The future in three dimensions

25 02 2010

Speaking with great passion for his subject matter, Lee Culp, CDT, seemed like an evangelist for the digital future of dentistry and dental lab work as he addressed the 82nd annual meeting of the American Prosthodontic Society Thursday at the Westin Chicago River North. Calling his presentation, “Beyond Imagination” Culp offered countless bold pronouncements as he mixed charming humor and an array of photos illustrating the range of restorations he has completed with digital dental and production technology.

His vision is of a dental world filled with the ones and zeros of binary code, where impression materials, physical waxups and lab technicians painstakingly layering porcelains to build the perfect crown are just memories of how things once were done. Insisting that this digital future still leaves plenty of room the artistry and craftsmanship of lab technicians, Culp said the digital path is one of speedy, efficient in production, and is already capable of producing high quality, long lasting restorations.

“The computers and machines can do incredible things today,” he said.

Of course, those computers are only as good as the people who use them, and Culp said good restorative work still must begin with a good impression. A digital impression with poor visualization of the margins is no better than a poor physical impression, but with a good impression as a starting point, the materials, computers and mills exist today to create highly esthetic full-contour restorations. Culp said he prefers glass ceramic materials such as Ivoclar Vivadent’s e.max lithium disilicate and thinks the future of lab work will involve digital design, computer milling and finally artful staining and glazing to make things anatomically realistic.

The approaching future he talks about will involve full 3D imaging of a patients entire oral anatomy, and Culp said the “3D patient” will be a reality by the end of the year. To accomplish this, diagnostically valuable DICOM data from cone beam scans will be integrated with the more detailed and machinable images from digital impressions to create restorations from start to finish in just hours with no physical model or even temporary required. In fact, Culp said he is already doing this on some cases.

Showing off the latest in imaging technologies, Culp displayed slides of the detailed images captured through optical coherence tomography. This laser-based imaging technique is not yet commercially available, but it is in the works, and when ready will allow clinicians to scan digital impressions that capture data beneath the margins. In fact, the scans are so detailed they can show the thickness of a tooth’s enamel layer to guide preparations and help spot caries that are still beneath the surface and invisible to existing technologies.

“Technology is there today to do these things,” he said. “We are going into the ones and zeros and we are going there fast.”

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Matters of materials science

25 02 2010

While the tradeshow floor at the Chicago Dental Society’s Midwinter Meeting was the place to see the latest products, a number of other meetings around Chicago’s downtown provided clinicians and technicians a range of educational opportunities. Over at the Michigan Avenue Westin, Boston University Assistant Professor and Director of Biomaterials in the department of Restorative Dentistry/Biomaterials Russell Giordano, DMD, DMSc, FADM, Cert. Pros. provided attendees of the 84th Annual Cal-Lab meeting with detailed breakdown of some of the latest science on materials available for CAD/CAM restorations.

After opening his talk quoting statistics from DPR’s 2008 Purchasing Survey showing the growing prominence of the technology, Dr. Giordano explained that a big reason behind the growth in this segment is the success of the restorations and the reliability of the materials available for use with CAD/CAM systems. This consistency comes from the fact that the materials are milled in consistent batches and are largely free of defects, even when viewed at microscopic levels. Hand layered porcelains and pressed restorations often have tiny porosities, that are not found in the more uniform CAD/CAM blocks.

Dr. Giordano predicted an increase in full-contour restorations being sent to labs as digital impressions become more common, and said the materials required to make these restorations esthetic and durable are already available. Multi-layered CAD/CAM blocks allow for milled restorations that mimic both dentinal and enamel layers, while new millable temporary materials allow for the creation of durable and esthetic temporaries.

Testing in his and other labs shows that when properly bonded rather than cemented in place, milled restorations can have lengthy, functional lives in the mouths of patients. A key to this lasting success can be found in the smaller particle size of the newer materials. Smaller particles mean the restorations are kinder to opposing dentition, and thus more likely to be successful. With the durability of a range of millable materials continuing to be proven in laboratory testing and in the mouths of a growing number of patients, properly designed and placed CAD/CAM restorations, even full-contours, should play a big role in the future of dentistry.





Colonial Dental Studio launches Smart Choice affiliate program

25 02 2010

Colonial Dental Studio is localizing national lab services.

Its affiliate program, Smart Choice Dental Laboratory, gives laboratories the opportunity to offer scanning, designing and manufacturing services while eliminating shipping costs and shortening turnaround times.

How are they doing it? Dental Wings is providing the infrastructure that pulls it all together, Dental Wings Director of International Business Development Vincent A. Munoz said during a press conference at the Chicago Midwinter Meeting Thursday afternoon. The company’s iSeries scanner can scan an impression, collect the necessary data and then transport it digitally to an affiliate lab.  The lab, with the help of the company’s software, can then use that virtual data to create a virtual model and design the restoration the doctor will actually place.

The open architecture systems make the manufacturing step easy, Munoz said, because it can interface with all technologies. The flexible system can take the digital data and send the coping to one affiliate and the crown design to another if that’s something the dentist wants to do, maximizing the technology. Someone from an affiliate lab will hand deliver the final restoration or it will be sent through the mail.

Dr. David Jarrin and Deborah Vessell use the Dental Wings scanner in their 3D Mobile Imaging van, which Dr. Jarrin said brings the entire solution to the dentist. CBVT offers the ability to treatment plan implant cases before going into surgery, while the scanner can get clinicians to the final restoration quicker, easier and cheaper.





How women can lead in dentistry, life

25 02 2010

Dr. Stephanie Houseman had it all, or so it seemed.
She had just expanded her practice into a beautiful, high-tech five-op facility and everything seemed to be in place. But the Jerseyville, Ill., dentist found herself dreading her daily trips to the office. She was working too hard, loo long and the stress was getting to her.
At Thursday’s sold-out “Leadership Fundementals for Women in Dentistry” course, she explained the importance of positive attitude and of following through with one’s life values. Dr. Houseman offered three key tools: Know Thyself, Relationship Management and Communication. “I was working too hard at working too hard,” said the daughter of a dentist who followed her “best friend and mentor” into a career in dentistry. “What I’m telling you today is that you have to get clear on your values and vision.”
She told a room full of dentists, hygienists and assistants to work “on” your business and not just “in” it. “Things that matter most should never be at the mercy of the things that matter the least,” she said.
After a morning lecture that covered the importance of taking charge of your choices, Dr. Houseman focused on tips and steps to help simplify your space, maintain helath of mind, body and spirit, and how to “choose” positive thoughts over “negative” ones that can be pursuaded by emotions and beliefs.
“Think you can’t and you won’t,” she said. “The more you dwell on positive, the more you attract positive in your life.”
The course, designed to awaken leadership potential, also helped attendees understand the importance of balancing their professional and personal lives, a lesson Dr. Houseman learned the hard way. For more information, course “handouts” are available on the Chicago Dental Society Web site and Dr. Houseman’s Web site at http://www.7steps2abalancedlife.com





World’s first “personal laser”

25 02 2010

Biolase iLase

After a Thursday morning press conference, Biolase Technology headed out to the trade show floor Thursday afternoon to unveil its iLase soft-tissue laser to attendees at the CMW dental meeting.
The 5W cordless laser, described as “beyond portable,” features 10 presets and 8 language options. “The iLase will provide minimally invasive procedures and hygiene procedures for everyone,” Senior Product Manager Bing Kongmebhol said. “It sets up in seconds and there are no external controls or interfaces.”
At the crowded unveiling, Biolase CEO Dave Mulder expressed excitement in the company’s second straight big announcement at the CMW. Last year Biolase launched the Waterlase MD Turbo here.
Expected to be available shortly, the iLase will be “very competitively priced,” according to Mulder, who says the nifty, pen-like instrument will provide an entry point for dentists and hygienists looking for an affordable laser that will perform a wide variety of soft-tissue treatments.





Protect yourself from risks

25 02 2010

Thursday morning’s half-day courses included one titled “Risk Management: Protect Yorself” and featured experts in law, insurance and dental practice.

Michael Terrell of the Cincinnati Insurance Company offered valuable advice on making sure you and your practice are covered against a variety of risks — some most docs may not think of until it’s too late. Dr. John Hayskar gave advice on helping make your your practice eliminate risks involved with OSHA requirements, while Dr. John Green, an attorney and dentist, sharerd some of his expertise in “Defending the Dental Profession.”

Among Terrell’s advice were ways to make sure record keeping errors are avoided and that all the necessary discussions and treatment plans are well documented. A big topic throughout the lecture was oral cancer, whether dealing with failures to diagnose or how to handle the situations in which the patient is found to have some form of cancer. “If you do an exam and see something, do something about this,” Terrell said.

He also said communicating ell with your patients can lessen the risk of lawsuits, while adding that while dealing with informed consent, the doctor should not delegate this to staff, rather handle the task themselves since the doctor is the one who is ultimately responsible.

Dr. Green offered suggestions on how to handle interviews with employees, how to make sure doctors working with implants and other potentially complex cases are covered in terms of training, as well as a number of libility issues that might not be on the top of the minds of dentists focused on delivering clinical care. Dr. Green established a law firm devoted exclusively to the representation of the dental proffesion. Dr. Green’s Web site (www.GreenLawOffice.net) offers additional information on his services.

Dr. Hayskar, who has a practice in Antioch, Ill, touched a lot on infection control and OSHA guidelines and suggested that practices visit http://www.osha.org if they’re not clear on the requirements and best methods to protect their practices and their staff.