NEW DENTAL TECHNOLOGIES

Anyone who has watched “Extreme Makeover” or “The Swan,” has seen some of the miracles of modern dentistry. It’s now possible to go into the dentist toothless and come out with a full set of permanent teeth—the same day. You can have that snaggle-toothed smile changed into pearly white perfection. You can get a tooth crowned in the dentist’s office while you wait. You can have a cavity filled painlessly. This is all happening so fast that what your dentist told you couldn’t be done during your last checkup might be available at the next one.

When it comes to dentistry, the term “space-age technology” is literally true. For instance, one of the adhesives used to attach the tiles to the space shuttle is now being used for a dental bonding material—to make repairs that used to be impossible.

All these miracles come with a high price tag, however. Unless you’re chosen to be a contestant on a makeover show, you may not be able to afford high-tech dentistry. However, some of the procedures may be worth taking out a home equity loan for, since an attractive smile and being able to eat comfortably is crucial to most people’s quality of life.

Here’s a roundup of a few of the most important advances, comparing the costs versus the benefits.

IMPLANTS

“Many people still have the image that implants are experimental or only for the rich,” says Michael C. Alfano, DMD, Ph.D., Dean of New York University’s Dental School. “But what was a marginal technology 15 years ago has now moved into the mainstream. We are teaching our dental students how to do implants”.

Dental implants are basically ˝ to ľ inch metal posts inserted into the jawbone, which serve as replacement roots for missing teeth. The replacement teeth that are later attached to the implants look, feel, and function like natural teeth.

Implants are made of medically pure titanium, the same metal used for hip, knee and other orthopedic replacements. “The jawbone fuses to the implant during what’s called “osseointegration” creating anchors for new, prosthetic teeth.

Implants can be used to replace a single tooth, or to anchor an entire arch of bridgework.” explains Thomas Balshi, DDS in his book “A Patient’s Guide to Dental Implants.”

Implants have enormous benefits over other types of restorations. When a single tooth is missing, the conventional treatment is a three-unit bridge. However, that entails cutting down adjacent healthy teeth, which can’t be cleaned as effectively when crowned and may decay over time. The alternative is a single tooth implant. ‘The cost is similar and there’s a 90% success rate,’ says Alfano.

Another advantage of implants is that they last a lifetime. If you lose a bridge and the teeth that support it, you’ve lost them permanently. If an implant tooth cracks, you still have the implant and can use it for another tooth or bridge.

Implants are a godsend for older people who may have lost most or all of their teeth. The traditional replacement is a full or partial denture. Although a denture is acceptable, and the cost is modest, dentures can be agony for some people. The problem can be more than discomfort. Bone tends to erode under a denture--in the lower jaw particularly. Implants preserve the jawbone, since, like real teeth, they put stress on it. “People who get implants instead of dentures at 50 will still be able to eat a bagel at age 85,” Dean Alfano says.

I was facing a full upper denture a few years ago, at age 58. I knew I wouldn’t be able to tolerate it since I’d once had to wear one temporarily and it went so far back on my palate I thought I would choke to death. However, I also knew I wouldn’t be able to afford a full upper set of implants and the permanent bridgework that would be attached to them, which can cost $20,000 and up. My oral surgeon, Gary Wahdwa DDS of Albany, New York, explained that I could opt for a less expensive overdenture, a smaller removable denture attached to implants, which I was very happy with. Now, 5 years later, implant technology has advanced again, and I can have permanent teeth with only two more implants.

The biggest downside to implants is the cost, which can be prohibitive. Luckily some forward-thinking insurance companies are beginning to see that implants will save them money in the long run, and they’re starting to provide coverage. That trend is expected to continue.

However, it can be well worth financing your implants. Mary Mihaly, 55, who put off getting implants for years despite the fact that her lower jaw had seriously eroded because she’d worn dentures since her 20s, says “People shouldn't necessarily turn away from this because of the price, like I did for years. It's pretty easy to finance part or all of it.” She’s thrilled with her new implants, which have improved both her looks and her functioning.

Due to the high cost of implants a lot of consumers shop around, and might wind up going to a dentist who advertises cheap implants in the local paper. This is not an area where you want to cut costs. Badly placed implants can cause massive problems, including infection, nerve damage, or they can simply fail to fuse with the bone. “Implants should be done by an oral surgeon or periodontist, says Dr. Edmund Hewlett DDS, Consumer Advisor for the American Dental Association, “especially for people with medical problems.” However, dental schools today are graduating dentists with training in implantology, so if you’re getting a simple one-tooth implant, a well-trained general dentist might be able to handle it.

Implants should be coordinated by two specialists, the surgical dentist and the restorative dentist, working as a team. “You want to know what the final result will be. “You don’t want your restoring dentist to find implants in places he can’t use them,” says Mihaly’s dentist, Hudson Hiedorf DDS who practices in Cleveland, Ohio with surgical dentist, Michael. H. Morgan DDS.

Another downside to implants, until now, has been the length of time it takes to get your teeth. Patients have had to wait six to eight months while the implant fuses to bone. However, Nobel Biocare, the company that pioneered dental implants, has also pioneered “instant load” implants for both single teeth and entire arches. Their “Teeth in an Hour” implants, manufactured with a surface that integrates more quickly with bone, though not yet widely available, are definitely the future of implantology.

Not only patients, but also dentists love implants. “It’s so rewarding and satisfying doing this,” says Dr. Wadhwa, who also instructs other dentists in implantology. “Surgeons spend their lives removing stuff, and now I can give people back their teeth. I change people’s lives.”

CAD/CAM (Computer Aided Design/Computer Aided Manufacturing)

The latest miracle gadget, the CEREC machine, uses CAD/CAM technology so dentists can make crowns, inlays or onlays in their offices in one visit. Instead of a filling a tray with impression “goop” that you have to bite into and hold in your mouth until it hardens, your dentist coats the tooth with a white powder, a camera takes a digital picture of it, and the CEREC software converts it into a three-dimensional virtual model on the computer screen. The dentist then sends the data to a separate milling machine in the office, which shapes a ceramic block that matches your tooth shade. About ten to twenty minutes later, your all-ceramic, tooth-colored restoration is finished and ready to bond in place. Voila! Instant tooth. No temporaries, no return visits for fittings. The cost is about the same as for a crown made in the lab.

In-office CEREC is mostly used for back teeth, since the restorations it creates aren’t aesthetic enough yet for front teeth. CEREC is not yet used for veneers for that reason. However, CAD/CAM technology is used in labs as well these days to mill materials such as white zirconia, which is used under porcelain to create more aesthetic crowns. It’s even used for implants such as “Teeth in an Hour,” where a digitized image is sent to Nobel Biocare in Sweden and used to manufacture the titanium framework for the teeth.

“Patients love this technology,” says Denise Estefan DDS, MS Associate Professor and Director of Aesthetics at New York University College of Dentistry. “With CEREC 3D they get to see the dentist designing the crown on the computer, they get to see the adjacent teeth, they see it before it goes in.”

Marjorie Casteel, a patient of Nashville dentist, Matt McGee, DDS, agrees, “The crown was great. Not having to come back for a second appointment was wonderful. I didn’t have to worry about a temporary coming off.”

However, not every dentist is a fan. Dr. Sherri Worth, the cosmetic and reconstructive dentist who re-did the mouths of 44 contestants on the FOX reality show, “The Swan,” says CEREC crowns just don’t last. “I have never seen a CEREC crown that fits perfectly. The margins aren’t perfect, so eventually they develop leaks and fall out. They also don’t look as good. I haven’t seen one that can mimic what my lab guys can do.”

Neuromuscular Dentistry

Neuromuscular dentistry is a new specialty within general dentistry that addresses TMJ, or temporomandibular joint disorder. TMJ is a catchall term for a group of symptoms including headaches, facial pain, jaw pain, teeth clenching, chipped, broken or worn teeth, popping in the jaw, and limited jaw movement. Even neck, back and shoulder pain and vertigo may be associated with TMJ according to Robert Jankelson, DDS, author of Getting Your Bite Right, “Until recently most dentistry has been based on the assumption that wherever your bite was naturally was the correct position. Today, most dental treatments are still planned from the patient’s existing or habitual bite. Neuromuscular dentistry considers the entire system that controls the positioning and function of your jaw—the teeth, muscles and joints—and tries to establish a harmonious relationship between them.

Neuromuscular dentists reposition the jaw before they do reconstruction of the teeth, using a variety of techniques. Patients are treated with the TENS machine which performs electric muscle stimulation to relax the jaw muscles, to find out where the natural bite should be. Then they may be fitted with an orthotic appliance for a few months to reposition the bite. Computerized equipment measures the pattern of the jaw opening and closing to make sure the jaw is in the right position. Finally the neuromuscular dentist, who is usually also trained in aesthetic dentistry, may reconstruct the teeth with crowns, implants, or veneers in line with the new bite, to keep the jaw in the proper position and maximize the cosmetic outcome.

The results can be quite dramatic. After going to several dentists who didn’t want to deal with his problems, William Gregory, a 56 year old railroad engineer found neuromuscular dentist Joseph Pilatich in Catskill, New York. “I had crowns that were too short which ruined the way I looked, my jaw was tense, I clenched my teeth so that I wound up breaking the crowns. It was hard to eat, I had headaches and was pretty miserable.” Dr. Pilatich opened up his bite, centered his teeth and found the natural position of his face and jaw muscles. After a few months of wearing an orthotic appliance to reposition his jaw, he totally reconstructed Gregory’s mouth in the new position with all new crowns. “I’m now pain free, look great and no longer clench my teeth,” says Gregory. Cost: $26,000 so far. The cost of neuromuscular treatment can range from $5,000 to $50,000 depending on what’s needed and who is doing the treatment.

Pilatich, like most neuromuscular dentists was trained at the Las Vegas Institute for Advanced Dental Studies. LVI is the only school that gives regular courses in the subject, training dentists all over the country in the specialty. There are about 600 graduates of their program who can be found at www.leadingdentist.com.

Outside of LVI dentists, the jury in the general dental community is still out on the benefits of neuromuscular dentistry. Most know very little about it, and are skeptical of some of its claims. “It’s controversial because it’s new,” says William Dickerson, DDS, founder and CEO of LVI.

“ Implants were once controversial. We got into neuromuscular dentistry because it was the right thing to do. We know that fixing someone’s bite can get rid of a lifetime of pain.”

Lasers

Lasers, now the treatment of choice in eye surgery, dermatology, and many general surgical procedures, are becoming the new hope for painless dentistry.

Heat and vibration are the causes of most of the pain associated with the drill. Dental lasers actually use water to cut both gums and tooth decay. The most advanced dental laser, the Waterlase, used for both soft and hard tissue, works by emitting laser energy into a spray of atomized water. The water is energized and then is capable of cutting a wide range of human tissue, including enamel, bone, cartilage and soft tissue.

Lasers remove decay very precisely which allows patients to keep more healthy tooth structure. The Waterlase also performs numerous soft tissue (gum) procedures with little or no bleeding, giving your general dentist a new high-tech tool for many procedures that previously required referral to a periodontist. The dental laser avoids many common problems of the high-speed drill, including cracks in the teeth from the vibration and rapid turning of the drill burrs which can weaken your teeth. Lasers decontaminate as they cut, reducing the chance for bacterial contamination. Your restoration is even likely to last longer if prepared with a laser, according to Dr. Chris Kammer, founding member of the American Academy of Cosmetic Dentistry.

As with CAD/CAM technology, patients love the dental laser. Lynda Matos who had her cavities lasered at New York City Smile Design said, “It was just a slight warm sensation, not harsh at all. The healing process was a lot quicker.”

Although lasers are the treatment of choice when it comes to gum recontouring and soft tissue periodontal surgery, they are still limited when it comes to removing cavities. They can only be used on the top surface of teeth, on areas that can be easily seen, not in between teeth, which makes them most effective for smaller cavities.

“Lasers have a place in dentistry, but they’ve been less rapidly adopted because they’re so expensive.” says Columbus, Ohio dentist Matthew Messina, consumer advisor for the American Dental Association. At $70,000, they’re prohibitively expensive for most general dentists.

Pediatric dentists are the early adopters, however, because kids are so scared of the dental drill, and they tend to have smaller cavities. Despite their limitations and high expense at the moment, lasers are probably the future of painless, and more effective, dentistry. You can find a Waterlase dentist at http://biolase.findlocation.com.

Digital imaging

The days when dentists tacked an x-ray film on a light box and showed you a tiny shadow that was supposedly a cavity but looked exactly like the rest of the tooth are quickly passing. Along with the computerization of everything in our lives, dentists are digitizing their x-ray technology. This doesn’t mean that you no longer need those lead aprons or those big clumsy sensors in your mouth. What it does mean, is that you can see that cavity enlarged up to 300 times, and get only 10 to 20% of the radiation you’d get from traditional x-rays.

Just like the traditional x-ray sensor that you bit down on, the digital sensor goes in your mouth, but it’s connected to a digital x-ray machine which is connected to a computer. In the past the dentist developed the film, but now an x-ray beam activates the sensor and you see the image on a computer monitor. Like digital photography, the image appears instantly-- there’s no developing time--and the dentist can manipulate it in a variety of ways including increasing the size and contrast.

Digital imaging improves dental record keeping, since the patient’s chart can be stored on the computer with the x-rays. “Eventually the digital images will just be emailed to insurance companies along with claims, but unfortunately insurance companies aren’t there yet,” says Matthew Messina DDS, the consumer advisor for the American Dental Association.

Sensors are the downside of digital imaging for the patient. Digital sensors are thicker and less comfortable inside the patient’s mouth than film sensors. Cost is the downside for the dentist—The digital sensors cost about $4000 for each dental chair.

However, as in every area of computer technology, better imaging is on the horizon. “It would be great if we could see caries earlier on--that’s being worked on,” says “Dr. Titus Schleyer, DMD, Ph.D., Director of the Center for Dental Informatics at the University of Pittsburgh School of Dental Medicine. “New imaging technologies will allow us to image areas in 3D. Sensors are also improving. Eventually we’ll be using phosphor storage plates, which use a scanner instead of a developer. They’re the same dimension and size as a film plate and will be more comfortable for the patient.”