Kristen Mott is the associate editor for Dental Products Report and Digital Esthetics.

Kristen Mott

Articles

Want to avoid a visit from OSHA at your lab? Here's what you need to know.

5 surefire ways to get an OSHA inspection in your dental lab

	While more awareness is being spread about opioid abuse, the opioid epidemic remains a significant problem in the United States. Fortunately, the percentage of opioid prescriptions prescribed by dentists has fallen to 6.4 percent as of 2012, but the fact remains that dentists are typically one of the first medical professionals to prescribe opioids to teens and young adults for the treatment of acute pain, such as wisdom tooth removal. And according to new research, young people who fill an opioid prescription after wisdom tooth extraction may set themselves up for long-term opioid use.

Michigan Opioid Prescribing Engagement Network

 (Michigan OPEN) at the University of Michigan used insurance data to focus on young people who were “opioid naive,” meaning they hadn’t had an opioid prescription in the six months before their wisdom teeth extraction and who hadn’t had any other procedures requiring anesthesia in the following year. The data came from employer-based insurance plans, available through the Truven MarketScan database.

Trending article: The dental prescriptions that are killing your patients

	The team of researchers discovered that 1.3 percent of 56,686 wisdom tooth patients who filled their opioid prescription between 2009 and 2015 went on to persistent opioid use. The researchers defined persistent opioid use as two or more prescriptions filled in the next year written by any provider for any reason. The team also determined that young people ages 13 to 30 who filled an 

 immediately before or after they had their wisdom teeth removed were nearly three times as likely as their peers to still be filling opioid prescriptions weeks or months later. Patients in their late teens and twenties had the highest odds of persistent opioid use compared to patients in middle school or high school.

	“We found that filling an opioid prescription increased the odds of developing new persistent use nearly three-fold, isolated from other patient factors such as age, tooth impaction and health conditions,” says 

, a Michigan OPEN research fellow and lead author of the study. “With 3.5 million healthy young people having their wisdom teeth pulled each year, this translates to nearly 50,000 young people who could develop new persistent opioid use each year because of the opioid prescription alone. This is an important step in understanding the unintended effects of prescribing when no prescription may be indicated at all.”

Harbaugh says the team of researchers had previously discovered that about 5 percent of teens and young adults who don’t take opioids but then receive a prescription after an operation develop new persistent opioid use where opioids are used far longer than expected for recovery. This time, the team decided to focus its attention on the effects specifically after wisdom tooth extraction since there’s evidence that shows that opioids are no more effective for pain control than non-opioid 

 when used in combination. By examining this population, Harbaugh says the team could look at the effects of opioid prescribing after wisdom tooth removal.

	“The death toll from the opioid epidemic has continued to rise each year. Many efforts importantly focus on prevention of opioid-related overdose among people who already use opioids. There is another important population of people who do not already take opioids, who will receive an opioid prescription for a surgery or dental procedure, and may go on to new chronic opioid use,” she says.

	“In addition, 72 percent of opioids prescribed for surgery go unused and these overprescribed medications are sources of diversion and misuse. At Michigan OPEN, we have focused our efforts on primary prevention of new chronic opioid use, overprescribing that can lead to diversion and disposal efforts to remove opioid sources from the community.”

Read more: What dentists NEED to know about the opioid epidemic

	Because of the growing opioid overdose crisis, the American Dental Association earlier this year announced 

 to combat the opioid epidemic. The policy in part supports mandatory continuing education in prescribing opioids and other controlled substances.

	“Children are in a vulnerable time in terms of risk of persistent use and addiction to opioids,” says 

, clinical associate professor and director of pre-doctoral clinical education at the University of Michigan and a co-author of the study. “Additionally, dentists are the most prolific prescribing to the age group 10-19 and every prescription should be considered very thoughtfully and should be a last resort after all other pain management strategies have been ruled out.”

	The team of researchers at Michigan OPEN is currently studying this topic further by speaking with patients and parents about their wisdom tooth extraction experience and how many opioid pills they actually took. The team hopes this will allow them to create evidence-based prescribing guidelines.

Persistent Opioid Use After Wisdom Tooth Extraction

," was published in the Journal of the American Medical Association.

New research shows that young people who filled an opioid prescription immediately before or after wisdom tooth surgery were nearly three times as likely to still be filling opioid prescriptions months later. 


Can opioids prescribed for wisdom tooth extraction lead to long-term drug use?

	As the demographic of older adults continues to grow, geriatric dentistry is becoming a focus of many dental offices. Elderly dental patients present their own unique set of challenges. Physical or cognitive impairments can make home dental care difficult, while prescription medications can lead to adverse reactions. Many older adults also lack dental insurance, which can present an obstacle to obtaining needed dental care.

	In addition, older adults are susceptible to tooth decay. According to a 1999-2004 National Health and Nutrition Examination Survey, approximately 18 percent of adults ages 65 and older with retained natural teeth have 

. Moreover, a 2009-2012 study found that 68 percent of those patients have periodontitis.

	Caries in elderly individuals may present a major problem, as new research suggests that older adults with caries and fewer teeth may develop respiratory problems.

Trending article: 7 MORE of the scariest medical conditions with links to oral health

	Researchers in Japan set out to investigate the variation in tongue microbiota among community-dwelling elderly adults. According to 

, previous research has determined that constant aspiration of saliva can lead to pneumonia, which is a major cause of death among older adults with swallowing impairments. In addition, studies have shown that tongue microbiota are a dominant source of oral microbial populations that are ingested with saliva, and that the dysbiotic shift of indigenous tongue microbiota is associated with an increased risk of death from pneumonia in frail elderly adults.

The researchers in Japan collected tongue coatings from a 15-mm-diameter area at the center of the tongue of 506 elderly adults ages 70-80 who inhabit the town of Hisayama, Japan. The microbial composition of the samples was determined using a gene sequencing approach and quantitative PCR analysis.

	The researchers discovered that the microbiota composition showed an association with tooth conditions. In addition, co-occurrence network analysis identified two cohabiting groups of predominant commensals, including one primarily composed of organisms that have been previously associated with an increased risk of mortality due to pneumonia in the frail elderly.

	“The bacterial group was more predominant in the elderly with fewer teeth, a higher plaque index and more dental caries experience, whereas the total bacterial density was independent of these traits,” 

. “A higher density of fungi was also observed in the elderly with these traits as well as in individuals who wore dentures. These results suggest that elderly adults with poorer oral health swallow a more dysbiotic microbiota formed on the tongue.”

	The researchers concluded that careful attention should be given to the tongue microbiota status of elderly adults who exhibit poor dental conditions.

More from the author: The states with the best and worst oral health in 2018

	This isn’t the first time research has discovered a connection between oral health and respiratory problems. In 2016, 

 found that individuals with gum disease have a 1.24-fold increased risk of developing lung cancer. In addition, the research indicated that women with periodontal disease are more likely than males to develop lung cancer.

, part of the American Dental Association, notes that a common cause of caries in older adults is dry mouth. To relieve dry mouth symptoms and prevent cavities, the organization recommends using over-the-counter oral moisturizers, drinking more water, using sugar-free gum or lozenges to stimulate saliva production, and avoiding foods and beverages that irritate dry mouths such as coffee, alcohol and carbonated drinks. In addition, spouses or family members should make sure elderly relatives are brushing twice a day and flossing daily as well as visiting the dentist regularly.

, titled "Tongue Microbiota and Oral Health Status in Community-Dwelling Elderly Adults," appeared in 

, an open access journal published by the American Society for Microbiology.

New research takes a look at the link between poor dental hygiene and breathing issues.

Are elderly patients with caries at risk of developing respiratory problems?

	Bulk fill materials are changing restorative dentistry as we know it. Innovation has led to bulk fills that are simpler to use, faster to cure and easier to handle, resulting in restorations that are superior and long-lasting.

Esthetics have improved as well. From nanofillers that ensure wear resistance and polish retention to increased material opacity that doesn’t sacrifice depth of cure, patients are leaving dental offices with more esthetic and natural-looking restorations.

Trending article: A composite technology to prevent secondary caries

	The bulk fills on the following pages are prime examples of advanced, next-generation materials that are changing the way clinicians approach restorative dentistry at their practices.

	Click through the slides to see the products.

	3M™ Filtek™ One Bulk Fill Restorative

• Designed for the posterior, this material’s unique optical properties and increased opacity allow for the simplicity of one-step placement without compromising esthetic results.
	• With excellent adaptation and handling, it can be placed in one fast, easy increment up to 5 mm with no need for layering.
	• 3M’s true nanotechnology results in superior wear resistance and excellent polish retention.

	• This new light-cured bulk fill restorative composite is optimized for simpler and faster posterior restorations.
	• REVEAL HD Bulk combines appropriate handling, depth of cure and polishability, allowing clinicians to provide patients with functional and esthetic composites while saving chair time.
	• With its HD Filler Technology, the material allows for layering increments in 5-6 mm due to its predictable depth of cure.

• Fill-Up!™ is a dual-cured, medium viscosity bulk composite that has been developed for indications that demand fast, esthetic, tooth-colored restorations.
	• The material is suitable for bulk fill technique in the posterior region and can be applied in a single layer of any depth.
	• Surface light curing for only five seconds is said to finish the restoration with no top layer needed.

	• A posterior restorative composite , Ecosite Bulk Fill is engineered to deliver superior esthetics with a single, quick 20-second light cure.
	• The material’s ability to flow smoothly under pressure is said to ensure high packability without sticking to instruments.
	• It reliably cures in a single-layer application to a depth of 5 mm while providing unmatched handling, polishability and superb adaptation.

 flow+ is said to be the first bulk fill flowable that self-levels, providing excellent cavity adaptation and significantly lower shrinkage stress.
	• The material is designed to allow for a bulk fill of up to 4 mm without any manipulation for a fast, easy application with lasting results.
	• The bulk fill is approved to be used in Class III and Class V restorations where a capping agent wouldn’t be used.

	Dentsply Sirona Restorative
	800-532-2855  |  

	• G-ænial™ BULK Injectable  is an injectable, high-strength, nano-particle composite with ideal viscosity, handling and adaptation characteristics.
	• The material can be used as a one-step application for bulk filling up to the occlusal surface (up to 4 mm) without the need for capping or veneering with another composite.
	• The homogeneously dispersed nano-particle formula provides high flexural strength and wear resistance for a durable and long-lasting restoration that retains its gloss.

 is a light-cured, flowable bulk fill composite.
	• The self-leveling composite eliminates the need for layering, allowing 4 mm increments to be placed in a single step.
	• The material is radiopaque and designed to be fast, versatile and easy to use.

Tetric EvoCeram Bulk Fill and Tetric EvoFlow Bulk Fill

	• Tetric EvoCeram Bulk Fill is a unique nano-hybrid developed for fast, efficient placement of direct posterior composite restorations.
	• Tetric EvoFlow Bulk Fill features opacity-shifting technology for the high-performance dentin replacement material clinicians have been looking for.
	• The two materials can be paired together for optimum predictability, efficiency and bulk fill esthetics.

	SonicFill™ 3 SingleFill™ Composite System

• SonicFill™ 3 SingleFill™ Composite System is a sonic-activated bulk fill composite that reportedly helps clinicians craft quality restorations with greater ease and speed compared to incremental layering techniques.
	• SonicFill 3 is said to fill cavities in seconds, and the formula is non-sticky and slump-free.
	• Cavities up to 5 mm in depth can be filled in a single increment without the need for a liner or capping layer.

	• Venus Bulk Fill is a flowable, low-shrinkage composite for creating posterior restorations with the bulk filling technique.
	• The material is indicated as a base in Class I and Class II direct restorations (up to 4 mm) and for cavity lining under direct restorative materials.
	• Self-adaptive handling is said to eliminate steps and provides ideal coverage of cavity floor and walls.

• Beautifil-Bulk Restorative is a conventional packable composite resin that incorporates the unique bioactive benefits of Giomer, a surface pre-reacted glass filler that’s backed by 13 years of clinical success.
	• It’s designed to have optimum translucency and a high fill ratio, which reduces polymerization shrinkage stress while increasing compressive and flexural strength.
	• The material is said to have an ideal balance of light diffusion and transmission that ensures complete polymerization at 4 mm depth of cure.

	Shofu Dental Corporation
	800-827-4638  |  

 is a flowable bulk fill composite that’s esthetic and strong all on its own - no capping layer needed.
	• The material requires no additional composites for outstanding esthetics and strength, offering faster and simpler single-increment restorations up to 4 mm.
	• Utilizing Estelite Spherical Filler technology, the bulk fill is said to provide more natural-looking restorations via higher shade matching ability, opacity and polishability than other products.

	Tokuyama Dental America
	877-378-3548  |  

• Admira Fusion x-tra is the world’s first all ceramic-based direct bulk fill restorative material.
	• As a nano-ORMOCER

, the material’s chemistry base is formed by silicon oxide, making up both the glass fillers and ceramic resin matrix, a first of its kind.
	• Advantages are said to include up to 50-percent lower polymerization shrinkage than today’s conventional composites as well as up to 50-percent lower shrinkage stress.

 is an easy-to-use, dual-cure, bulk fill composite incorporating Zest Dental Solutions’ proprietary IntelliTek

 Curing Technology.
	• Formulated to overcome the limitations associated with current composites, Bulk EZ has been proven in independent studies to eliminate gap formation and stop microleakage.
	• Featuring high strength and wear resistance, the material demonstrates a quick self-cure mode and is said to require minimal manipulation or adjustment.

	Zest Dental Solutions
	800-262-2310  |  

• x-tra base is a fast-setting bulk fill flowable posterior composite indicated to cure in 4-mm layers in only 10 seconds (universal shade).
	• Supported by its 75-percent (by weight) fill rate, it’s designed to offer a combination of strength, speed and adaptability.
	• Its viscosity and low water solubility extend its indications to both the closed and open sandwich technique with a self-leveling effect that allows for easy adaptation to the cavity walls.

Rounding up some of the top bulk fills available on the market.

How to provide better results with bulk fill materials

	As former British Prime Minister Benjamin Disraeli once said, “Change is inevitable. Change is constant.” While that quote may hold personal meaning for some, it’s quite apropos for the business world. In order for an industry or sector to grow and thrive, change must take place. Often, technological advancements serve as a driving force for that change.

	Dentistry is a prime example of how technology is changing the scope of an industry. From advancements in 3D printing to digital impressions to cloud-based software, technology is molding every aspect of the dental industry.

	We spoke with several industry experts to get their perspective on the greatest areas of change that have shaped the current state of dental technology and what this growth means for the future of the industry.

More from the author: What dentists NEED to know about the opioid epidemic

	Digital impressions have made a big impact on the industry, especially for dentists doing chairside dentistry. Intraoral scanners currently on the market are engineered to produce highly accurate and detailed scans, leading to higher clinical success rates and streamlined workflows. Patient comfort is also enhanced since there’s no need to bite into a tray of gooey impression material.

Dr. John Flucke, technology editor for Dental Products Report, considers digital impressions one of the largest areas of advancement for the dental industry.

	“The chairside units have evolved tremendously,” says Dr. Flucke, who has a private practice in Lee’s Summit, Missouri. “Back in the day, most took a series of individual pictures that were taken by using a foot pedal to capture the image. While those worked adequately, the speed and convenience factor was lacking.

	Now, the units take hundreds or thousands of images automatically in a matter of seconds, pulling in tons more data that allows the software to create renderings that are so accurate, it’s almost beyond comprehension.”

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Many scanners can also determine if and where data is missing and indicate to the clinician where to add to the scan. “This allows for a pretty much seamless acquisition,” Dr. Flucke says. “Many offices are reporting full dual-arch scans being accomplished in easily less than five minutes.”

 also aid in articulation, and Dr. Flucke says he’s optimistic about the implications of this technology.

	“I’m looking forward to being able to merge CBCT imaging with the .STL files created by digital impression systems,” he says. “Imagine virtually articulating a complicated case and working out the entire occlusal scheme by rendering it in 3D on a screen. We are already reaping the benefits of digital impression systems that require very minimal adjustments based on simple articulation. If we could articulate virtually and work out all the occlusal components on an exact replica of the patient’s existing masticatory scheme, adjustments could well be a thing of the past.”

 are one of the hottest pieces of technology in the dental industry. While dental labs are currently utilizing this technology more than private practices, Gideon Balloch, dental product lead at 

, says he’s been surprised by the volume of dentists who are using 3D printers.

	“Formlabs has only been selling into the dental industry for two-and-a-half years,” Balloch says. “We were kind of expecting that we would be paying most of our attention to dental labs for a really extended period of time, and the long-term future would be heading toward greater use of technology in the actual dental practice. We were kind of surprised to find that actually we’ve seen a ton of adoption with dentists and it’s growing very quickly.”

Read more: How to ensure the entire team is on board with technology

	The most practical implementation of 3D printing at the moment, Balloch says, is the practice lab.

	"Practices are still working with three or so dental labs, but on a couple of different indications they’ve decided that 3D printing makes sense for them, so they do that in-house,” he explains. “Sometimes they work with a lab on the design, sometimes they do everything including the design themselves. It’s a very nuts-and-bolts, approachable solution that’s not totally changing the makeup of their practice.”

	One of the biggest developments when it comes to 3D printing has been materials and the availability of different resins.

	“You have companies coming out with materials where you can print a 

,” says Matt Alles, digital solutions marketing manager for 

. “You can actually print a denture base, mill out the teeth and then you can just bond them onto this 3D printed denture base and characterize.”

	“The real advancement is going to be the printing of restorations,” Dr. Flucke adds. “Once a material is developed that is as strong and esthetic as current options, the floodgates will be wide open.”

	3D printers on the market today are also taking less time to print. Take Straumann printers, for instance, that can print two surgical guides in just 15 minutes, Alles says. Being able to print surgical guides during an appointment can give patients some much needed comfort.

	“When you just show them a drill and the implant and you say we’re going to drill into your bone and place an implant, it can kind of scare you,” Alles says. “With guided surgery, you can print that guide and show the patient what you’re doing.

	“The time of the 3D printers is getting very impressive where you’ll have surgical guides within 15 minutes. You can really almost do immediate placement-guided surgery in one day if you wanted to do so,” he adds.

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	3D printing is making digital dentistry more affordable as well, Balloch says, especially when it comes to splints or occlusal guards.

	“3D printing in a practice lab situation can really make a huge difference because there’s a slight improvement in fit, which drives better comfort, but the bigger difference really centers more around that fact that if the technology is in the practice, then the practice can offer that at a lower price to their customers and they can prescribe it at a much higher rate,” he says. “If you talk to any sort of general dentist out there and you ask them what percentage of people need night guards, they’ll say something in the high majority. But when you ask them how many patients did they actually place occlusal guards with, they’ll say something below 10 percent.

	“The reason for that is that type of treatment is often not covered by insurance,” he continues. “It’s often a very large out-of-pocket cost. But by having that technology in the practice lab, the users that we’ve seen have been able to offer these technologies more often to their customers and it’s a better way to drive a higher percentage of treatment to people who need it.”

	Dental software and cloud-based computing

	While many people may think of technology in terms of equipment, software also plays a major role. And with more and more applications in our lives utilizing the cloud, it’s no surprise that dental software would follow suit.

Mike Uretz, a dental software and electronic health records (EHR) expert and the founder of 

 says that cloud-based computing is leading the technology front, particularly due to the growth of DSOs and multi-location groups.

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	“Cloud-based computing is becoming more and more popular partially because the growth and the need for it in DSOs and groups,” Uretz says. “One of the main reasons is because of all the locations and the need to aggregate information throughout the organization, including the increasing use of analytics to manage group operations. Cloud-based computing helps with that. In the medical software industry over the past few years, we saw the multi-location groups lead the way in adoption cloud-based technology, and I believe we will see the same trend in dentistry.”

 also allows for the easier integration of third-party plugins and applications, which enhances the software’s functionality.

	“We’re starting to see more ability for images to be held in the cloud and accessed anywhere and be more closely integrated into the electronic health records portion of your software,” Uretz says. “Instead of having to separately access the software of your imaging devices and then back to your dental software, everything is integrated together.”

	In addition to being able to access important information wherever they’re located, dentists may also see some cost savings when it comes to cloud-based computing since they no longer need IT people on staff.

	“With cloud-based computing, you basically have a 24/7 IT department that is managing your servers, your information, and these people are experts at it. Because of that, cloud-based computing also gives you subscription models. Instead of a major outlay upfront, you’re paying each month like you would a utility.”

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	The design of the software itself has evolved too. More clinicians are now using smartphones, tablets and laptops to access both practice management and clinical information, so vendors are investing more time and money in the user interface.

	“They have to design the software so that it will be easy to use on different devices,” Uretz says. “It’s the design of the software that’s changing. As we get more technologically advanced and the developers have better tools to use, you’re getting more user-friendly designs.”

	Finally, Uretz points out that just as electronic health record (EHR) technology has become a critical mainstay in medicine, we’re now seeing more dental software vendors invest money and resources integrating EHRs in their dental software applications. This is leading to more efficient clinical workflows and better patient care.

	Milling units have evolved in multifactorial ways, Dr. Flucke says, and because of this, there are currently some outstanding milling units on the market. Open source mills in particular are giving dentists the flexibility they need.

	“Open source mills allow any acquisition unit to export their .STL files to their mill of choice,” Dr. Flucke says. “Current 5-axis mills are capable of creating almost any dental prosthetic in a variety of materials, including but not limited to wax, zirconia, PMMA, glass ceramics, lithium disilicate and Lava™ Ultimate (3M Oral Care).”

Related reading: Is the future of dentures digital?

	Developments in milling are going in two directions, according to Steve Braykovich, president and CEO of 

. The first is toward very high speeds and low chip cross-sections. The second direction is toward high feeds and low depths of cut at moderate cutting speeds to increase metal removal rates.

	“Tooling and machining dynamics play a significant role in achieving longer cutting tool life and accuracy while maintaining high-quality surface finishes with reduced chipping and thinner restorative margins,” Braykovich says. “Tool manufacturers are working in both directions to offer optimum solutions to customers based on application and machine capabilities.”

	Significant improvements have also been made in open-source 

	“Capabilities that used to be available with high-end, industrial-centric hardware and software are slowly working their way into open-source solutions for the dental industry,” Braykovich explains. “This is largely due to the emergence of customized dental CAM solutions from industrial CAM software publishers whose products contain algorithms and software features with decades of testing against highly sophisticated industrial, high-speed, multi-axis machining applications. Additionally, dental CAM software with less real-time cycles, based on ‘home-grown’ or purchased core technology, are improving through the natural software development cycle related to use over time.”

	Because of these recent advancements, there’s been an impact on workflows, Braykovich says, whether it be crown and bridge, fixed partial dentures, removable appliances or surgical-guide fabrication. However, an understanding of the product’s capabilities, operation and place in the workflow is crucial for clinicians to comprehend.

	“To successfully integrate CAD/CAM technology into their practices, clinicians should start with an understanding of what functions are of value now as well as the capabilities they seek for future expansion of services,” Braykovich says. “At the end of the day, implementation can save clinicians time and money, increase operational efficiency and better control costs while significantly increasing the quality of care provided to their patients.”

	Patients can also reap the benefits of milling technology, from faster turnaround times to fewer office visits to more comfortable and durable restorations.

	“The precision of today’s mills combined with the precision of the latest acquisition units allow for the creation of prosthetics that have a better fit and require fewer adjustments than traditional techniques,” Dr. Flucke says.

	Clinical software and electronic health records

 continue to change the landscape of the dental industry, Uretz says there’s going to be a shift toward integrated single databases. Rather than holding information at each separate office location, all of the clinical and patient information will be stored in a single database.

	“With an integrated single database, you have all the information - clinical, administrative and financial - at your fingertips in one place,” Uretz says.

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	Traditionally, dental software supported basic functions such as scheduling, insurance and billing. But with the introduction of EHRs, many software vendors are now investing heavily in clinical and 

	“What you’re starting to see happen now is a big movement toward vendors investing in the clinical and electronic health records side of things,” Uretz says. “Some of the things that you’ll see now are electronic prescribing, which has been around for a long time, but it’s really starting to take hold more. And even though it’s not big right now, we’re starting to see vendors looking at including diagnostic codes.

	“We’re also starting to see better and more secure messaging portals and ways to communicate from patient to practice or group, group or practice back to the patient, or practice to practice,” Uretz adds. “That leads to better communication, better care and reduced liability.”

	Some of the newer software even includes analytics and business intelligence tools. This is especially helpful for groups with multiple locations as it allows them to develop a better understanding of the areas in which they’re doing well along with the areas in which they need to improve.

	“The benefit of analytics is better cash flow,” Uretz explains. “Dentists can be more successful financially because you can analyze trends, you can look at scheduling. From an operational standpoint, using some of the newer tools helps you to run a more efficient practice or group.”	 

	While the current state of dental technology may seem impressive enough, there are already new innovations and applications on the horizon.

	Dr. Flucke predicts that data mining and 

 will be big players in the not too distant future.

	“I’m currently working with a company that is using artificial intelligence to help read bitewings,” he says. “Having the ability to work with an impartial third party when performing diagnosis is a serious disruption to the traditional way we diagnose. I’m all about maximum disruption if it provides better care.”

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	When it comes to 3D printing, Alles says permanent crowns are on the top of everyone’s mind.

	“I believe within the next year to three years, we can have a permanent crown from a company. When you’re talking about chairside dentistry, I think that’s the development that’s going to be coming out,” he says.

	Taking things one step further, Alles highlights the fact that researchers have 3D printed cartilage with an 

 printer. He predicts that same technology will one day be applied to crowns.

	“Companies will look into can I actually print a crown that has DNA in it that can be accepted by the body as a natural tooth and maybe not even have an implant,” he says. “So, you’ll have that root structure still in place and you can print a crown with that DNA and have it get absorbed into the body.”

	As for milling, Braykovich expects future developments to provide more refinements and advancements in machine construction, controls, tooling, work-holding, CAM software and automation.

	“I believe we are not far from a multi-platform CNC machine combining additive and subtractive technologies along with the specialized software required to support its operation,” he says. “These integrated machines and software are currently available at some level in the industrial space and it is likely we will see more of them in the dental space in the future. This could be fueled by the ever-advancing field of material science, which will continue to bring new products that could lead to milling machine and processing challenges, as well as new disruptive technologies and opportunities.”

	While new technological advancements will shape the future of the dental industry, in order for change to truly take place, companies must collaborate with one another. Balloch believes greater collaboration will take place as new developments are made across the industry in terms of digital dentistry.

Read more: How is dental technology REALLY being used?

	“In the last three years, 3D printing has gone from being sort of way back behind a lot of the other technological developments in terms of digital dentistry and it’s sort of caught up. Now, we’re right there with some other very innovative companies at the leading-edge of changing standards of care and changing different types of indications to be digital,” Balloch says.

	“In order to continue changing the industry and improving standards of care through digital dentistry, there’s going to have to be not just improvements in 

 but also improvements in software and improvements in scanning in order to deliver the types of changes that we are currently delivering for current 3D printable applications.

Taking a look at current technology trends in the dental industry - and what the future holds. 

The state of dental technology in 2018

	Dr. Daniel Ward, a Dentist based in Columbus, Ohio, is no stranger to GC Fuji II LC

. In fact, he’s been using the light-cured, resin-reinforced glass ionomer for more than 20 years. He first heard about the material during a presentation at a local study club in the early 1990s and started using it as a base under large composites. Patients immediately began saying that they didn’t have the post-operative sensitivity that they had experienced in the past with composite restorations.

	“Over the next several years, I was becoming frustrated by patients who would come in with recurrent decay around the margins of their composite restorations,” Dr. Ward says. “For that reason, I began using GC Fuji II LC as a 

 and not just as a base in my patients who were at greater risk for decay. When I changed to using GC Fuji II LC, rather than my traditional light-cured composite, I noticed that they were lasting quite a bit longer.”

 as a base underneath composites, Dr. Ward uses the material for Class III and Class V restorations as well as in buccal and lingual repairs around crown margins. He also prefers using it for crown buildups.

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	“Glass ionomers are wonderful for crown buildups,” he says. “First, they’re very technique insensitive. They’re very simple to use, so you don’t have to go through a lengthy bonding procedure. Secondly, the bond to tooth structure is consistent and long-lasting. The bond in deep areas with composites may change over time. … With glass ionomers, that bond strength doesn’t decrease over time, so you have the added advantage that you know it’s going to strongly adhere over a long period of time.”

	Glass ionomers play a role when it comes to creating esthetic restorations. With more patients requesting picture-perfect smiles, products like GC Fuji II LC are crucial.

“Our patients are coming in and they all want esthetic, tooth-colored restorations, but the challenge is how can we provide tooth-colored restorations that are going to last? That’s where glass ionomers are ideal because they often help the restorations to last longer,” Dr. Ward says. “The No. 1 cause of replacing composite restorations is recurrent decay. So, if you use a material that helps cut down on recurrent decay, then that’s an ideal material to use with many of our patients.”

 II LC is for transitional restorations, particularly with patients who need a quick yet durable solution.

	“Let’s say that it’s Friday around 4:30 p.m. and a patient comes in and they broke part of their tooth. They ask if you can put something over it to get them through. Obviously, when it’s late in the day, you need to figure out a quick, easy way to put something over the area that’s missing. With GC Fuji II LC, you don’t need to anesthetize, and it holds up very well over the interim. How do I know? I have a GC Fuji II LC restoration that’s in my upper left first molar that’s been there for six years.”

	Dr. Ward enjoys the fact that GC Fuji II LC is easy to use and place.

Trending article: 6 ways to help patients overcome fear of the dentist

	“Glass ionomers require very exact and precise manufacturing techniques,” he says. “That’s why few companies make them. The name GC is really synonymous with glass ionomers. They’ve been making them for decades. So, it really comes down to trust. I trust the Fuji products. They work well in my hands and they last.”

	Patients of all ages experience tooth decay, so it’s important for clinicians to use products that are going to be long-lasting. For Dr. Ward, that often means using GC Fuji II LC.

	“Patients are keeping their teeth longer and patients are living longer, so we have to use myriad ways of helping these people keep their teeth for their lifetimes,” he says. “Without products like GC Fuji II LC, I could not practice. I use it on a daily basis. It helps my patients to keep their smiles for a lifetime."

Why one clinician has been using this resin-reinforced glass ionomer for two decades.

How to create long-lasting restorations with GC Fuji II LC

	The problem: Intraoral scanners can be bulky and uncomfortable for patients

 becoming more popular, many dentists are adding intraoral scanners to their practices. However, some of these scanners can be large and bulky, making it difficult for clinicians to take accurate scans and leading to an uncomfortable experience for the patient.

Read more: How to complete same-day restorations using intraoral scanning

		Planmeca Emerald™ is an ultra-lightweight, next-generation intraoral scanner that delivers flawless accuracy.

		A compact, ergonomic design is said to provide patients with unparalleled patient comfort.

		Single-handed, two-button operation is designed to offer superior control and encourage continuous scanning.

 produces vibrant, realistic digital impressions for full arch scanning for restorative dentistry, implantology, orthodontics and dental appliances.

		Clinicians can send files to third parties without additional click fees or subscription fees.

The Planmeca Emerald™ encourages continuous scanning and improved patient comfort.

Solve my problem: Simplifying digital impressions

	Insurance and billing are important components of any dental practice. Unfortunately, many dentists aren’t well-versed on these topics, which could lead to lost revenue for their practices or even legal issues.

	In an effort to make dentists more comfortable with billing and diagnostic codes, Christine Taxin, founder and president of 

Dental and Medical Insurance Extravaganza for the Modern Dental Practice

	Taxin, who has taught both dental and medical billing for the last seven years, says she was asked by the NYU College of Dentistry to introduce 

 and the various legal issues of billing to senior dental students. At the same time, Harvard University contacted her to discuss the changes they had made to their dental program, which now requires students to rotate for two years with medical. Add to this that she frequently receives calls and emails from patients across the country inquiring about billing their oral treatments to medical, and the idea for the conference was born.

Related reading: 8 ways to make insurance less of a pain

	“After all of this, and the fact that there is no official training for one of the most critical areas of our practice, I decided to bring together the top people in our industry so that everyone can understand the effects of dental, medical and legal issues that surround how we receive payment,” she says. “The outcome of this meeting has several components, and it will depend on the dynamic of the office. To the best of my knowledge there has never been a meeting incorporating everything about insurance and billing.”

	The two-day event will cover a range of topics, from code changes in 2019 to negotiating fees with insurance companies to how to avoid an insurance audit. Speakers will include Taxin, 

, Teresa Duncan, an international speaker, and Ben Tuinei, president of Veritas Dental Resources, among others.

Taxin says one of the goals of the conference is to spread awareness of how to implement the oral-systemic connection in dental offices and understanding of how to bill both dental and medical if needed. Patient communication and treatment planning will also be discussed.

	“Work with patients so they’re able to take our advice on treatment and not make it about the payment but to accept the treatment that they need. We do want to help them get maximum payment, so they can afford the best. An example is a diabetic who needs additional procedures to keep their sugar under control and we will help them get refunded if possible. Each office should understand the compliance coding and documentation,” Taxin says.

The two-day event this October will cover a range of topics dentists need to know about insurance and billing. 