2011 Technology Update
How new developments are impacting dentists, patients, and the profession.
The digital age has contributed to an evolution of the dental profession, one in which the development and introduction of new technologies has enabled oral healthcare professionals to improve predictability and productivity in their day-to-day operations, as well as enhance the level of care they provide their patients. Dentistry is increasingly using digital technology. In particular, dentists and laboratories are fabricating restorations digitally, either chairside or in the dental laboratory, observes Russell Giordano, DMD. These advances may improve the quality and delivery efficiency of restorations.
So will other technologies, such as digital dental impressioning scanners, the underlying technologies, precision, and range of applications for which have undergone rapid growth within the past five years, observes Nathan S. Birnbaum, DDS. However, he cautions that as technologically advanced as any device or technique that a dentist uses might be, its successful implementation requires that everyone involved in carrying out the procedure be knowledgeable and skilled in the system, particularly the dental technicians charged with the fabrication of the restorations.
“Digital technology has fostered the development of monolithic restorations due to the full-contour fabrication capability of CAD/CAM systems. Although most of the emphasis has been on ceramic materials, such as leucite-reinforced porcelain, feldspathic porcelain, lithium disilicate, and zirconia, the latest material innovations may be in composite materials,” says Dennis Fasbinder, DDS. “Recent long-term research has demonstrated comparable occlusal wear with CAD/CAM composite inlays compared to feldspathic inlays. Several manufacturers will launch new composite materials for CAD/CAM application for both temporary and long-term indications.”
According to Donald Coluzzi, DDS, patients understand and appreciate such modern technology, and many have had laser treatment performed on them for dermatology or vision correction, for example. In fact, they may expect a similar “new” manner of dental treatment, he suggests. The continuing evolution of dental lasers allows practitioners to consider adding a dental laser to their treatment protocol. In some cases, the list price of the instruments has decreased as well.
Other digital technologies also are gaining ground throughout the profession. “Digital radiology is continually evolving, just like every other technologically driven field,” observes Claudio Levato, DDS. “Both hardware and software applications continue to move this science forward, resulting in improved systems across the board, with an ever-growing body of vendors.”
However, not all areas of digital dental radiology are experiencing innovations and enhancements. For example, according to Allan G. Farman, DSc (Odont), perhaps the greatest change in cone beam technology for dentistry is the fact that there have been no substantial innovations over the recent past to Cone Beam CT (CBCT) technology and associated software products. CBCT is now a mature market free from substantial continued innovation. Entering this stage of product maturity, CBCT has become a safer investment, he explains.
“Choices continue between small, medium, and larger field of view, regarding highest spatial resolution, and whether the patient sits, stands, or is supine. While there are apparently many choices, there are actually fewer companies involved due to mergers and acquisitions,” Farman elaborates. “For example, one company, Danaher, now owns Imaging Sciences International, Gendex, Kavo, Soredex, and Instrumentarium, all with dental 3D X-ray products. Further, a shakeout of the market has started, which is inevitable when a product approaches maturity. Hitachi has exited the dental CBCT market, which means that the MerkuRay (which in studies had been reported at the upper end of the spectrum for radiation dose) is no longer available.”
Where different applications are concerned, dentistry has capitalized on technological innovations that have enhanced predictability in other industries. “Technology in shade matching has not changed significantly in the past several years,” explains Chad J. Anderson, MS, DMD. “However, some advances and refinements have been made in the way the information for shade matching is communicated between the dentist and the laboratory technician.”
However, it’s important to note that the overall goal of dentistry is helping the public maintain primary oral health, emphasizes V. Kim Kutsch, DMD. Yet despite the profession’s best efforts, dental caries, the most common childhood disease in the United States, is increasing. Dental caries is best defined today as a biofilm-mediated disease that is pH-specific, with prolonged periods of low pH resulting in net mineral loss from the teeth. Facing the challenges of an increasing disease incidence, recent years have witnessed the development of new caries-detection technologies to improve early diagnosis of the disease stages. Commonly referred to as caries detection, these technologies can be divided into two categories: diagnosis of dental caries disease risk or a biometric for the disease, and site-specific lesion detection, he elaborates.
“We are truly entering an age that can forecast early existing disease both locally in the oral cavity and at sites remote in the body,” comments Ronald McGlennen, MD, of OralDNA, regarding salivary diagnostic technologies. “Among these advanced technologies are new and simpler methods to image both the macroscopic and microscopic anatomy of the oropharynx, the application of molecular genetic tests, and the advent of molecular tests to characterize proteins in saliva.”
Consider the oral cancer detection arena. According to J.E. Bouquot, DDS, since the 1960s, dentists have had acceptable but inconsistent success predicting high-risk lesions via their clinical features, but they are now moving into a time when this will seem very primitive and inadequate. Dentistry is already in the space age of early cancer detection, with much more to come, he observes.
This month, eleven key opinion leaders in the areas of digital imaging, diagnostics, digital impressioning, CAD/CAM, and lasers each discuss what is new in their respective technology category, as well as issues that may influence integration and adoption throughout the profession. They also provide guidance about how best to integrate the technology into practice in order to maximize benefits for themselves and their patients.