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Digital Dentistry
Computerization comes to the dental chair


July 2015

A patient room at East Town Dental Group of Milwaukee offers picturesque city views.

Much to the patient’s advantage, emerging dental technologies are changing the way in which procedures are performed. Efficiency is increased, patient safety is improved, and cost is often decreased.

Drs. Timothy Hart and Steve Koutnik added a 3-D printer to their Shorewood practice last year. Hart and Koutnik claim they are the first dentists in Wisconsin to use 3-D print surgical guides on-site, and the prosthodontists now create prints for select oral surgeons in the Milwaukee area. The final print, which takes about two hours to complete, is just as cost effective as it is efficient. For example, making the print costs the practice just $14, while outsourcing a similar handmade print would likely run upward of $3,000.

Both dentists also use computer-guided implant surgery to replace fractured or decayed teeth — a technology that has been used for more than a decade, but is continually evolving and improving. A CT scan of the affected tooth (or teeth) is performed, producing a 3-D X-ray of the surrounding tissues, critical nerve, artery and sinuses. Then, a plaster model of the tooth is digitally merged into the 3-D scan. "We’re able to observe where the teeth and the tissue are, and then we’re able to basically design where a tooth goes," explains Hart. "From there, we can perform a virtual surgery on the computer that places the implant." Channels guide the dental instruments and even the implant itself, ensuring its placement is spot-on.

Drs. Steve Koutnik and Timothy Hart were the first dentists in the state to print 3-D surgical guides on-site.

Hart says it is possible to implant a tooth that functions well but doesn’t look good — an aesthetic factor that may be permissible for a molar, but highly undesirable for a more visible tooth. He says proper placement to support surrounding gum tissue is key in avoiding this issue. "Attention needs to be paid to placement to support the gum tissue, and then the final restoration is indistinguishable from a natural tooth," says Hart.

Furthermore, computer-guided implant surgery is more minimally invasive than traditional procedures, which involve peeling back the gums. "By combining the CT scan with the 3-D printed surgical template, the surgery becomes very minimally invasive," explains Koutnik. "It’s less invasive than extracting a tooth." Plus, patients’ ability to have visual access to the elements of treatment keeps them more informed.

East Town Dental Group of Milwaukee even has its own surgical and prosthetic suite and dental laboratory — a feature that allows its physicians to perform All-on-4® immediate implant procedure. Generally reserved for patients with failing dentition and those wearing some form of removable dentures, the procedure, from extraction to implantation of a fixed prototype bridge, can be completed in a single visit. "Conventionally, if there was a case like this to be done, you would see a prosthodontist for diagnostics, planning and fabrication of surgical guides, then go to the remote imaging center for cat scans, then to an oral surgeon for the surgery, and then return to the prosthodontist who would design the teeth attached to the implants," explains Dr. Daniel Domagala, a practice dentist trained in prosthodontics and oral surgery. "Because we’ve streamlined this entire process, everything is in one spot. The patient doesn’t have to go from office to office."

More importantly, conventional methods usually require patients to be without teeth for up to six months after extraction and then for another six months after the implant placement. "Because of the unique design of our implant, in most patients we can place the implants and place the teeth on the implants on the same day. The patient is back to function virtually that same day," adds Domagala. "Similar to hip and knee replacement procedures, the teeth go into immediate function, and the patient heals while wearing a fixed set of teeth, which don’t move or cause sore spots. The recovery time is so much faster because of that."

Dr. Stephanie Murphy, who operates her own practice in Glendale, equally understands dental technology’s role in improving services. She began using the CEREC® system, a technology used to create and place crowns, two years ago. "What happened in the past was that a person would come in, we would take an impression and that would get sent to a lab, and it would take a lab a few weeks to make," explains Murphy. With CEREC, a photo is taken with a digital camera (avoiding that chalky impression paste), and then the system’s imaging software designs a 3-D model of the crown. An on-site milling unit constructs the crown from ceramic material, using the virtual model’s exact specifications as a guide. The entire process, from the initial digital photo to patient implementation, takes just two hours.

The system not only reduces a patient’s required time commitment, but improves safety too. "With digital X-rays, there’s much less radiation for the patient," Murphy explains. "In a lot of different ways, the technology is more convenient for patients but also safer." So what’s next? Murphy says that new software advances may allow CEREC to add Invisalign and braces to its imaging capabilities.


This story ran in the July 2015 issue of: