in the future is limitless, from detecting periodontal disease and bone loss to predicting tooth movement and detecting oral cancer earlier than ever before.

	The experts agree that this era of new technology holds great promise for the dental industry. Whether the technology improves business efficiency or better protects patients’ teeth, practitioners are looking forward to incorporating these intriguing technologies into their practices.

	“There are many other areas where research is occurring that hold huge promise for transforming dentistry,” Dr. Kim says. For instance, researchers are developing a milling process that uses a powdered dental material with disease-fighting additives incorporated into it before it’s cured into a solid product. Other projects in the works include a technology that would allow practitioners to affix oral bio-sensors to a bridge or crown, allowing them to monitor the health within the oral cavity.

Trending article: How to achieve esthetic restorations with direct composites

	Since change is occurring at such a fast pace, Dr. Kim says dentists are well-advised to keep track of new developments by doing their homework and getting involved in local dental societies.

	“I think you can do it best by getting involved with your local dental society and by taking quality continuing education classes,” he says.

	Experts like Dr. Kim and the Hungates predict the technology of the future will improve patient outcomes, make practices more efficient, and save dentists time and money. It may also lead to dentists who feel more fulfilled in their work and are less stressed.

	“I think new technologies will help dentists make more money, so they can go home and hang out with their families,” Zach Hungate says. As workflows become automated and materials take on larger roles, the work-life balance of dental professionals should increase. And that would mean a better world for everyone involved.

Exploring the future of cutting-edge technology and what it will mean for the dental industry. 

The true science fiction of future dentistry

Picture this: A poster featuring a boy in old-fashioned short pants and with a bandaged face scrawling “Liar” in chalk on the wall of a 

 with a sign that reads “Painless Dentist.”

Scroll further through the vintage posters and artwork displayed at 

 and you’ll find other intriguing works such as an old-time ad that claims a dentist recommended smoking Viceroy cigarettes and another advertising “Mrs. Winslow’s Soothing Syrup” for children feeling the pain of teething. 

The website featuring prints of old-time dental artwork is run by Mike Danley, a retired registered 

 who got interested in collecting items related to his profession about a decade ago. He practiced for many years in Kansas and now lives in Fort Myers, Fl.

He put some of his collection of memorabilia to good use in 2003 when he started the business that provides prints for dental offices. The items he sells includes dental art, 

, and limited edition serigraphs that highlight dental history.

The sources of these works are paper ephemera that include postcards, Victorian trade cards (the first form of color advertising), dental journals, catalogs, comic books, games, old-time textbooks, paintings and cartoons.

“A lot of them are humorous,” said Danley of the artwork and other dental memorabilia that he started gathering when he first noticed that there was a wide range of items available for purchase via his computer. Dental history spans centuries so there was plenty to choose from.

“The idea came from the web,” he said. “I’d just go on eBay and look under dental collectibles and there was just a lot of stuff out there that hadn’t been exposed.”

In addition to the artwork he sells, Danley has amassed a collection that includes intriguing items such as a dental chair from the mid-1800s, dental games, dental trading cards and posters, and bone and ivory teeth.

Nearly anything from old dental textbooks to tins that were used for dental soap to vintage instruments and equipment have found their way into Danley’s collection.

“I like looking at the history of my profession and seeing how it has evolved,” he said. “Even some items that seem like they are relatively new ideas are actually ones that were tried before. Reach came out with the angled toothbrush, but that had been done a long time before that. It just didn’t take. Now people think it’s a brand new thing.”

Danley said it’s not as easy to find items on eBay as it used to be. 

“There didn’t use to be as much competition with people bidding against you,” he said. “Prices have gone up.”

With prices on the rise, he said he focuses more on sharing his collection with the dentists and others who purchase it. He also enjoys playing a role in the preservation of dental history.

Picture this: A poster featuring a boy in old-fashioned short pants and with a bandaged face scrawling “Liar” in chalk on the wall of a dental office with a sign that reads “Painless Dentist.”

Dental office advertising

Whether surgically placing or just restoring, many of you are getting more into implants. Here, we explain why and offer some tips to help ensure you’re successful.

More general dentists are integrating implants as a service they can offer patients, and it’s easy to see why they are capitalizing on this burgeoning market. Implants are on a steep upward trend, according to iData Research, an international marketing research and consulting firm that studies the dental industry.

It reports that, in 2011, the total U.S. dental implants market for dental fixtures and final abutments was valued at $754.6 million, while the dental prosthetics market hit $9.64 billion. Every segment of the dental implants market, as well as the final abutment and dental prosthetic market, experienced growth in that year except for inlays/onlays, as a result of the decline of the in-laboratory fabrication of inlay/onlays.

U.S. demographic trends are bolstering the increasing demand for implants. 

The American Association of Oral and Maxillofacial Surgeons

 has found that 69 percent of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Additionally, by the age of 74, it is estimated that 26 percent of all adults will have lost all of their permanent teeth.

Babyboomers, too, are accounting for the increased use of implants. They want to maintain attractive, youthful smiles and the dentures their parents took in and out of their mouths won’t cut it. At the same time, the attributes of cosmetic dentistry, commonly pictured on reality TV shows, have become a more accepted part of American culture, fueling patient interest.

For providers, improved technology makes implants easier to place. More dentists- with the appropriate education-are willing to delve into offering them.

The future for dental implants looks rosy, but the experts agree there are tips and strategies that general dentists should consider to successfully integrate the service into their practices.

We spoke with dentists who have practiced implant dentistry for decades to get their input and strategies on how to make implants a thriving part of a general dentistry practice. You’ll also find manufacturer-submitted tips and advice throughout the article, all designed to help you master implant care in your practice-whether you’re actually placing implants or offering treatment planning and implant restoration.

Education, of course, is key to achieving competence in placing implants and making it part of a general dentistry practice. Fortunately, much has changed, including the availability of continuing education, in the 62 years since implants were first introduced. In the early days, implants had a dubious reputation among dental professionals, and dental schools even refused to teach about them, according to the

, has been placing implants for 34 years.

“I was ahead of the curve,” said Dr. Orrico, a past president of AAID. “There wasn’t a whole lot mentioned about them in dental school, and they didn’t have the continuing education courses they have today.”

Because of this, Dr. Orrico said he learned by doing. “You watched a few, you assisted on a few and then you went out and did them,” he remembered.

Dr. John Minichetti, of Englewood Dental in Englewood, N.J., said he was lucky to receive good oral surgical and periodontal training in dental school and during his residency before he started placing implants 30 years ago. He also received on-the-job training while working under a prothodontist/implantologist.

While training is more prevalent, technology is always changing, and both recommend keeping up on advances through CE programs.

“Implant dentistry is consistently evolving. The key to staying ahead is continuing education,” Dr. Orrico said.

Any general dentist interested in placing implants will need to evaluate the depth of training they require. Dr. Minichetti recommends a comprehensive course such as the MaxiCourse, offered through the AAID.

It provides 300 or more hours of lecture, laboratory sessions, live surgical demonstrations and home/office assignments, and is presented in 10 parts, once a month, over a 10-month period.

Implant dentistry is not a recognized specialty, but dentists can receive certification from AAID. (Dentists who graduate from an approved MaxiCourse will meet the minimum educational requirements for an associate fellowship.)

AAID offers an Associate Fellow Membership that has educational and experiential requirements, as well as a two-part examination. Candidates interested in the more rigorous credential of Fellow Membership must have practiced implant dentistry for at least five years, provide both the surgical and restorative phases of treatment, and meet the educational and experiential requirements for the examination.

Another certification is the Diplomate in Implant Dentistry offered by the

 American Board of Oral Implantology/Implant Dentistry

Dr. Orrico said pursuing rigorous credentials establishes competence, as well as credibility, with your patients.

“It’s not a recognized specialty. Credentialing is all we have,” he said.

The potential patient base for implants is broad, especially given the statistic that 26 percent of adults will lose all their natural teeth by age 74.

Dr. Orrico said 80 percent of his patients receive implant surgery or prosthetics at his practice. He acknowledges the name of his practice-Illinois Implant Dentistry-draws patients to his door who already expect they will need to replace a tooth or teeth.

“It’s how you market your practice. People come here knowing what we do,” Dr. Orrico said.

Dr. Minichetti said he reaches out to potential patients through a variety of means including his website, e-blasts to patients and other external marketing.

“Start easy.” That’s how both Drs. Orrico and Minichetti advise general dentists who are new to implants. They suggest handling simple cases such as single teeth extractions and referring more complex cases such, as impactions, to specialists. Dr. Minichetti said he tries to have a rapport with other specialists to whom he may refer. On occasion- for patients who want it-he will tap the expertise of an anesthesiologist who visits his office to put patients under.

Dr. Orrico said he does all his own surgery, and he hasn’t experienced any negative feedback from specialists in regards to his work. The patient base is great enough that he believes there is plenty of work to go around.

“There are a lot of patients out there,” he said.

Both Drs. Orrico and Minchetti said their team members are eager to learn new procedures.

“They love it. They don’t want to be bored doing the same thing all the time,” Dr. Minichetti said.

However, dentists need to consider what training the team may need and how it will be done. Opportunities are available through professional associations, and dentists may even choose to take it on themselves. In addition to assisting the dentist, there are other areas staff may need to get more training on such as financing and scheduling.

The cost of purchasing basic equipment and systems to deliver implant care is estimated at $10,000 to $15,000, Drs. Orrico and Minichetti said. Additional expenses can be significantly greater when 

adding technology like 2D and 3D imaging, but the diagnostics delivered by 3D imaging can be invaluable

 when treatment planning and surgically guiding implants.

“That’s for a basic set-up,” said Dr. Minichetti, who also advised choosing an implant company that provides ample knowledge and support.

“A Panorex is still considered the gold standard, and it’s been that way for years,” Dr. Orrico added.

Both suggested GPs take advantage of this technology to improve their implants care, but added that some practices may want to consider outsourcing these 3D scans if purchasing a unit isn’t in their budget. Mobile imaging centers have evolved and are a nice option for those not yet ready to invest in 

The good news is that technologies and materials have advanced significantly, and placement has become easier.

“There are a lot of advances in bone grafting materials,” Dr. Orrico said. “It’s always evolving.”