Dental Products Report explores the technologies dental professionals need to know in the coming year.
Back in the day, a trip to the dentist started with a friendly check-in with the receptionist (or even less personally by signing in on a check-in sheet), soon to be taken back to the operatory where the dental hygienist-paper file in hand-would look around the patient’s mouth with a hand mirror, possibly take some periapical X-rays, and pop out of the room to let the doctor know the patient was ready.
Upon arrival, the doctor would check the patient file and start work in the patient’s mouth, possibly poking around with an explorer looking for caries or taking an impression with polyvinyl siloxane. Worst-case scenario: A dreaded shot of anesthetic was injected into the gums and work was begun. If endodontics were needed, a series of tiny files were necessary to complete the work properly.
In 2017, many of those elements may still be present in the dental practice, but now digital check-in systems, electronic patient files, and digital X-rays usually welcome patients. Caries can be more reliably found with specialized equipment and, if work is needed, doctors supplant the polyvinyl siloxane with an intraoral scan. Anesthetic shots are eased with pain-free injections.
We talked to the Dental Products Report advisory board about the 17 pieces of technology-some cutting-edge, some that might already be familiar-that doctors should consider for their practices in 2017. Here’s what they told us.
Technology can benefit the practice the moment patients walk through the front door.
Upon arriving at the practice, a patient with an appointment can check-in at a kiosk or on a tablet, alerting staff that they have arrived and are ready to be seen. Automated patient check-in streamlines the process, presenting the patient with the forms that he or she needs to fill out. The system can be used for new patients that have to create a new file along with their complaints and dental history. The patient can also use the kiosk to enter any information, including updating their medical history, entering contact information or updating insurance information. The data goes directly into the digital patient record and staff doesn’t waste time performing data entry.
“It just streamlines things,” says John Flucke, DDS, Chief Dental Editor and Technology Editor for Dental Products Report. “It makes it easier for patients to check in. They can come in, sit down, check in on a computer or tablet and run through your forms, whether it’s a new patient that has to go through all of your forms or somebody that we’re just updating a health history.”
Digital caries detection
It would seem that something as basic as caries detection would be fairly straightforward and easy to accomplish, especially in 2017. But that’s not actually the case. Because fluoride is so widely used, caries detection is actually more difficult. The traditional methods-the use of explorers and radiographs-may not catch caries in their early stages.
However, a number of companies offer digital caries detection systems. Most of these devices detect caries through the use of fluorescence. That is, light emitted into a tooth is measured and the resulting measurement can determine whether caries is present and to what degree.
Other systems use electrical signals to determine the presence of caries.
“There are several of those devices on the market now,” Dr. Flucke says. “All of them work, it just kind of depends on which one is in your price range, but there’re lots of those on the market.”
Intraoral cameras are not used as often as they could be, and it is an easy way to help show patients what is going on with their particular cases.
“It’s the ability to show the patient what’s going on in their mouth,” Jason Watts, DMD, a general dentist in Cape Coral, Fla. says. “You can take pictures of individual teeth for multiple teeth. It’s like a little wand.”
In addition to the ability to show patients what the doctor sees, there are other benefits to intraoral cameras.
“It’s not a new technology by any means, but it’s underutilized by a lot of dentists, especially in treatment planning situations,” adds Kris Mendoza, DDS, a dental anesthesiology resident at UCLA. “Even for dentists who have digital radiographs, which are great to help diagnose caries and other pathological processes, having a good intraoral camera and knowing how to use it can really help display to your patients what it is that you’re looking at. It can really make it realistic for them. Sometimes they can’t see what you’re seeing in the mouth.”
While an intraoral camera is specifically made for dental work, even a conventional camera can be useful.
“Photographs are excellent for patient education, insurance claims and laboratory communication,” says Leah Capozzi, DDS, a general dentist in Buffalo, N.Y. “I use a DSLR camera and an intraoral camera. Most patients don’t know what decayed occlusal grooves or broken amalgam fillings look like, so I love taking the images to educate them and gain trust and treatment acceptance. Those images can also be used if you need to send claims to an insurance company. I also email cosmetic photographs to the lab for custom shade matching.”
CAD/CAM is seen largely as the future of dental restorations, and the CAD/CAM workflow can begin at the doctor’s office with digital impressions, captured with an intraoral scanner.
“The future of dentistry is digital, and the future is now,” says David Rice, DDS, a general dentist in East Amherst, N.Y. “Some practices win with simple scanning. That is, a digital version replaces your traditional impressions and all else stays the same. If, however, you’re seeking the ultimate in results, team efficiency and patient engagement, today’s complete CAD/CAM systems, like CEREC by Dentsply Sirona, are an absolute home run.”
While most digital impressions are used in cooperation with a lab, there are still duties within the practice.
“[You] can use it for Invisalign,” Dr. Watts says. “You can also use it for diagnosis or scan for shifting in patients’ mouths. Some of them are dual function, where you can show the patient what their teeth are looking like as you’re working. They offer a huge number of functions.”
Where the CAD/CAM process starts with an intraoral scan, it concludes with manufacturing. Conventionally, this is accomplished at the lab, but more and more it can be done within the four walls of the practice.
“It allows you to take an impression, digitally scan the preparation, and then you’re able to build a restoration that day,” Dr. Mendoza says. “Within a few hours you can finish preparing and delivering a crown to a patient. This is very advantageous to those people that don’t want to have a temporary; they don’t want to wait for the crown to come back from the lab. However, it is also very expensive for the dentist to buy the system.”
“CAD/CAM technology can add a cutting-edge ‘Wow’ factor to your practice,” Dr. Capozzi adds. “Patients will appreciate not having impressions made or wearing provisionals, but CAD/CAM can do more than just single units. Scans can be used for patient education and orthodontics. [Systems like] CEREC can be used to make single units, bridges, full-arch rehabilitation, implant planning, surgical guides and implant abutments.”
Because of a milling unit’s price, they aren’t suited for every practice, but circumstances-like a practice’s size or clientele-might put a machine within reach.
“I have seen multiple dentists use it very successfully,” Dr. Mendoza says. “They don’t do every single crown with the CAM machine, but there are many dentists who have switched to mainly using that technology. I think a lot of it depends on the patient population that you’re treating. Because if you have a lot of patients who, maybe, are a little wealthier, a little more demanding and have the money, I think that CAD/CAM could be a great way to go for your office to make it worth your while.”
As useful as milling machines are, they can’t do everything (yet) and it is still necessary to maintain a relationship with a lab.
“You’re going to need to keep a lab for certain crowns, because they’re not indicated for every type of procedure,” Dr. Mendoza says. “But when it’s appropriate, I think it’s a great technology that dentists could utilize in their offices.”
Milling is the most common way to produce chairside restorations, but as the technology-and materials-improve, so will manufacturing methods.
“You can do some type of milling now, and before not too awfully long, we’ll be able to do 3D printing,” Dr. Flucke says. “I think that’s a big deal.”
In order to do quality work, dentists must be able to see what they’re working on. Getting the best view is facilitated with proper magnification, courtesy of loupes.
Dr. Watts was introduced to loupes in dental school and it’s a foreign concept to him when he sees doctors who don’t use them.
“I see people without them, and I just don’t know how they do efficient work without loupes, because I can see things three, four, five times closer than people can just looking through regular glasses,” Dr. Watts says. “My work is that much better.
“To have loupes not only makes your work nicer, but you’re also doing a better service for your patient; you’re giving them a better product,” he continues. “If you’re not using loupes, you’re not doing the best dentistry that you can on your patient.”
Loupes not only help improve what you see, they also prevent you from sitting in awkward, uncomfortable positions-the sorts of positions that can lead to chronic pain.
“They’re not only giving you greater magnification of the patient’s mouth or the tooth that you’re working on, but there’s also the ability for you to keep better ergonomics,” Dr. Watts observes. “So not only is it better for the patient, but it’s also better for the practitioner, because it gives you less risk of health effects, like kyphosis or back or neck issues later in life, because you’re able to sit more upright. It’s a benefit for the dentist as well as the patient.”
Something as simple as having a second monitor in the operatory can help with patient education. The monitor should be positioned where the patient can see it and is used to display case information, including X-rays or any other information that would help explain the patient’s condition or treatment options.
“Any dental office should be able to transfer a photo over from their monitor to a display monitor for their patients to use to look at while they’re in their chair,” Dr. Watts says. “Patients don’t know what I’m talking about. So when I take a photo and show it to them, and I say, ‘How does that look?’ They say, ‘That’s the coolest thing I’ve ever seen. I didn’t know you could do that.’”
Over the past year, Erinne Kennedy, DMD and GPR resident at the VA hospital in Baltimore, has tried different types of lasers, but is particularly impressed with the Laser Assisted New Attachment Procedure (LANAP) protocol performed with the Millennium Dental Technologies’ laser.
LANAP is a protocol where the laser is shone onto the tissue between the gum and teeth to remove diseased tissue. It kills diseased tissue and germs, while leaving healthy tissue unharmed.
Also, the system can help re-grow the tissues and bone lost to gum disease.
“It’s a bargain,” she says. “Not only can you use it for specific periodontal procedures, but you can biostimulate, after an injection, to help with healing time. You can help with coagulation and help with healing after, let’s say, an extraction. You can utilize lasers to help treat cold sores.”
As the LANAP protocol is FDA-approved, she has more confidence in its abilities.
“Being FDA-approved for the LANAP procedure is something that’s really great, because it means that it’s gone through all that stringent research criteria,” she says.
CO2 lasers allow practitioners to perform procedures on both hard and soft tissue. This technology also allows for blood-free and anesthesia-free procedures.
“Have you ever had a patient who liked ‘the drill,’ ‘the needle’ and multiple appointments?” Dr. Rice asks. “Where CAD/CAM and cone beam corner the market on efficiency and effectiveness for larger treatments, the latest CO2 lasers, like Solea [from Convergent Dental], will entirely change your bread-and-butter game. With hard and soft tissue applications, picture the possibilities when you go noiseless, anesthesia-less and you can target decay.”
No one likes to get a needle stuck into his or her gums for a dose of anesthetic. However, that pain can be minimized with a device like the DentalVibe.
“It’s basically a retractor that vibrates the teeth while you’re injecting,” Dr. Kennedy explains. “It helps with the gate control theory of pain, so that allows you to give painless injections to a patient.”
According to the gate control theory, pain signals do not reach the brain as soon as they are generated at the injured site. First, they must go through certain neurological “gates” at the spinal cord level. These gates determine whether or not the pain signals should reach the brain. That is, pain is perceived when the gate gives way to the pain signals. It is less intense-or not noticed at all-when the gate closes for the signals to pass through. This is why people generally find relief when rubbing an area that has been injured.
If the gum is vibrated while an injection is administered, the patient’s mind may not notice the needle jab because the “gates” have closed.
Performing endodontic work can be long and laborious as multiple files are often needed to clean and shape the root canal. However, a new design makes that process faster and easier.
The WaveOne provides a single-file shaping technique, regardless of the length, diameter or curvature of any given canal.
“The WaveOne is a rotary handpiece used for root canals,” Emily Hobart, DMD, a general dentist in Phoenix, Arizona says. “It makes it so that I only have to use two files as opposed to several. Some systems require 10 files. It cuts down the time for a root canal significantly. I learned to use it in dental school and purchased one for myself when I got out into practice.”
Cone beam scanner
Digital radiography is certainly an improvement over periapicals, but some procedures benefit from even more information. Cone beam scanners provide that extra level of detail, showing the intricate detail needed for complex treatments.
“When seeing is believing, adding the third dimension to radiography will take any dental practice to the next level,” Dr. Rice says. “We need to see it to treat it. Think [about] mastering endodontics and never missing a canal. Last but not least, imagine total implant integration, and building perfect harmony from prosthetics to surgery and back.”
“It’s something that, if you’re doing implants, or lots of complicated treatments, it definitely makes it easier,” Dr. Flucke says.
Guided surgery (surgical guides)
Dr. Flucke also recommends being able to make surgical guides.
Implant placement is becoming more and more common and many clinicians are comfortable “freehanding” where holes are drilled on a patient. However, not every doctor is comfortable with that method-and some cases are more complex than others.
When it comes time to perform an implant, doctors can turn to surgical guides-devices that fit over the patient’s gums-to ensure they are drilling in the exact location with the precise angle and depth. These guides are made most often by the lab, but sometimes can be fabricated chairside, based on the scan data.
Surgical guides are not new creations, but advances in manufacturing have made them less costly and more readily accessible to doctors. They used to be difficult and costly to make or order from a lab.
Now, however, thanks to intraoral scanning and 3D printing, they can be made in as little as 40 minutes using milling or 3D printing technologies.
The iCHIROPRO from Swiss manufacturer Bien-Air is an implantology system that couples its electric handpiece to an iPad. The system provides complete, pre-programmed operating sequences from the largest implant manufacturers and the integration of patient files and a number of options for customization.
In addition to helping with implants, it also maintains data from the procedures, in case the data is needed later.
“They have a really neat product,” Dr. Flucke says. “It records all the handpiece data, such as the RPMs of the handpiece, torque, all the little nuances. And it saves all that information in a patient file. What I like about that is if you ever have something go wrong with the surgery, maybe somewhere down the road an implant doesn’t take, and somebody gets upset with you and tries to take you to a court of law, you actually have proof of exactly what you did. I think it’s great for recordkeeping.”
While not necessarily considered a “dental” technology, your computer systems are important technological essentials of your practice and should not be overlooked. There are plenty of areas where IT systems need to be checked and maintained.
“That is really something that a lot of people don’t think about,” Dr. Flucke says. “That includes things like computer security, good backups for your data, doing an evaluation of your digital infrastructure to make sure it’s running correctly, running safely, running antivirus, and so forth.”
Computer systems are complex entities and, for best results, should be handled by a skilled professional.
“Have somebody who is a true IT professional come into your office and do an evaluation on your network security,” Dr. Flucke says. “Make sure things are running correctly and running safely from the standpoint of protecting your data. That’s a really big deal.”
In the age of HIPAA, you must take extra care to ensure that patient information is protected. Failure to do so can result in hefty fines from the government as well as potential, possibly irreparable, damage to your practice’s reputation.
Using a secure email system-especially when transmitting patient information-is a necessity.
“We are going to see more and more HIPAA problems as time goes on,” Dr. Flucke says. “Being able to look at your emails securely and being able to send them securely, that’s going to continue to be a big deal.”
Clear aligners provide a cosmetic dentistry service that is easy for the practice to add and is highly sought after by patients. Typically, invisible aligners are initiated by the practice using either impression materials or an intraoral scanner. Those impressions are sent to the clear aligner manufacturers before being delivered to the patient.
But clear aligners aren’t just for looks.
“Invisalign can provide your practice with far more than just cosmetic solutions for patients,” Dr. Capozzi says. “I discuss occlusal and alignment issues with my patients. Around half those patients tell me no one [has] ever discussed that with them. Most adult patients are not interested in metal braces, but may want to improve their smiles, prevent wear on their teeth, improve oral hygiene or align teeth for more conservative restorations. Implementing Invisalign is a low-cost addition to any dental practice and a great service for patients.”
It may seem like there are endless demands for your practices technology budget, but there are plenty of purchases that can not only help make your day-to-day work better and easier, but can also ensure that your practice keeps up with the times.
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