Dr. John Flucke is in private practice in Lee’s Summit, Mo. He also serves as technology editor for Dental Products Report magazine and keeps an active blog filled with thoughts and tidbits on the world of technology at blog.denticle.com.

Dr. John Flucke

I have seen many changes in periodontics. Younger doctors may find this hard to believe, but when I graduated a piece of advice instructors gave us was this: If you are considering buying an existing practice, be sure it has perio probes in the examination kits.

In the late 1980s and early 1990s, it was not uncommon to find offices that either did not perio probe or only did so occasionally. I suspect that because the focus was on restorative treatment (many patients had grown up without fluoride) and there was a lack of understanding of perio disease, treatment of the problem had been pushed to the back of the proverbial shelf.

Perio is not a thrilling topic, even to other practitioners. When we discuss dentistry among ourselves, it is rare for the conversation to turn to periodontal issues. It is much more exciting to talk about bonding science and emerging technology than it is to discuss scraping hard deposits from the teeth.

And there, I think, is where some of those earlier problems originated. Doctors in the generation before mine regarded perio treatment as only removing calculus from subgingival areas. There were even the Stockholm studies that showed once pocket depths exceeded 6 mm, it was practically impossible to thoroughly clean the root surfaces without laying a flap. Of course, flap surgery is painful and perio treatment began to get a bad reputation among the public.

In the 1980s, periodontal disease became a hot topic for research. One of the great things about research is that it is frequently like a snowball rolling downhill. Once a subject becomes popular, more researchers explore it, and the knowledge base expands almost exponentially.

One of the best things to come out of this research is that periodontal pathogens were frequently found in, or contributed to, other disease processes. Suddenly, mainstream media outlets figured out that the oral cavity was connected to the rest of the body and began to report on how perio problems were contributing to heart disease and diabetes, for instance.

This shift of focus brought more interest in the subject. Patients, for perhaps the first time, began to understand the importance of periodontal health in overall health and quality of life.

As with any disease process, this one is multifactorial and requires more attention to detail than some other health problems. The most important component of treatment is patient motivation. Some individuals have genetics that let their bodies create more calculus and immune systems that do not fight the problem effectively. However, those patients are less common. Perio, unfortunately, is frequently a disease of neglect; a shift in personal habits is needed to effectively fight it.

The second big factor is the hard tissue side of the problem. Calculus must be located and effectively removed to prevent the foreign body reaction that causes the disease process. Not only is this removal intrinsic to success, but patient motivation again comes into play. The patient must be committed to a frequent recall schedule that allows the professional to maintain the calculus removal in the pockets.

The third big factor is one professionals had a harder time treating in the beginning, which is the soft tissue side of the equation. Bacteria from the subgingival deposits easily migrated to the soft tissues, and even when the hard deposits were removed the pathogens remained in the soft tissue side of the pockets, where they continued to trigger the inflammatory process.

If we can remove the hard tissue buildup that helps promote healing, what can be done about the soft tissue aspect? This speaks to why we are seeing more of an emphasis on light-activated types of treatment rather than chemical ones.

One of the original ideas for soft tissue treatment was chemical curettage. Some type of mild caustic chemical, usually citric acid, was placed into the pocket and used to remove the pocket lining. However, the clinical success was less effective than anticipated.

Enter the soft tissue laser. The soft tissue lasers in use in dentistry produce wavelengths attracted to dark colors. Some perio pathogens are dark-colored, and inflamed tissues turn darker because of increased blood flow in the area to activate the body’s infection-fighting processes.

These darker colorations create an incredible absorption of laser energy. Laser fiber optic tips are normally between 200 and 400 µm and can be easily placed into the pocket. Low energy pulses are then delivered into the area, vaporizing the inflamed tissues and bacteria. The concept is that when irritants and pathogens are removed from the root surface and the soft tissue surface, healing can take place in an environment devoid of potentially noxious materials.

To envision another step forward in this treatment, consider antimicrobial photodynamic therapy (aDPT) as a discussion point. It uses a combination of light-sensitive material (a gel) placed into perio pockets. A light source is introduced into the pocket. The gel absorbs energy from the light source and then the gel goes through a chain of photodynamic actions that release oxygen-free radicals. These free radicals quickly destroy the surrounding pathogens. The gel is a photosensitizer based on vitamin B2, curcumin, and hydrogen peroxide. It is a powder that is mixed with water to form the gel.

The gel is not an antibiotic, so no resistance can develop. That means the treatment can be performed when necessary. Studies have shown that this therapy combined with scaling and root planning (SRP) can eliminate more than 85% of pathogens.

This treatment concept comes from a company called CMS Dental based in Denmark. The light source used is the company’s FlashMax P7 light. This device is multifaceted. It can be used as a curing light that has an intensity of 5500 mW/cm2 (a phenomenally strong curing output). For the perio treatment, the device has different settings.

Used in the Biofilm Control mode, the light has an output of 7500 mW/cm2. However, this is not simply a case of increasing light intensity. To treat the pocket, the device also requires a special disposable tip. This thin, flexible, and clear plastic tip is designed to easily be placed into the pocket and allows the user to deliver the light to the critical areas it needs to reach.

The treatment can also be used with adjunctive probiotic therapy. The probiotic changes the makeup of the biofilm, making it less pathogenic and helping to reduce pocket depths.

Both laser disinfection and aDPT are effective soft tissue side treatments, but they require clean root surfaces and patient dedication on the maintenance level. Both treatments need effective scaling and root planing prior to using the light source, and vigilant home care to ensure a positive long-term prognosis.

As more research is done, we are seeing more connections between periodontal disease and breakdowns in other parts of the body. This is no longer speculation. It seems that practically every day there is a story in the media linking periodontal disease to things such as diabetes, heart disease, and Alzheimer’s disease. This information is driving greater patient interest and adherence to bettering periodontal health.

It behooves us as professionals to explore and implement treatment that helps us provide the better health we owe our patients.

Articles

Soft and hard tissue and patient habits make periodontal disease a multifaceted challenge.


The Changing Facets of Periodontal Treatment

I live and breathe tech. In the early days, when technology was just beginning to seep into our society, I built and configured my own computer network. I actually crawled above the ceiling tiles of my small office with an ethernet cable in my teeth, dragging it to the operatories and my personal office.

When it became fashionable to have a web page, I really wanted 1 (back then they were for personal stuff; there weren’t any business websites yet). However, even though I was willing to pay someone, I couldn’t find anyone who knew how to do it. So I went to my local Barnes & Noble (remember book stores?) and bought a book on how to program in Hypertext Markup Language (HTML). Over time, I actually wrote the code for my very first website…in a text editor.

 that I’m super smart, just dedicated. Back in the early days, if you wanted to put in the time, much of tech could be a DIY hobby project, and it became my hobby.Today…not so much. Heck, there are people graduating with college degrees in website design. My meager little effort in HTML programming is probably now considered so rudimentary that elementary school kids would find it overly basic.

Now things are so specialized that they can often be hard to comprehend. Our focus in this issue of 

® is artificial intelligence (AI), and try as I might, I just cannot comprehend how this branch of technology manages to do what it does. That being said, I can tell you that it works and it is extraordinary.

The best example of what AI is all about is when you search your photos, whether on your phone or in the cloud. Even though I have an iPhone and Apple’s iCloud, I use other apps to back up and store my pictures. One of my favorites is Google Photos. You can set the app to back up every picture you take and send it to the cloud. It also can sort your photos using AI.

Here’s an example. In my family, I’m the one who loves to take pictures. The problem is that my wife loves her Android phone, and with the 2 different operating systems we both can’t share my iCloud account where my pictures are backed up. But, as I use Google Photos, I set up a folder that I share with my wife. I also set up the folder to use AI to identify family members by their faces.

Now whenever I take a photo with my phone, it is rapidly uploaded to Google Photos. There, the algorithms run over the photo, scouring it for family faces. When they find one, the photo is copied and placed into the shared folder…and it happens with every photo with no effort on my part.

One other quick example. On Halloween I saw a kid dressed up as a hotdog and I thought it was hysterical. One day, I went to show the picture to a friend, but couldn’t find it on my phone.Rather than scrolling through all the photos, I simply searched on hotdog, and every picture showing a hotdog quickly showed up. The weird thing was, there was one photo I had taken of Kansas City Royals Kauffman Stadium that also showed up. The photo was of the field itself and a small portion of the outfield seats, so I was stumped as to why it popped up in the search result. Later, I opened the picture on my computer and noticed that way in the background there was a food stand, and next to a large Pepsi logo there was, you guessed it, a tiny picture of a hotdog next to a cup of Pepsi. I was stunned. The image was so small, I would not have even noticed it if it were not for the AI. However, the AI had seen it, and I found that incredible.


Fascinating as I’m sure these stories are, what do they have to do with dentistry? Simply put, there is a technological “trickle down” when it comes to amazing new ways to apply things learned in other areas.

Just as NASA created nickel titanium, which then changed endodontics, the war on terror changed AI. The mobility of our world made it difficult to screen all the people entering the United States who were passing through customs and immigration. The idea was to have a photo database of known bad guys and compare those photos with people entering the country. This work, combined with the sudden proliferation of closed-circuit television cameras, led to some amazing captures and greater security at the border. Then the technology began to trickle down from government agencies to the rest of us.

For our profession, imagine a database not of bad guys but of “bad teeth,” which algorithms could access and compare. One of the biggest problems we have as diagnosticians is reading radiographs, partly because the systems that create the images render them in black and white. There are limitations because the human eye can perceive only 30 shades of gray. That doesn’t give us a lot to work with.

Computers, however, can see 256 shades of gray and are much better than humans at differentiating very small nuances. They can look at an image and analyze each individual pixel, comparing it with all the other pixels around it, looking for differences.

This is one of the reasons digital radiography software has filters that the user can apply. Those filters enable doctors to remove degrees of gray or enhance the contrast to aid them in noticing where darker areas lie.

That is why AI has such a great future in health care. The hardware has the ability to sense things we cannot and the software has the ability to put it into context.

Imagine sitting down to review radiographs and they have already been “marked up” by software that essentially tells you, “Here are areas that look suspicious.” These AI systems already exist, and they become smarter with every use. Tell the software, “Positive caries here,” and it learns. Tell it, “Negative caries here,” and it learns. As you work with the software, its diagnostic accuracy grows.

Next, add in the ability to apply statistics and the power grows exponentially. Think of something, such as “Caries in this area of the furcation results in extraction 82% of the time.” Software engineers can enable systems to give you some type of statistical confidence for you to consider in decision-making and treatment planning.

Our profession relies on both experience and whatever data we can gather. The more data points we have to aid in our decision-making process, the better our decisions will be. Although critical decision-making will always rest with the doctor, I see a future in which machine learning will provide critical and objective data points. Whether pixels on a radiograph, suggested designs on CAD/CAM software, the planning of a clear aligner orthodontic case, or diagnostic aids that actually improve with experience—just like humans—await us. How incredible is that?

Why artificial intelligence is the next big thing in dentistry.

Smarter and Smarter

When I was a kid, I loved the comedian George Burns. He and his wife, Gracie Allen, had been a vaudeville act, with George playing straight man to Gracie’s “ditzy wife” routine. They moved their act to television in the early days of that medium and were very popular until Gracie’s unfortunate passing at the age of 62. George lived to be 100.

To end their comedy routines, George would lead with the line “Say good night, Gracie.” She replied with “Good night, Gracie!” It was a signature sign-off, and audiences loved it.

Why are we talking about 2 comedians from the black-and-white era of television? George Burns always reminded me of my Grandpa Flucke (who was quite the philosopher and whom I quote frequently). I also think it’s a great way to introduce the concept of having a good night, plus my grandfather always said, “Son, there’s no substitute for a good night’s sleep.”

® as spending my time searching and researching for disruptors—those products, techniques, and ideas waiting just over the horizon, ready to change our profession.

Sleep is a disruptor that I am incredibly excited about. Although it isn’t a subject that is “just over the horizon,” it’s still in the category of a serious disruptor. It holds so much promise that we are devoting a large percentage of this month’s issue to discussing it. Let’s see how we can help patients lead healthier lives with better quality of life than perhaps they’ve ever had before.

It frequently amazes me to look back a few decades and see how our understanding of dangerous situations and risk has evolved, in health care and life in general. When I was young, there were no seat-belt laws (or seat belts, for that matter), and I can remember being next to my mom in the front seat of the car as she ran errands. If she had to slam on the brakes, she would throw out her right arm and clothesline me across the throat to keep me from bouncing off the windshield. That was the idea of “child restraint systems,” and everyone did it. I have some vivid memories of my mother’s arm crushing my trachea as the brakes and tires let out that bloodcurdling squeal.

Sleep is a lot like that. As recently as 10 years ago, we truly had no concept of the importance of sleep. Our lives accelerated beyond what our bodies could handle, but no one thought much of it, beyond the proliferation of coffee shops and energy drinks.

Studies have shown that lack of quality sleep (and that’s an important delineation: not just sleep, but quality sleep) increases the likelihood of type 2 diabetes, obesity, and heart disease, to name a few potential sequelae. Studies with test animals have demonstrated lack of some or all sleep cycles could reduce life expectancy from 2 to 3 years to 3 to 5 weeks in those animals.

In addition to the physical diseases related to lack of sleep (and that list is not limited to the 3 mentioned above), there are many psychological pathologies associated with lack of sleep.

Memory and information processing seem especially affected by lack of sleep, specifically REM sleep. Many of us complain of being schedule overloaded and not able to remember things well. There is a high degree of probability that these symptoms are related to a lack of restful sleep.

Depression also affects our psychological well-being. There are different levels of sleep, and a healthy sleep cycle involves spending the proper time in each level. REM sleep is critical and when a person is not sleeping well, they do not spend enough time in that cycle. This leads to the brain trying to make up for lost REM during the next night. This can sometimes result in a person stating, “All I did last night is dream, and I woke up exhausted.” This is from a process referred to as REM rebound, where the brain tries to make up for lost REM. However, most medications prescribed as antidepressants tend to reduce REM. This creates the potential of prescription chemistry interfering with the sleep cycle, which could then affect the patient’s depression. It’s sort of a pharmacological chicken-and-egg syndrome that works both ends against the middle.

Physicians were first on the scene of obstructive sleep apnea (OSA). Unfortunately, the medical model of treatment was not exactly a perfect delivery vehicle for treating OSA. The medical model frequently involved expensive scans, overnight sleep studies in special facilities, and expensive equipment, usually a continuous positive airway pressure (CPAP) device.

In addition, few have a dentist’s training and knowledge of the head and neck. OSA is a medical issue that dentists are uniquely qualified to solve.

Most of us have heard the old expression of “drinking from a fire hose.” The basic meaning is that there is so much of something being delivered that it is impossible to keep up. That is also the idea behind CPAP. The device pumps a high volume of air into the nose and/or mouth under high enough pressure to open the airway and push oxygenated air into the lungs. The problem for many patients is the incredible volume of air, as well as the hardware covering the face. A sealed face mask or sealed nasal cannula is necessary to allow the proper volume of air to be delivered. Although the device is effective, for many patients it is uncomfortable and brings on feelings of claustrophobia.

Among individuals who purchase a CPAP, 60% do not use it. That is an amazing opportunity for our profession. Think about that—the success rate of CPAP is 40%. And that is just the percentage of users. That does not account for the number of individuals in that 40% who, despite usage, still suffer from low oxygenation while sleeping or fail to get restful sleep because of the hardware on their face.

This 60% is the low-hanging fruit of the sleep crisis. They have been informed of a medical diagnosis and are simply waiting for a solution.

For the portion of the patient base not given a diagnosis, most patients are willing to discuss their problems with you because most are very aware of their situation. They either have woken up gasping or been told they snore like a freight train. The best way to engage with patients on this problem is to begin asking and/or putting materials in the office about signs and symptoms of OSA. After doing this, I noticed patients or significant others brought up the subject before I could.

There are many great resources for training to treat this disease and doing so is straightforward. I’ll discuss training later in this column.

I happen to work with a company called SleepArchiTx for the sleep part of my practice, and I reached out to CEO Alice Limkakeng for a discussion on this article. When I asked her about why a doctor would want to treat sleep disorders during the coronavirus disease 2019 (COVID-19) pandemic, here was her response:

“It is only in the deepest part of our sleep cycle (the N3 stage) where our bodies repair and rebuild our immune systems and maintain health. If we have sleep apnea, we don’t get to the N3 stage and our immune systems are compromised. In this environment, we need our immune systems to be at their peak, so everyone needs to be getting high-quality, deep sleep.”

CPAPs increase risk of virus transmission and oral appliance solutions by dentists to treat sleep apnea are now frontline therapy. Medical sleep doctors know this and are more willing to work with dentists than ever before.

Treating patients for sleep is safe. It involves a non aerosol screening, and sleep testing can be done remotely. Treating patients for sleep is essential—doctors can talk about the necessity and incredible importance of treatment (vs other procedures patients might deem optional).

Quite obviously, our patients need our help. While we are fighting COVID-19, we are also dealing with a sleep epidemic. Many patients are suffering from the disease, and those unfortunate individuals need our help.

Many doctors are interested in treating this disease but are wondering about next steps for learning. There are many continuing education options that can be studied virtually. Simply entering 

Learning to treat sleep disorders is not difficult. It provides a lift knowing that you are potentially saving lives.

) provides a training solution, including sleep studies analyzed by certified sleep physicians, consultations with experienced clinicians, device fabrication, and billing help. Whether you are new to sleep or have experience, they can help.

When I was younger, I was a night owl. Often, I wouldn’t even think about heading to bed until 11:30 pm at the earliest. I would sleep maybe 5 hours, then drag myself out of bed, drink caffeine, and repeat the cycle. I thought I was simply someone who didn’t need sleep, but I was wrong. My lack of sleep was a symptom of OSA. I won’t go into the details here, but I eventually received a diagnosis, and my life changed in remarkable ways.

That started me down a path of helping others like me, suffering from horrible sleep and not realizing it—or, in my case, denying it.

There is no time like now to make changes. Why not resolve to help your patients by learning how to treat sleep apnea? It’s a worthwhile endeavor, and dentistry truly does hold the key to potentially improving lots of lives.

Check it out. I think you’ll be glad you did.

Dental practices are in a unique position to help patients realize the multiple benefits that come from reliably sleeping longer and better.

Say “Good Night, Gracie!” The Lowdown on Sleep

s one of the highlights of my work here at 

®. As many of you know, throughout the year I get to evaluate a fair number of new or improved products. I keep a list of my favorites, and the 5 I like the best end up as my top 5 test-drives.

I hope you enjoy reading this as much as I enjoy tinkering with and evaluating new ideas and products.

We’ve seen some tremendous advances in curing lights over the years. The devices continue to get smaller and more powerful every year. Every curing light on the market is slim and ergonomic and has more than enough power to cure any shade of composite. As the market stabilized, I thought we had pretty much seen just about all the tricks that photopolymerization had up its sleeve…and then came PinkWave.

The PinkWave from Vista | Apex uses a unique array of LEDs, some of which give off a pinkish glow. In the last few years we’ve seen companies produce broadband curing lights with wavelengths that cure any material on the market. The PinkWave does even more by offering its QuadWave Technology to provide even more curing energy. QuadWave consists of ultraviolet light, blue light, red light, and NIR (near infrared) to deliver an incredible cure. In addition to the curing LEDs, Vista | Apex included a white LED that can be switched on separately to turn the PinkWave into a transilluminator.

The device can provide a 4.7-mm depth of cure, and company studies show a 15% decrease in polymerization shrinkage. The company also says there is a 19% increase in polymerization, and the curing head is currently the largest on the market at 115 mm2.

Current “blue only” lights put out different wavelengths of blue. The problem is that the blue light is easily absorbed by the pulp. As blue lights have become more powerful, they are also putting a fair amount of heat into pulpal tissues. The NIR wavelength is not absorbed by the pulp. This decreases postoperative sensitivity that may be caused by heat absorption by the pulp while generating better depth of cure.

This is a pretty amazing composite that I’ve been using for about 2 months. By the time you read this, you should be able to order it and see for yourself.

VisCalor is an interesting material. It is a thermoviscous bulk fill composite, which means it is used in a specialized composite warming gun. The gun warms the compules using infrared energy, and this heat energy makes VisCalor flowable. With the special warming gun you express the composite into the prep where it is easily sculpted. My best description of the viscosity is that it is similar to cake icing. The material is smooth and very easy to work with.

Its low viscosity allows it to easily adapt to proximal boxes and hard to reach undercuts.

The compule is designed with a thin cannula diameter that makes placement very simple, and the low viscosity of the warmed material allows it to pass through the cannula easily.

Another great feature is the composite’s esthetic appeal. I found that VisCalor blends incredibly well with surrounding tooth structure. It comes in 4 shades, and I have yet to find a case where the restoration wasn’t almost invisible when finished.

It polishes well, and it can be placed in 4-mm increments, handy for bulk filling in many clinical applications. VOCO has always been an industry leader, but VisCalor takes it to a whole new level.

In this crazy, topsy-turvy pandemic world, we are seeing our infection controls taken to new levels. Before 2020 we were more concerned about bloodborne pathogens or those spread by bodily fluids, but then along came SARS-CoV-2, the virus that causes coronavirus disease 2019. Suddenly we also had to be concerned about airborne pathogens.

What to do? How about filtering the air—better yet, filter it as soon as it leaves the patient’s mouth. That’s the concept behind the Aegis Aerosol VacStation.

The VacStation is a high-powered system that has a large, positionable hose that attaches to a powerful vacuum. The other end of the hose has a large clear plastic dome that can be positioned very close to the oral cavity.

The device creates a suction of 3.5 m3, which can recirculate the air in a standard 8 x 8-ft room every 5 minutes. Air is then moved through 4 types of filtration: high fiber, fiberglass, active carbon, and LEDs, which are on a wavelength known to kill viruses.

This unit has been independently evaluated by the Medical University of South Carolina to reduce spatter and aerosols to almost zero.

Also, patients are impressed when they see units such as this cleaning the air. They know we are doing all we can to protect everyone in the office.

Printing in 3D has come to dentistry in a big way, and one of the true market leaders is SprintRay. Their newest 3D printer is the SprintRay Pro, and I’ve been working with it a lot this year.

Printing in 3D allows dentists to expand the scope of care by being able to create an amazing number of dental items.

The SprintRay Pro is a digital light processing device that uses a special light source to photopolymerize a type of liquid resin (the science is very similar to composites). The printer has a tub that is filled with the liquid resin. A build plate is lowered into the resin. The light source polymerizes layers in the liquid, which harden. Then the polymerized materials are attached to the build plate, which is mechanically raised slowly out of the resin as each layer is added. As the build plate rises, bit by bit, more and more layers are polymerized, until finally the finished project rises out of the resin.

The device can create many types of dental appliances and prosthetics such as surgical guides, study models, models for aligner production, indirect bonding trays, digital dentures, and occlusal guards.

The SprintRay Pro is fast; it can print models in under an hour in most cases. When you combine this speed with an accuracy of 55 microns, you get an incredibly accurate and precise device that has many applications in today’s dental office.

The device is connected to your office network, which means it can be accessed and used from any computer in your office. It also allows the printer to automatically check for and download updates from SprintRay. The company is always updating the software that drives the machine, so new features are always being added.

Offices also are supplied with RayWare, which is SprintRay’s design, build, and layout software. Intraoral scanners create their data as STL files, which can be downloaded. Simply drag and drop an STL file into RayWare and it will render the file in 3D and place it on the build plate. Depending on the size of your project, you can place multiple projects on the build plate, which means you can print multiple models or other things at the same time.

Being able to fabricate something like an occlusal guard in 3D in a couple of hours is a great service to your patients and a boon to your marketing.

Bringing device fabrication in-house lowers your costs and speeds delivery while also producing incredibly accurate appliances. That translates as “cheaper, faster, better,” which is always good for the bottom line of a business.

Printing in 3D is affordable and definitely the wave of the future in dentistry. The time to get into this market is now.

For decades, if you wanted to do same-day crowns, there were only 2 companies that offered dentists in-office milling. Now with technology expanding, doctors have many more options to accomplish this goal. The best part is that this aspect of care has moved almost totally to open source. This means that, instead of being tied into 1 system, doctors can pick and choose the intraoral scanner and mill they like the best.

In my office, those devices are the iTero Element and the Axsys Versamill 5X400.

The Versamill is an impressive piece of equipment. It is a true 5-axis simultaneous motion mill. Watching it work is fascinating. It can mill pretty much anything in any shape. That is the result of the 5-axis process, as well as 7 available tools that the device can change automatically as needed. It’s also incredibly fast due to its 60,000 rpm 500w spindle that spins the tools.

Most of us are familiar with CAD/CAM blocks, which allow mills to create single units. The Versamill will accept similar blocks, but it will also take discs (often referred to as pucks) that are about 100 mm in diameter with different thicknesses. These pucks allow the Versamill to create multiple single units, multiple connected units, occlusal guards, surgical guides, sleep apnea appliances, clear orthodontic aligners, custom implant abutments, and more. This is the true power of a 5-axis mill. It can create almost anything you can imagine as long as you have the raw material.

Speaking of material, the Versamill 5X400 can use a variety of dental materials. Imagine being able to create prosthetics using wax (yes, it can actually mill wax) for use in the lost wax technique. It can also mill zirconia, PMMA, glass ceramics, lithium disilicate, lava ultimate, and titanium.

The quality of the finished product? Amazing and sometimes beyond amazing. The idea of being able to create almost any dental restoration in your office in a matter of minutes is an incredible service to offer your patients. Because it is open source, it doesn’t matter what scanning system you use.

The market for mills will continue to grow. They are phenomenal devices that allow offices to create almost any prosthetic or appliance patients may need. If you’ve ever considered in-office milling, put Axsys on a short list!

There you have the top 5 test-drives of 2020. Hopefully, you’ve found some things here that strike your fancy. Rest assured, I’ll be back in 2021 to let you know about the biggest improvements in our profession. Thanks for reading 

 and Technology Evangelist. You folks rock!

Chief Clinical Editor and Technology Editor John Flucke, DDS, describes the most 
exciting products he tested in his practice this year.