This story has been updated since it first appeared in print.
Dr. Debra Haselton
For many teens and preteens, braces are a rite of passage. Now, it’s one that comes with some acceleration for patients of Richmond orthodontist Dr. Gustav Horsey.
As of June, patients ages 10 and up with braces and aligners from Horsey Orthodontics may be sent home with an OrthoPulse, a device designed to boost alignment speed and decrease treatment time.
“It’s a little mouth guard that you put in your mouth for five minutes on the top and five minutes on the bottom, and the near-infrared light stimulates blood flow and stimulates cells in the tissues to turn over quicker,” Horsey says.
Horsey says he learned about the treatment several months ago and studied the research on its efficacy. Its users report 75% less discomfort during orthodontic treatment and a reduction in treatment time by 50%, according to Horsey. The OrthoPulse has no medical contraindications and doesn’t affect other dental treatments. “It’s really cool technology,” Horsey says. “It makes it more comfortable to get through braces and aligners.”
Futuristic technical innovations like the OrthoPulse are reshaping dentistry across metro Richmond, from enhancing diagnostics to reducing the number of office visits needed for some treatments.
A New Dimension
Dr. Karen S. McAndrew, a prosthodontist with practices in Mechanicsville and Williamsburg, recently compared the efficacy of two dental treatments, photogrammetry and smart conversion, on one restorative dentistry patient.
Photogrammetry is a technique that creates 3D models from photographs, according to McAndrew. Smart conversion entails converting an existing denture into implant-supported restorations. “I did it both ways on the same patient so I could test it out and compare them. They both came out great,” she says.
Debuting in the dental world as of last year, photogrammetry takes the “glop” factor out of prosthodentistry. Instead of using mouthfuls of plaster to mold a model, photos are taken at different angles in the mouth and combined to make a 3D model that can be used to form and place custom prosthetics. “We’re taking photographs and stitching them all together,” McAndrew says.
Photogrammetry is faster and less messy than the traditional methods, with most of the work done on the computer, and the doctor is able to share results while the patient is still in the chair. The cost to the patient is “pretty much the same,” McAndrew says, as is the outcome. “The prosthesis is the same whether you did it the old conventional way or the newer way.”
Emerging technology to improve dental imaging isn’t just limited to photogrammetry. The new tool of choice for Dr. Debra Haselton of the Richmond Center for Advanced Dentistry is intraoral scanning. The scanners are basically camera wands that are moved along the surface of the teeth to capture a 3D image of the mouth and dentition. The image, which you can see as it’s being captured, is detailed and augmented and “gives you a view of the teeth that you can’t [otherwise] see,” she says.
An intraoral scanning device for mapping dental health
For Haselton, the best use of intraoral scans is as a communication tool with her patients. “The patients can instantly see their teeth on a screen,” she says. “We can communicate conditions, we can communicate the position of the teeth and what treatment is recommended and why. When they can see that outside of their mouth instead of in a little mirror, that’s been a big benefit beyond the component where we use it for actual treatment.”
Other dental practices that incorporate intraoral scanning technology use the images in-house to mill crowns (dental restorations to cover a tooth), fillings and bridges, or restoration. The replacements can be crafted in-house with a 3D printer, often using alternative materials such as zirconia, which is tooth colored “and makes for a lovely restoration,” says Dr. Lyndon F. Cooper, dean of the Virginia Commonwealth University School of Dentistry and a professor of prosthodontics.
Cooper notes that the emerging uses for these tech advances are widespread. Fillings can be designed on a computer, printed and filled in within minutes. Metal braces are being replaced with 3D-printed aligners. Crowns typically require two or three office visits, but with 3D tech, a crown can be created and placed in one sitting. A more complicated treatment, such as dentures (a removable plate holding artificial teeth) used to involve three to five office visits, but that can be reduced to two visits with new tech, Cooper says.
For patients, fewer visits can mean less hassle in terms of missed work or arranging child care. It also saves time for the practitioner. “It can elevate both experiences,” Cooper says. (An additional timesaver, Cooper adds, are AI-assisted programs that transcribe patient sessions in real time, freeing dentists from typing in notes.)
McAndrew, who is also a member of the Bon Secours Cleft & Craniofacial Care team at St. Mary’s Hospital and teaches in the Pediatric Dental Residency Program with Bon Secours, says she’s interested in expanding the use of scanning technology.
“Prosthodontist [visits are] more than conventional cleaning and fillings,” she says. “That’s where I’ll use these newer skills, to advance those outcomes for new patients’ cancer, cleft patients, patients that have had some type of accidents. ... There’s not necessarily a cookbook that tells us how to do it; we just have to come up with it on our own.”
Dr. Gustav Horsey
High Tech, High Price
One factor that isn’t clear yet is the full impact of tech innovation in terms of reducing costs and increasing care, according to Cooper. He says the essential equipment needed for a practice includes 3D scanning technology and a mill, which creates tooth restorations from blocks of material. With only 3D imaging in house, a dentist can still save time and send the images instead of mouth molds to a dental lab as a fulfillment center.
Dentistry has traditionally been a cottage industry, with many small or one-person practices, but that is changing. Cooper notes that about a quarter of new dentists now go to larger practices. Opening your own practice is expensive and capital-intensive, especially as the cost of more efficient technology increases. “A young dentist probably doesn’t go out and start a practice,” Cooper says.
Change comes quickly, and equipment can become outdated soon after purchase. New equipment also entails an investment in training and in securing records to comply with patient privacy rights. “There is a big cost. And if you buy technology and it just sits in your office and gathers dust, well, it’s a bad investment,” Haselton says.
On the Horizon
Haselton contends that artificial intelligence will have a major impact on everyday dental practice, helping to “confirm or deny what we are really seeing” and leading to better detection of oral cancers and decay in X-ray results. “It can make X-ray technology a little less subjective and a little more objective,” she says.
Radiographs and AI can evaluate patients and see areas of decay that were overlooked when viewed with the naked eye, but a clinician is still needed, McAndrew says.
“Sometimes AI is making mistakes, too,” she says.
As with other fields, dentistry is also incorporating new tech in the front office. In some practices, you can make your own appointment and access your dental records online. “I truly believe that tech will make dentistry more available,” Cooper says.
Teledentistry is another new addition to the field, but Cooper notes its impact may be limited. Dentistry is a hands-on, surgically or interventionally oriented field, he says. A teledentistry session may be good for a consultation, though. “You can’t really do surgery on a computer,” Cooper says. “You can speak to your patients, you can guide your patients, you can give them advice and help them, particularly where people live more than 15 or 20 miles from the nearest dentist.”
Innovations have also led to some treatments that are less common, such as work with stem cells and bone regeneration. Cooper cites work in Japan where researchers are seeking to regrow teeth. He says such work is in its infancy, but researchers are beginning to understand the fundamentals of the process.
While tech advancements are changing treatments, it’s the personal touch that matters in a practice. At VCU, the dental school seeks to impart a culture of care and excellence to its students. Technology is just a tool in that process. “A computer doesn’t come with any values,” Cooper says.
Haselton notes that new tools are only as good as the person wielding them. “It doesn’t take the place of the thinking skills and the knowledge base of the dentist. It’s really just a tool to augment the knowledge and communicate to the patient and help plan and, in a lot of cases, to manufacture,” she says.
“At the end of the day, hopefully my patient has gotten better treatment [which allows] me to augment my treatment planning to another level.”
