High-tech Teeth By Laurie Bazemore   Dental advancements lead to smiling patients     Photography by Allison Davis-Sandfoot Photography   A trip to the dentist can be somewhat analogous to a student taking a class: It’s either required, or it’s chosen as an elective. While general dentistry comprises the required courses of treatment that reluctant and disciplined patients alike cannot avoid, cosmetic dentistry is more of an option. For some it’s a worthy investment in their smiles. Dr. Michael Willock, a Chapel Hill dentist, uses the popular CEREC technology, which incorporates computer-aided design and manufacturing to custom-fabricate restorations in one visit. Patients are able to watch the procedure as it's being performed. And while morphing a chipped tooth into one that’s smoothed out hardly compares with the urgency of building a sturdy crown for deep decay, modern dental practices commonly use the same technology for both. As up-to-date practices compete to offer a menu of comprehensive services, many are increasingly investing in emerging dental technology that efficiently serves both corrective and cosmetic purposes. Laser technology In diagnostic medicine, improved sensitivity drives technological advancements, and the latest early-detection tools make general dentistry no exception. While biannual cleanings are standard patient discipline for preventing a variety of dental health issues, neither the skilled maneuvering of a dental pick nor a dentist’s well-trained eye are adequate for catching a progressing decay. DIAGNOdent, a laser-probe technology, has become many dentists’ diagnostic detection tool of choice. When the probe’s sensor passes over a tooth’s surface, it detects any decayed region that exhibits a radiating fluorescence, indicating absorption of the laser’s radiation. Absorbed radiation produces a scale reading measured by number and audible sound. The higher the reading, the greater the extent of decay. “The prominence of fluoride in our water (makes it) hard to use the old traditional way of detection, which is using a sharp explorer and getting a stick where the cavity is present,” says Dr. Ashley Ashley Mann, a Cary-based dentist who has used DIAGNOdent for the past six years.     “DIAGNOdent lets us catch the decay early, just when it gets into the dentin, or soft part of the tooth.” Chapel Hill-based dentist Dr. Jean Woods uses DIAGNOdent to help diagnose pathology and measure a tooth’s hardness. “All of these newer technologies help diagnose any pathology sooner than could ever be seen by the human eye or on X-rays,” she notes. Similar to radiation-detection technology used in DIAGNOdent, handheld device VELscope detects the presence of oral cancer by emitting a blue light with a higher oral screening sensitivity than the conventional white light. Mann often uses VELscope, citing its ability to detect cancerous lesions down to the oral cavity’s basal-cell membrane. "We recommend that (oral-cancer screenings)be done once every three years for nontobacco users, and yearly for those who use tobacco or consume more than two alcoholic drinks daily," he says. "The earlier you detect oral cancer, the better the chances of survival." For many medical subspecialties, laser surgery is increasingly appealing because it reduces the need for local anesthesia, and causes little to no post-operative pain, consequently minimizing bleeding and swelling. In periodontics-a field dedicated to treatment of moderate to severe gum disease-conventional scalpel surgery can easily turn dental-office dread into fear. Dr. Rebecca Schmorr offers no-scalpel Periolase, or Laser Assisted New Attachment Procedure (LANAP), as an attractive alternative to traditional periodontal surgery at her Raleigh practice. “Periolase treats advanced periodontal disease surgically, but without having to cut the gums and suture them back up,” she notes adding that she prefers Periolose over traditional surgery because of the reduced amount of procedural discomfort and post-surgery gum recession. Pretty Porcelain Where general and cosmetic dentistry intertwine, tooth-colored porcelain and ceramic have emerged as attractive alternatives to the gold and silver traditionally used for tooth restorations such as crowns. In fact, porcelain and ceramic preparations previously fused to metal crowns now are the main components in restorations. “Patients want their teeth to look like teeth, not metal. Because porcelain reflects light like enamel, it looks very natural in the mouth,” notes Dr. Bobbi Stanley, a Cary-based family and cosmetic dentist. Wafer-thin veneers masking only the front of the tooth are an ideal option for teet that are worn down, small, misshapen or discolored. “Porcelain is the choice for veneers and onlays because it reflects the light as a natural tooth would,” notes Chapel Hill-based dentist Dr. Michael Willock, adding that many patients can have negative reactions to metals in some onlays. “Veneers are the No. 1 diagnosed and requested procedure in cosmetic dentistry,” Mann notes. “Porcelain is great because the patient can choose the shape, length and how white they want the final outcome to be,” he adds. “Patients like this because we take little or no tooth structures off and get a beautiful, natural-looking result.” Schmorr uses prepped porcelain to make a variety of composite fillings, crowns and onlays, and eggshell-thin veneers. Schmorr uses prepped porcelain to make a variety of composite fillings, crowns and onlays, and eggshell-thin veneers. Stacked porcelain, a fired liquid-powder mixture, and pressed porcelain, a malleable ceramic ingot, are molded to the tooth and used for no-prep and almost-no-prep veneers. For repairing more extensive decay, porcelain fused with zirconia can produce a strong, durable crown. “There are incredible new materials coming out every month,” Schmorr says. “What’s nice now is that the materials accommodate this preparation done on the tooth, as opposed to before when we had to prepare the tooth to accommodate the material.” Crowns and veneers vary in procedureal complexity, but technological advances allow marketers to capitalize on manufacturing either one during a single appointment. Traditionally, a temporary crown is placed before a patient returns for a laboratory-manufactured permanent crown. The popular CEREC technology allows trained dentists to employ computer-aided design and manufacturing (CAD/CAM) to custom-fabricate restorations during one-hour appointments. At the patient’s chairside, a dentist uses CEREC to photograph an impression of a prepared tooth’s exact dimensions, which then are used to produce a computerized restoration. Once a porcelain or ceramic composite is selected to match the tooth, the patient can watch a milling machine produce a custom-fit crown or veneer in a matter of minutes. “CEREC is a great concept, although not every tooth is a candidate,” Willock notes. “When we do a CEREC restoration, our patients are excited that this will be a one-visit treatment, and they enjoy seeing the machine work.” Evolving education To remain current on the latest technologies, many area dentists visit tradeshows, while others conduct routine reviews of dental journals and refer to expert forums online. Schmorr learned about Powerprox six month braces by visiting Dentaltown, an online dental forum, when she sought an affordable alternative for patients who didn’t want long-term braces or a full oral porcelain reconstruction. “(Powerprox) was a revolutionary discovery for me since it filled a cosmetic dentistry gap that I’d been seeing for a long time,” says Schmorr, who also devotes a substantial amount of time to attending continuing-education seminars. “There are always new materials being invented, so between new materials and new procedures, there’s a ton of information out there,” she adds. Willock also takes continuing-education classes to keep abreast of the latest trends, averaging more than 100 hours each year through workshops and seminars across the country. “The Triangle area is so progressive that our patients really like knowing that we are on the cutting edge of our field,” he says. “Dentistry is rapidly improving in all aspects, and I feel it’s very necessary for any dentist to stay current through seminars, workshops, and journals,” adds Woods, who frequently attends seminar and continuing-education classes as well. Investment in and promotion of new dental technologies unsurprisingly compels some dentists to purchase educational equipment to be able to share their knowledge with patients. When she opened her Wakefield practice in 2002, Dr. Melissa Davidian invested in patient educationvideos, chairside computer monitors, an intra-oral camara and digital radiography. In particular, digital radiography allowed her to not only construct a better patient dignosis, but also to explain to patients the issues she determined were affecting their oral health. “The ability to use the image for patient education has enabled me to help my patients understand their diagnosis better,” she notes. “Patients love seeing the images of their teeth in radiograph and picture forms, and will say “’I get it’ with confidence,” Davidian adds. “The value in patient education is invaluable.” WL