Articles

by Trish Jones, RDH, BS, Sr. Clinical Trainer, Align Technology, Inc

As dentistry becomes more high tech, it is often the success of an office incorporating digital technology dependent on the dental team’s support. This not only includes the assistants but hygienists as well.

One of the newer technologies that dental offices have seen rapid growth is digital impression taking. What exactly is this? How can the office and patient benefit from it? What all does it entail and how team members use it?

Unique Digital Impression System

There are several digital impression systems on the market, however, only one that is truly powder free and versatile that can be used by Oral Surgeons, Periodontists, General Dentists, and Orthodontists. Think of utilizing a digital impression system as evolution of the digital era in dentistry. Look at the availability of office software to record patient information, or digital radiographs. An office may be considered “old school” if they use a physical appointment book, or use traditional x-rays. This digital evolution is to make patient care better, faster, and more efficient for everyone involved. Gone are the days, where the only option the dentist had was to wait on an x-ray to process to view it. With digital radiographs, an image can be viewed immediately. The same goes for a digital impression. No longer do you have to pour it up, and let it set in order to view it. A digital impression can be viewed in the positive and negative impression views as soon as scans are done while the patient is still in the office!

Versatility

The iTero Digital Scanner by Align Technologies is an open architecture self contained unit that has several attractive features.  What does this mean? The scanner is a mobile computer on a cart with a monitor, built in sealed keyboard, wireless mouse and foot pedal, and a handheld wand. Open architecture meaning any type of restorative material can be selected and your laboratory of choice can be used. It can also be used for implant impressions and as well for taking impressions for Invisalign dental treatment. Therefore it has a wide range of functionality for the appropriate office.

Accuracy

It uses parallel confocal imaging to capture tooth structure and the surrounding tissues. What exactly is parallel confocal imaging? It means accuracy. To put it in more relatable terms, light is emitted from the wand of the scanner to the tooth and the surrounding structures, and it is then reflected back to t

he tip of the wand. Only the light in focus will return thru the wand “eye”. This distance from the tooth structure is captured and an image is formed. Therefore only near exact data is received and it can be viewed immediately. This is known as real time modeling (RTM). The best part about this technology is no powder is needed to coat the teeth.

Efficiency

Not all patients love having traditional impressions taken. Many may complain about the taste, tray size and the time it takes. Also, not to leave out if the patient has a small mouth, tori or a severe gag reflex. With digital scanning, the patient experience is greatly enhanced and the comfort factor is extremely satisfactory. There is a modest learning curve, like with any new technology, on how to successfully capture the scans/images. This is an impression system and you do still have to evaluate the impression before sending to the laboratory or to Invisalign. The best part is the can be reviewed and evaluated while the patient is still present in the dental chair!  Patients tend to embrace this technology, especially the younger generation who may think it is the “norm”, as they have grown up in the era of cell phones, digital video games and high definition television.

Flexibility

The iTero Scanner has many applications and variations that can be customized to every office. The scanner can be used for traditional crown and bridge impressions, as well as capturing data for implants, and full mouth scanning for Invisalign. STL files created from the digital scan can be exported to various programs to assist in creation of implant placement guides utilizing cone beam technology, and other various software applications to help design restoration or implant treatment planning. In case you are wondering, STL stands for Standard Tessellation Language which is a file format that is associated with stereolithography CAD (computer aided design) software.

General dentists who also offer Invisalign to their patients, now have an option to utilize their scanner for taking crown and bridge impressions but also capturing Invisalign impressions to submit to Invisalign to process aligners for patient treatment. They can also use it to capture implant information as well. The iTero is capable of scanning for single units, smile designs, or even full arch impressions.

Specialists have found the scanner quite useful in working with capturing a Scan Body so an abutment and final restoration can be fabricated while facilitating communication with the General Dentist. A Scan Body is like an impression coping that is used in traditional impressions to help transfer the data of the location of the implant in the bone, except it is scanned. Straumann and 3i have Scan Body options at this time with iTero scanner. Implant abutments can be scanned as well.

Orthodontists have embraced the scanner because not only can they take digital records for their patients, they can speed up the Invisalign process as well as the accuracy for the aligners. A scan can be taken and sent in the same day. Usually within 2-3 days, the ClinCheck“ or treatment plan is sent back to the office for approval. Once approved, the aligner can be fabricated. It eliminates the time for poly vinyl siloxane (PVS) to be physically sent, poured and scanned into a digital format before the ClinCheck“ can be created, which can be up to a week.

Benefits

One of the unique features of the scanner is the ability to mill hard models for restorative care. Models can be milled from polyurethane. Polyurethane is a stable material that is resistance to wear, shrinkage and breakage. One model can be made and used by the laboratory to make the restoration so that the die model and solid model are one. What does this mean? Restorations fit with minimal adjustments because the margins are checked on the die, and the die fits into the solid model with tissue intact to check the contacts. It minimizes any errors or discrepancies that may be attributed to using 2 models in the traditional sense: one for the die which the restoration and margin is made from and a 2nd model that replicates all the teeth to check the contact fit the restoration.

Reality

The real benefit is the time saving that is associated with seating appointments. With minimal or no adjustments, the restorations can be bonded and/or cemented in and the happy patient is on their way. Even more so, a happier dentist and team!

Another practical feature of the scanner is it is something the team can do! Assistants and/or hygienists can scan adjacent teeth to the prep and opposing arches. They can also scan for full mouth reference models or Invisalign scans. It can add to the repertoire to the functions of the team, and empower them to take a more proactive approach in patient treatment and promote job satisfaction.

Investment into digital technology can be rewarding as it can be affordable and have a positive impact on the dental practice. Not only enhancing the patient experience, it provides exceptional quality of restorations, reduces remakes, brings new patients into the office, and increases job satisfaction of the team. It definitely takes the office and team to a new high tech level!

Resources

1. Mitchem C. Why digital impressions? Dental Economics. Vol. 102, No. 01: 32,54,88.

2. Jones P. The iTero optical scanner for use with Invisalign: a descriptive review. Penwell Publication Supplement. Feb. 2012.

3. Lowe R. Digital master impression: a clinical reality. Dental Compare. July 2009. Accessed online Mar 15, 2012.

4. Clark K. Reivew of the iTero digital impression system: an assistant’s perspective. Dental Compare. February 2012. Accessed online Mar 15, 2012.

By Ross W. Nash, DDS

For more than twenty five years I have been providing my patients with direct composite resin veneers. I learned from pioneers like Dr. Irwin Smigel, Dr. Paul Belvedere, Dr. Buddy Mopper, Dr. Norman Fiegenbaum, Dr. Ron Goldstien and others. These men showed me early in my career how direct composite could solve many esthetic and cosmetic problems while giving me total control of the end result. I have found that ten years is a reasonable life expectancy for direct veneers and that some have lasted even longer.

There are a number of ad-vantages of direct composite veneers over indirect veneers made in a dental laboratory. Very little preparation is needed for a direct composite resin veneer because composite resin can be made to be very thin in areas due the fact that it is built directly on the tooth structure. Unlike indirect restorations, direct composite placed into undercuts or around corners without removing tooth structure. Margins can be feather edged. Only one appointment is required for the patient to acquire the restoration. Because there is no lab expense, the cost of fabrication is less than with indirect veneers. Due to this cost savings and the need for only one appointment, the fee to the patient can be lower. When it is necessary or desirable to remove composite resin from the tooth, it can be accomplished by using a carbide-finishing bur. The bur removes the composite without damaging the underlying natural tooth structure. If a repair is necessary, composite resin can be roughened with a diamond bur or an intra-oral micro-etcher and cleaned with phosphoric acid. A bonding agent can then be applied and new composite resin can be added and light cured. The new material can be finished and polished and the repair is usually imperceptible and may last for the life of the restoration.

Direct veneers can be used to alter the color of a natural tooth, to close small diastemas and correct the appearance of crowded teeth without orthodontic treatment. They can be used to replace missing tooth structure and to cover defects or malformations. The end result lies in the hands of the operator. Some have more artistic ability than others, but the techniques can be learned.

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by Ray M. Becker, DDS
Private Practice, Ellicott City, Maryland; International Certifying Instructor for Total BioPak and Biometric Technologies Featured Speaker at the 2009 BioRESEARCH Annual Conference

Every dentist recognizes the importance of occlusion for clinical success in dentistry, yet very few take the necessary steps to understand and control its impact objectively in everyday practice. Most dentists are aware of the ongoing debate over whether it is more important to treat just the teeth, the muscles, or the joint as the Rosetta stone of occlusion. However while dentists acknowledge that they need to know more, it is hard to know where to start. This article outlines a strategy to address occlusion using biometrics. Biometrics is the gathering of objective data from the patient’s stomatognathic system. Biometrics is used widely throughout all fields of medicine. The term refers to the gathering of recordable, measurable, and reproducible data from the patient. Blood pressure, cholesterol levels, and blood chemistry are only a few examples of recordable biometric data that physicians routinely gather to evaluate, diagnose, and treat patients. The significance of being able to record data for analysis, comparison, and archiving cannot be overstated. This is what elevates occlusal analysis to a true science as compared with subjective analytical methods.

Generating recordable data is important, and recordable, objective data points cannot be obtained with articulating paper. Historically, articulating paper has been used as the sole instrument for gathering data from the patient’s occlusion. However, it is impossible to use articulating paper to obtain specific defined data to measure, archive, compare, and study occlusion. This fact alone prevents research to obtain parameters to analyze, study, and therefore, standardize the use of articulating paper. In contrast, using biometrics in dentistry does provide objective data that has been studied, researched, and evaluated for more than 40 years. Research has defined specific pathologies related to the objective data obtained from biometrics. Therefore, a clear and objective understanding of the interrelationships that exist with the teeth, muscles, and joints of the patient is now possible with a high degree of accuracy. This data and its accuracy provide practitioners with the ability to evaluate, diagnose, and treat occlusion as never before. Read more

For over 75 years, and into the third generation, the Shafer family has served the dental industry with commitment, professionalism and passion. Mr. Vernon Shafer, Sr. began his career in the dental laboratory field in the 1930’s. During World War 2, he served as the senior dental technician, managing the central lab for the allies in London. Vernon Sr. was involved with the Mobile Dental Units; vans outfitted with a dental chair and staffed by a dentist and technician. These units were sent to the front lines in Europe to replace the missing, or damaged, dentures of the soldiers engaged in the fighting. After the war, Vernon Sr. returned home to continue his career and open his first lab. Vernon Sr. was the first dental technician in the state of Virginia to work with cast gold for crowns and quickly became known as an expert in the emerging field of “crown and bridge.”

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By Shannon Brinker, CDA CDD

The economy has most people, regardless of socioeconomic status, looking for ways to cut back or have more self-control on discretionary spending. We’re all faced with tough decisions — what to buy, what to put off, what to pass up. Wants suddenly give way to necessities. Money that might have been saved for a more esthetic smile, restoring a fractured tooth, or eliminating tooth pain might now be used to pay the utilities or phone bill.

As part of a progressive practice that offers comprehensive care, we are seeing more often that the current patient focus has shifted from what was once cosmetic and elective to what is now basic and essential. But despite a continuing dismal economic forecast, we are using inn ovation and technology, particularly with the E4D Dentist System (Figure 1), to overcome many of our patients’ economic concerns and continue to provide the oral health care that they not only need but also want. As both an empathetic practitioner and a small-business owner, my clinician has made the conscious decision to evolve his practice into the digital age because, especially in today’s economy, each patient experience becomes critical for continued success. In dentistry, time is money — for the patient, the team, and the clinician. Read more

by Elizabeth Nies, RDH, EA, AS

My slow speed hand piece stopped working one day. Not only did it stop working the metal connection that attached the hand piece to my unit was fused together. When we wanted to remove the hand piece to oil it or put on a different angle we had to use two wrenches to pry it apart. Needless to say it did not get oiled as regularly as it should which may have contributed to the seizing I experienced that day. Be that as it may, while looking through a hygiene magazine I came across an ad for the ZEN cordless polisher. I compared the price of a corded handpiece like the one I had been using and the ZEN – they cost just about the same. I immediately called the company to find out if they had a demo I could try. The answer was no, but you can try it risk free for 60 days and if you don’t like it you can return it for a full refund. Worth repeating – BUT you can try it risk free for 60 days and if you don’t like it you can return it for a full refund.

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by Dr. Dennis M. Abbott

Spurred on by recent dental and medical research, many dental professionals have taken a closer look at saliva and its role in oral health. Studies have shown that low levels of salivary antioxidants and high levels of oxidative stress have been linked to maladies ranging from halitosis to oral cancer. This new awareness about salivary antioxidants is making an impact in clinical practice.

The primary antioxidants in saliva include uric acid, albumin, ascorbic acid, glutathione and antioxidant enzymes. Because of their ability to neutralize free radicals—reactive oxygen species (ROS)—and counteract oxidative stress, salivary antioxidants are critical to the body’s defense system. Some of the antioxidant compounds in saliva have shown anti-microbial properties, and are an important component of salivary protection against infection. Read more

by Phillip Kemp, D.D.S.

With Christmas behind us, I know there are a lot of people who are holding those new cameras ready to capture images in the dental world and in their personal life. Though you may think it is different, capturing dental images is not any more difficult than capturing images in life.  The most important thing is to know your equipment and how it works. Understanding just the basics of your DSLR camera will put you light years ahead of most people when it comes to the type of images they capture.

I want to share with you a basic intro to DSLR photography. If you have a DSLR camera and are nervous to take it out of auto mode, a quick tutorial is all you need to have the confidence to have control over you images. You may have heard words like Aperture, ISO, and Shutter Speed and wondered just how on earth they come together to give you a better photo. Once you understand what some people call the “Exposure Triangle” there is no photography situation you can’t handle.  This brief introduction on what each part of the exposure triangle means and how they affect your photos can make the difference between your images turning out too bright, too dark, too blurry or being AMAZING.  This guide will show you how to get the most out of your DSLR camera and give you confidence to take it out of auto mode in no time! (Figure 1) Read more

Dr. Becker is a life long resident of Maryland. He grew up in Carroll County and graduated from Westminster High School in 1978. He then attended the University of Maryland Baltimore County (UMBC) where he graduated Cum Laude in Pre-Medical/Pre-Dental studies in 1982. He then studied Dentistry at the Baltimore College of Dental Surgery (University of Maryland Dental School) in 1986.

Dr. Becker graduated from Dental School with various honors and awards including receiving the Omicron Kappa Upsilon gold key (the Phi Beta Kappa of Dental Colleges), The International College of Dentistry Award for outstanding achievement, The Maryland Academy of General Dentistry Award for ‘outstanding clinical skills and patient management’, as well as being inducted into the Gorgas Odontological Society (for academic achievement) and Gamma Pi Delta (Prosthodontic Honor Society).

He then continued training with his post-doctoral residency at Prince George’s Hospital and Medical Center where he met his wife of 24 years Colleen. He has resided in Howard County for the past 24 years and they have 3 children who attended Trinity School, Resurrection School, Mount Saint Joseph High School, and Mount deSales High School. They enjoy family camping, biking, and attending their children’s many sporting events.

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By Robert Shaffer, AIA, CID, LEED AP

The latest spark in the world marketplace is sustainability and everything “green.” Now that spark includes even dental practices. Green dentistry has become a focus of many clinics around the country and is serving them well as an approach to social conscience, environmental stewardship, reduction of everyday expenses, and potential tax incentives. Years ago, who would have thought that green would be a positive thing to call a dental practice? With all of the options available today, green dentistry is quickly becoming the standard.

Green means different things to different people in different circumstances. There are different shades of green: different degrees to which you can green your dental practice. Whichever shade you choose—whether greening your current practice, planning a new green clinic in an existing building, or designing a new green clinic building all your own—you are climbing aboard one of the strongest marketing waves to sweep modern businesses since the Internet. Your LEED AP (Leadership in Energy and Environmental Design Accredited Professional) architect can help you choose the level of green that makes the most sense for your dental practice as you ride this green wave. Read more