healthcaretechoutlook

Dentistry in the Digital Age

By R. Timothy Verceles, DDS MAGD AEGD Program Director, Advanced Education in General Dentistry, Highland Hospital-Alameda Health System

R. Timothy Verceles, DDS MAGD AEGD Program Director, Advanced Education in General Dentistry, Highland Hospital-Alameda Health System

I graduated from dental school more than 25 years ago and continue to be impressed with the unimaginable breakthroughs in dental technology during this time. I am very excited to embrace the new technologies that allow me to perform dental procedures more efficiently and keep my patients safe. For these patients at Alameda Health System-Highland Hospital, a public SafetyNet hospital where state-of-the-art procedures and equipment are used to treat all patients regardless of race, religion, gender or ability to pay, their dental experience can be life-changing.

"Advances in digital dentistry should help make the delivery of dental services more efficient and cost effective in the long run"

An example of the new technology currently used in the Highland Hospital Dental Clinic is the 3D ConeBeam radiography imaging system. At Highland Hospital, we use an I-Cat 3D cone beam scanner to capture images of the head and neck region of our dental patients. This versatile machine can assist with oral surgery planning, endodontic or root canal evaluations, orthodontic planning, implant and restorative dentistry planning, and airway evaluation. It has many uses in the dental field and is extremely safe for patients in that it captures an image in 4.8 seconds, therefore reducing a patient’s exposure to radiation. The scanner provides very valuable information and is cost effective at the retail price of about $100,000.

The first patient case study is for the pre-operative planning of treatment for head and neck, maxillo-facial trauma victims.

The patient below, a 18 year old male had a fractured lower left, angle fracture and a right parasymphysis fracture caused by trauma from a fist fight. (FTF, fist to face trauma)

1.

Image #1 shows the clinical presentation of the two fracture locations—note the dramatic step of the bite that indicates the presence of a jaw fracture. Images #2 and #3 are possible because the 3D cone beam allows the computer to do a reconstruction of digital image showing the existing fracture areas.

2.

Completed case with the reconstructed conebeam of the patient’s repaired jaw showing the arch bars and reconstruction plates in position.

A side by side comparison of before and after the surgery.

------

The Cone Beam can be used to help plan oral surgery treatment for patients with abnormal findings in their jaws.

This patient had a non-healing ulcer in her lower left jaw.

3.

Traditional 2D imaging showed the lesion.

4.

3D Cone beam frontal view image of the lesion filled with dead bone (bony sequestrum).

5.

                                                                              3 D Cone Beam shows the dimensions of the lesion.

Bony sequestrum (dead bone) secondary to osteomyelitis(bone infection) was removed.

______________

I am most involved with the use of Cone Beam imaging to plan dental implant reconstructions.

My patient was unhappy with his smile. 

He wanted dental implants, so we did an evaluation of his jaw bones using the cone beam.

6.

Sites were evaluated for appropriate implant placement.

This was the result.  The patient now has upper and lower implant retained dentures

7.

8.

Before and After

Our Highland AEGD Residents rotate to the University of the Pacific, Union City Community clinic. At the clinic they are able to use the CEREC scanner and milling machine to create CAD/CAM, (Computer Aided Design/Computer Aided Manufacturing) dental restorations with state of the art dental materials. This system usually retails for around $100,000. This technology allows the dentist to do a crown or dental restoration in a single visit. Traditionally, the dentist would prepare the tooth, take an impression, put a temporary crown on the tooth and then send the impression to the lab for the technician to fabricate a crown. The patient would then return for the cementation appointment.

With this technology, the tooth is prepared in the normal manner and instead of taking an impression of the preparation, a scanner is used to capture a digital image of the preparation. The restoration can be digitally designed on the computer and then the file is sent to a milling machine for fabrication.

9.

Tooth preparation is scanned.

10.

The dental restoration is designed on the computer.

11.

Restoration is sent to the milling machine and then the restoration is milled and ready to deliver to the patient.

3D printing has now come of age in dentistry and the FDA has recently approved the use of some 3D printers to produce dental restorations and dentures for use in the mouth.

12.

This is a sample of a denture created by 3D printing. Our primary dental lab service provider is going to integrate this technology in the next 6 months and we will now be able to use dental prostheses that have been 3D printed.

The digital age of dentistry is here and Highland Hospital is using the newest technology in dental care.  Also, on the horizon for Alameda Health System is implementation of an electronic health record system in 2019 that will integrate existing EHR systems into one cohesive system to share records of each patient’s interactions with every department in the health system. These advances in digital dentistry should help make the delivery of dental services more efficient and cost effective in the long run.

The Golden Age of Dentistry exists right now! I am happy that we can offer some of the best technology available for our patients.

New Editions