The switch from traditional (film) dental x-rays to digital radiography is much like the transition that occurred back in the 1990's when people switched from film to digital cameras.
At Inspire Dental, we utilize digital radiography and have completely phased-out conventional film because it offers a number of technical, environmental and clinical benefits. First, and possibly foremost, is the aspect of patient education. They say a picture is worth a thousand words and this one below, quite possibly says it all! Do you think the patient here, can see what their dentist is trying to show them?
There is a great value in you as a patient being able to 'see' and understand what the conditions are, and thus why you may require treatment. It is therefore one of the most important benefits to digital radiography, having images "larger-than-life" on a computer screen, to allow the dentist to show and teach their patients about what can be seen in a dental radiograph.
Another advantage is time savings! The fact that your dental hygienist, after exposure will not have to take a film out of your mouth then put it in a film processor, wait for it to be developed, then mount each in a film holder... translates into less time spent in the dental chair for you as a patient. Within seconds of an exposure, the image of your teeth appears on-screen and your practitioner will know whether they captured the information that is needed.
Whereas film requires a processor, and chemicals such as developer, fixer and various other maintenance solutions, digital radiography has no such requirements. A digital sensor also requires significantly less radiation to create a diagnostic quality image (50-90% less depending on what type of film you are comparing it to), so it's safer, to you as a patient.
The other major difference between digital radiography and conventional film is more technical, but it makes a big difference to you as a patient. The idea here is that the human eye can only distinguish 10-15 shades of grey when they're lined up side, by side. A computer program can be more discerning, capturing 256+ shades. While the overall diagnostic quality of a digital image is equal to that of film, software and enhancements offer the clinician tools which can help distinguish subtleties in the shades of grey to aid in the diagnosis of tooth decay (dental caries.) The advantage, is that your dentist will catch problems earlier and more often, before they turn into conditions that cause tooth pain or require more advanced treatment such as root canals or extractions.
The advantages are numerous. The advantages for the patient include a reduction in radiation and improved patient education capabilities. The biggest advantage to the patient is that, when an image is taken, they're able to see it immediately on a monitor. It's a 17-inch image instead of an image just more than one inch that you have to view through a view box or through the light in the operatory. This enables better communication since the doctor can make specific points while the patient comfortably sees his/her condition...
If you were to compare an excellent film image to an excellent digital image, the digital image would still have a lot more diagnostic information available. We have tools that allow us to electronically enhance the image. We're not changing the image so we're not putting in something or seeing something that's not there. Instead, we're able to focus on the different tissues of interest. It is a marvelous tool and the diagnostic applications are phenomenal.
- Dr. Dr. Claudio Levato, Dental Economics Dental Economics Vol. 94, Issue 12
The development of chairside "CAD/CAM" (Computer Assisted Design/Manufacture) of porcelain crowns has changed patients experience and improved the quality of patient care in a variety of ways.
If you have had crowns placed in the past, you may recall the traditional methods. A dentist will get the area numb and prepare the tooth for the crown (also commonly referred to as "cap"). This portion of the appointment is the same whether it is done the traditional method or through CAD-CAM. Using traditional techniques, your dentist then "takes an impression." Which means they place "PVS" a rubbery goo on a tray and you hold still while the material sets.
At a traditional crown appointment, a temporary crown must then be fabricated and temporarily cemented. Your first appointment concludes when the dentist has checked the bite and temporary crown fit. Meanwhile, the impression is sent to a lab where a technician pours up a stone model of your tooth/preparation and fabricates the crown out of all gold, PFM (porcelain fused to metal) or all porcelain. Typically, your second appointment is scheduled 10-14 days later, to test fit (and if all is well) permanently cement your crown.
Utilizing CAD-CAM method, your appointment and experience will be quite different than the traditional workflow. Following the preparation of your tooth, the prep is then digitally scanned.
At this point, you, the patient, have a 30-40 minute break (bring a good book, an iPad or laptop and enjoy our complimentary WiFi!) Once the digital scans are complete, the dentist designs the crown using computer software. This typically takes 10-20 minutes. The crown is then sent to a milling machine, located in our dental lab where a small block of porcelain (typically either Empress or IPS E.Max).
Once milling is complete the porcelain crown is then test fitted in your mouth, to ensure that the real crown feels and fits as well in reality as it does in the digital design world. Once that determination has been made, your crown is either hand-polished or baked in a porcelain oven. Then it is permanently cemented. One appointment, typically around two hour duration, and you leave the office with your permanent crown in place for good!
The role and use of lasers in dentistry has grown considerably in the last few decades. Below is a brief description of how they are utilized at Inspire Dental of Maine.
There are different types of lasers, for different applications. We use an "ErYAG" type laser, which denotes that its "lasing medium" is erbium-doped yttrium aluminium garnet. Without getting too technical, this type of laser produces specific wavelengths of light (2940 nm), which makes it ideal for "hard tissue" (teeth) applications, because this wavelength resonates very strongly with water (and to a much lesser extent hydroxyapatite, the mineral which teeth are largely comprised of). Why does this matter? Because the components of healthy teeth are mostly mineral and very little water; whereas tooth-decay and bacteria are mostly water. So, whereas a traditional dental bur does not discriminate, cutting whatever it touches, a laser does! An ErYAG laser will provide a more conservative preparation, preferentially removing more of the bad stuff (killing harmful bacteria and ablating tooth decay) while preserving more of the good stuff, like healthy dentin and enamel.
There are other benefits as well. Perhaps foremost in the minds of our patients, is that we can provide most (though not all) fillings without the need for injection of local anesthetic. No-needle, no-shot fillings may be the advantage of dental lasers that patients appreciate the most! It is thought that pain from dental work occurs through heat build-up from friction of a bur cutting a tooth. Because a laser removes decayed tissue without friction, most fillings can be done pain-free, without injections. There are exceptions, such as when the tooth is already sensitive to cold air/water or if the decay extends very deep, near to the nerves (tooth pulp) or if we are removing a old, broken down metal filling... we may sometimes still need to give an injection and perform the procedure through traditional methods. However, a majority of the restorations at our office do not require a shot.
Using a dental laser for cavity preparations also eliminates vibrations experienced with a traditional dental handpiece/drill.
There are also significant time savings for patients through use of the laser in dentistry. For example, we do not have to wait for the anesthetic injection to take effect and thus your time in the chair is often decreased. Another example, if you require four fillings, each one in a different corner of your mouth, we would normally break this into 2-4 appointments because we not want to get your your entire mouth numb all at once. With a laser in contrast, we can complete "four-quadrant dentistry" in a single visit, when the work does not require anesthetic injection.
Advances in laser technology are changing the way that patients experience treatment as well as the ways that dental problems are being resolved. Lasers provide more efficient, more comfortable and more predictable outcomes for patients.
- Dr. Ambrose Chan