3D Printing + 7 More Exciting Advances in Dental Tech [in 2019]

The world is moving from analogue to digital, and so are dentists. Technology has revolutionized the dental industry to optimize patient care and satisfaction. The latest advancements have made the time you spend in the dental chair more efficient, while making sure your absolute comfort is never compromised.

Dentistry is moving forward, and I’ve listed a few ways how:

1. Dental 3D Printing

As with many other fields of science and art, the potential applications of 3D printing technology are endless.

If you ever needed a restoration procedure done, the sequence might go as follows:

Your dentist takes an impression of your upper and lower arch
S/he sends that to the lab
You both wait for the lab to create the desired dental models
You will be asked to return when the final product has been delivered to your dentist

With the advent of 3D printing, this can all be done in one appointment.

If you happen to have a tech-savvy dentist, he or she will scan your mouth with an intra-oral scanner that is then presented as a 3D image on the computer. (1) The dentist will then digitally design the desired treatment and send this information to the 3D printer that brings it to life.

A 3D printer has many uses in the dental practice:

Inlays and onlays
Dental crowns
Bridges
Implants
Mouth guards and night guards
Full or partial dentures
Orthodontic appliances (e.g. Invisalign or other clear aligners)

Not only does this save you weeks of waiting for dental labs to finish your dental product, but it also provides you with more accurate results. And, let’s be honest, who doesn’t want to skip the lengthy manufacturing process?

Whereas traditional methods allows your dentist to fix any defects after the restoration has been placed in your mouth, this newer method allows him or her to adjust any faults digitally before going to print set-up. This optimizes both your time, your dentist’s time, and your overall healthcare.

2. Digital X-Rays

Radiographs, also known as X-rays, are an essential part of treatment. They are used to diagnose many oral health issues not visible to the naked eye. This includes cavities, periodontal (gum) disease, and root infections, to name a few.

Traditionally, you dentist or dental hygienist would have film in a plastic holder and place it in the area of your mouth they would like to view. There are intra-oral and extra-oral x-rays that target different parts of the head. After capturing the images, they will be processed and analyzed by your doctor.

Although traditional x-rays have been a great diagnostic tool for many years and continue to be used for their lower cost, they have their drawbacks:

Film-based X-rays must be processed, which takes time
Processing film requires chemicals that may be toxic and hard to dispose of
Film isn’t as sensitive to the x-ray beam as digital technology, meaning there’s more radiation output from the x-ray head to produce an image

Digital radiography uses digital sensors to replace the conventional film that dentists have depended on for so many years. The sensor is connected to the computer and when it receives the image, it is immediately displayed on the screen for viewing and analysis. (2) The result? A totally digital workflow, completed in seconds.

It may be more expensive to purchase for the dentist, but the benefits outweigh the initial costs:

No use of chemicals
Environmentally friendly
Faster processing, saving valuable time for you and your dentist
Image enhancement with computer software (with high resolution originals)
50-80% less radiation than film
Images stored in electronic patient records, and sent quickly to referring dentists or insurance companies

If you are concerned about the radiation of x-rays, we have answered a few of your questions here and here.

3. CBCT (Cone Beam)

The types of X-rays we use for diagnosis vary on a case-to-case basis, and in some instances, we need a little more information than what a regular dental x-ray provides us.

Cone beam computed tomography (CBCT) is used to create 3D images of your teeth, surrounding tissues, nerves, ligaments, and bone in the maxillofacial region (head, neck, face, jaws). Think of it as 3D scanners making a digital model of everything your dentist needs to see.

Your dentist will position you in the center of the beam, and the machine will rotate around you in a 360 degree fashion. The whole process takes about 20-40 seconds for a complete scan.

Here are a few reasons a dentist may need to use a CBCT for a better look at a patient’s mouth:

Endodontic surgery (root canals): Gives clinicians valuable information on vulnerable structures such as sinuses, missed canals, and nerve channels
Implant placements: Provides accurate placement of implants in bone and the position of the inferior alveolar nerve as it relates to the placement of implants to prevent nerve damage
Orthodontic work: High quality analysis for the correction of malocclusions and facial disproportion
Diagnosing TMJ
Detecting and measuring jaw tumors

The 3-D images the CBCT produces identifies about 40 percent more lesions (3). That’s why Dr. Burhenne suggests patients get cone beam scans every 5-10 years after a root canal to identify any problems that arise.

Due to a much higher radiation exposure than regular dental x-rays, however, it is only done in cases where the information provided for treatment planning outweighs the radiation risk. That’s why the FDA recommends cone beams not be the first route for dental imagery.

4. DIAGNOdent

Dental caries, or cavities, are one of the most prominent problems in oral health care. Traditionally, dentists diagnose cavities using bite-wing x-rays and a dental explorer. Most cavities occur on the pits and fissures of the tooth, but many go undetected by using traditional methods.

One study showed sensitivity (ability of a test to correctly identify those with a disease) and specificity (ability of a test to correctly identify those without the disease) values of 62% and 84% with the conventional method.

In other words, dentists correctly detected cavities 62% of the time, and correctly determined no cavities 84% of the time (4).

Our goal as dentists is to not only treat cavities accurately, but also to arrest and prevent them in their pre-cavitation stages before a potentially rapid spread of decay. With the introduction of instruments such as the DIAGNOdent pen, in conjunction with our traditional methods, we can do just that.

The laser fluorescence it emits allows us to detect cavitated lesions from non-cavitated lesions.

At the 655 wavelength the device operates, cavitated lesions result in higher scale readings, while non-cavitated lesions result in lower scale readings (4).

DIAGNOdent helps improve treatment in several ways:

Audio signal allows dentist to distinguish between different scale readings
Increases detection accuracy at earlier stages than traditional methods alone
More precise in identifying pit-and-fissure cavities and proximal cavities
Minimally invasive

Read more about how dentists are diagnosing cavities with lasers in another post.

5. Intra-Oral Scanner & Intra-Oral Camera

If you have ever needed restorative or aesthetic work done, you know that one of the first things your dentist or dental assistant does is take an impression.

You see them mixing several materials together to create a uniform consistency, transfer that to a tray, and insert it in your upper or lower arch. They hold the impression material down for a few minutes until it sets, and then remove it.

Most patients are very uncomfortable with this process due to the taste of the material, time it takes to set, and uncontrollable gag reflexes. Patient comfort, along with several other factors can affect the accuracy of a traditional impression due to:

Proper material preparation
Mixing material
Application technique
Setting time

These challenges can lead to improper margins and missed details, resulting in improper fitting of restorations as well as improper occlusion (bite). Digital dental impressions provide an alternative to these complications so that a patient’s teeth may be restored without as much discomfort.

Intraoral scanners are shaped like a pen and project a light source onto the area to be scanned, such as your upper and lower arches for instance (5). Your entire mouth anatomy is captured by imaging sensors and projected onto a computer.

This creates a 3D model of your teeth and surrounding tissues and allows your dentist to diagnose and treat you with increase accuracy and precision.

Some reasons why dentists are moving from traditional to digital impressions are:

Increased patient comfort (this is especially true for those who struggle with mouth breathing, as the airway isn’t blocked by a big tray of impression putty)
No gag reflex or pain
Time efficient
Improved quality and detail of impressions for better-fitting restorations
Reduction in technique sensitive errors
Eco-friendly solution that reduces the need for plastic and impression material
Increases communication and understanding between dentists and patients

The latest technology includes intra-oral cameras that allow your dentist to capture images from points during the scan to be enlarged. This provides a greater overall comfort for the patient, better diagnosis, and more efficient treatment planning.

6. TekScan

Your oral cavity is a complex system made up of muscles, bones, and ligaments. These must all be in harmony for you to talk, bite, and chew properly.

If one of these components is out of balance, it can lead to several problems such as:

Temporomandibular joint (TMJ) disorder
Headaches
Bruxism
Fractured teeth
Broken restorations
Tooth pain
Gum disease

Traditionally, dentists check occlusion (the contact between teeth), with articulating paper. You will notice that your dentist will put this colored piece of paper between your teeth and ask you to bite down a few times. Your dentist will then diagnose these colored marks left on opposing teeth to check that they are contacting properly.

Articulating paper is also used to check if new restorations, such as fillings, inlays and onlays, crowns, and bridges are in proper occlusion with the rest of your dentition.

One study surveyed a group of 295 dentists, many of whom reported that they are “unable to reliably differentiate high and low occlusal force from looking at articulating paper marks.” The analysis from this study showed a sensitivity of 12.6% and specificity of 12.4%, which proves extremely low reliability and confidence using articulating paper as a diagnostic tool. (6)

TekScan offers a modernized solution to these issues. The TekScan device has an extremely thin sensor that is placed inside of your mouth, and just like with articulating paper, you are asked to bite down on it (2). A specialized software then displays your occlusion on a computer screen.

Here are a few things TekScan can do:

Detect biting time and force of bite
Show how occlusion is related to your TMJ
Identify what forces are causing trauma to your TMJ
Detect presence of any occlusal interferences

With this device, any of the guesswork involved in using articulating paper or other traditional methods is eliminated. Your dentist will be able to more accurately diagnose and correct any bite issues, optimizing your post-operative recovery.

7. The Wand

If you are someone who fears going to the dentist, it is probably because of one thing: injections.

Injections gives patients increased anxiety levels and discomfort. A needle can be very intimidating to some people, and the thought of getting one at the dentist’s office prevents patients from coming in altogether. The Wand offers a solution to that.

The Wand is an extremely thin needle that looks more like a pen than it does a needle. This automatically relaxes a patient that otherwise seems extremely anxious in the dental chair. A cartridge filled with local anesthetic is inserted into the Wand, and the delivery of the anesthetic is controlled by a computer (7).

The major benefits of the Wand include (7):

Single Tooth Anesthesia (his allows dentists to numb just one tooth rather than the entire lower jaw)
Three different delivery speeds (Slow, Fast, and Turbo) depending on the injection site
Reduces patient anxiety levels
Extremely thin needle that results in less pain upon injection

For those of you who are looking for other ways to manage your anxiety, we explore the benefits of taking CBD before coming to the clinic.

8. CAD/CAM

Computer-aided design and computer-aided manufacturing (CAD/CAM) is a computer software that is used to design and create prosthesis (8). A dental prosthesis is a dental appliance used to replace defects such as missing teeth or parts of intact teeth that need restoration.

Why are dentists shifting to CAD/CAM?

Faster fabrication
More precise fit
Increased predictability
Improved efficiency

How does CAD/CAM do all of this? With the help of an intra-oral scanner called CEREC, (CEramic REconstruction) that digitally transfers the information to the computer.

As previously mentioned, the source of digital light on the scanner scans the tooth in need of a restoration and all adjacent teeth that impact its function. The computer then uses this information to precisely calculate a 3D image of restoration for the tooth in question.

We use this creation of orthodontic models for several procedures, such as:

Inlays and Onlays
Crowns
Bridges
Dental implants

This all comes to life using the manufacturing part of the device, the CAM unit.

A specific material is placed in the milling unit, such as titanium, resins, glass ceramics, and zirconium oxide to name a few. The CAM unit mills the material to the precise structure created on the computer, bringing the image to life in a matter of minutes.

While it used to take several visits to the dentists for a restoration, CAD/CAM cuts that down to just one. The application of this technology are numerous and aids dentists in achieving more accurate clinical results.

Revolutionizing Dentistry through Technology

From 3-D printing to on-site milling machines, the world of dentistry has been completely revolutionized by modern technology on the dental market.

Dentists can now provide higher quality treatment faster than traditional methods. They are able to be more accurate and precise in their treatment, preventing future complications. Leading-edge equipment gives dentists more confidence and predictability, which results in improved healthcare for their patients.

It is more than a trend; It is the future of the field, and it is here now.

8 References

Oberoi, G., Nitsch, S., Edelmayer, M., Janjić, K., Müller, A. S., & Agis, H. (2018). 3D Printing—Encompassing the Facets of Dentistry. Frontiers in bioengineering and biotechnology, 6. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262086/
Ozcete, E., Boydak, B., Ersel, M., Kiyan, S., Ilhan, U. Z., & Cevrim, O. (2015). Comparison of Conventional Radiography and Digital Computerized Radiography in Patients Presenting to Emergency Department. Turkish journal of emergency medicine, 15(1), 8-12. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909933/
Peters, C. I., & Peters, O. A. (2018, April 03). CBCT: The New Standard of Care? Retrieved from https://www.aae.org/specialty/2018/04/03/cbct-new-standard-care/
Nokhbatolfoghahaie, H., Alikhasi, M., Chiniforush, N., Khoei, F., Safavi, N., & Zadeh, B. Y. (2013). Evaluation of accuracy of DIAGNOdent in diagnosis of primary and secondary caries in comparison to conventional methods. Journal of lasers in medical sciences, 4(4), 159. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282000/
Mangano, F., Gandolfi, A., Luongo, G., & Logozzo, S. (2017). Intraoral scanners in dentistry: a review of the current literature. BMC oral health, 17(1), 149. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5727697/
Kerstein, R. B., & Radke, J. (2014, January). Clinician accuracy when subjectively interpreting articulating paper markings. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24660642
Dubey, A., Singh, P., Pagaria, S., & Avinash, A. (2014). The Wand: A Mini Review of an Advanced Technique for Local Anesthesia Delivery in Dentistry. Retrieved from http://www.imedpub.com/articles/the-wand-a-mini-review-of-an-advanced-technique-for-local-anesthesia-delivery-in-dentistry.pdf
Parkash, H. (2016). Digital dentistry: Unraveling the mysteries of computer-aided design computer-aided manufacturing in prosthodontic rehabilitation. Contemporary clinical dentistry, 7(3). Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004535/

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