Archive for September, 2014

Dentistry goes High Tech

Tuesday, September 2nd, 2014

By Paul Feuerstein, DMD


The world of computers and smart devices has not escaped dentistry. Simple things like looking for cavities with a little bent sharp wire (the explorer), waiting for xrays to be developed or having a mouthful of putty impressions are things of the past. Also the way that small cavities are treated is changing with new chemistry including calcium that can replenish some lost enamel.

A new buzz word in dentistry is CAMBRA- Caries Management By Risk Assessment.  It basically states that the dentist does not need to pick up the dental handpiece very time there is a suspicious lesion.  There are many cases where you will get a “stick” and there is not conclusive radiographic evidence that there are caries in that tooth. If this is a patient with a high level of oral hygiene and few cavities, vs one who sits with a can of Mountain Dew at their desk all day, the proposed treatment is different.  New devices allow the dentist to measure the small cavities with lasers, heat and fluorescence and give a measurable marker to determine if this is something to fill, perhaps watch digitally or treat with new fluorides and recalcification products.

Traditional film xrays have been replaced by digital sensors which are faster, more accurate, use less radiation and don’t need environmentally unfriendly developing chemicals.  New advances have also brought us 3D xrays (Conebeam CT)  to enhance diagnosis and treatment planning. The dentist can now essentially do a CT scan on a tooth, group of teeth or the jaws. This is quite helpful in diagnosing patient problems as well as helping guide the development of a child’s teeth. Formerly difficult to diagnose problems such as root fractures, precise location of pathology or anatomical structures is now extremely accurate. Planning for tooth replacement with implants has also become more predictable, and in the realm of the general practitioners.

Impressions and laboratory techniques have also gone digital with  3D optical scanning devices replacing the puttys in the mouth, and CAD/CAM allows dental  labs to create extremely accurate restorations out of new more aesthetic materials that are more durable than ever before. This has also spilled right into the dental office with new milling units and software that allow the dentist to create the final restoration in just one visit so that patient does not have to come back for the “final” one.

In recent months, there has been an amazing convergence of these technologies.  Digital intraoral scans are being merged with Conebeam 3D scans. Many companies have standardized their devices allowing integration of components from different companies (like stereo components) creating more choices for the dentists to be able to personalize some of these systems. This comes with a large amount of new studying of the industry, which to some is troubling but to most is exciting.

It is a great time to be a dentist and a better one to be a patient.

FeuersteinDr. Feuerstein received his undergraduate training at SUNY Stony Brook studying chemistry, engineering, computer science and music. A 1972 graduate of UNJMD he maintains a general practice in Massachusetts. He installed one of the first in-office computers in 1978, teaching and consulting since then. As Technology Editor of Dental Economics, author of several technology articles, he lectures at many national and local dental meetings. His work with CAD/CAM helped develop the LAVA COS intraoral scanning system.  He was named Clinician of the Year at the 2010 Yankee Dental Congress and is an Adjunct Assistant Professor in General Dentistry at Tufts University.