Cone Beam Computerized Tomography (CBCT)
This technology allows dentists to take and visualize a 3d x-ray of their patients head and neck region or just the gums and teeth.
Two dimensional x-rays often prevent adequate visualization and lead to an inability to diagnose pathology. This call for a 'wait and watch' approach where the patient continues to experience discomfort or the extent of the pathology becomes worse. In some situations, the dentist is forced to venture a guess and render treatment based on that guess. If incorrect, this leads to un necessary treatment without addressing the real problem.
A traditional dental x-ray gives a two dimensional picture of 2-3 teeth. When a patient presents with a problem, an x-ray is taken of that area with the hope that the area that is being pointed to has the pathology. Dental pain can be referred from other teeth in the jaw or sometimes the opposite jaw. By taking a CBCT, it is much easier to accurately diagnose and subsequently render appropriate treatment.
If you were given the task of writing a detailed description of an apple and were given a photograph of an apple versus actually being given the apple in your hand, which would you prefer?
The data that is acquired with a CBCT can further be processed with various software programs to enhance diagnostic and treatment capability.
Dental Implant planning software. This allows visualization of the volume of bone in 3d as well as vital anatomical structures. Ideal surgical and prosthetic implant placement can be finalized in the software. This takes away the guess work, potential for operator error and creates the opportunity for minimally invasive implant surgery. This is achieved by transferring the implant planning to a CAM unit that fabricates a surgical guide. The entire surgical procedure is done through a small hole within the confines of the surgical guide.
Sleep Apnea software. This processes the CBCT data and creates a 3d map of your patients airway. This is an emerging subspecialty and will continue to expand in the dental arena due to dentists unique training. Any obstruction in the airway can easily be identified. Based on the cause of the obstruction, an appropriate Sleep Apnea appliance can be ordered with the click of a button.
Endodontics Software. This allows for individual teeth to be segmented out of the data set. A three dimensional reconstruction is generated of the pulp chambers and canal of the tooth being treated. This provides a clear visualization of any complicated anatomy or accessory canals. Guides can be fabricated to create the best access preparation. Information on the working length and sequential rotary instrumentation can also be provided.
Intra oral imaging has significantly improved in recent years. It consists of a hand held device that has an extension that is about the size of a large pen. This part is introduced into the patients oral cavity for data acquisition. The head of the extension has several cameras that are oriented in different directions relative to each other. Video acquisition is performed with relative ease without the need for spraying the teeth with contrast powder. The CAD software processes the data aquired from the different cameras and correlates it to produce a very accurate 3d rendering of the patients teeth. This eliminates the need for traditional impression making techniques. It allows for fabrication of almost any kind of restoration or appliance include inlays, onlays, crowns, bridges, veneers, implants, dentures, mothguards, clear orthodontic aligners, surgical guides, night guards, sleep apnea appliances and more.
The speed and accuracy of fabrication are significantly improved and the fabrication process is significantly less labor intensive.
Cost of the equipment and learning how to use the computer software are some challenges for the dentist new to this technology.
Benchtop scanners expand on the capability of intra-oral scanning. They have articulating robotic arms that intuitively position the object being scanned. It has autofocus features and are capable of creating extremely accurate CAD models of the whole mouth in a matter of minutes.
Scanning full arch implant models is one of the primary objectives of these scanners.
Impression scanning (single arch and triple that) is possible.
The scope of intra-oral scanning is continually expanding however, benchtop scanners will probably always have an important place in the digital workflow.
Computer Aided Design software has drastically expanded our ability to design practically any kind of dental restoration or appliance. The software processes the data aquired from intra-oral or benchtop scanners and generates extremely accurate 3D renditions of the hard and soft tissues. The programming algorithms intuitively predict the position, size and morphology of the intended restorations with ease and speed. Minor tweeks if any are required by the operator. For the advanced user, a broad array of customization features are also available.
This allows determination of the dynamic and static contact surfaces by visualizing the complete paths of movement, hence making for correct functional occlusion.
This allows simultaneous design of numerous levels of restoration in cases that are complex.
This allows different design elements for generating restorations with a gingival component.
This allows balancing of the smile line through a 3D patient image as well as the simulation of the effect of design proposal.
This allows aesthetically pleasing restorations in cases where the spaces are confined and narrow. The Third Premolar function enables both direct and classical screw retained implant bridge designs.
After the restoration/prostheses have been designed in the CAD software, the files are exported to the CAM units. These include 4 axis, 5 axis milling units as well as 3d printers. Unit selection is governed by the complexity of the restoration being fabricated and is somewhat dependent on the material being used.
It works at a unique wavelength with simple yet sophisticated computer controls that ensure high speed precision cutting on soft tissue as well as hard tissue. Solea can operate on everything from enamel and bone to gingiva and dentin. This laser will give you the ability to work anywhere in the oral cavity with ease and speed, and from any angle. The laser will be ideal for replacing old restorations as well as for working on virgin teeth. For soft tissues, it will allow you to feather into cuts with a higher precision, higher speed and much lesser bleeding than you can expect. Our laser allows us to choose a size specific spot suited to the job. We can easily choose the required spot size and depend on the computer for doing everything else with no compromises – no more defocusing and focusing speed and affecting power. The variable speed foot pedal offered by Solea is special amongst dentistry lasers. The speed of the cut is determined by how hard it is presses – hence saving time, increasing control and allowing a quick transition from the drill. The three hand pieces offered by our Solea laser are designed to be weightless and are the idea tools for soft tissue procedures as well as hard tissue procedures. It uses hollow waveguide attachments for numerous sizes and is designed especially for accessing the periodontal pocket and cutting the soft tissue.
Lasers have been used in dentistry for a number of years primarily being of the diode variety with numerous improvements in the last decade.
The latest advance is the Solea, pulsed CO2 Laser, manufactured by Convergent Dental. This technology has the potential for revolutionizing the way we practice dentistry.
The Co2 laser in the 900 micrometer range is pulsed at approximately 10,000/second. This supposedly interferes with the nerves to transmit the pain signal to the brain. This analgesic effect lasts for up to 7 minutes after initial use of the laser allowing for time to use a traditional handpice as well as complete restorative procedures.
The laser is capable of vaporizing enamel and dentin without the use of a high speed handpiece. There is a significant number of patients that are averse to the sounds made by the handpiece.
3D Printing In Dentistry
3D printing has gradually increased in popularity and scope of applications. Its use in dentistry for medical modelling and surgical guides has a well documented history going back 20years. At present, it seems as though there is a new printer available every other day. From a dentists perspective, there is certainly a cool factor that is appealing to both the doctor and the patient. However, the practical aspect of owning the equipment, learning how to use it as well as managing the various materials should be carefully considered compared with the convenience of outsourcing.
Anatomical Models from Conebeam data and bone supported surgical guides.
Obstructive Sleep Apnea Appliance
Implant Verification Jig and custom tray
Screw retained anatomic verification jig/ trial prosthesis
Soprocare, Manufacturer Acteon diagnostic camera allows us to see what was previously not visible to the eye. It allows us to diagnose tooth decay at various steps of its duration – hence making it possible to find the best suited treatment. It allows us to distinguish the infected tissue from the healthy tissue and hence get rid of only the tissue that is affected by disease. The auto fluorescence technology allows us to detect interproximal as well occlusal decay in their earliest stages. The diagnostic camera is highly accurate and efficient in diagnosing the development of proximal or occlusal carious lesions. This allows us to enhance our clinical performance and visually distinguish the affected tissue from the infected tissue in the excavated site. In white light, from Macro to Portrait, our diagnostic cameras give an unparalleled quality of images. Moreover, it enables the decision making process in treatment planning to be much speedier, hence allowing much safer options for patients by decreasing the number of x-rays. It will allow you to interact more effectively with the patients, and also provide the ability to view details that are not visible to the naked eye.
The InFire HTC furnace can reach temperatures of approximately 3000 degrees Fahrenheit. This allows for sintering of Zirconia, a material that is gradually gaining popularity in dentistry due to its strength characteristics. The newer materials are also significantly improved in their optical and esthetic properties. The materials have increased translucency, available in multilayer disks and more recently, millable blocks are also available.
The furnace is capable of sintering milled metal. An argon tank is required for this function.
It has a speed sintering cycle that can fire a single zirconia crown in 10 minutes.
It is capable of stacking firing trays and upto 60 units have been fired in one cycle.