Lauren Krzyzostaniak

	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 Dr. Lou Shuman, founder and CEO of 

, 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.

	Dr. Jeffrey Kim, project leader at the ADA Foundation Volpe Research Center, 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 regrowing teeth may soon be possible.

 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.

Trending research: Is wine a good mouthwash?

	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.

	1. “Adult dental health survey: dental restorations in the UK in 1998 and implications for the future.” British Dental Journal, Volume 190, pages 4-8 (13 January 2001)
	2. “Drug self-assembly for synthesis of highly-loaded antimicrobial drug-silica particles,” Scientific Reports, DOI: 10.1038/s41598-018-19166-8.  
	3. “Practical whole-tooth restoration utilizing autologous bioengineered tooth germ transplantation in a postnatal canine model.” Scientific Reports, DOI:10.1038/srep44522.

Articles

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

The true science fiction of future dentistry

	Lee Ann Brady, DMD, operates a private restorative practice in Phoenix, Arizona. She’s also the director of education for The Pankey Institute, which offers educational programs focused on occlusion and restorative dentistry. In addition, she’s the founder of Restorative Nation, a learning community for dentists that offers educational resources, forums and webinars.

	It’s fair to say that Dr. Brady spends a lot of time thinking about creating the most natural restorations (in both look and feel) for her patients. That’s why she sought to find the best polisher available in terms of polishability, efficiency and longevity.

	When Dr. Brady started looking around for a better polisher, it was because she had experienced frustration with other polishers becoming dull rather quickly. Because the shape of her previous polisher came to a tight point, it allowed her to get into the fine detail of the occlusal surface of the tooth. The downside of that sharp point is that, like a freshly sharpened pencil, it would soon wear down. The blunted tip would no longer be able to get into a tooth’s grooves and fissures.

Read more: Brasseler USA introduces C-Series carbides

	“Literally in the first use, you’ve blunted the tip,” she says. “You might be able to polish just two or three teeth before you no longer have access to all those grooves.”

	As she started looking for alternatives, one in particular caught her eye: 

. She discovered that the sterilizable and reusable Brasseler Feather Lite polishers can easily adapt to any surface, thanks to their shape.

 just looked like it would give me greater access and not wear down or change shape over time,” she says. “And that has turned out to be true.”

	The Feather Lite gets its name from its design: a miniature and more refined version of an 18th-century chimney sweep broom. Made from different types of a durable, diamond-impregnated rubber - depending on the type of restoration - the Feather Lite polishers are able to get into the fine details of the tooth surface as it’s polished.

	Because of that feathery design, it doesn’t wear down and change shape over time, providing consistent access in its life.

	Patients benefit from a polished tooth by enjoying an esthetic result and a natural feel. An effective polish allows the dentist to create a restoration that feels identical to the tooth surface - the patient shouldn’t be able to discern a difference. Also, the smoother the surface, the less opportunity plaque and bacteria have to stick, ensuring the tooth’s longevity.

Trending article: What you NEED to know about single-use instruments

	“When you’re looking at a polisher, you’re looking for something that’s highly effective, so you’re going to get a nice polish, but it’s also efficient so that you’re going to get that high polish without having to spend an extended period of time polishing them,” Dr. Brady says. “And that you’re going to have great access so the polisher can get into all of the different nooks and crannies and crevices, whether you’re working on a front tooth or a back tooth. These polishers have all of those features.”

	Dr. Brady also loves that the shape is available for many types of dental materials. With three shapes available - the DiaComp™ for intraoral composites, the Dialite

 - clinicians aren’t limited by the type of restoration they use.

	“You can get that shape and use it specifically for composite or specifically for ceramic crowns and most effectively polish all the different materials we use in dentistry today,” she says.

Finding a polisher that works for you can be tough. Here’s what one practitioner says works for her.

Better polishability with Brasseler Feather Lite polishers

	There are so many amazing technologies available in dental practices today, from imaging equipment to treatment planning software that’s verging on the border of - if not actually considered - augmented reality. But the traditional drill-and-fill aspect of dentistry is still going strong.

	Fortunately for dentists and patients alike, modern 

 has made its way into the surgical restorative arena in the way of dental lasers. Here, one dentist explains why he recently implemented one of these lasers and what kind of results he’s seen so far.

	A major improvement to the patient experience

	For most patients, the needle is the lesser of two evils; something that’s tolerated so as not to experience any further pain as the dentist works in their mouth. Part of tolerating the needle is dealing with hours of numbness afterward, which can affect the day-to-day needs of patients who just visited the dentist.

Read more: Convergent Dental introduces Solea Software 3.2

	“I’ve been in private practice for 32 years and the thing people dislike most about going to the dentist is being stuck with a needle and then the hours of numbness afterward,” says Jim Sandras, DDS.

	Consider that it’s already difficult for many people to see the dentist in the first place. Taking time off work and making sure they have coverage for the procedure they need and the out-of-pocket costs makes visiting the dentist an inconvenient necessity. As a result, patients often find themselves debating whether they have the time and resources for a dental visit at all.

And because patients are numb, they can’t tell if their bite is off while they’re in the chair, which means that patients will often call in after their appointment complaining that their bite is off or that their tooth is sensitive.

	Because Dr. Sandras is always looking for an easier and better way to take care of his patients and improve their experience, he started looking around for a better option.

	“If someone needs fillings on opposite sides of their mouth and you use anesthetic, their whole face will be numb for hours,” he says. “That’s not enjoyable for anyone. Anything to eliminate that would be a huge plus for patients.”
	Cue the 

 from Convergent Dental, a quiet, anesthesia-free option that works for the majority of cases. At first, it sounded too good to be true to Dr. Sandras. But, he scheduled an in-office demonstration anyway. Unlike other lasers he had looked into, Solea could cut teeth quickly and smoothly.

	He was so amazed at what he saw that he decided to purchase Solea. Since adding Solea to his repertoire, Dr. Sandras has noticed that he only needs to use anesthesia for fillings about 10 percent of the time, such as when the filling is deep or if he’s removing a large surface amalgam.

 is more tooth-friendly than a drill, as it only takes minimal amounts of tooth structure and leaves healthier teeth intact. 

	“Since I’ve been using it this past year, I haven’t had one person call back complaining that a tooth was sensitive or that their bite was off,” he says. “When I used the drill, I would often get people calling back complaining that their tooth was sensitive to the cold or that they felt like they were hitting on the filling. I haven’t had that problem once in the past year since using Solea because they can tell right away if the bite is off because they’re not numb.”

	Solea is also a great option for Dr. Sandras’ 

. Not only can the doctor avoid giving his patients a shot, but he can satisfy their inherent curiosity by showing them how the laser works and allowing them to wear “cool” glasses. Because he hasn’t given a shot to a child since he bought Solea a year ago, he no longer worries about self-imposed injuries that often result from being numb for hours afterward.

Related article: 10 ways lasers can make your practice money right now

	Another benefit Dr. Sandras and his patients enjoy is the ability of Solea laser to cut and cauterize tissue. That positively impacts his work with subgingival fillings, frenectomies and gingivectomies.

	Typically, bleeding slows and frustrates the restorative process when a filling goes below the gumline, Dr. Sandras explains. But because Solea cauterizes tissue, he’s able to remove subgingival decay more effectively. With gingivectomies, the laser ablates the tissue, so there’s no need for curettage afterward. And frenectomies can often be done without anesthesia. 

	As a dentist who’s focused on keeping his patients comfortable and optimizing his workflow, Dr. Sandras says he’s happy to have found the Solea laser. His patients appreciate that he keeps up with technology and takes the time to do the research in order to provide a better patient experience.

	“Patients absolutely love Solea,” he says. “As soon as patients sit up after treatment, they say how awesome their dental experience was and that they’re going to put it on Facebook, and then they go and tell everyone about Solea.”

	Dr. Sandras is excited by the progress happening in dentistry and the rate of change the industry is experiencing. To him, Solea is a “huge step forward" - one equal to the effect digital X-rays had when they were first introduced.

	“I believe it’s just a matter of time before every dentist is using lasers,” he says. “Patients are very informed these days and will find out about it and start looking for practices that have the Solea laser."

How this laser from Convergent Dental can be used for anesthesia-free dentistry.

How to enhance patient experiences with the Solea laser

	Infection control is one of the most important aspects of running a successful dental practice, but every practice knows that being successful in this area is largely reliant on how well staff members follow protocol. And even under the best circumstances, the dental office is never 100 percent sterile. Consider dental unit waterlines, which still contain some level of bacteria even just after a cleaning.

 has several weaknesses when it comes to water treatment. The first is that the bacteria isn’t killed immediately, giving it time to multiply. The second is that even if all but 0.01 percent of the bacteria in the line is destroyed, it doesn’t take long for the rest of it to replicate and exceed the 500 CFU/mL limit recommended by the 

Centers for Disease Control and Prevention (CDC

	An additional shortcoming is that chemicals kill free-floating bacteria, but they’re not effective at eliminating biofilm, a slimy film on the inside of water pipes and waterlines that stores and protects bacteria. Biofilm isn’t affected by flushing the waterlines, a daily procedure recommended by the CDC to ensure clean water in dental offices.

 are a breeding ground for the very pathogens dental practices are trying to avoid, such as Legionella. Therefore, dental staff must use a combination of chemicals, procedures and protocols to keep patients safe.

	Luckily, there’s an alternative that’s more effective at removing bacteria and viruses from waterlines, simpler to implement, and safer for staff, patients and the environment. It has been utilized in medicine and dentistry in the European Union for years but is only now being introduced in the U.S. It’s called ozone, and it’s part of Toppen Dental’s three-pronged approach to water disinfection in the dental practice.

 founders Owen Boyd and Al Dube sat down to discuss ozone and quantum disinfection, two technologies they offer to keep dental practice equipment and waterlines sterile and safe.

	Ozone gas is often used in water treatment as a chemical-free method of disinfection. The process, called ozonation, has been used in bottled water treatment since the 1970s. Before that, the shelf life of bottled water was about 90 days, Boyd says. While the dental community continues to rely on chlorine tablets and other chemical treatments for dental unit waterlines, ozone is more effective at combating microorganisms in water.

Toppen Dental uses ozone in one of its marquee products, The Oz. The Oz is a spray bottle that uses an ozone generator to sanitize the water. It’s designed to replace glass cleaners, hard surface cleaners, 

	The process is simple: Fill the bottle with tap water. Once ozonated, water from The Oz can kill pathogens such as E. coli, Salmonella, and MRSA.

	There are two big benefits to The Oz, according to Boyd and Dube. The first is that it kills bacteria within 30 seconds. The second is that it’s safe to use on any surface, including dental chairs. In fact, in a video posted on Toppen Dental’s website, Boyd sprays water from The Oz directly into his mouth, highlighting just how innocuous ozone is to our health.

	“I always tell people, if you’re using a cleaner, open up a cabinet under your kitchen sink and read the warning labels,” Boyd says. “You probably would not use most of the cleaners you have underneath there.”

	Unlike most cleaners, which contain around 40 to 60 percent isopropyl alcohol, ozone can be used on any surface and provides a deeper clean.

	“Because it’s a gas in water, sort of like CO

 in your beer, that small ozone molecule gets into the little crevices that you have on glass and wood and fiber,” Boyd says. “So, it’s going to sanitize deep down where most of your other large-molecule cleaners strip stuff off the surface and leave bacteria in the crevices. You may have done a great job cleaning your surface, but bacteria are still there, resident.”

	“You can use this spray bottle and spray it on the chair itself and you’ll sanitize it, and the only byproduct is water and oxygen,” Dube adds.

	The Oz is part of a family of ozone products from Toppen Dental, including a faucet and a wall mount for chairside water bottles.

	The other technology Toppen Dental offers is QDfx, an inline filter that utilizes quantum disinfection technology to destroy bacteria and viruses in the water. Within the filter are tiny ceramic balls that attract electrons from microorganisms, stripping away their outer membrane and destroying the entire cell.

“It essentially uses a charged ceramic chemistry, whereby the cation charge is so powerful that it attracts bacteria and steals the bacteria’s outer ring of electrons, killing it in a tenth of a second before destroying its innards,” Boyd says.

	This process is called lysis, and it affects free-floating bacteria as well as bacteria in biofilm. Compare this to a chemical treatment, which requires 30 to 90 minutes of contact to combat the DNA of free-floating microorganisms. Chemicals also have little effect on the biofilm, where most microbial activity takes place.

	Boyd and Dube say that the QDfx technology provides a 24/7 secondary kill.

	“Just by doing dental procedures on their patients, dentists are going to have disinfection accomplished,” Boyd says. “They don’t need the protocols.”

	They add that using QDfx is a much simpler process. It takes about five minutes to install the QDfx cartridge, which plugs into the dental unit waterline with a quick connect fitting. There’s no daily process to attend to, as the cartridge is designed to be replaced annually.

	These technologies work together to offer significant benefits to dental team members, patients and the environment as a whole. While most water treatment options are considered pesticides by the EPA, The Oz and QDfx are devices that add nothing to the water. Therefore, staff members aren’t vulnerable to chemical byproducts and patients aren’t ingesting pesticides. The Oz can even be used to sanitize hands before a procedure without dealing with the sticky residue that alcohol leaves behind.

	“We think that there’s a bit of a missing link in some of the things that are going on in dentistry,” Dube says. “One of the pieces is how you have chemistries that may solve one particular kind of problem, but then they create a secondary problem. If you have a disinfectant that creates an aerosol that’s a potential carcinogenic, you could be creating a hazardous potential for a staff member.”

	Boyd and Dube emphasize that a priority of Toppen Dental is to create products that solve existing problems without creating new ones.

	“In our company, everything has to have an oral health benefit, a human health benefit and an environmental health benefit,” Boyd says. “It can’t meet one of the three. It’s got to meet three of the three, or we’re not going to develop that as a product. It’s that simple.”

How these two products from Toppen Dental can be used to sanitize a dental practice.

Using The Oz and QDfx as water treatment options

	When first starting out as a cosmetic dentist, it can be easy to get excited about a case and its possibilities and get swept away. A result is that dentists often take on too much too soon, or they sign on to do cases that need more than just a cosmetic touch.

Read more: 4 easy ways to get into cosmetic dentistry

	To avoid making some rookie mistakes, check out this list of the six most common mistakes made in 

, as told by fellows and accredited members of the 

	Click through the slides to view the mistakes.

	The first mistake many dentists make is taking on too much too soon.

	“The first mistake is tackling a case that’s too big at the beginning,” says Fred H. Peck, DDS, AAACD. “You get lost. You’re not sure what direction to go because there are too many ancillary problems that the patient may have, such as occlusal issues, periodontal problems, and orthodontic concerns.”

Related reading: Why cosmetic dentistry matters to every practice

	He advises breaking the case down and seeking out experts for guidance. If there are 

, talk to a periodontist. If the teeth are in the wrong position, connect with an orthodontist. Using specialists to their advantage will help newer cosmetic dentists break down the case into easier components.

	“There are also a lot of dentists that will act as mentors to dentists that are newer to cosmetic dentistry,” Dr. Peck says. “They just have to reach out to those dentists for help.”

	Likewise, overpromising is a common mistake that dentists make early on. That’s why it’s important for dentists to make sure they’re on the same page as their patients in terms of their expectations.

More from the author: The clinical procedure that can make or break your career

	“You always have to make sure that you have a great line of communication as well as the skill to meet the patient’s expectations,” says John Rowe, DDS, AAACD. “If their expectations are unreasonable or don’t meet the ability that you can deliver, then the end result will be an unhappy patient, and that leads to stress for both the practitioner and the patient.”

	Before accepting a case or doing any treatment planning, make sure you understand what the patient’s end goal is - and don’t promise a result without offering diagnosis first.  

	Mistake #3: Not establishing a diagnosis for the patient

	That brings us to the next mistake: not establishing a diagnosis for the patient.

Trending article: Are you a facial estheticsodontist?

	“At a certain point we become so excited about what we can do to enhance the patient's appearance that our enthusiasm can cause us to gloss over diagnosing and evaluating the patient comprehensively,” says Betsy Bakeman, DDS, FAACD.

	Before diving in, think about why the teeth look the way they do. Are stains a result of tetracycline or defective restorations? Why do certain teeth have areas of chipping? Why is the gingiva inflamed? Dr. Bakeman argues that not addressing the causes of certain problems leaves room for those to negatively impact the future of the restorations placed.

	Dr. Bakeman adds that, because most of dentists’ training is devoted to teeth, they sometimes forget to look at the influence of the 

More from the author: The evolution of cosmetic dentistry

	“It is important to look at tissue heights and contours,” she says. “Sometimes a beautiful job is done restoring the teeth, but the gum heights are uneven, which is distracting and non-esthetic and most likely could have been addressed as part of the treatment.”

	Dr. Bakeman says that understanding the line angles and contours of the gingiva and the teeth is what makes the difference between a mediocre and a beautiful outcome.

	Mistake #5: Not digitally planning a case

	Many mistakes are the result of not enough planning, which is why many of the doctors interviewed in this article spoke about treatment planning at length.

	“A lot of times, the dentists do not get as involved in the actual planning or fabrication of the restorations,” says John F. Weston DDS, FAACD. “There is a tendency to just prep the teeth the same way as all the other cases, take impressions, send the case to the lab and tell them to ‘make veneers.’”

	Dr. Weston adds that dentists who practice this way end up with patient smiles that look the same because the lab is building them the same way. Unlike the dentist, the lab doesn’t have access to the patient’s features and can’t modify a case to best suit that patient. The end result is something “random” that may or may not satisfy the patient.

Trending research: Can tooth loss lead to cardiovascular disease?

	To avoid giving patients Chiclet teeth, dentists have to find a way to send the patient to the lab. Luckily, that’s easy to do with digital photography and digital planning, which allow a clinician to get a more personal fit for the patient, Weston says.

While these rookie mistakes are easy to make, they’re avoidable so long as dentists have the right resources.