by November 5, 2002 0 comments

Filling of carious teeth, capping or crowning of teeth comes under restorative dentistry. Traditional restorative dentistry requires several visits by the patient, who must endure extensive drilling, the rubbery impression material in his mouth, a fragile temporary restoration, and a two to four week wait for the laboratory to fabricate the crown. 

CEREC (Chair side Economical Restoration of Esthetic Ceramics), a computerized dental-restorative system, takes as less as an hour. It allows the dentist to quickly restore damaged teeth with natural-colored ceramic (porcelain) fillings, saving patients time and inconvenience. 

Cosmetic imaging software allows the dentists to show his patients how their teeth would appear as a result of dental procedures

How not
to do IT 

There is a flip side to the usage
of IT. The problem lies with the way we use it.

There is this well-established private
hospital in the capital city of God’s Own Country. It has a
critical-care unit, where at any given time there are about half a dozen
patients, fighting for their lives. These patients are under constant
monitoring. So far so good. Only, right around mid night, every night, an
old dot-matrix printer starts its high-pitched screech somewhere right
inside the unit. Maybe they print bills or instructions for the next
shift. But surely, the patients could have done without this unpleasant
sound right at the time they are battling for life itself!

CEREC uses CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) technology, incorporating an intra-oral digital camera, computer and milling machine in one instrument. The dentist uses this special camera to take an accurate picture of the damaged tooth. This optical impression is transferred and displayed on a color computer screen, where the dentist uses CAD technology to design the restoration. Then CAM takes over and automatically creates the restoration while the patient waits. Finally, the dentist bonds the new restoration to the surface of the old tooth.

The whole process takes about one hour. 

A tooth-colored restoration means no more silver fillings discoloring smiles; the filling is natural looking, compatible with tissue in the mouth, anti-abrasive and plaque- resistant. Dentists no longer need to create temporaries or take impressions and send them to a lab. Because of this, the traditional second visit has been eliminated. The CEREC has over a decade of clinical research and documentation to support the technology. The restorations have been proven precise, safe and effective. 

The patient benefits by saving time and enduring lesser pain, while the dentist benefits as the procedure is simple, precise and completely under operator control. It saves time, reduces lab costs, processed completely by chair side, and is dependable.
Cosmetic dentistry

Computerized cosmetic dentistry gives the dentist and the patient a chance to get a detailed look at the teeth, and view the potential results of dental procedures in advance.

Cosmetic imaging 
Cosmetic imaging software allows the dentist to show clients how their teeth would appear as the result of one or more procedures. The dentist takes a picture of the patient’s smile with a digital camera, and then customizes the results on the computer screen to lighten, straighten and/or reshape teeth. Patients can customize the smile to their specifications. The process takes about 30 minutes. These software are excellent for patient motivation and more and more dentists are investing in such systems.

Dental radiography

Before and after

Cosmetic jaw surgery (orthognathic surgery) sometimes alters the appearance of the patient. This change is, therefore, planned to be a positive one. Computer video imaging assists the surgeon in predicting the post-operative aesthetic look from orthognathic surgery. The video-imaging package from Orthovisions Technologies, for instance, encourage patients to examine a computer video-imaging prediction of their upcoming orthognathic surgery. 
This allows patients to see themselves on a high-resolution color video monitor while their image is redesigned electronically. The patient’s image is instantly captured with a video camera and displayed in color on the screen. The image is altered by the computer, and in just a few minutes one can see a before and after picture. 

Panoramic X-Ray
The digital panoramic X-ray unit is more comfortable and convenient for patients than conventional machines. Developed by Siemens, it uses the most advanced low-radiation technology. Because the X-ray shows the mouth seamlessly from all sides, the dentists can actually see 70% more than with multiple single X-rays, allowing them to localize problems with teeth, sinuses and jaws. The process itself is much more comfortable because no film is put in the patient’s mouth.

Digital X-Ray (Radiovisuography)
Compared with conventional X-rays, the dose of radiation has been reduced by about 80%. Digital X-rays are viewable in seconds on the computer screen, and allow the dentist to enhance the image for the greatest diagnostic effect. Some systems, like Denoptix, capture information on storage-phosphor imaging plates and use its high-speed scanner to convert the data into electronic files for viewing on a monitor using the VixWin software program. Others like the Schick CDR (Computed Dental Radiography) are computerized imaging systems that utilize an electronic sensor where dentists would normally use film. The sensors produce sharp and clear X-ray images that appear almost instantly on a computer monitor. Acquisition of CDR images uses up to 90% less radiation than conventional film X-rays. In addition, CDR is compatible with virtually all X-ray tubes

Usually PC-based planning software programs are used for two-dimensional cephalometrical analysis and documentation. These software take normal frontal and profile photographs as well as special X-ray images to enable the cephalometry by
comparing profile values with standard values.

Grid against cancer
The government of UK, along with the University of Oxford, IBM and Miranda (a company spun off from Oxford’s research initiative) is setting up a computational grid called eDiamond to help improve breast-cancer diagnosis. Ultimately, the grid could cover all the 92 breast-cancer scanning centers in the UK. But to begin with, the $6 million project will cover three hospitals and two screening centers. The objective is to standardize digital mammogram images and make them easily available, so that physicians and patients can compare scans accurately.

A 3D CAD system has recently been developed for the diagnostic setup of casts in orthodontic diagnosis and treatment planning, and its preliminary clinical applications. The system comprises a measuring unit, which obtains 3D information from the dental model using laser scanning, and a PC to generate the 3D graphics. When measuring the 3D shape of the model, to minimize blind sectors, the model is scanned from two different directions with the slit-ray laser beam by rotating the mounting angle of the model on the measuring device. For computed simulation of tooth movement, the representative planes, defined by the anatomical reference points, are formed for each individual tooth and are arranged along a guideline descriptive of the individual arch form. Subsequently, the 3D shape is imparted to each of the teeth arranged on the representative plane to form an arrangement of the 3D profile. When necessary, orthognathic surgery can be simulated by moving the mandibular dental arch three-dimensionally to establish the optimum occlusal relationship.

Compared with hand-made setup models, the computed diagnostic cast has advantages such as high-speed processing and quantitative evaluation on the amount of 3D movement of the individual tooth relative to the craniofacial plane. 

Trial clinical applications demonstrated that the use of this system facilitated the otherwise complicated and time-consuming mock surgery for treatment planning in orthognathic surgery.

Dental practice management 
Several fully-automated 32-bit charting software available now, are powerful and cost effective. They allow the dentist to fully integrate the clinic with most front-office practice management programs. These programs provide effective patient marketing and legal documentation while saving time and money.

Dr Sanjeev Kumar (maxillofacial surgeon) with Dr Susmita Saxena (oral pathologist)

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