From wands a little bigger than an electric toothbrush that instantly capture high-resolution images of the inside of your mouth to 3-D printers that can fabricate detailed models of a patient’s teeth and jaw, technology is helping make dentistry quicker, more precise and more comfortable. Here we explore a few cutting-edge technologies that some Richmond-area practices are using to transform the patient experience.
Digital Impression Scanners
For many patients, the process of creating dental impressions is at the top of the list of uncomfortable experiences at the dentist’s office. Impressions — which are used for everything from fitting crowns to designing mouth guards and custom bleaching trays — involve pouring a liquid material into a tray and placing the tray into a patient’s mouth. The process requires the patient to hold still for several minutes while the substance hardens.
“It’s time consuming and not the most comfortable experience,” says Marci Guthrie, a Bon Air-based dentist and owner of James River Family Dentistry. “For patients with small mouths, you can get a lot of gagging. It makes you drool. If the impression isn’t accurate to the level you want it to be accurate, you have to take another.”
About a year ago, Guthrie began using an iTero digital impression scanner in her practice. A hand-held intraoral camera is used to take images of the inside of a patient’s mouth and create a real-time digital “impression” of the teeth and surrounding structures. Guthrie sends that information to a dental lab, where treatments like Invisalign and mouth guards are fabricated based on those specifications.
Guthrie says digital scanners have helped open communication with all her patients, not just patients getting impressions taken, since the system also allows her to instantly display images of a patient’s teeth for them on a screen in the room.
“A lot of times people will come in and say their teeth don’t hurt, and then they see this hole in their tooth and say, ‘Oh, my gosh, I had no idea that was there,’ ” she says. “It’s kind of nice for patients to see what I see.”
Same-Day Crowns
Being fitted with a dental crown traditionally requires two trips to the dentist’s office. At the first visit, the dentist examines and prepares the existing tooth to receive the crown and takes an impression of the tooth and surrounding dentition. A temporary crown is fitted, and the patient is sent home while the impression is shipped to a dental lab, where the permanent crown is milled. The patient then returns a second time to be fitted with their permanent crown.
The growth of digital scanners and 3-D printers has allowed some dentists to cut out the physical impression process and dental lab, creating digital impressions in their offices and milling crowns on the spot.
Stephen Young has been practicing family, cosmetic and implant dentistry for 30 years. In 2009, he purchased his first CAD-CAM (computer aided design, computer aided manufacturing) machine, a CEREC system, to print dental implants at his Henrico office.
For crowns, the process starts by using an intraoral camera to image the tooth and develop the digital impression that is used to design the crown restoration. The crown is then milled and glazed right in the office using a 3-D router.
“The technology is really to benefit the patient,” Young says. “They only have to be numbed once, they don’t have to deal with the gooey impressions, and they get a much better restoration.”
The process is more comfortable, and having one visit makes the cost of the crowns slightly lower as well.
“It makes the visits more comfortable and shorter [as well],” he says, noting that digital scanning means no physical impressions. “We can deliver a high-quality product, which makes [patients] very happy.”
CariVu Caries Detection
When Paul Stanovick’s son, Brant, graduated dental school and joined the family dental practice in Mechanicsville three years ago, father bought son a CariVu caries detection device as a graduation gift.
“I thought with him being young, he needs new technology,” Stanovick says.
The device — a wand about the size of an electric toothbrush — uses an intense white light to illuminate the edges of a patient’s teeth and detect dental decay. According to Stanovick, the device allows him and his son to catch cavities much earlier than they could using X-rays.
“Your tooth is made up of enamel, which you chew with, and on the inside there’s dentin,” he explains. “What happens is this light can contrast between the dentin and the enamel very, very effectively, and you can see cavities you can’t see on X-rays.”
Stanovick says the device has been “a game changer” in his practice. “Once we started using it, it was amazing the things we found that we wouldn’t have found from X-rays.”
Earlier cavity detection improves the odds of saving more of the tooth, Stanovick says. “You can make [repairs] a third of the size you would need to make them if you had to wait for the cavity to get big enough for an X-ray to pick up.”
The technology uses white light instead of X-rays, an advantage for some patients who are concerned about exposure to radiation, Stanovick says. (He notes that the switch from film to digital X-rays in most dental offices has already reduced the amount of radiation a patient is exposed to.)
Stanovick also likes that compared to many new technologies on the market, the CariVu is relatively affordable and simple to use. “It just plugs right into the computer through a USB port," he says.
Karen McAndrew (Photo by Jay Paul)
3-D-Printed Devices
While many dentists upload and send the data received by external and intraoral scanners to third-party labs where crowns, bridges, aligners and other devices are produced and shipped back to the dentist office, others are investing in 3-D printers to fabricate these and other applications in their own offices.
Prosthodontist Karen McAndrew has been using a 3-D printer at her practice, Virginia Center for Prosthodontics, for a few years. As a dental specialty, prosthodontics deals with the functional and aesthetic restoration of the teeth and jaw.
“We use it a lot for our cancer patients who maybe can’t open [their mouths] as wide because they’ve had surgery or they’ve had radiation therapy,” McAndrew says. In such cases, an intraoral scanner can be used to create a virtual model of a patient’s mouth, which McAndrew can then print and examine.
McAndrew and her team also use the printer to generate models of a patient’s mouth as a guide for surgery. “If the surgeon is going to have to reset the jaw, for example, we can actually do the surgery on this model,” she says. This can mean less time for the patient under anesthesia, as well as more accurate fits.
Digital technology allows McAndrew to “see” a patient without them being in front of her, she says. Not only can this make care more efficient, but, she points out, it has applications for serving populations that, because of time, money or geography, might not have access to dental services. She envisions a future in which digital technology could be taken into nursing homes to generate lower-cost dentures for residents.
“The limit really is your imagination,” she says.
Graham Gardner (Photo by Jay Paul)
Cone Beam CT
Like traditional CT scans, cone beam CT — or CBCT — systems allow doctors to take a series of images that are then converted to a high-resolution, 3-D visual of a patient’s teeth and skull.
Used most often by orthodontists and other specialists, CBCTs provide a more detailed view of a patient’s teeth and surrounding bones than a traditional two-dimensional X-ray. They also allow the doctor to image soft tissue and nerves.
“We can see things we really couldn’t before, like the angle of the teeth coming in and if they’re damaging other teeth or if they’re stuck,” says Graham Gardner, an orthodontist and owner of Gardner Orthodontics. He uses an i-CAT FLX CBCT system in his office.
Gardner has had his current system for five years; before that, he had another CBCT machine. He chose the i-CAT, in part, for its lower doses of radiation. (Although CBCT scanners emit less radiation than traditional CTs, it’s still higher than the dose emitted by digital X-rays.)
CBCT technology has been available in the United States since the early 2000s. The machines are smaller and less expensive than traditional CTs, making them feasible for outpatient settings.
“You’re paying more to keep up with the latest technology,” Gardner says, “but then you’re able to use it to treat patients more effectively, or more efficiently or comfortably.”
Gardner says he and his team can use the images to see exactly where an impacted tooth is and how to treat it, or to see where nerves are if surgery is going to be performed.
“Sometimes we’re seeing some things we’re not expecting that don’t even have to do with dentistry,” he says. Recently the machine picked up a previously undiagnosed spinal condition in one patient.
