The Best in the North West: 2017 Technology Review

    By Sophia Bennett

    As the year comes to a close and another one prepares to dawn, you may be thinking about investing in new technology for your practice. Have you ever wondered what your colleagues are choosing and why? We asked eight dentists (most of whom practice in the Northwest) to divulge some details about their favorite technology purchases. The list includes some exciting new technology as well as tried and true favorites.

    Computer-Assisted Local Anesthesia: Aseptico

    Computer-assisted local anesthesia delivery utilizes technology to control the flow rate of dental injections, ensuring a smooth and gentle flow of anesthesia. This means less pain for the patient and a host of benefits for the clinician.

    The Calaject computer-assisted local anesthesia system features a lightweight handpiece that allows clinicians to use an ergonomic pen grip when administering injections for superior tactile control. The Calaject handpiece houses the anesthesia cartridge in a transparent, autoclavable barrel, providing visual contact with the carpule throughout the injection. Calaject uses standard dental needles and anesthesia cartridges, saving practices money on disposable handpieces. It does not require the use of tubing sets or other disposable accessories.

    Three different program settings allow dentists to administer intraligamentary injections, infiltrations, regional nerve blocks and palatal injections. Aspiration is performed automatically whenever the foot switch is released. The device is powered by a lithium battery, making movement between operatories very convenient.

    Calaject has been used in Europe for years but is just becoming available in the United States. Dr. Jan Frydensberg Thomsen from the Hovedstaden region of Denmark has high praise for the system. “I was first introduced to computer-assisted local anesthesia in 2007 and have been using such a device ever since,” he says. “Computer-controlled injection has an incomparable ergonomic advantage over manual injection, as you do not need to bend your wrist and press the plunger simultaneously. I can sit relaxed and inject. I have a greater success rate with nerve blocks—and the low computer-controlled injection rate makes it virtually pain-free for the patient.”

    Virtual Reality: OperaVR

    The OperaVR virtual reality system was designed by Dr. Bryan Laskin, who took to heart the multiple scientific studies demonstrating that virtual reality can lower anxiety and reduce pain. His system uses a 360 degree headset that shows patients immersive videos of waterfalls, mountain scenes, beaches, starry nights or other soothing visuals. When they wear the headset, they no longer see what’s happening in front of them or hear sounds from your equipment.

    The system comes with a headset and two video devices. The first fits into the headset, and the second is used as a remote to control what the patient is seeing. The extra video player sits on a charger when not in use, so if the first device loses power during a long procedure, it can easily be swapped out.

    “I love pretty much everything about it,” says Dr. Megan Pint at Lake Minnetonka Dental in Wayzata, Minnesota (systems have only been mailed to Northwest dentists in the past month). One of her first opportunities to use the OperaVR came in the middle of an appointment, when a patient started to develop anxiety about a procedure. “We switched her to it and it really made a difference for her.”

    Since that time she’s used it for everything from hygiene appointments to surgical procedures, and on patients ranging from children to adults in their 70s. The technology is intended to be easy for everyone to use, even people who aren’t tech-savvy. “Anyone in five minutes could be walked through a tutorial of how to use it for patients,” Pint says.

    Clients appreciate that VR is offered at no charge, unlike some forms of sedation. Pint finds the system more convenient to work around than nitrous. “It’s nice because it isn’t restrictive when working on MX anteriors,” she says. “Nitrous can be cumbersome for those anterior fillings if the mask/nosepiece is resting on the upper lip. VR is nice since it’s out of the way for working in that region.”

    CO2 Laser: LightScalpel

    The LightScalpel CO2 laser is intended for a variety of soft-tissue surgical procedures including frenectomy, gingivectomy, gingivoplasty, operculectomy, excision of fibromas and mucoceles/ranulas, and biopsies. When compared to traditional surgery methods, LightScalpel laser treatments result in minimal to no bleeding, little to no swelling and discomfort, a reduced risk of infection, and great cosmetic outcomes.

    These qualities are what attracted Dr. Kim Hort with the Children’s Dental Clinic at the Southeast Alaska Regional Health Consortium to the LightScalpel. “The Children’s Dental Clinic was exploring options for infant frenectomy procedures—methods that were quick, safe and effective,” she says. “Dr. Joe Jackson and I attended a continuing education course at Tufts University in Boston and had some hands-on time with this laser. The LightScalpel fit all of our criteria, “including that it was safe to use on patients ranging from infants to adults.”

    “We’ve only had the laser for a month, but in that time we have found it to be easy to use,” she says. Patients feel very comfortable with it, in part because they have less post-operative sensitivity. The laser gives us options that we did not previously have, which means that we are able to offer more services that would have been deferred or referred.

    “Hands-on and didactic training was a key element in the incorporation of this laser into our practice,” Hort adds. “It is an investment, so having the training provides the confidence and skill to effectively add these procedures into our practice to enhance the experience of our patients.”

    Dental Shade Matching Software: ShadeWave

    Precisely matching the shade of a new tooth or other dental lab product can be a source of anxiety for dentists. That’s why ShadeWave created an advanced software solution that accurately matches the color and translucency of a patient’s existing teeth with any new devices they need.

    With ShadeWave, a dentist uses their own camera to photograph and upload a picture of their patient’s teeth. The company’s cloud-based software uses an advanced algorithm to create a detailed map showing shade, translucency and value. A dental lab can then follow that map when making the crown, bridge or other implement.

    “I’ve used ShadeWave for about three years [mostly through Issaquah Dental Lab],” says Dr. Thomas R. Quickstad, who practices in Issaquah, Washington.
    “It has been very helpful for getting the correct value in shade selection at the lab.  Depending on how much time the lab takes to utilize the color map created by ShadeWave, I think a very detailed match of color and characteristics can be made. You still need to get a custom shade match for that lone central incisor, but for bicuspids and matching adjacent PFMs or e.max on anterior teeth it’s great.”

    Oral Cancer Screening: VELscope

    VELscope was developed to provide enhanced visualization of oral mucosal abnormalities, including oral cancer or pre-malignant dysplasia. Today it remains one of the most common cancer screening tools on the market. The hand-held device emits a blue light that’s used to inspect the mouth and tongue. The blue-spectrum light causes the soft tissue to naturally fluoresce. Healthy tissue fluorescence may be visibly disrupted when tissue undergoes an abnormal change. There can be many reasons for these disruptions, but they tell the dentist that further screening is warranted.

    Dr. V. Kim Kutsch with Kutsch & Renyer Family and Cosmetic Dentistry in Albany, Oregon bought the technology when it first came on the market. “I teach a lot, and when I’m out lecturing at different dental meetings I get to see what’s on the market and what’s coming on the market,” he says. “When I saw the VELscope I thought, ‘What a great technology that we could use to be more accurate and more definitive when doing those cancer screenings.’”

    Kutsch acquired a machine as soon as he could. He recently replaced the old one with a newer model. “It’s a great product to have in your practice,” he says. “I can’t tell you how many patients we’ve found different lesions on that we’ve sent out for biopsies. It makes a big impression on patients, especially if you see an area of concern. Patients are coming to expect that kind of care, so if you’re looking to take your practice to the next level and offer preventative services, it’s something you need to investigate.”

    It’s a good idea to arrange for an in-office demonstration to test the VELscope before buying it. “New things can be intimidating, but if you can get your hands on it, you’ll see it’s easy to use and interpret,” Kutsch says.

    12 O’Clock Cabinet and Stool: A-dec

    Dr. Nicole Keck-Erickson with Summit Family Dental Care in Medford, Oregon sings the praises of the A-dec 500 12 O’Clock Dual Delivery system to everyone who will listen. “It’s got a digital touchpad that controls the lighting in the room, and other functions that can turn on different equipment in the rest of the room,” she says. “It’s like the brains of the operatory.”

    One of her favorite features is the system’s ability to memorize three different preset positions for the patient chair. “This way you don’t have to toggle the patient up and down,” she says. “The electric handpiece also can be preset to four different RPMs, which is really nice too.”

    Although there’s nothing high-tech about A-dec’s dental stools, Keck-Erickson has been pleased with that purchase too. “They’re fully adjustable—you can adjust the lumbar support, height, tilt, everything,” she says. “They’re really ergonomic and comfortable. My pain level has gone down quite a bit since we switched because I was reaching behind me to get my instruments, and my stool was shaped like a hill, so when you sat down you felt like you were going to fall off it. The A-dec ones are shaped to your body, so you don’t feel like you’re going to fall off. My instruments and drills are now in front of me, so I reach forward instead of having to twist and turn back behind me. Moving around is also much easier—they really roll and glide. And they have really soft leather.”

    CAD/CAM technology: 3Shape, Formlabs, Roland

    The University of Washington School of Dentistry has been using computer-aided design and computer-aided manufacturing (CAD/CAM) technology with students since 2014 with great success. “Instead of taking traditional physical impressions, we use optical scanning to take digital impressions of the teeth,” says Dr. Yen-Wei Chen, an assistant professor in the Department of Restorative Dentistry. The 3D printer generates a model, and then the milling machine fabricates the restoration on site.

    The School of Dentistry uses the TRIOS3 intraoral scanner from 3Shape, Form 2 3D printer from Formlabs, and DWX-4W milling machine from Roland when teaching this technology. There are a few reasons they selected these devices. “They are some of the major systems in the dental market right now,” Chen says. “Size-wise, they’re very compact. We can fit them easily in the clinic. Their speed and accuracy are just phenomenal.”

    Chen believes it is imperative to educate students about this important part of the future of dentistry. They need to understand the machine, but also need a good grasp on the type of work that’s involved, he says. “It is a digital workflow, much different than that of traditional dentistry.” This will greatly affect how offices run and operate, as well as the timing and level of service patients can expect.,,

    Cone Beam CT: KaVo

    When the Southeast Alaska Regional Health Consortium went searching for a cone beam CT, they settled on the Instrumentarium OP300 Maxio from KaVo. “The cone beam is similar to the pano [panoramic x-ray] machine, which many patients are familiar with as the x-ray image of the whole mouth,” says Dr. Matthew J. West, the clinic’s director of dental services. “Where the cone beam differs is it allows us to see a three-dimensional image instead of a two-dimension image. The image is similar to what doctors see with a CT machine in medicine.

    “Having a three-dimensional images allows a significantly higher level of diagnostic ability,” he continues. “In a 2D image we can’t tell exactly where things are in relation to each other. So when we are looking at a pano, we can see a large nerve canal, but cannot tell if it’s in the front or back of a tooth. With the cone beam, we can. This allows a higher level of safety and success with surgery and implants.”

    West is enthusiastic about the machine and hopes to bring it to more of the nonprofit’s sites in the future. “The machine take incredible images,” he says. “We can also decide to take a whole mouth image or just a small area depending on the need, so the patients get the least amount of radiation possible.”