Modern Technology

INTRODUCTION

Technological advancements continue to evolve the capabilities of our society. In healthcare, it allows us to discover pathology earlier so that we can be less invasive and people can live longer, healthier lives. The dental industry is no different in that technology continues to advance the level of care we can provide to our patients. Providing our patients with modern diagnostic technology allows us to provide less invasive dental procedures, which typically offer better longevity for our restorative materials and potentially save more tooth structure. Patients may experience less dentistry in their lives, and because of it, their teeth may be functional and present for more years or their whole lives.

Less invasive preparation designs are achievable by finding the pathology earlier. Smaller preparation designs have many benefits for both the dentist and the patient. A smaller preparation design can benefit the tooth by obviously maintaining more of it for the future. However, it also benefits the dentist in that the cavo surface and proximosurfaces might still have enamel present, which relates to a potentially longer-lasting bond to the tooth, creating better longevity. The preparation design may also stay supragingival when found earlier, making it easier to place with less risk of contamination. It will also be easier for the patient to cleanse once placed, potentially contributing to better longevity of the filling material and tooth. When dentin is exposed, it would be superficial dentin, which has been shown to have the highest bond strength of anywhere on tooth structure. A small preparation design, as it relates to occlusion from the opposing dentition and wear or damage from mastication, could also be substantially longer-lasting. This is due to less force being placed upon it by having more tooth structure around it to take the brunt of the masticatory forces. However, all of these benefits don’t come without some level of difficulty. Hence, technological changes with current materials and techniques have become of interest. When creating smaller preparations within the tooth, it becomes more difficult to place traditional restorative materials. Current materials and matrix devices are either too thick or too curved to place interproximally when small amounts of tooth structure are removed. Rather than remove more healthy tooth structure to create space to place traditional restorative materials and matrix systems, we can instead utilize new devices and various restorative materials that simplify the filling process. This also creates final restorations that have improved strength and/or bioactive properties to help fight off cavities and strengthen the tooth structure. case 1 are presented here that highlight the materials and devices being utilized to provide minimally invasive, modern, or bioactive restorations.

CASE REPORT

Case 1

By utilizing the latest diagnostic technology in dentistry, we can better understand what is happening to the tooth structure’s crystalline structure so that we can either monitor the tooth or try to remineralize it. We can have earlier intervention to create minimally invasive preparations so that there is less amputation of tooth structure. Two types of modern diagnostic technology were implemented. The first technology is The Canary System (Quantum Dental Technologies) (Figure 1) and the second is modern digital radiograph evaluation (DEXIS) (Figure 2). The Canary System is a low-level laser diagnostic tool that quantifies the tooth’s crystalline structure, providing a numerical value and an audible notification for the patient and practitioner to hear. It was determined that there was damage to the crystalline structure of the tooth when a numerical value of 39 was found on the distal of tooth No. 21, which relates to the presence of a cavity.

The CariVu transilluminator diagnostic device (DEXIS) (Figure 3) is another tool that can be implemented. The transilluminator of the tooth structure utilizing live video- and photo-capturing technology allows the clinician to see in real time what is happening within the tooth structure. Once a defect within the tooth is found, a photo can be captured from the live video for the patient to see. It was evident from the CariVu image that decay was present on the distal of the tooth and extending into the superficial dentin (Figure 4).

Radiographic interpretation can often be lacking. For example, in this case, a small defect may be noted on the digital radiograph, which could cause some practitioners to misdiagnose the cavity or visually not see the cavity. When evaluating the teeth using the CariVu, the decay that is noted from The Canary System is further verified, allowing the practitioner and patient to see the distal decay requiring removal. The ability to find pathology earlier and intercept it with smaller preparation designs, small matrices, and new injectable composites, as well as the ability to utilize remineralization techniques or minimally invasive preparation designs, is better in comparison to traditionally more invasive modalities.??

Furthermore, radiographs lack the ability to view the location of tooth decay spatially from buccal to lingual. We can only perceive decay on the radiograph once enough damage is present, and we can only see its location from occlusal to gingival. When it comes time to prepare the tooth, the interproximal decay is often found by cutting through healthy tooth structures until we locate the decay. Then, based on one’s preparation design and matrix system, additional healthy tooth structure can be removed buccally and lingually to create space for placement of the matrix and materials.

The ability to look down on the tooth from above with a CariVu gives us a spatial orientation that radiographs cannot provide. Knowing where the tooth decay is allows the dentist to be more conservative in his or her preparation design with less removal and exploration to find the tooth decay (Figure 5). Once found, the decay can be further accessed for any remnants with various intraoral cameras and caries indicator solutions.

Another area of concern when working interproximally is the prevalence of iatrogenic trauma to adjacent teeth, which often happens during direct and indirect restorative procedures. The removal of healthy tooth structure from adjacent teeth can leave the tooth rough, which can allow bacteria to colonize, and potentially exposed to future tooth decay via easier access because of a lack of protective enamel on the tooth. Furthermore, altering the emergence profile of the tooth can create future problems when trying to recreate ideal interproximal contacts, which, when done incorrectly, may give rise to additional tooth decay and gum disease. It is for this reason that there are devices available to help protect the adjacent teeth while allowing the practitioner to make smaller, less invasive preparation designs (Figures 6 and 7). Various types of metal shim devices can be pushed between the teeth such that they create a metal wall or barrier shielding the adjacent tooth from any accidental bur strikes. They can also be used when preparing teeth for indirect restorations. This allows the practitioner to make smaller, less invasive preparations without damaging adjacent teeth, and creating a smaller preparation allows for faster placement of restorative materials.

DISCUSSION??

1. There are a lot of factors to consider in today’s economic environment as office overhead, rent, materials, employees, and other costs of business continue to rise along with current increases in inflation. The win is to find tooth decay earlier for our patients to necessitate less invasive treatment so that they can hopefully maintain more tooth structure for the rest of their lives and have less occlusal loading and stress on their restorations. This will also allow dentists to make smaller preparations necessitating less time and materials, which is a side benefit of the minimally invasive mindset.

CONCLUSION

In conclusion, the techniques, preparation designs, devices, and materials we have used previously continue to evolve into better, stronger, more durable materials that can help us heal a tooth internally and fight off external bacterial microleakage and pH challenges. Combined, all of this allows dentists to conserve more tooth structure than ever before while, at the same time, providing the potential for a longer-lasting filling material due to improved physical properties that also feature less occlusal loading due to the smaller restorative footprint. Utilizing newer materials that offer bioactive properties can also help strengthen the tooth to increase its longevity by fighting off acid attacks and reducing demineralization and microleakage. These newer materials and devices can certainly benefit the patient as well as the dentist in many ways.