Scott Froum, DDS
Kyle L. Summerford
The long-term success rate of dental implants has been well-documented in the literature1 and is a technology that has been a boon to the financial element of dentistry. Similarly, retention of teeth with moderate to advanced bone loss via various periodontal treatment methods has enjoyed similar to higher long-term success rates.2 The practitioner often relies on clinical experience and therapeutic familiarity when deciding whether to extract periodontally involved teeth and replace with dental implants vs. saving the natural dentition with regenerative or resective therapy. A relatively new concept, however, that should be incorporated into this decision matrix is the long-term cost effectiveness to the patient when comparing treatment modalities.
Retention of periodontally compromised teeth with initial, surgical, and supportive therapy has been shown to have high long-term success rates in the literature.3,4 Typical periodontal treatment for patients with moderate to advanced disease when first presenting to a dental office can consist of quadrant scaling and root planing, osseous surgery with or without regenerative therapy (Figs. 1 and 1a), and supportive periodontal maintenance at specific intervals. Estimated totals for this type of "start-up" treatment are in the range of $2,000 to $4,000 depending on geographic location (see Table A). This treatment, if maintained by the patient with diligent home care, has proven to be effective in terms of the prevention of further periodontal progression and tooth retention over a long-term period.5
When analyzing the cost to maintain this start-up treatment via supportive periodontal therapy with maintenance intervals of three to four times a year with or without local adjunctive antibiotics, dollar amounts range from $500 to $1,000 a year, again dependent upon geographic location. In a small subset of the population (less than 5%), periodontal disease can reoccur after treatment, excluding those patients who demonstrate blatant noncompliance with home care, and treatment will have to be rendered again, increasing the overall costs of this type of therapy.6
Although implants have typically enjoyed high long-term survival rates,7 their associated initial financial impact is much higher than that of saving the natural dentition.8 Conservative valuations place start-up costs for implant treatment around two to three times higher than saving natural dentition via periodontal therapy (Table 2). In addition, implants are not without complications, and both biologic and/or mechanical complications can be associated with additional treatment costs to the patient. Recently, the literature has been replete with discussion of biologic complications in the form of peri-implant disease. Peri-implant diseases fall into two categories: peri-implant mucositis and peri-implantitis.
The term peri-implant mucositis describes a reversible inflammatory reaction in the mucosa adjacent to an implant,9 a term that has become known as implant gingivitis. Typical treatment involves quadrant scaling and root planing with implant-friendly armamentarium. The literature also has shown that mechanical debridement in conjunction with systemic and/or local antibiotic placement has increased the efficacy of this type of treatment10, but it can obviously be associated with higher treatment costs (Fig. 2). Studies show that the prevalence of peri-implant mucositis can be as high as 50% to 80% of implants in function.11 Peri-implantitis has been defined as an inflammatory process that affects the tissues around an osseointegrated implant in function and, like periodontitis, results in loss of supporting bone.
Clinical treatment of this disease is often determined by severity, but in general often includes flap surgery, bone grafts, membranes, growth factors, and/or soft-tissue grafts12 (Figs. 3 and 3a). The overall financial impact upon the patient for this type of treatment can be quite high considering the patient was already subject to initial start-up costs of treatment. (Table C). In addition, maintenance intervals after implant therapy should be equal to if not more stringent than those of natural teeth. The prevalence of peri-implantitis has been shown in some studies to range from 11% to as high as 47% of implant sites analyzed.13 A large disparity in percentages can be seen when comparing the prevalence of reoccurring periodontal disease after treatment vs. the percentage of implants that will demonstrate complications after prosthesis insertion. With that said, studies show that periodontal therapy has proven to be cost effective when compared to other types of tooth replacement therapy over a 15-year period evaluation.14
The following tables present actual treatment cost differences between the patient opting to "save" the natural tooth (Treatment Plan A) vs. "removal" with extraction and implant (Treatment Plan B). These fees are dependent on geographic location and represent insurance codes from the New York City, Los Angeles, and Chicago areas.
This information was presented to a real patient in a private practice setting along with long-term survival rate percentages of each of the comparative treatments. After reviewing the survival rates as well as the financial costs in relation to each treatment plan, the patient accepted Treatment Plan A, citing the following reasons: desire to keep her own teeth, less cost, and quicker time to completion.
Another real scenario that took place in a private practice with actual dollar amounts can be seen with Table 3. A patient had already paid for treatment in Table 2 in the $5,000 to $7,000 range and presented to the office with moderate peri-implantitis. In addition to the invested money, she was now going to be responsible for the dollar amounts shown in Table 3.
After reviewing the additional costs and lengthy healing time involved with surgery to correct the ailing implant, the overall costs associated with treatment were in the $8,000 to $9,000 range with more than three years of treatment time invested. Of important note is that most insurance companies limit the amount of reimbursement for implant-related services. Accurate ADA coding and submissions when dealing with insurance companies must occur in order to facilitate services and expedite reimbursements.
In conclusion, when deciding between saving the natural dentition and extracting and placing implants, there are many factors to consider. In addition to long-term success rates, the practitioner and the patient need to consider the long-term economic impact the patient will endure. Both implants and periodontal therapy to save natural teeth have high initial success rates with implants usually demonstrating higher start-up costs. However, when looking at long-term retention rates, teeth often demonstrate fewer complications and have less of a financial impact when correction is needed.
References
1. Simonis et al. Long-term implant survival and success: A 10-16-year follow-up of non-submerged dental implants. Clin Oral Implants Res. Jul. 2010;21(7):772-777.
2. Carnevale G, Di Febo G, Tonelli MP, Marin C, Fuzzi M. A retrospective analysis of the periodontal-prosthetic treatment of molars with interradicular lesions. The International Journal of Periodontics & Restorative Dentistry 1991;11:189-205.
3. Hirschfeld L, Wasserman B. A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol. 1978;49:225-237.
4. Oliver RC, Brown LJ, Loe H. Periodontal diseases in the United States population. J Periodontol. 1998;69:269-278.
5. Axelsson P, Lindhe J, Nyström B. On the prevention of caries and periodontal disease. Journal of Clinical Periodontology, 1991;18:182-189.
6. Magnusson et al. Refractory periodontitis or recurrence of disease. J Clin Periodontol. Mar. 1992;23(3 Pt 2):289-292.
7. Simonis P, Dufour T, Tenenbaum H. Long-term implant survival and success: A 10-16-year follow-up of nonsubmerged dental implants. Clin Oral Implants Res. Jul. 2010;21(7):772-777.
8. Schwendicke F, Graetz C, Stolpe M, Dörfer CE. Retaining or replacing molars with furcation involvement: A cost-effectiveness comparison of different strategies. J Clin Periodontol 2014; 41:1090-1097.
9. Albrektsson T, Isidor F. Consensus report of session IV. In: Lang NP, Karring T, ed. Proceedings of the First European Workshop on Periodontology. London: Quintessence, 1994: 365-369.
10. Salvi et al. Adjunctive local antibiotic therapy in the treatment of peri-implantitis II: Clinical and radiographic outcomes. COIR 2007;18:281-285.
11. Lindhe J, Myle J. Peri-implant diseases: Consensus report of the Sixth European Workshop on Periodontology. J Clin Periodontology 2008;35(suppl 8):282-285.
12. Froum SJ, Froum SH, Rosen PS. Successful management of peri-implantitis with a regenerative approach: A consecutive series of 51 treated implants with a 3- to 7.5- year follow-up. IJPRD 2012;32(1):1-20.
13. Koldsland O et al. Prevalence of peri-implantitis related to severity of the disease with different degrees of bone loss. J Perio Feb. 2010;81(2)231-238.
14. Pretzl B, Wiedemann D, Cosgarea R, Kaltsch-mitt J, Kim TS, Staehle HJ, Eickholz P. Effort and costs of tooth preservation in supportive periodontal treatment in a German population. Journal of Clinical Periodontology 2009;36:669-676.
Scott Froum, DDS, is a periodontist and coeditor of Surgical-Restorative Resource e-newsletter, as well as a contributing author for DentistryIQ and Dental Economics. He is a clinical associate professor at the New York University Dental School in the Department of Periodontology and Implantology. Dr. Froum is in private practice in New York City. You may contact him through his website at www.drscottfroum.com.
Kyle L. Summerford is CEO and founder of Summerford Solutions, Inc., and editorial director of PennWell's Dental Assisting Digest e-newsletter. He provides private business coaching for dentists. Mr. Summerford is a professional speaker focusing on topics such as increasing profits, staff etiquette training, and maximizing dental insurance benefits. He is a contributing author for Dental Economics, DentistryIQ, and Surgical-Restorative Resource. Visit his website atwww.ddsguru.com, available to dentists and team members for educational purposes, or contact him by email at KyleLSummerford@gmail.com with inquiries regarding his practice management consulting services.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-2/science-tech/dollars-and-sense-saving-teeth-vs-placing-implants.html
Visit us: http://affinitydentalfresno.net/
22 Jul 2015
Dental implants have been around since ancient times, but new teeth can also fall out
People usually lose their adult teeth because of neglect or a lifestyle or environment that places them at high risk of decay or destructive gum disease. While high-sugar diets can lead to tooth decay, genetics can also increase the risk of bad gum disease, as does smoking and poor glucose control in diabetes patients. If you combine these with inadequate oral hygiene then tooth loss is a real possibility.
Destructive gum disease (or periodontal disease as it’s known in dental circles) is the leading cause of tooth loss and is the most common chronic inflammatory disease in humans and almost 50% of the world’s population suffer from periodontitis, where the gums pull away from the teeth and form spaces that become infected and bacterial toxins and the immune system break down the bone and tissue system supporting the teeth.
Replacing lost natural teeth with prosthetic implants secured into the jaw bone is one way to overcome the problem of losing teeth. However, as an NHS consultant who has had to salvage implants that have failed, they may not be the perfect answer you imagine.
Ancient implants
Screw-in teeth are not a feat of modern dentistry. Archaeological evidence suggests the ancient Chinese used bamboo pegs to replace lost teeth. The purpose of these early implants was much the same as today – to restore an aesthetic smile (in life or after death perhaps) – but rather than being made from titanium they were fabricated from other materials. Dental implants have also been dated back to the Maya in 600 AD. Ancient Egyptian and Celtic remains have revealed precious metals, ivory and even other human teeth used in their implants.
A landmark discovery in the bio-engineering of dental implants came in 1952 when Per-Ingvar Brånemark, a Swedish orthopaedic surgeon studying the biology of bone healing, discovered that he was unable to remove implants of pure titanium cylinders that appeared to have integrated with the surrounding bone after healing. The titanium seemed to attract bone formation onto its surface and the term osseo-integration was born.
By the 1960s there was a desire for fixed replacements that were embedded into the jaws, rather than traditional bridges or dentures that sat on the surface. In 1967 “Blade Vent” implants became popular, but with mixed success. These were metal blades that were implanted into the jaw bone and healed with a fibrous capsule between the metal implant and the investing bone. It meant that they were not completely immobile, not truly integrated with the bone and prone to infection, inflammation and implant loss.
It wasn’t until 1981, after 30 years of meticulous research and human studies that Brånemark published his findings and modern implants as we know them were born. The first Brånemark implants were produced as parallel cylinders of titanium which had an external screw thread, so they could literally be “screwed into” the bone. A second generation of meticulously engineered “self-tapping” cylindrical implants appeared in the early 1990s.
Their placement was facilitated by a five-drill bit set with bespoke surgical instruments, along with cover screws, torquing wrenches and all manner of equipment, designed to provide a surgical procedure that no well-trained surgeon could fail to follow. It was essential to attend manufacturer-run training days and become certified to place these implants. In return each implant was guaranteed and replaced free of charge if it failed.
Changing landscape
Over the next decade competitor systems emerged. While some were well researched and manufactured, others were poorly conceived and doomed to create misery for increasingly demanding patients who wanted fast replacements and were prepared to pay obscene amounts of money. Travelling abroad for affordable implants, with no guarantee of any after care, became increasingly an option.
Manufacturers took risks, patients became more demanding, standards fell and the General Dental Council decided not to create a specialist list of trained and accredited implant surgeons. Now there are more than 500 different types of implant available. Patients can be ill-advised, completely unsuited to particular systems or they may simply ignore advice/warnings to travel abroad for “holiday implant surgery”.
The irony
The irony is, however, that dental implants are most likely to fail for the same reasons the teeth were lost in the first place. Implants are far harder to clean than natural teeth due to their narrow cylindrical shape and because the bone grows directly onto the implant surface they lack a periodontal ligament, which provides stem cells and healing proteins that can delay or help resolve inflammation. So if this inflammation starts the implants begin to lose their attachment to the bone. This can be relentless until the implants literally fall out.
The success rates of the original Brånemark implants were 95%-98% over three decades. However, designs changed to satisfy an increasingly demanding market place have changed our definitions of “failure”. Today, a quarter of patients with implants will experience failure of one or more implants within ten to 12 years.
Failure was originally defined as “loss of implant”. However, modern implants support a bridge or denture, and loss of one implant likely means loss of the bridge or denture, so the “proportion of patients who have lost one or more implants” was deemed a more appropriate definition of “failure” meaning a rise in failure rates to 11-12%. After another redefinition of failure as a “progressive loss of bone” around the implant the failure rate rose again to 22-25%. Moreover, the proportion with the early signs of inflammation around their implant – peri-implant mucositis – was 46%.
More importantly, studies have demonstrated that “periodontally hopeless” teeth over a 15-year period out-survive newly-placed dental implants, and protracted treatment to retain molar teeth most severely affected by periodontitis was more cost effective and successfulin terms of “tooth survival” than newly placed implants.
So if retaining teeth is possible, it is significantly preferable to extracting them and replacing with an implant. If planned carefully, placed well and maintained very carefully, implants are still an excellent treatment for missing teeth. However, for patients who have lost teeth to gum disease, who have gum disease, who smoke or who struggle to control their oral hygiene, or for that matter their diabetes, dental implants are a high-risk and high-cost option that may end in tears.
Source: http://theconversation.com/dental-implants-have-been-around-since-ancient-times-but-new-teeth-can-also-fall-out-41465
Visit us: http://affinitydentalfresno.net/
Destructive gum disease (or periodontal disease as it’s known in dental circles) is the leading cause of tooth loss and is the most common chronic inflammatory disease in humans and almost 50% of the world’s population suffer from periodontitis, where the gums pull away from the teeth and form spaces that become infected and bacterial toxins and the immune system break down the bone and tissue system supporting the teeth.
Replacing lost natural teeth with prosthetic implants secured into the jaw bone is one way to overcome the problem of losing teeth. However, as an NHS consultant who has had to salvage implants that have failed, they may not be the perfect answer you imagine.
Ancient implants
Screw-in teeth are not a feat of modern dentistry. Archaeological evidence suggests the ancient Chinese used bamboo pegs to replace lost teeth. The purpose of these early implants was much the same as today – to restore an aesthetic smile (in life or after death perhaps) – but rather than being made from titanium they were fabricated from other materials. Dental implants have also been dated back to the Maya in 600 AD. Ancient Egyptian and Celtic remains have revealed precious metals, ivory and even other human teeth used in their implants.
A landmark discovery in the bio-engineering of dental implants came in 1952 when Per-Ingvar Brånemark, a Swedish orthopaedic surgeon studying the biology of bone healing, discovered that he was unable to remove implants of pure titanium cylinders that appeared to have integrated with the surrounding bone after healing. The titanium seemed to attract bone formation onto its surface and the term osseo-integration was born.
By the 1960s there was a desire for fixed replacements that were embedded into the jaws, rather than traditional bridges or dentures that sat on the surface. In 1967 “Blade Vent” implants became popular, but with mixed success. These were metal blades that were implanted into the jaw bone and healed with a fibrous capsule between the metal implant and the investing bone. It meant that they were not completely immobile, not truly integrated with the bone and prone to infection, inflammation and implant loss.
It wasn’t until 1981, after 30 years of meticulous research and human studies that Brånemark published his findings and modern implants as we know them were born. The first Brånemark implants were produced as parallel cylinders of titanium which had an external screw thread, so they could literally be “screwed into” the bone. A second generation of meticulously engineered “self-tapping” cylindrical implants appeared in the early 1990s.
Their placement was facilitated by a five-drill bit set with bespoke surgical instruments, along with cover screws, torquing wrenches and all manner of equipment, designed to provide a surgical procedure that no well-trained surgeon could fail to follow. It was essential to attend manufacturer-run training days and become certified to place these implants. In return each implant was guaranteed and replaced free of charge if it failed.
Changing landscape
Over the next decade competitor systems emerged. While some were well researched and manufactured, others were poorly conceived and doomed to create misery for increasingly demanding patients who wanted fast replacements and were prepared to pay obscene amounts of money. Travelling abroad for affordable implants, with no guarantee of any after care, became increasingly an option.
Manufacturers took risks, patients became more demanding, standards fell and the General Dental Council decided not to create a specialist list of trained and accredited implant surgeons. Now there are more than 500 different types of implant available. Patients can be ill-advised, completely unsuited to particular systems or they may simply ignore advice/warnings to travel abroad for “holiday implant surgery”.
The irony
The irony is, however, that dental implants are most likely to fail for the same reasons the teeth were lost in the first place. Implants are far harder to clean than natural teeth due to their narrow cylindrical shape and because the bone grows directly onto the implant surface they lack a periodontal ligament, which provides stem cells and healing proteins that can delay or help resolve inflammation. So if this inflammation starts the implants begin to lose their attachment to the bone. This can be relentless until the implants literally fall out.
The success rates of the original Brånemark implants were 95%-98% over three decades. However, designs changed to satisfy an increasingly demanding market place have changed our definitions of “failure”. Today, a quarter of patients with implants will experience failure of one or more implants within ten to 12 years.
Failure was originally defined as “loss of implant”. However, modern implants support a bridge or denture, and loss of one implant likely means loss of the bridge or denture, so the “proportion of patients who have lost one or more implants” was deemed a more appropriate definition of “failure” meaning a rise in failure rates to 11-12%. After another redefinition of failure as a “progressive loss of bone” around the implant the failure rate rose again to 22-25%. Moreover, the proportion with the early signs of inflammation around their implant – peri-implant mucositis – was 46%.
More importantly, studies have demonstrated that “periodontally hopeless” teeth over a 15-year period out-survive newly-placed dental implants, and protracted treatment to retain molar teeth most severely affected by periodontitis was more cost effective and successfulin terms of “tooth survival” than newly placed implants.
So if retaining teeth is possible, it is significantly preferable to extracting them and replacing with an implant. If planned carefully, placed well and maintained very carefully, implants are still an excellent treatment for missing teeth. However, for patients who have lost teeth to gum disease, who have gum disease, who smoke or who struggle to control their oral hygiene, or for that matter their diabetes, dental implants are a high-risk and high-cost option that may end in tears.
Source: http://theconversation.com/dental-implants-have-been-around-since-ancient-times-but-new-teeth-can-also-fall-out-41465
Visit us: http://affinitydentalfresno.net/
Using digital impressions for implants
Bart Silverman, DMD
Computer-aided design/computer-aided manufacturing (CAD/CAM) devices seem to be taking over the dental space. Of these, 3-D intraoral scanners are revolutionizing the way we take impressions. However, many focus only on the restorative aspects of this exciting new technology, not realizing that advancements in digital impressions apply to implants as well.
The way we were taught to take conventional impressions in dental school is quite a process. The initial setup includes choosing the correct impression material (whether alginate or polyvinyl), setting up the mixing pads, spatulas, adhesive, lubricating agents, mixing bowls, and a whole slew of different tray size options. Then, we have to select the correct maxillary and mandibular tray, prep the tray, and start mixing the materials.
And, of course, this all has to be done on a live dental patient-one who sometimes doesn't want to be there, has dental phobias, and who sometimes gags. When all is said and done, taking the impression can be stressful for both the patient and staff. If all went well, only one impression was necessary; however, a whole range of errors could occur, whether in the practice or at the lab, requiring us to do it all over again.
Fortunately, digital impressions have exponentially simplified this process. Setup is as easy as unplugging the scanner from one laptop and plugging into the USB port of the computer you want to use. A series of quick intraoral images are stitched together by the computer, completing the digital impression in a matter of minutes. The speed and efficiency a scanner offers can combat any champion dental-phobe or gagger.
In my practice, we use the CS 3500 intraoral scanner by Carestream Dental. Featuring "plug-and-play" technology, the handpiece is lightweight and can be easily moved from operatory to operatory. And, while some units require powder to take an impression-something that doesn't make sense when it comes to scanning a surgical site-this scanner is powderless.
Once the digital file is obtained, it can be sent to a lab or opened in implant- or surgical-planning software.
Basic surgical guides
When placing dental implants, using a surgical guide is always recommended. In addition to aiding in the proper placement of dental implants, surgical guides can help prevent malposition and spacing of dental implants, which can be a nightmare to restore. They can also prevent the need for a custom abutment during the restorative phase, keeping patient costs down.
Fabricating a surgical guide using the conventional impression technique requires taking a conventional impression with alginate or polyvinyl and pouring up the stone model-two time-intensive steps. After the model sets, the lab places a denture tooth or teeth in the edentulous area and a vacuform tray is made by heating a thermoplastic material and adapting it down over a model with a special vacuum machine.
Fortunately, with a digital scanner, once the intraoral scan is performed, the digital file is sent to the lab where a virtual tooth is added and a guide is fabricated and sent back to the office. No model is made, eliminating additional costs.
Implant dentistry
After an implant is placed and osseointegration occurs, one must determine what type of abutment will be placed. Should you choose a standard or stock abutment or a custom abutment to serve as the connector on top of which the crown will be placed? A standard abutment is one that is provided by the implant manufacturer and is typically used when there are no concerns about angulation of the implant, while a custom abutment is considered when implant positioning or interocclusal space is a concern.
If conventional or analog impressions are used to take an impression of a standard abutment, an impression coping is placed on top of the abutment. A goopy material is syringed into a tray and then the patient's mouth. Once set, it is removed from the mouth with the coping. An implant analog is placed into the coping and the lab receives this and pours up a stone model. Along the same line with analog dentistry, if a custom abutment is planned, we are taking an impression of the top of the implant fixture, affording the fabrication of a connector specific for each patient. A fixture-level impression coping is placed inside the implant and a similar impression technique is performed. The laboratory technician takes the impression, pours up a stone model and waxes up a custom abutment. The wax abutment is then invested, cast, and polished.
This conventional technnique, which many of us are used to, has many steps that allow for the introduction of potential errors. This has a direct impact on patient care, as we cannot accurately predict the length of crown insertion appointments and the results are inconsistent. In addition, this unknown chairtime can cost our practices a lot of potential lost income.
Let's explore digital dentistry as an alternative. We choose whether we are going to use a standard or custom abutment using our same criteria; this first step does not change. However, from there, digital impressions make for a more accurate and streamlined process. If we decide to place a standard abutment, we use a digital scanner to scan the actual abutment. Here, in the adjacent photo, we used the CS 3500 to take a digital impression of the abutment in the patient's mouth.
The patient presented with three edentulous areas and multiple implants were placed. Standard abutments were torqued into position and the CS 3500 was used to capture the impressions. No setup time was needed for trays, and there was no gagging or clean up.
In the next case, we decided to fabricate a custom abutment which would require a fixture level impression. With analog dentistry, a fixture level impression coping is placed. With digital dentistry, we have the ability to place a scanning body, which is the digital equivalent of a fixture level impression coping.
A couple of caveats: the scanning bodies are implant- and digital lab-specific. In other words, you must request these specifically from the digital lab that you will work with for the specific implant that you placed.
Guided surgery
The latest trend in implant dentistry is to be prosthetically driven when we plan our cases; that is, we need to go to the final result and work backward to plan where we have to place our implants. Guided surgery enables us to do this and place our implants precisely based upon final prosthetic restorations limited by bone morphology. In order for us to do this, we take impressions, pour up models, and plan our cases. We then need to send this along with a CBCT scan to a guided surgery facility. Guides are fabricated and implants placed. We can now shorten the process by using the intraoral scanner to scan our patients instead of using the analog model technique. This STL file is then merged with the DICOM file of the cone beam scan into the implant-planning software to plan our cases.
Digital dentistry is in its beginning stages. The technology is new and exciting, with many uses in dentistry and-more specifically-implant dentistry. It allows for more precision when treating our patients. From guided surgery to abutment and crown fabrication, digital technology provides more exact treatment planning and decreased chairtimes. In the days of trying to maintain and attract new patients, the patient "WOW" factor can't be matched.
Bart Silverman, DMD, is a graduate of Fairleigh Dickinson University in New Jersey. He completed his graduate training from Fairleigh S. Dickinson Jr. School of Dentistry in 1986 where he received his doctorate of dental medicine degree. He completed his residency in oral and maxillofacial surgery at Westchester County Medical Center and served as chief resident in 1989. He currently is board certified in oral and maxillofacial surgery with a private practice in New City, New York. Dr. Silverman is a clinical assistant attending at Westchester County Medical Center in Valhalla, New York.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/using-digital-impressions-for-implants.html
Visit us: http://affinitydentalfresno.net/
Computer-aided design/computer-aided manufacturing (CAD/CAM) devices seem to be taking over the dental space. Of these, 3-D intraoral scanners are revolutionizing the way we take impressions. However, many focus only on the restorative aspects of this exciting new technology, not realizing that advancements in digital impressions apply to implants as well.
The way we were taught to take conventional impressions in dental school is quite a process. The initial setup includes choosing the correct impression material (whether alginate or polyvinyl), setting up the mixing pads, spatulas, adhesive, lubricating agents, mixing bowls, and a whole slew of different tray size options. Then, we have to select the correct maxillary and mandibular tray, prep the tray, and start mixing the materials.
And, of course, this all has to be done on a live dental patient-one who sometimes doesn't want to be there, has dental phobias, and who sometimes gags. When all is said and done, taking the impression can be stressful for both the patient and staff. If all went well, only one impression was necessary; however, a whole range of errors could occur, whether in the practice or at the lab, requiring us to do it all over again.
Fortunately, digital impressions have exponentially simplified this process. Setup is as easy as unplugging the scanner from one laptop and plugging into the USB port of the computer you want to use. A series of quick intraoral images are stitched together by the computer, completing the digital impression in a matter of minutes. The speed and efficiency a scanner offers can combat any champion dental-phobe or gagger.
In my practice, we use the CS 3500 intraoral scanner by Carestream Dental. Featuring "plug-and-play" technology, the handpiece is lightweight and can be easily moved from operatory to operatory. And, while some units require powder to take an impression-something that doesn't make sense when it comes to scanning a surgical site-this scanner is powderless.
Once the digital file is obtained, it can be sent to a lab or opened in implant- or surgical-planning software.
Basic surgical guides
When placing dental implants, using a surgical guide is always recommended. In addition to aiding in the proper placement of dental implants, surgical guides can help prevent malposition and spacing of dental implants, which can be a nightmare to restore. They can also prevent the need for a custom abutment during the restorative phase, keeping patient costs down.
Fabricating a surgical guide using the conventional impression technique requires taking a conventional impression with alginate or polyvinyl and pouring up the stone model-two time-intensive steps. After the model sets, the lab places a denture tooth or teeth in the edentulous area and a vacuform tray is made by heating a thermoplastic material and adapting it down over a model with a special vacuum machine.
Fortunately, with a digital scanner, once the intraoral scan is performed, the digital file is sent to the lab where a virtual tooth is added and a guide is fabricated and sent back to the office. No model is made, eliminating additional costs.
Implant dentistry
After an implant is placed and osseointegration occurs, one must determine what type of abutment will be placed. Should you choose a standard or stock abutment or a custom abutment to serve as the connector on top of which the crown will be placed? A standard abutment is one that is provided by the implant manufacturer and is typically used when there are no concerns about angulation of the implant, while a custom abutment is considered when implant positioning or interocclusal space is a concern.
If conventional or analog impressions are used to take an impression of a standard abutment, an impression coping is placed on top of the abutment. A goopy material is syringed into a tray and then the patient's mouth. Once set, it is removed from the mouth with the coping. An implant analog is placed into the coping and the lab receives this and pours up a stone model. Along the same line with analog dentistry, if a custom abutment is planned, we are taking an impression of the top of the implant fixture, affording the fabrication of a connector specific for each patient. A fixture-level impression coping is placed inside the implant and a similar impression technique is performed. The laboratory technician takes the impression, pours up a stone model and waxes up a custom abutment. The wax abutment is then invested, cast, and polished.
This conventional technnique, which many of us are used to, has many steps that allow for the introduction of potential errors. This has a direct impact on patient care, as we cannot accurately predict the length of crown insertion appointments and the results are inconsistent. In addition, this unknown chairtime can cost our practices a lot of potential lost income.
Let's explore digital dentistry as an alternative. We choose whether we are going to use a standard or custom abutment using our same criteria; this first step does not change. However, from there, digital impressions make for a more accurate and streamlined process. If we decide to place a standard abutment, we use a digital scanner to scan the actual abutment. Here, in the adjacent photo, we used the CS 3500 to take a digital impression of the abutment in the patient's mouth.
The patient presented with three edentulous areas and multiple implants were placed. Standard abutments were torqued into position and the CS 3500 was used to capture the impressions. No setup time was needed for trays, and there was no gagging or clean up.
In the next case, we decided to fabricate a custom abutment which would require a fixture level impression. With analog dentistry, a fixture level impression coping is placed. With digital dentistry, we have the ability to place a scanning body, which is the digital equivalent of a fixture level impression coping.
A couple of caveats: the scanning bodies are implant- and digital lab-specific. In other words, you must request these specifically from the digital lab that you will work with for the specific implant that you placed.
Guided surgery
The latest trend in implant dentistry is to be prosthetically driven when we plan our cases; that is, we need to go to the final result and work backward to plan where we have to place our implants. Guided surgery enables us to do this and place our implants precisely based upon final prosthetic restorations limited by bone morphology. In order for us to do this, we take impressions, pour up models, and plan our cases. We then need to send this along with a CBCT scan to a guided surgery facility. Guides are fabricated and implants placed. We can now shorten the process by using the intraoral scanner to scan our patients instead of using the analog model technique. This STL file is then merged with the DICOM file of the cone beam scan into the implant-planning software to plan our cases.
Digital dentistry is in its beginning stages. The technology is new and exciting, with many uses in dentistry and-more specifically-implant dentistry. It allows for more precision when treating our patients. From guided surgery to abutment and crown fabrication, digital technology provides more exact treatment planning and decreased chairtimes. In the days of trying to maintain and attract new patients, the patient "WOW" factor can't be matched.
Bart Silverman, DMD, is a graduate of Fairleigh Dickinson University in New Jersey. He completed his graduate training from Fairleigh S. Dickinson Jr. School of Dentistry in 1986 where he received his doctorate of dental medicine degree. He completed his residency in oral and maxillofacial surgery at Westchester County Medical Center and served as chief resident in 1989. He currently is board certified in oral and maxillofacial surgery with a private practice in New City, New York. Dr. Silverman is a clinical assistant attending at Westchester County Medical Center in Valhalla, New York.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/using-digital-impressions-for-implants.html
Visit us: http://affinitydentalfresno.net/
15 Jul 2015
Dental implants have been around since ancient times, but new teeth can also fall out
People usually lose their adult teeth because of neglect or a lifestyle or environment that places them at high risk of decay or destructive gum disease. While high-sugar diets can lead to tooth decay, genetics can also increase the risk of bad gum disease, as does smoking and poor glucose control in diabetes patients. If you combine these with inadequate oral hygiene then tooth loss is a real possibility.
Destructive gum disease (or periodontal disease as it’s known in dental circles) is the leading cause of tooth loss and is the most common chronic inflammatory disease in humans and almost 50% of the world’s population suffer from periodontitis, where the gums pull away from the teeth and form spaces that become infected and bacterial toxins and the immune system break down the bone and tissue system supporting the teeth.
Replacing lost natural teeth with prosthetic implants secured into the jaw bone is one way to overcome the problem of losing teeth. However, as an NHS consultant who has had to salvage implants that have failed, they may not be the perfect answer you imagine.
Ancient implants
Screw-in teeth are not a feat of modern dentistry. Archaeological evidence suggests the ancient Chinese used bamboo pegs to replace lost teeth. The purpose of these early implants was much the same as today – to restore an aesthetic smile (in life or after death perhaps) – but rather than being made from titanium they were fabricated from other materials. Dental implants have also been dated back to the Maya in 600 AD. Ancient Egyptian and Celtic remains have revealed precious metals, ivory and even other human teeth used in their implants.
A landmark discovery in the bio-engineering of dental implants came in 1952 when Per-Ingvar Brånemark, a Swedish orthopaedic surgeon studying the biology of bone healing, discovered that he was unable to remove implants of pure titanium cylinders that appeared to have integrated with the surrounding bone after healing. The titanium seemed to attract bone formation onto its surface and the term osseo-integration was born.
By the 1960s there was a desire for fixed replacements that were embedded into the jaws, rather than traditional bridges or dentures that sat on the surface. In 1967 “Blade Vent” implants became popular, but with mixed success. These were metal blades that were implanted into the jaw bone and healed with a fibrous capsule between the metal implant and the investing bone. It meant that they were not completely immobile, not truly integrated with the bone and prone to infection, inflammation and implant loss.
It wasn’t until 1981, after 30 years of meticulous research and human studies that Brånemark published his findings and modern implants as we know them were born. The first Brånemark implants were produced as parallel cylinders of titanium which had an external screw thread, so they could literally be “screwed into” the bone. A second generation of meticulously engineered “self-tapping” cylindrical implants appeared in the early 1990s.
Their placement was facilitated by a five-drill bit set with bespoke surgical instruments, along with cover screws, torquing wrenches and all manner of equipment, designed to provide a surgical procedure that no well-trained surgeon could fail to follow. It was essential to attend manufacturer-run training days and become certified to place these implants. In return each implant was guaranteed and replaced free of charge if it failed.
Changing landscape
Over the next decade competitor systems emerged. While some were well researched and manufactured, others were poorly conceived and doomed to create misery for increasingly demanding patients who wanted fast replacements and were prepared to pay obscene amounts of money. Travelling abroad for affordable implants, with no guarantee of any after care, became increasingly an option.
Manufacturers took risks, patients became more demanding, standards fell and the General Dental Council decided not to create a specialist list of trained and accredited implant surgeons. Now there are more than 500 different types of implant available. Patients can be ill-advised, completely unsuited to particular systems or they may simply ignore advice/warnings to travel abroad for “holiday implant surgery”.
The irony
The irony is, however, that dental implants are most likely to fail for the same reasons the teeth were lost in the first place. Implants are far harder to clean than natural teeth due to their narrow cylindrical shape and because the bone grows directly onto the implant surface they lack a periodontal ligament, which provides stem cells and healing proteins that can delay or help resolve inflammation. So if this inflammation starts the implants begin to lose their attachment to the bone. This can be relentless until the implants literally fall out.
The success rates of the original Brånemark implants were 95%-98% over three decades. However, designs changed to satisfy an increasingly demanding market place have changed our definitions of “failure”. Today, a quarter of patients with implants will experience failure of one or more implants within ten to 12 years.
Failure was originally defined as “loss of implant”. However, modern implants support a bridge or denture, and loss of one implant likely means loss of the bridge or denture, so the “proportion of patients who have lost one or more implants” was deemed a more appropriate definition of “failure” meaning a rise in failure rates to 11-12%. After another redefinition of failure as a “progressive loss of bone” around the implant the failure rate rose again to 22-25%. Moreover, the proportion with the early signs of inflammation around their implant – peri-implant mucositis – was 46%.
More importantly, studies have demonstrated that “periodontally hopeless” teeth over a 15-year period out-survive newly-placed dental implants, and protracted treatment to retain molar teeth most severely affected by periodontitis was more cost effective and successfulin terms of “tooth survival” than newly placed implants.
So if retaining teeth is possible, it is significantly preferable to extracting them and replacing with an implant. If planned carefully, placed well and maintained very carefully, implants are still an excellent treatment for missing teeth. However, for patients who have lost teeth to gum disease, who have gum disease, who smoke or who struggle to control their oral hygiene, or for that matter their diabetes, dental implants are a high-risk and high-cost option that may end in tears.
Source: http://theconversation.com/dental-implants-have-been-around-since-ancient-times-but-new-teeth-can-also-fall-out-41465
Visit us: http://affinitydentalfresno.net/
Destructive gum disease (or periodontal disease as it’s known in dental circles) is the leading cause of tooth loss and is the most common chronic inflammatory disease in humans and almost 50% of the world’s population suffer from periodontitis, where the gums pull away from the teeth and form spaces that become infected and bacterial toxins and the immune system break down the bone and tissue system supporting the teeth.
Replacing lost natural teeth with prosthetic implants secured into the jaw bone is one way to overcome the problem of losing teeth. However, as an NHS consultant who has had to salvage implants that have failed, they may not be the perfect answer you imagine.
Ancient implants
Screw-in teeth are not a feat of modern dentistry. Archaeological evidence suggests the ancient Chinese used bamboo pegs to replace lost teeth. The purpose of these early implants was much the same as today – to restore an aesthetic smile (in life or after death perhaps) – but rather than being made from titanium they were fabricated from other materials. Dental implants have also been dated back to the Maya in 600 AD. Ancient Egyptian and Celtic remains have revealed precious metals, ivory and even other human teeth used in their implants.
A landmark discovery in the bio-engineering of dental implants came in 1952 when Per-Ingvar Brånemark, a Swedish orthopaedic surgeon studying the biology of bone healing, discovered that he was unable to remove implants of pure titanium cylinders that appeared to have integrated with the surrounding bone after healing. The titanium seemed to attract bone formation onto its surface and the term osseo-integration was born.
By the 1960s there was a desire for fixed replacements that were embedded into the jaws, rather than traditional bridges or dentures that sat on the surface. In 1967 “Blade Vent” implants became popular, but with mixed success. These were metal blades that were implanted into the jaw bone and healed with a fibrous capsule between the metal implant and the investing bone. It meant that they were not completely immobile, not truly integrated with the bone and prone to infection, inflammation and implant loss.
It wasn’t until 1981, after 30 years of meticulous research and human studies that Brånemark published his findings and modern implants as we know them were born. The first Brånemark implants were produced as parallel cylinders of titanium which had an external screw thread, so they could literally be “screwed into” the bone. A second generation of meticulously engineered “self-tapping” cylindrical implants appeared in the early 1990s.
Their placement was facilitated by a five-drill bit set with bespoke surgical instruments, along with cover screws, torquing wrenches and all manner of equipment, designed to provide a surgical procedure that no well-trained surgeon could fail to follow. It was essential to attend manufacturer-run training days and become certified to place these implants. In return each implant was guaranteed and replaced free of charge if it failed.
Changing landscape
Over the next decade competitor systems emerged. While some were well researched and manufactured, others were poorly conceived and doomed to create misery for increasingly demanding patients who wanted fast replacements and were prepared to pay obscene amounts of money. Travelling abroad for affordable implants, with no guarantee of any after care, became increasingly an option.
Manufacturers took risks, patients became more demanding, standards fell and the General Dental Council decided not to create a specialist list of trained and accredited implant surgeons. Now there are more than 500 different types of implant available. Patients can be ill-advised, completely unsuited to particular systems or they may simply ignore advice/warnings to travel abroad for “holiday implant surgery”.
The irony
The irony is, however, that dental implants are most likely to fail for the same reasons the teeth were lost in the first place. Implants are far harder to clean than natural teeth due to their narrow cylindrical shape and because the bone grows directly onto the implant surface they lack a periodontal ligament, which provides stem cells and healing proteins that can delay or help resolve inflammation. So if this inflammation starts the implants begin to lose their attachment to the bone. This can be relentless until the implants literally fall out.
The success rates of the original Brånemark implants were 95%-98% over three decades. However, designs changed to satisfy an increasingly demanding market place have changed our definitions of “failure”. Today, a quarter of patients with implants will experience failure of one or more implants within ten to 12 years.
Failure was originally defined as “loss of implant”. However, modern implants support a bridge or denture, and loss of one implant likely means loss of the bridge or denture, so the “proportion of patients who have lost one or more implants” was deemed a more appropriate definition of “failure” meaning a rise in failure rates to 11-12%. After another redefinition of failure as a “progressive loss of bone” around the implant the failure rate rose again to 22-25%. Moreover, the proportion with the early signs of inflammation around their implant – peri-implant mucositis – was 46%.
More importantly, studies have demonstrated that “periodontally hopeless” teeth over a 15-year period out-survive newly-placed dental implants, and protracted treatment to retain molar teeth most severely affected by periodontitis was more cost effective and successfulin terms of “tooth survival” than newly placed implants.
So if retaining teeth is possible, it is significantly preferable to extracting them and replacing with an implant. If planned carefully, placed well and maintained very carefully, implants are still an excellent treatment for missing teeth. However, for patients who have lost teeth to gum disease, who have gum disease, who smoke or who struggle to control their oral hygiene, or for that matter their diabetes, dental implants are a high-risk and high-cost option that may end in tears.
Source: http://theconversation.com/dental-implants-have-been-around-since-ancient-times-but-new-teeth-can-also-fall-out-41465
Visit us: http://affinitydentalfresno.net/
8 Jul 2015
Dental Implants improve lives of Postmenopausal Women with Osteoporosis
It is known that postmenopausal women with osteoporosis have higher risk of losing their teeth, but a new study suggests that dental implants can provide the highest satisfaction in such cases.
The study was conducted by Case Western Reserve University School of Dental Medicine.
According to Leena Palomo, associate professor of periodontics and corresponding author of 'Dental Implant Supported Restorations Improve the Quality of Life in Osteoporotic Women', dental implants may be the best path to take in such cases.
Findings of the research were published in the Journal of international Dentistry. The research is part of a series of studies analyzing dental outcomes for women with osteoporosis.
Researchers surveyed 237 women about their satisfaction with replacement teeth and how it improved their lives at work and in social situations.
The 23-question survey rated satisfaction about work, health, emotional and sexual aspects of their lives.
As per experts, osteoporotic women with one or more adjacent teeth missing were chosen for the study.
The women had gotten restoration work done, like implants, fixed partial denture, which is a false tooth, cemented to crowns of two teeth, a removal denture, better known as false teeth, or had no restoration work done.
Christine DeBaz, a third-year Case Western Reserve dental student, said women with dental implants reported a higher overall satisfaction with their lives.
Fixed dentures were the next best alternative for the highest satisfaction, followed by false teeth and, finally, women with no restoration work.
Women with dental implants also reported the highest satisfaction in emotional and sexual areas, while those without restorations scored the lowest in those two areas, found the study.
Source: http://uncovercalifornia.com/content/25025-dental-implants-improve-lives-postmenopausal-women-osteoporosis
Visit us: http://affinitydentalfresno.net/
The study was conducted by Case Western Reserve University School of Dental Medicine.
According to Leena Palomo, associate professor of periodontics and corresponding author of 'Dental Implant Supported Restorations Improve the Quality of Life in Osteoporotic Women', dental implants may be the best path to take in such cases.
Findings of the research were published in the Journal of international Dentistry. The research is part of a series of studies analyzing dental outcomes for women with osteoporosis.
Researchers surveyed 237 women about their satisfaction with replacement teeth and how it improved their lives at work and in social situations.
The 23-question survey rated satisfaction about work, health, emotional and sexual aspects of their lives.
As per experts, osteoporotic women with one or more adjacent teeth missing were chosen for the study.
The women had gotten restoration work done, like implants, fixed partial denture, which is a false tooth, cemented to crowns of two teeth, a removal denture, better known as false teeth, or had no restoration work done.
Christine DeBaz, a third-year Case Western Reserve dental student, said women with dental implants reported a higher overall satisfaction with their lives.
Fixed dentures were the next best alternative for the highest satisfaction, followed by false teeth and, finally, women with no restoration work.
Women with dental implants also reported the highest satisfaction in emotional and sexual areas, while those without restorations scored the lowest in those two areas, found the study.
Source: http://uncovercalifornia.com/content/25025-dental-implants-improve-lives-postmenopausal-women-osteoporosis
Visit us: http://affinitydentalfresno.net/
5 Jul 2015
Does digital dentistry make you a better dentist?
Gary Kaye, DDS, FAGD
I am often asked whether or not I believe that the addition of digital dentistry to a practice can make you a better dentist. Unequivocally, I believe that the answer is yes. Now, that does not mean that digital dentistry will replace every process in the office, or that implementing it will immediately change the treatment of patients or automatically improve our level of care.
Like anything in dentistry, there is a learning curve. It takes a certain level of commitment and preparation in order to take proper advantage of such leaps in technology. But, if the correct mind-set is paired with the right advancements, there is little doubt that it makes us better in our profession.
It is very important that the principles of dentistry are considered in order to get the maximum benefit from digital dentistry. We arrive at a correct diagnosis and communicate that diagnosis to our patients. Thus, our patients understand the implications to their oral and systemic health. Furthermore, it gives us the ability to perform the treatment efficiently, cost-effectively, and to the highest standards. When it comes to diagnosis, there is an array of digital modalities starting with digital records, radiographs (both 2-D and 3-D), high-definition intraoral cameras, caries detectors, cancer screening devices, and digital occlusal analyzers that, when applied correctly, greatly improve our diagnostic capability. As for direct interaction with our patients, we now have tools that improve our ability to properly communicate conditions, treatment options, and outcomes. It is, of course, incumbent on us to implement these tools. Many can be delegated to a team member such as an assistant or hygienist.
When it comes to treatment, digital dentistry gives us the option for digital impressions and chairside CAD/CAM milling. This can deliver restorations with the benefit of complete, step-by-step control. We have immediate access to emergence profiles, marginal ridge heights, and precise occlusal stops. In addition, we can send the virtual impressions directly to the laboratory and have unprecedented two-way communication with our lab technician colleagues. This allows us to deliver a better and more consistent restoration, which, among the other benefits of digital dentistry, makes us better dentists.
How does digital dentistry improve patient treatment outcomes at lower costs?
Better outcomes at lower costs is a hot topic in medical care, and as the dental profession moves toward the model of being physicians of the oral cavity and masticatory system, the subject of treatment outcomes at lower costs will be crucial. The links between oral and systemic health continue to emerge and, as a result, we as dentists become more integrated into the public scope of overall health. It is going to be imperative that we be able to deliver better outcomes at lower costs if we are going to adapt to the rising importance of our branch of medicine.
In practice, we have been delivering this model of dentistry for quite some time. We focus on both disease control and eradication of caries with fluoride, as well as periodontal disease, through communication and patient compliance. Improvements in dental materials and techniques give rise to longer-lasting and better-functioning restorations. In line with the goal of producing long-term benefits to our patients, reducing overall caries gives rise to better patient outcomes and lower long-term costs, namely fewer restorations over time.
Digital dentistry fits right in with these principles. We have found that, through improved and more accurate diagnoses using digital modalities, as well as our enhanced ability to communicate, we have better engagement with our patients. The more engaged patients are, the more likely they are to take ownership of their care. This, in turn, leads to better compliance. Digital impressions, computer-aided design, and milling CAD/CAM improve the consistency and quality of restorations, which should lead to longer-lasting-and therefore improved-quality at lower costs. Lastly, our computerized practice management systems allow us to better track outcomes, further enhancing the use of digital dentistry in the modern practice.
Gary Kaye, DDS, FAGD, founder of the New York Center for Digital Dentistry, has practiced comprehensive dentistry in New York City since 1993. He graduated from Columbia University of Dental Medicine in 1993 where he received awards in endodontics, prosthodontics, and geriatric dentistry. Dr. Kaye consults with other dentists and dental manufacturers and lectures on topics including ceramics, occlusion, and digital dentistry. He is on the guest faculty of Planmeca University in Dallas, Texas.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/does-digital-dentistry-make-you-a-better-dentist.html
Visit us: http://affinitydentalfresno.net/
I am often asked whether or not I believe that the addition of digital dentistry to a practice can make you a better dentist. Unequivocally, I believe that the answer is yes. Now, that does not mean that digital dentistry will replace every process in the office, or that implementing it will immediately change the treatment of patients or automatically improve our level of care.
Like anything in dentistry, there is a learning curve. It takes a certain level of commitment and preparation in order to take proper advantage of such leaps in technology. But, if the correct mind-set is paired with the right advancements, there is little doubt that it makes us better in our profession.
It is very important that the principles of dentistry are considered in order to get the maximum benefit from digital dentistry. We arrive at a correct diagnosis and communicate that diagnosis to our patients. Thus, our patients understand the implications to their oral and systemic health. Furthermore, it gives us the ability to perform the treatment efficiently, cost-effectively, and to the highest standards. When it comes to diagnosis, there is an array of digital modalities starting with digital records, radiographs (both 2-D and 3-D), high-definition intraoral cameras, caries detectors, cancer screening devices, and digital occlusal analyzers that, when applied correctly, greatly improve our diagnostic capability. As for direct interaction with our patients, we now have tools that improve our ability to properly communicate conditions, treatment options, and outcomes. It is, of course, incumbent on us to implement these tools. Many can be delegated to a team member such as an assistant or hygienist.
When it comes to treatment, digital dentistry gives us the option for digital impressions and chairside CAD/CAM milling. This can deliver restorations with the benefit of complete, step-by-step control. We have immediate access to emergence profiles, marginal ridge heights, and precise occlusal stops. In addition, we can send the virtual impressions directly to the laboratory and have unprecedented two-way communication with our lab technician colleagues. This allows us to deliver a better and more consistent restoration, which, among the other benefits of digital dentistry, makes us better dentists.
How does digital dentistry improve patient treatment outcomes at lower costs?
Better outcomes at lower costs is a hot topic in medical care, and as the dental profession moves toward the model of being physicians of the oral cavity and masticatory system, the subject of treatment outcomes at lower costs will be crucial. The links between oral and systemic health continue to emerge and, as a result, we as dentists become more integrated into the public scope of overall health. It is going to be imperative that we be able to deliver better outcomes at lower costs if we are going to adapt to the rising importance of our branch of medicine.
In practice, we have been delivering this model of dentistry for quite some time. We focus on both disease control and eradication of caries with fluoride, as well as periodontal disease, through communication and patient compliance. Improvements in dental materials and techniques give rise to longer-lasting and better-functioning restorations. In line with the goal of producing long-term benefits to our patients, reducing overall caries gives rise to better patient outcomes and lower long-term costs, namely fewer restorations over time.
Digital dentistry fits right in with these principles. We have found that, through improved and more accurate diagnoses using digital modalities, as well as our enhanced ability to communicate, we have better engagement with our patients. The more engaged patients are, the more likely they are to take ownership of their care. This, in turn, leads to better compliance. Digital impressions, computer-aided design, and milling CAD/CAM improve the consistency and quality of restorations, which should lead to longer-lasting-and therefore improved-quality at lower costs. Lastly, our computerized practice management systems allow us to better track outcomes, further enhancing the use of digital dentistry in the modern practice.
Gary Kaye, DDS, FAGD, founder of the New York Center for Digital Dentistry, has practiced comprehensive dentistry in New York City since 1993. He graduated from Columbia University of Dental Medicine in 1993 where he received awards in endodontics, prosthodontics, and geriatric dentistry. Dr. Kaye consults with other dentists and dental manufacturers and lectures on topics including ceramics, occlusion, and digital dentistry. He is on the guest faculty of Planmeca University in Dallas, Texas.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/does-digital-dentistry-make-you-a-better-dentist.html
Visit us: http://affinitydentalfresno.net/
Does digital dentistry make you a better dentist?
Gary Kaye, DDS, FAGD
I am often asked whether or not I believe that the addition of digital dentistry to a practice can make you a better dentist. Unequivocally, I believe that the answer is yes. Now, that does not mean that digital dentistry will replace every process in the office, or that implementing it will immediately change the treatment of patients or automatically improve our level of care.
Like anything in dentistry, there is a learning curve. It takes a certain level of commitment and preparation in order to take proper advantage of such leaps in technology. But, if the correct mind-set is paired with the right advancements, there is little doubt that it makes us better in our profession.
It is very important that the principles of dentistry are considered in order to get the maximum benefit from digital dentistry. We arrive at a correct diagnosis and communicate that diagnosis to our patients. Thus, our patients understand the implications to their oral and systemic health. Furthermore, it gives us the ability to perform the treatment efficiently, cost-effectively, and to the highest standards. When it comes to diagnosis, there is an array of digital modalities starting with digital records, radiographs (both 2-D and 3-D), high-definition intraoral cameras, caries detectors, cancer screening devices, and digital occlusal analyzers that, when applied correctly, greatly improve our diagnostic capability. As for direct interaction with our patients, we now have tools that improve our ability to properly communicate conditions, treatment options, and outcomes. It is, of course, incumbent on us to implement these tools. Many can be delegated to a team member such as an assistant or hygienist.
When it comes to treatment, digital dentistry gives us the option for digital impressions and chairside CAD/CAM milling. This can deliver restorations with the benefit of complete, step-by-step control. We have immediate access to emergence profiles, marginal ridge heights, and precise occlusal stops. In addition, we can send the virtual impressions directly to the laboratory and have unprecedented two-way communication with our lab technician colleagues. This allows us to deliver a better and more consistent restoration, which, among the other benefits of digital dentistry, makes us better dentists.
How does digital dentistry improve patient treatment outcomes at lower costs?
Better outcomes at lower costs is a hot topic in medical care, and as the dental profession moves toward the model of being physicians of the oral cavity and masticatory system, the subject of treatment outcomes at lower costs will be crucial. The links between oral and systemic health continue to emerge and, as a result, we as dentists become more integrated into the public scope of overall health. It is going to be imperative that we be able to deliver better outcomes at lower costs if we are going to adapt to the rising importance of our branch of medicine.
In practice, we have been delivering this model of dentistry for quite some time. We focus on both disease control and eradication of caries with fluoride, as well as periodontal disease, through communication and patient compliance. Improvements in dental materials and techniques give rise to longer-lasting and better-functioning restorations. In line with the goal of producing long-term benefits to our patients, reducing overall caries gives rise to better patient outcomes and lower long-term costs, namely fewer restorations over time.
Digital dentistry fits right in with these principles. We have found that, through improved and more accurate diagnoses using digital modalities, as well as our enhanced ability to communicate, we have better engagement with our patients. The more engaged patients are, the more likely they are to take ownership of their care. This, in turn, leads to better compliance. Digital impressions, computer-aided design, and milling CAD/CAM improve the consistency and quality of restorations, which should lead to longer-lasting-and therefore improved-quality at lower costs. Lastly, our computerized practice management systems allow us to better track outcomes, further enhancing the use of digital dentistry in the modern practice.
Gary Kaye, DDS, FAGD, founder of the New York Center for Digital Dentistry, has practiced comprehensive dentistry in New York City since 1993. He graduated from Columbia University of Dental Medicine in 1993 where he received awards in endodontics, prosthodontics, and geriatric dentistry. Dr. Kaye consults with other dentists and dental manufacturers and lectures on topics including ceramics, occlusion, and digital dentistry. He is on the guest faculty of Planmeca University in Dallas, Texas.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/does-digital-dentistry-make-you-a-better-dentist.html
Visit us: http://affinitydentalfresno.net/
I am often asked whether or not I believe that the addition of digital dentistry to a practice can make you a better dentist. Unequivocally, I believe that the answer is yes. Now, that does not mean that digital dentistry will replace every process in the office, or that implementing it will immediately change the treatment of patients or automatically improve our level of care.
Like anything in dentistry, there is a learning curve. It takes a certain level of commitment and preparation in order to take proper advantage of such leaps in technology. But, if the correct mind-set is paired with the right advancements, there is little doubt that it makes us better in our profession.
It is very important that the principles of dentistry are considered in order to get the maximum benefit from digital dentistry. We arrive at a correct diagnosis and communicate that diagnosis to our patients. Thus, our patients understand the implications to their oral and systemic health. Furthermore, it gives us the ability to perform the treatment efficiently, cost-effectively, and to the highest standards. When it comes to diagnosis, there is an array of digital modalities starting with digital records, radiographs (both 2-D and 3-D), high-definition intraoral cameras, caries detectors, cancer screening devices, and digital occlusal analyzers that, when applied correctly, greatly improve our diagnostic capability. As for direct interaction with our patients, we now have tools that improve our ability to properly communicate conditions, treatment options, and outcomes. It is, of course, incumbent on us to implement these tools. Many can be delegated to a team member such as an assistant or hygienist.
When it comes to treatment, digital dentistry gives us the option for digital impressions and chairside CAD/CAM milling. This can deliver restorations with the benefit of complete, step-by-step control. We have immediate access to emergence profiles, marginal ridge heights, and precise occlusal stops. In addition, we can send the virtual impressions directly to the laboratory and have unprecedented two-way communication with our lab technician colleagues. This allows us to deliver a better and more consistent restoration, which, among the other benefits of digital dentistry, makes us better dentists.
How does digital dentistry improve patient treatment outcomes at lower costs?
Better outcomes at lower costs is a hot topic in medical care, and as the dental profession moves toward the model of being physicians of the oral cavity and masticatory system, the subject of treatment outcomes at lower costs will be crucial. The links between oral and systemic health continue to emerge and, as a result, we as dentists become more integrated into the public scope of overall health. It is going to be imperative that we be able to deliver better outcomes at lower costs if we are going to adapt to the rising importance of our branch of medicine.
In practice, we have been delivering this model of dentistry for quite some time. We focus on both disease control and eradication of caries with fluoride, as well as periodontal disease, through communication and patient compliance. Improvements in dental materials and techniques give rise to longer-lasting and better-functioning restorations. In line with the goal of producing long-term benefits to our patients, reducing overall caries gives rise to better patient outcomes and lower long-term costs, namely fewer restorations over time.
Digital dentistry fits right in with these principles. We have found that, through improved and more accurate diagnoses using digital modalities, as well as our enhanced ability to communicate, we have better engagement with our patients. The more engaged patients are, the more likely they are to take ownership of their care. This, in turn, leads to better compliance. Digital impressions, computer-aided design, and milling CAD/CAM improve the consistency and quality of restorations, which should lead to longer-lasting-and therefore improved-quality at lower costs. Lastly, our computerized practice management systems allow us to better track outcomes, further enhancing the use of digital dentistry in the modern practice.
Gary Kaye, DDS, FAGD, founder of the New York Center for Digital Dentistry, has practiced comprehensive dentistry in New York City since 1993. He graduated from Columbia University of Dental Medicine in 1993 where he received awards in endodontics, prosthodontics, and geriatric dentistry. Dr. Kaye consults with other dentists and dental manufacturers and lectures on topics including ceramics, occlusion, and digital dentistry. He is on the guest faculty of Planmeca University in Dallas, Texas.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/does-digital-dentistry-make-you-a-better-dentist.html
Visit us: http://affinitydentalfresno.net/
Subscribe to:
Posts (Atom)