Stan Goff is the Managing Editor of Dental Products Report, Dental Lab Products and Modern Hygienist. He has covered the dental industry since 1999 and can be reached at sgoff@mjhlifesciences.com.  

Stan Goff

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Technique Touch-Ups

Articles

Experts from across the industry share their favorite tips, tricks, and solutions to make dental care better for patients and easier for you. 

Technique Touch-Ups 2023

Good isolation is critical for restorative dentists, and patients appreciate it as well.

For one California dentist and his patients, the DryShield isolation system from Solmetex is part of the daily routine. DryShield helps keep the working area inside the patient’s mouth dry, clean, and visible, and Troy Schmedding, DDS, credits it with delivering a more productive office and happier patients.

“It really came about just as part of a 2-fold process,” says Dr Schmedding, who maintains a private practice in Walnut Creek. “We were using at one time a system without an autoclave ability and I didn’t want to have to throw away all these pieces. A little bit of my environmentalist comes out and, oh my God, that’s a lot of plastic rubber to be throwing away.”

The second factor in his thinking was wanting a reliable alternative to using a rubber dam all the time. “I do a lot of adhesive dentistry, and isolation is critical for me in terms of success,” he says. “Not everyone can tolerate a rubber dam. I don’t think DryShield is a replacement for absolutely everything, but ultimately, I found the DryShield to be able to be utilized in a large majority of my patients for quick, easy isolation in a comfortable fashion.”

Dr Schmedding has been using DryShield for about 7 years in his practice, which focuses on esthetic and functional dentistry. Clinicians can opt for the cost savings of autoclavable mouthpieces or the convenience of single-use mouthpieces.

DryShield combines the tasks of high-suction evacuator, saliva ejector, bite block, tongue shield, and oral pathway protector in one easy-to-use device. It is described as an intelligent breakthrough in isolation, bringing ease and comfort to doctors and patients. Designed by a dentist for dentists, the DryShield system is said to dramatically reduce chair time by 25% to 40% per procedure, allowing more appointments and more consistent schedules. It is described as the first all-in-one isolation system to offer a full slate of autoclavable and single-use mouthpiece options to meet the needs of clinicians while also being economical and convenient.

“It really is awesome. It’s autoclavable, and then overall, just the process of delivering the isolation is critical,” Dr Schmedding says. “I can’t work in that type of environment without good isolation, and the DryShield seems to cover it with variable options in terms of sizes and matching bite blocks. The patients get great isolation and it helps us provide good dentistry.”

Every patient in his practice will have some form of isolation, and the majority of that is using the DryShield because of its convenience. It attaches directly to the high-volume evacuator and saves time during procedures.

“Rubber dam is still probably the gold standard in some instances, but ultimately rubber dams are a little bit more difficult,” he says. “DryShield is a great alternative for sure, and for patient comfort the patients tolerate it better.”

Using DryShield also reduces aerosol spread, a risk that became well known during the pandemic. “Patients are more aware of aerosols and that type of thing than ever because of COVID[-19]. So, they are more in tune with what’s going on in your dental operatory than they ever have been before,” Dr Schmedding says. “And that’s really another selling point to a lot of patients. This is great at containing a lot of aerosols, so…it does have an extra benefit. That is important. I definitely use that for a selling strategy as well for those patients [who] may be a bit on the edge. What it’s doing for you and the aerosol containment is huge.”

Increased efficiency is another plus. According to Solmetex, DryShield dentists are seeing chair time reduced by an average of 25% to 40% per procedure.

“There’s less stopping and starting…when you have some form of isolation,” explains Dr Schmedding, who uses DryShield regularly when seating crowns. “So, yes, it does help with efficiency…. It’s a [really] solid product. It checks a lot of boxes in terms of what you’re trying to accomplish.”

Why one clinician loves using the DryShield isolation system from Solmetex and how it benefits his practice and patients.

Closer Look: Reliable, Efficient Isolation Is Critical

With over 200 continuing education courses and more than 400 exhibitors, CDA Presents had plenty to offer its attendees at the Anaheim Convention Center, May 18-20. Here’s a look at just some of the many highlights.

The QuickConnect Anatomy Band made its trade show debut at the Rhondium booth. The circumferential matrix band can be swiftly placed using a specialized carrier that can be positioned for placement in any quadrant and allows for efficient tightening. Team members from Rhondium 

Team members from Rhondium demonstrated the nifty system at their booth at the CDA in Anaheim.

demonstrated the nifty system at the booth. Made of hard, contoured foil and just 35 microns thick, the matrix bands are designed to replicate the contours of the natural dentition and retain their shape while pushing through tight contacts.

It also helps solve the problem of loose contacts due to matrices not maintaining optimal contact with the adjacent tooth.

Peter Eisenhuth, whose wife is a dentist and engineer, manned the Dr. Jen Natural booth at CDA, where the company launched its latest Super Paste, which features double the cavity protection by using both fluoride and nano-hydroxyapatite. Designed for patients with weak enamel, sensitive teeth or those seeking extra protection against cavities, the new paste can be purchased online at DrJenNatural.com or wholesale to dentists.

With science to back it up, Eisenhuth said Dr. Jen’s toothpastes and flosses offer something for all patients looking for optimal oral care at home. The company’s pastes include naturally flavored cool mist and strawberry versions and even some without fluoride for those patients who have asked for non-fluoride products.

The new powered impression gun from Ultradent was on display at the company’s booth at CDA. The BFC3 impression gun—Ultradent’s first cordless, handheld impression gun—is designed specifically to express dental impression material in an efficient and precise way. It is compatible with 25 ml, 50 ml, and 75 ml 1:1 or 2:1 automix cartridges and can dispense up to 60 full 50 ml heavy body VPS cartridges on a fully charged battery. Combining this compatibility with BFC3’s anti-drip feature, which momentarily reverses the plunger to prevent waste when dispensing, this impression gun is designed with convenience in mind.

Crowds at the booth last week were also learning about the company’s Transcend™, a new universal composite designed with high levels of translucency to allow clinicians to achieve esthetic results that patients desire from their restorative work. The material uses Ultradent’s Resin Particle Match™ technology to ensure those high levels of translucency which in turn lead to ideal pigmentation and opacity.

Owandy Radiology General Manager Boris Loyez showed staff members from 

âsome of the features of the company’s newest CBCT unit, the I-Max 3D Pro.

The unit has 2D, 3D, and CAD/CAM capabilities, and boasts exceptional performance and a smaller size. He describes the new CBCT unit as 

the lightest, most compact, wall-mounted unit on the market. Loyez says the I-Max 3D Pro is designed for any budget or office size and will deliver a quick ROI to clinicians.

Boris Loyez talks about the features of the company’s newest CBCT unit, the I-Max 3D Pro.

It features a new generation CMOS sensor, a high resolution of 7272 μ Voxels for 3D HD volumes, an optional integrated artificial intelligence for ceph analysis, and the reduction of metal artifacts via Owandy’s AutoMAR and sensor geometric correction.

IVE Dental, part of GOBRO Web Services, demonstrated its trained virtual assistant on the tradeshow floor. The company provides well-trained, full-time virtual dental assistants who can take care of administrative duties like processing billing and coding, following up on insurance claims, and managing appointments.

IVE Dental's trained virtual assistant on the tradeshow floor at the CDA.

With both a mobile, robot model and a table top robot tablet version, the virtual assistant provides a “cool factor to dental offices” and is designed help get things done and save on overhead costs. Additional benefits include not needing to have to deal with turnover issues or employee taxes, according to IVE Dental.

This is just a quick look at the many innovative products on display at CDA and as always, CDA Presents included courses from experts on a wide variety of topics.

Annual conference in Anaheim showcased hundreds of new and existing dental products, while also including top-notch courses for attendees.

CDA Presents Filled with Innovative Products, Great Education

Dental labs and dental practices that perform the milling of aligners, splints, and other occlusal appliances.

When processing occlusal appliances, the innovative E3 enables users to automate the precision trimming. You can expect optimal results in the shortest time, with no arduous reworking.

The E3 is a very compact milling machine that has been specially developed for cutting out the most diverse shapes of thermoformed splints such as aligners, bite splints, grinding splints, and other variants up to sports mouth guards. It is the first vhf machine for this field, which has been very much characterized by manual work so far.

The TRIMCAMsoftware, which vhf has developed especially for this purpose, automatically recognizes the so-called trimline on which the occlusal appliance will later be milled out from the available planning data. The fixation of the workpiece in the E3 is done in 1 second: without any tools, the splint is simply clipped into the holder. For example, an aligner is milled out in less than 60 seconds so that an entire series can be produced in the shortest time. The user benefits from the high quality of computer numerical control production, and virtually no reworking is required.

The TRIMCAMsoftware, which vhf has developed especially for this purpose, automatically recognizes the so-called trimline on which the occlusal appliance will later be milled out from the available planning data.

The latest milling machine from vhf Inc is designed to deliver effortless workflows for the processing of occlusal appliances. 

5Ws* E3

Aligner materials, orthodontic software, imaging and photography, and the latest in 3D printing all were on display when the exhibit hall opened Saturday for this year’s American Association of Orthodontists (AAO) Annual Session at Chicago’s McCormick Place West.

The definitive event for orthodontists and their ortho teams drew a large crowd Saturday for the event, which runs through Monday. Whether you want to master a new clinical technique, check out the latest product offerings, tap into the power of 3D printing technology or learn how to overcome current labor shortages, the AAO’s Annual Session has you covered.

Here’s a quick look at some of the many products that were drawing attention on Saturday.

Philippe Salah, the chief executive officer at DentalMonitoring, demonstrated the company’s ScanBoxpro to a group media members Saturday morning. Part of DentalMonitoring’s family of devices and software solutions including SmileMate, for engagement, triage and patient conversion and DentalMonitoring, the only available AI-based remote monitoring solution available to both fixed and removable orthodontic appliances of all brands.

With ScanBoxpro,which can be used with any smartphone,patients can take a full scan of their mouth in just 1 minute in a “super cool way,” Salah says. It’s lightweight, portable and can easily join patients on-the-go, anywhere, for high-quality scans powered by AI. It also allows clinicians to have control at every stage of treatment and helps automate their workflow while enhancing their patient experiences.

Salah adds that DentalMonitoring’s Smart STL technology, currently in use in Europe, should be available in the US sometime in 2023 after it garners FDA approval. Smart STL is said to bring the only platform in the oral healthcare industry capable of creating updated STL files 100% remotely. This addition to remote oral healthcare technology supports clinicians in providing treatment in convenient and cost-effective ways that have previously been impossible.

Salah says the technology allows patients to use Smart STL without needing to come back to the practice for intraoral scans. A company, for example Ormco and its SPARK clear aligner system, can create new aligners for the patient based off the STL file representing the most up-to-date model based on a patient’s current smile.

Capital Dental Equipment kept busy demonstrating its new, natural hand hygiene system. Iggy is described as a natural and sustainable solution for health and wellbeing.

Manufactured by 30eScientific, Iggy cleans hands in 7 seconds using a miniaturized ozone generator and mechanical water spray. The eco-friendly system is free of alcohol and harsh chemicals, and is said to leave skin feeling clean and soft. Iggy uses aqueous ozone, a potent disinfectant that occurs naturally when electricity meets water.

Designed to improve gum health in 7 seconds a day, Proclaim utilizes intraoral scanning and 3D printing to craft a customized mouthpiece that contains up to 60 pressurized jets. Jets send precision pulsing water between the teeth and gum line, automating the irrigation system for patients at home.

David Yin demonstrates just how fast and effective the Proclaim system is at the AAO on Saturday in Chicago.

Fresh Health, which is demonstrating the system at its booth #609, is designed to personalize and automate patient’s at-home oral care. It is said to reduce gingival bleeding by 82 %. 

The customizable irrigation tool is proven to reduce bleeding, plaque, and inflammation and to allow patients to improve their home care hygiene routine, improving teeth and gum health.

Chief marketing officer David Yin demonstrated just how fast and effective the system is and also shared studies indicating that Proclaim is more effective than flossing. Households can have customized mouthpieces made for each person, with the ability to each use the same Proclaim system. For more information, visit proclaimhealth.com.

OrthoFX's new NiTime Aligner, the first aligner system that is explicitly designed for overnight wear, is being showcased at the AAO Annual Session at booth #641.

OrthoFX announced the U.S Food and Drug Administration (FDA) 510(k)clearance of their NiTime Aligners just ahead of the AAO meeting, and on Saturday the company’s co-founder and president Nichole Garcia talked with 

The hyper-elastic polymer maintains biologically favored force levels, allowing predictable tooth movement with less wear time, says Garcia, who has been wearing the new NiTime Aligners herself at night. The latest offering from OrthoFX is described as the first aligner system cleared by the FDA and supported by clinical studies that demonstrate treatment efficacy for reduced duration of wear.Additionally, it’sthe first aligner system that reduces daily wear time to 9-12 hours without increasing the number of stages in the treatment.

Orthodontists converge on Chicago’s McCormick Place for education and a chance to see the latest product offerings.

Large Crowds, Plenty of Product Launches at AAO on Saturday

In the past year, quite a bit has happened at Dentsply Sirona and in the world of dental implants. Tony Susino, Group Vice President of Global Implant Solutions at Dentsply Sirona, recently sat down with 

® Managing Editor Stan Goff to discuss these recent happenings as well as to take a look at the future.

Susino, who works out of Dentsply Sirona’s headquarters in Charlotte, NC, came on board with the company 1 year ago. Previously, he held executive positions with Straumann and Henry Schein, gaining a wealth of experience in dental implants and oral surgeries.

In March, Dentsply Sirona launched its latest implant solution, the DS OmniTaper Implant System®, at the Academy of Osseointegration (AO) Annual Meeting.

In this interview with DPR, Susino talks about the new implant system, the company as a whole, and about 

Dentsply Sirona’s Implant Solutions World Summit 2023

 to take place this summer in Athens, Greece. [link to DPR release on this event]

 Tell us about the company’s implant business strategy for the US, as well as its focus for oral health as a whole.

Regarding oral health as a whole, I can say our vision is to transform dentistry to improve oral health globally. It’s what moves us, what makes us want to do better, and to support dental professionals in delivering their best for every patient they treat. This goal is especially relevant as awareness grows on the impact good oral health has in relation to overall systemic health.

Tony Susino, Group Vice President of Global Implant Solutions at Dentsply Sirona.

Our aim is to continuously assess the implant portfolio in the pursuit of providing a clinically relevant assortment. OmniTaper EV is an excellent example of this: it combines clinically proven features with modern techniques (drilling protocols, prosthetics) and our investment in long-term science and clinical studies is a key differentiator in the premium market segment.

Implant therapy has become the gold standard of care and more insurance providers are covering it. Ten to 15 years ago, the biggest competition to implant dentistry was crown and bridge dentistry. Now, implant dentistry is increasingly a preferred and accessible option so reasons to delay treatment are lessening.

 What have been some of the challenges and success stories so far?

 Well, from a portfolio perspective, it can sometimes be a challenge to integrate various brands and tell a harmonious story. So, a key focus area in the last year has been to ensure that we are creating brand clarity with our product offering and providing value to our customers with the products that we have. The launch of our EV Implant Family has gone a long way in creating that clarity.

We've brought in some top-level talent into the implant organization to lead our various implant businesses. Knowledge of our industry, how our customers behave and how they want to be treated is key. We want to make sure we delight our customers, so we are completely focused on practices and the patients that they serve. The leaders we have brought in are already making a difference. Bill Benjaminsen is VP Product and Brand Marketing, who I've worked with in the past at Straumann and Neodent, and David Josza is VP of Market Development. He was the past president of Biomet3i.

These are people with strong relationships in the industry, highly competent, with track records of success. That has also helped us to build credibility along the way.

Other C-Suite additions like Andreas Frank, EVP and Chief Business Officer, and Simon Campion, our new CEO, bring in a wide industry experience. They're leading the charge in narrowing the focus at an enterprise level to win in a few critical areas and aligning the organization towards success. It has already made a big difference just even in the disposition of our organization.

 Now that the DS OmniTaper Implant System has been introduced, can you talk about the company’s extensive portfolio of implant solutions?

 The current Dentsply Sirona implants portfolio is the result of various acquisitions of very strong products and businesses over the years, such as Ankylos, MIS and Astra Tech, all of which have strengthened our positioning in the field and widened the range of options that we can offer dental professionals. When presented in a harmonized way and with a clear story, the possibilities of Dentsply Sirona’s extensive implant solutions, in partnership with our digitally connected solutions, are a key competitive advantage.

We have also complemented our inorganic growth strategy with very successful new product developments. Based on the consultations led by our R&D team with customers and the industry at large, we recognized that there were some opportunities to develop additional implants products, which has led to the launches of, for example, the DS PrimeTaper Implant. Our customers want to feel secure with implants that are primarily stable and PrimeTaper has had excellent results demonstrating primary stability, while also preserving bone. There is a 

that states that DS PrimeTaper has equal primary stability with lower torque values. PrimeTaper EV thread design contributes to a linear increase in insertion torque with increasing bone density and can achieve high primary stability compared to aggressive threaded implant designs known to attain the highest insertion torque. It also shows less compression forces, which is healthier for bone. If you can feel primary stability and reduce the risk of pressure necrosis like PrimeTaper does, it's a favorable result. We're so confident in our DS PrimeTaper Implant that we made an investment in launching the Implant Registry in the United States. There are currently 576 clinics participating in the Registry and documenting their PrimeTaper implant cases. The objective is to continue compiling cases and then publish the results.

 Can you explain how the EV Implant Family covers so many needs for clinicians involved with dental implants?

The EV Implant Family consists of the DS OmniTaper Implant System along with the Astra Tech Implant System and the DS PrimeTaper Implant System. The AstraTech Implant system has had great success for many years and features an elegant drilling sequence that’s clinically proven. All 3 systems deliver biologically driven implant designs for natural esthetics and lasting bone care, they have 1 connection for restorative clarity, and are optimized for a seamless fit with digital dentistry workflows. There have been many published reports indicating that the OsseoSpeed® implant surface stimulates early bone healing and speeds up the healing process, for increased bone formation and stronger bone-to-implant bonding.

So, regardless of whether you pick a parallel implant, a fully tapered implant or a traditional one like the OmniTaper EV, all of them have the OsseoSpeed surface which is clinically proven to have strong bone to implant contact, and they all have the same EV connection. The EV connection is our winning proposition. It provides access to the harmonized and comprehensive EV prosthetic portfolio for restorative flexibility and immediate chairside solutions. Dentsply Sirona really transcends the implant and we're the only company that is aligned along the value chain. Everything you need for an implant placement, from the initial patient consultation and intraoral scanning to the final crown that's placed—Dentsply Sirona is the only company that actually owns and manufactures all those parts and pieces allowing for a seamless workflow experience.

Additionally, with different styles of implants, there are invariably different drilling protocols and there are different clinician preferences. What I like about the OmniTaper EV implant is that the drilling protocol is intuitive. It's straightforward, and clinicians starting to place implants are beginning with straightforward cases. If they want a predictable drilling protocol, this implant and this surgical protocol could be appealing to them. Regardless of which one you choose, based on your preference, based on feeling, based on the bone, the connection is always the same. That means for the restoration you don't need 3 different inventories of abutments.

 Dentsply Sirona is known as the pioneer of CAD/CAM, and also a leader in software and imaging technology. As digital dentistry continues to evolve, tell us how the company is playing a role in digital workflows and in education.

 Standardized and digital workflows have the great advantage in that they work intuitively over and over again. It makes a difference if you don't have to rethink procedures every time. The results become more predictable and easier to plan. This also includes prosthetics, which are produced in the dental laboratory.In other words: workflows, driven by digital technology, can result in higher accuracy, repeatability of processes, and time savings. The 

EV Implant Family lives into this concept as they can all easily integrate into a digitally driven workflow through the EV connection. This is beneficial for both the experienced implant practitioner, as well as the clinician who is just embarking on their implant path.

Our vision is to strengthen our role as a digital solutions provider, and to enhance our already loyal and solid customer base by providing a unique customer experience, focusing on education, innovation and of course, supporting them in their practice growth.

Talking about education: Peer-to-peer education is a key differentiator in the market, and we are doing many things to drive this forward. On a local level we do this with local study clubs and local luncheons.On a global level, we are very excited about our upcoming Implant Solutions World Summit, which will take place in Athens from June 8-10. It is an event that will combine science and clinical education with networking and entertainment. There are 3 reasons implant dentistry professionals should not miss this event. First, the truly challenging scientific program. In addition to master classes, there will be presentations by renowned speakers who will talk about their own research and experiences. Second, we will be dealing with forward-looking topics and technologies that will help clinicians in their daily work. Third, we will meet face-to-face again and exchange ideas on the best treatment approaches. And on top of all that, the venue is really appealing. We’ll meet at the home of civilization, the place where science began, and have a chance to network and socialize.

Dentsply Sirona Global VP for Implants Tony Susino talks with DPR about the company’s newest dental implants, leadership team members, the importance of education, and more.


Comprehensive Implant Solutions that Focus on Both the Clinician and the Patient

Having worked with T2 Consulting, Inc in the past, Kari Kraemer welcomed the chance to implement the company’s new CloudPrep platform into the 2-location, 6-doctor dental practice where she has worked as the practice administrator for more than 25 years.

T2 Consulting’s CEO and founder Ted Takahashi reached out to Kraemer a few months ago to inform her of the introduction of CloudPrep and what the service has to offer to practices. CloudPrep is a website designed to assist dental practices preparing for the cloud.

Kari Kraemer
Practice Adminstrator,
Lakes Dental Care

“We worked with Ted several years ago when we decided to add computers to the operatories. His attention to detail and knowledge saved us a lot of time, money, and frustrations,” says Kraemer, a licensed dental assistant with a bachelor’s degree in business administration. “Ted reached out to me about CloudPrep, and his timing was great [because] I was in the process of starting to look at comparing what we are currently paying for computer, IT [information technology], and patient communication subscription costs to other options. His very detailed plan allowed me to think about things I had not considered prior to seeing them laid out like he has.”

Kraemer, who works at Lakes Dental Care in Baxter, Minnesota, says using T2 Consulting’s shopping list spreadsheet allowed her to take a good inventory of everything the practices are currently using and what it is costing, in addition to offering ideas of items they might want to look into adding.

T2 Consulting’s CloudPrep is a website designed to assist dental practices preparing for the cloud. CloudPrep has 3 primary goals: constructing a successful technology blueprint, eliminating sales pressure and bias in the learning space, and ensuring benefits offset costs through helpful, insightful content. To ensure these 3 goals are met, the platform has what is called the CloudPrep 6-point plan, which is designed to be a step-by-step guide to properly prepare dental practices and employees to be fully ready for the cloud. It also includes a bid-check spreadsheet for cost comparisons, idea galleries, e-forms, and more, according to the company. Now available, CloudPrep can be obtained through a monthly or yearly subscription. T2 Consulting is also offering a free online calculator to estimate cost savings for potential users. For a limited time, the CloudPrep yearly subscription includes (2) one-on-one consultations for added support.

“From there I was able to take that information and use his bid spreadsheet and have such an organized way to look at the individual vendor bids, the financial impact on the practice, and ultimately be able to make a clear and educated decision on the best decision for the practice,” she says. “With his spreadsheets showing how much those expenses cost over the course of 5 years, it was eye-opening to have it all in one spot and see that actual cost to the practice and then the potential savings with making some changes.”

The first benefit was being able to see the practices’ expenses—for all the various items—in one spot, Kraemer says. The second was being able to get bids from vendors and confidently be able to compare apples to apples. A third benefit was having very detailed, well-designed spreadsheets already created at her fingertips to utilize.

Using CloudPrep has increased efficiency and improved workflows at Lakes Dental Care.

“Patient communication has really changed over the years. As systems became available, nobody seemed to be able to do everything you needed in one system,” Kraemer explains. “You would need one vendor for texting patients, another for emailing, one for recall, etc. All of these subscriptions are not only very expensive but also a lot to keep track of.”

Now companies are really becoming more comprehensive with all they offer, according to Kraemer. Because the prep work was completed with CloudPrep, she was able to look at all the costs and the combined total in one spot. Also, she likes being able to compare features and prices with others to make a more educated decision on what to do. 

“Knowledge is priceless! Using the 6-step process can really give you the knowledge needed to make good decisions in areas that are so critical to the efficiency of the practice,” Kraemer adds. “Technology is ever changing and is a big investment and ongoing expense to the practice. Utilizing the years of experience and expertise that Ted brings will not only save you a lot of time and headaches, but also money.”

CloudPrep’s 6-point plan is designed to be a step-by-step guide to properly prepare dental practices and employees to be fully ready for the cloud.

Closer Look: How a New Website Platform Is Helping Dental Practices Use the Cloud’s Potential

Some features may not be available in all areas.

Caries Assist, an FDA-cleared artificial intelligence (AI)-powered dental caries detection and outlining software

Chairside in every practice to assist with caries detection and communication with dental patients.

This technology is applied in real-time to periapical radiographs and bitewing radiographs for patients 12 years and older with permanent teeth.

Overjet Caries Assist enables clinicians to detect caries, reduce the rate of false negatives (missed lesions), and enhance patient education through visualization. In an analysis of 7,000 tooth surfaces, Overjet Caries Assist helped dentists detect 32% more tooth surfaces containing caries, according to an Overjet study.

Overjet enables dentists to be more effective and efficient by providing an AI-generated analysis of dental radiographs to help with their clinical decision-making and case presentation. Overjet is the only dental AI company that is FDA-cleared to detect and outline decay, detect calculus, and quantify bone level measurements. The AI findings provide instant visualizations, which improve patient communication, elevate patient understanding of their oral health conditions, and support better patient outcomes.

Overjet’s AI-powered dental caries detection and outlining technology is a diagnostic adjunct that helps dentists save time, diagnose consistently, and increase patient understanding through powerful visualizations.

5Ws* Caries Assist

For years, patients associated root canals with 2 very negative things. One, the pain was going to be great. And two, years ago the end results could be unpredictable, so some patients have choosen to skip the endodontic treatment rather than risk failure and possibly suffer plenty of pain with no gain.

But those days are behind us. Advancements in technology, materials, and techniques have changed endodontic care dramatically. Diagnostic tools like CBCT and surgical microscopes have had a tremendous impact on improving care for patients and making the lives of clinicians a whole lot better.

These tools provide much more information than was previously available, enabling today’s clinicians to tackle endodontic cases with extensive knowledge and precise details. But another factor is knowing when certain cases just can’t be successfully performed. These diagnostic developments—especially CBCT—can guide clinicians away from taking on a case that’s most likely going to fail. The result is better treatment for the patients and fewer poor outcomes.

“Root canals get such a bad rap. Patients often report, ‘Oh, nothing [endodontic] works on me.’ I think this is further perpetuated by word of mouth [from] friends and family members, and it really bums me out because the actuality of what I see in my practice is that some patients present with a failing root canal often because they were looking for the fastest or lowest-cost root canal the first time around,” says Judy McIntyre, DMD, MS, an endodontist at Hopkinton Endodontics outside Boston, Massachusetts. “Unfortunately, doing quality work—in any field—is an investment.”

Dr McIntyre has long since invested in CBCT and surgical microscopes and uses both technologies all the time in her practice.

“I have both in my office, and, thankfully, I was trained with both,” she says. “I employ both on a daily basis, on almost every patient. My goal is to save teeth. But that’s not always possible. Diagnosis and treatment planning [are] seeing what exists and then planning what is actually possible and has the best/good prognosis, and going from there.

“Sometimes, sadly, it may mean turning patients toward an implant or extraction. I’m not just talking about unideal retreatments because the roots are too thin or there’s resorption or a large post,” Dr McIntyre adds. “I’m even thinking about some virgin teeth [that are] unrestorable due to cracks or resorption, etc.”

Brooke Blicher, DMD, an endodontist in private practice in Vermont and a member of the 

® Editorial Advisory Board, can’t say enough good things about the value of a cone beam unit in dentistry. The information provided from CBCT scans allows her practice to perform better endodontic care with increased confidence brought on by improved diagnostics.

“In endo, the answer [to diagnostics and treatment planning] is really simple; it’s CBCTs,” says Dr Blicher, who also teaches at Harvard School of Dental Medicine and Tufts University School of Dental Medicine in Boston, Massachusetts. “We bought a machine in 2013. Up until that point we sent a few patients out here and there because we know that CBCTs pick pathology up earlier so we can see infections and inflammation in an earlier stage as compared to traditional, periapical films. We’d also use it when we were planning for surgery and wanted to know if there was important anatomy close by—were we close to the sinus or the mandibular nerve. Eventually we sent enough out that we could justify buying a machine in our office.”

Once CBCT was in her office, Dr Blicher and her staff were amazed at how much information they consistently got and how often these new details were dramatically changing the diagnosis and treatment planning for the patients.

“Initially, we were fairly limited in our use of the CBCT,” Dr Blicher explains. “But as we used the machine more and more, we found an explosion in the amount of incidental findings. As a result, we now take an image on almost every diagnostic patient because of the number of cases where we find things that we don’t expect that dramatically change our diagnosis and our treatment plan.

“The classic example is resorption. When present, it can dramatically change our treatment planning. CBCT has revolutionized the accuracy of our diagnosis, the selective nature of our treated cases. Ultimately, our success rates are going to be better because we’re not getting into cases that aren’t going to work.”

Dr McIntyre says using CBCT, such as with the DEXIS Orthopantomograph™ OP 3D™, provides her with essential information—the additional details allow her to not only provide better care to her patients, but also to know when not to take on a case that’s likely to fail.

This complete 3D x-ray imaging platform from DEXIS provides easy-to-use features throughout the entire workflow. With its versatile imaging programs, intuitive user interface, and different configurations, the DEXIS OP 3D offers optimal imaging to any practice.

Her confidence increases when using CBCT and a microscope for diagnosis and for treatment planning. With versatile imaging programs, an intuitive user interface, and different configurations, the DEXIS OP 3D is designed to offer imaging excellence to any practice to support all clinician needs and help focus on delivering better patient care.

A number of companies have made big strides in CBCT units recently, including Carestream, Dentsply Sirona, J. Morita, Planmeca, and PreXion.

J. Morita developed one of the first 3D units in the dental sector worldwide, the 3D Accuitomo, which was introduced in 2001 at the International Dental Show. Improved clarity and dose reduction for improved patient protection are at the core of the company’s research and development. J. Morita’s x-ray units show even the most delicate structures, allowing for the evaluation of root fractures, fourth canals, apical lesions, resorption, and much more. Today, its fourth-generation unit is the 3D Accuitomo 170, while the company’s newest unit is the Veraview X800. Additionally, J. Morita manufactures Root ZX II, a popular apex locator.

“My focus and emphasis is high-quality endodontics. My goal is to perform the endodontic treatment correctly so that the patient will have complete restorative success and a pain-free tooth for their lifetime,” says Dr McIntyre, adding that this is why she has invested in CBCT and surgical microscopes.

Recently, the 3D technology enabled her to explain to a friend that performing endodontic treatment in their particular case was not the best option under the present conditions.

“Last week I told a friend, ‘Your tooth is actually kissing the adjacent tooth. So, if I go into it, I potentially could destroy the perfect tooth behind the one in question.’ Imagine [if I performed the root canal and it didn’t work out]? Or, if then, the patient became symptomatic on the adjacent tooth,” Dr McIntyre says. “These scenarios are why I rely so heavily on my cone beam—it is truly changing my treatment planning.

“In this example, because of what is visualized in 3D [vs 2D and cannot be appreciated fully], we realize that we must think beyond my specialty: Let’s discuss orthodontically moving the tooth [that’s] behind away from the tooth in question/adjacent so we don’t destroy both,” Dr McIntyre continues. “This is just 1 example, but I see cases like this weekly where I am so grateful for the 3D information. Explaining it to the patients when I review scans with them—‘You [the patient] are 3D, so of course it makes the most sense to have this information,’ they’re really blown away by it and really get it when they see the images/scan. I also explain that it provides me with the information to guide me where to go and to get everything right. I have no excuses because of this essential tool. The microscope is similarly valuable, as it illuminates things clearly so that I can do my best to clean inside the tooth.”

Dr Blicher adds that the improved diagnostics provided by CBCT changes the way clinicians plan treatment and steers them away from cases where an implant or extraction is a better option than endodontics.

“We used to do what we called exploratory treatment, where we’d say I’m not sure what’s happening, but let’s try it. Let’s see what happens in here,” Dr Blicher says. “Now, because of CBCT, we’re not doing exploratory treatment because we know ahead of time about a fracture or resorption where the tooth has to come out instead.”

She notes that a published study had clinicians look at periapical images and make a diagnosis and create a treatment plan based on those images. When these same clinicians were given CBCT images for the same cases, their diagnosis and treatment plans changed 60% of the time.

 That “totally applies” in her practice, so the very first thing she does when walking into a patient room is look at her cone beam scans.

“I don’t even want to do an exam before I’ve seen that image,” Dr Blicher says. “If you don’t have that information and it’s out there, you’re missing something.”

Further, CBCT imaging allows clinicians to be more efficient with treatment based on its abilities to identify root anatomy. “If I’m doing the treatment, I have my road map. I tell my patients, this is my GPS,” Dr Blicher says. “It allows me to be extremely efficient with treatment itself.”

The information provided to endodontists from the use of cone beam can really have an impact on both the treatment and on case selections.

“Reception-wise, we can inform retreatment patients,” Dr McIntyre says. “We want to figure out why it failed the first time—there may be a missed canal or a fracture. We explain that they may be able to save their money and put it elsewhere if [redoing the] root canal is not possible. But, with 2D only, that’s not discernible and can end up wasting patients’ resources. That’s really the priceless value in having that information. And when I perform a retreatment, I can say confidently that I did my best. I cleaned everything out. I didn’t leave anything behind.”

Dr McIntyre has used DEXIS CBCT since opening Hopkinton Endodontics in 2016. She shares her cases on Instagram and has been surprised by the compliments—not just from the dental community, but from other endodontists. She’s proud that her colleagues find her images clear and are impressed by DEXIS’ clarity. “They can recognize that DEXIS’ technology is better than what they may be viewing,” she says. “I get many compliments from peers, and that says a lot. I’m honored.”

Patient Communication and Case Acceptance

Clinicians not only now have access to more information and better scans to perform endodontic care, but they can show these detailed scans to patients to educate them and to illustrate just what is going on with their teeth.

For Rebekah Lucier Pryles, DMD, who practices with Dr Blicher in Vermont, having the information provided by CBCT scans is a big deal for both the clinicians and the patients ahead of treatment planning and performing care.

“Cone beams have really caused a huge paradigm shift in endodontic diagnosis and treatment planning,” says Dr Pryles, who, together with Dr Blicher, cofounded Pulp Nonfiction Endodontics, a continuing education collaborative. “When we’re treatment planning for our patients with this technology, we’re not getting into cases where there are fractures or that have other comorbid conditions that could lead to failure. We know so much more from the beginning with a cone beam that we’re saving our patients a lot of time and heartache and treatment time as well, and that’s been wonderful.”

Once you take advantage of what CBCT has to offer, it’s difficult to practice without it on any cases, Drs Pryles and Blicher state.

CBCT systems, such as the 3D Accuitomo 170 from J. Morita, provide details not previously available to clinicians, which is having a big impact on diagnosis and treatment planning today.

“I review each scan with every patient,” Dr McIntyre explains. “Some people are referred to me [who] don’t have any pain. So, this can be tricky. When I show them, ‘Look at this, this is your infection,’ [it often makes an impact]. It’s been eye-opening. [Dentists have] been pointing to x-rays with patients for almost 20 years, [but] I don’t think patients realize what we’ve been trying to show them on 2D films—I can’t help but wonder if they’ve kindly been nodding in the past. But with CBCT imaging, clinicians can show their patients exactly what is going on inside their mouths and with their root canals, when present.

“I’ve noticed that some patients really are impacted when I share their volume rendering and show them different views; they’re like, ‘Oh, that totally looks like me, and l get it.’ When I show them their periapical lucency, they can appreciate it much better than on 2D and, again, they’re really impacted; they see the infection in their skull/jawbone,” says Dr McIntyre. “Back to my friend, I could show the teeth touching and explain why I’m hesitant to proceed. The volume rendering really clearly points out what I’m trying to convey to them in 3D—they get it.”

As advances in care continue to evolve, patients and clinicians reap the benefits. Patients are getting better, less painful endodontic treatments, clinicians are more confident and successful, and the success stories are rewarding.

“Over the past 10-plus years, cone beam CT has skyrocketed in popularity in the dental industry. It has revolutionized how dentists treatment plan, diagnose, and acquire patient data,” says Ryan M. Walsh, DDS, MS, a member of Catapult Education. “This point-of-service imaging is comparable with imaging modalities that used to be limited to hospitals and imaging centers. With the prices for these machines dropping as the technology becomes more affordable, CBCTs are becoming an integral part of many [clinicians’] everyday practice.”

Dr Walsh, a diplomate of the American Board of Endodontics and endodontist/owner of Advanced Endodontics of Texas, also points out how safe today’s CBCT units are. With the low-dose radiation, often equivalent to a few hours spent in the sunlight or on a short regional flight within the US, he is now able to acquire high-resolution imaging.

“The days of digging around to find an MB2 are gone, and the new frontier of pretreatment CBCT to identify canal anatomy is here,” he says. “The CBCTs of today are critical for diagnosing cracks and fractures and other common pathologies. Manufacturers like Carestream, J. Morita, and PreXion offer CBCT units that also have a variety of field of view [FOV] choices. As an endodontist, I can use the 5 x 5-cm FOV to home in on a particular tooth of interest, but I can also expand to 8 x 8-cm to scan multiple teeth for a detailed and extensive exam without the need to stitch images together. One machine can truly serve all of my needs without needing to compromise.

“Outside the endodontic perspective and locating individual canals, clinicians are able to more accurately implant plan,” Dr Walsh adds. “It’s now possible to utilize integrated software to plan an implant with the patient in the chair. I can send a copy of the scan—either digitally or via CD/thumb drive—to a referring [general practitioner] or specialist to aid the patient in planning their next restoration,” he says. “Ten years ago, this just wasn’t possible. That same CBCT I initially made to aid endodontic diagnosis can be used for implant planning and can be translated, through 3D printing software, to make a surgical guide…all from the same low-dose scan. This type of technological revolution is amazing and only continues to improve.”

Dr McIntyre is equally wowed by the wealth of information CBCT can provide. “In the past, some patients might return to the dentist or endodontist reporting that a root canal may still be bothering them, or a tooth without any endodontic treatment. Historically, we’re looking at an x-ray, or you’re looking under the microscope, and you just don’t know and/or cannot see anything that could possibly still be bothersome,” she says. “You tell the patient, ‘Sorry, I don’t see anything.’ But with cone beam, I can factually share with them, this is all of you. It’s the only version. Other than bacteria or hairline fractures, you’re confidently sharing with them that something is there or is not. It provides more confidence.”

Dr Blicher is glad she practices in a time where CBCT, surgical microscopes, advanced rotary instrumentation, and other developments make providing root canals far less scary and far more predictable than in the past.

“The cone beam is huge for treatment planning as far as case selection goes. I love that I practice in a time and in a community where I have great surgeons doing really nice implant work, as well. We don’t have to get into heroics—cases where you know this isn’t going to work. It’s nice to know that there’s other options out there besides endodontics,” she says.

Dr Pryles is glad that all of the newer technologies available are helping change the way many patients feel about the “dreaded” root canal. Her practice has used Carestream CBCT for years now and loves the resolution of the scans.

“I would also argue that most of the fun of being an endodontist is getting to change patients’ misperceptions about endodontics,” she adds. “With the technology, and with the anesthetics that we have these days, the care can be painless and efficient, and providers are really kind. So it’s not unusual for us every day in the office to hear patients say what I worked on has been terrible previously, but that this was one of the better dental experiences they’ve ever had. That’s really gratifying to hear. It was so often maligned.”

Clinicians today can use CBCT, surgical microscopes, and more to provide predictable endodontic care, as well as plan treatment and communicate better with their patients.