Noah Levine

Each year, a select panel of dental technology experts gather to discuss the state of dental technology and debate which products deserve to be recognized as the best.

The panel consists of the editors of leading dental publications and recognized speakers and experts in the many areas of technology in dentistry.

Instead of trying to determine which products are the tops of their individual categories, this panel seeks to identify the products that are breaking new ground and expanding the possibilities within the world of dentistry. There is no minimum nor maximum number of awards to hand out, but after a lengthy dialogue, the products with the biggest potential to enhance both dental patient care and dental practice operations are named recipients of the Cellerant Best of Class Technology Award.

AIRFLOW® Prophylaxis Master

Amplify

ChairsideCAD

CS 9600

DentalMonitoring / ScanBox pro

DTX Studio™ Suite

Excelsior

EyeSpecial

FirstPlug®

i700

Infinix™

MiniBio Auto Reader

Nova

Pro S

RE-GEN™ Universal Adhesive

Remote Monitoring / The Grin Scope®

Second Opinion

TRIOS 4

YAPI

YOMI®

The Panel

2022 Cellerant Best of Class Technology Awards

Articles

Presenting the Dental Product Innovations Named Winners of the 2022 Cellerant Best of Class Technology Award.

The Standout Dental Technologies Of 2022

Dentists and hygienists do a lot to care for the oral health of their patients, but the real work of maintaining a healthy oral environment needs to be done at home between visits.

The basic protocols for caring for teeth and gums are well established, but choosing the best toothbrush, toothpaste, and other over the counter (OTC) home care products can be daunting for patients. In every category of home oral care product there are numerous brands, and many of those brands offer multiple options from which patients must choose.

As trusted oral health professionals, dentists and hygienists are often relied upon to provide guidance in this area. Knowing what type of toothbrush, floss, or mouthwash is best for each individual is important, and a good recommendation from a dentist or hygienist can provide the right motivation to get a patient more engaged with maintaining his or her oral health.

® is currently conducting the 3rd annual OTC Products Survey where we're asking dental professionals to share which brands of direct-to-consumer oral care products they most often recommend to patients. 

The survey includes more than a dozen categories of OTC products including several categories debuting in 2022 including night guards and sports mouthguards. To further enhance the value of participating in this survey, everyone who completes it will be entered to win a $250 Visa gift card.

Results are scheduled to be revealed in early December, but voting ends at the end of August, so don't wait to share your opinions and vote for the products you most often recommend to your patients.

Share your opinions about which over the counter oral care products are best for your patients and you could win a $250 gift card.

What OTC Dental Products Do You Recommend to Your Patients?

The work performed in dental labs can be described in many ways. Sculpture, design, engineering, production, fabrication, modeling, artistic expression, prototyping, painting, molding, and assembling are all fitting terms to cover at least some of the work being performed by dental technicians. The common factor in all these situations, like all creative situations, is the need for a medium to work with—a material.

A lot is expected from the materials used in dentistry. These materials are generally being used to stand in for all or part of a tooth, which means they must be strong yet relatively easy to shape into custom forms with minute details. Long-term durability is another key, as the final products from a dental lab must both fit and function in the oral cavity, which can be a harsh environment.

But replacing a tooth isn’t just about fit and function; these materials also must be made to look like the tooth they are replacing in many specific ways. Teeth are full of nuances and variations in shade, translucency, and surface texture, so dental lab materials must also be capable of mimicking these details and retaining that esthetic appearance over time.

This is a lot to ask of any 1 material, and it’s still quite a challenge to do with multiple materials that work together. For this reason, dental lab technicians are always on the lookout for new material options to try, and dental materials manufacturers are constantly producing new formulations and combinations to create a dizzying array of options in both types of materials and different versions of material types.

It’s a never-ending search for the perfect material, and the effort requires an ongoing education in the chemistry and physics behind the properties of each material option. That scientific foundation allows for constant experimentation and fine-tuning of workflows and processes in the search of the best possible restorative and esthetic outcomes. The decisions lab technicians make about the materials they choose are among the most important they face day in and day out.

® Materials Survey, here is a look at some of the ways dental lab technicians view the materials they choose to work with.

The 2022 Dental Lab Products® Materials Survey

A look at dental lab material trends, with the results of the 2022 Dental Lab Products® Materials Survey.

Making Sense of Dental Lab Material Matters

Dentistry is truly a materials industry. The industry is always looking for new material options that can provide the ideal combination of strength, shade, translucency, and durability to stand in for a natural tooth. This often comes down to a balance between strength and esthetics, even as the latest materials are closer than ever to replicating the physical properties of a tooth.

However, dentistry is not a huge industry by itself, and therefore many of the materials used in dental practices and labs were not developed specifically for dental use. In most cases, these raw materials are widely used in other industries—often in wildly different ways—to produce very different types of products. Here’s a look at how everyday dental materials are used in other industries.

As the dominant choice for indirect fixed restorations, zirconia is a great material for dental purposes because of its relatively low cost, high strength, ideal biocompatibility, and esthetic potential. But the material is also a key resource for a range of other industries. Because of its strength, temperature stability, and resistance to corrosion, the material is used for making refractory products, electronics, fuel cells, paints and tints, and it is used in engines for both cars and planes. Another common use of zirconia is in jewelry, which takes advantage of the material’s diamondlike appearance when it’s in its cubic formulation.

As a popular option for indirect dental restorations, glass ceramics, such as lithium disilicate and lithium silicate, are another material that offers a combination of strength and esthetics for the use of replacing natural teeth. Although the lithium used in these materials is also a key component of batteries, glass ceramics require lithium in a fine-grain size. Other industries using these glass ceramics include all types of glass, including fiberglass and high-temperature cooking dishes, as well as a range of ceramics and coatings for ceramic cooking dishes. Another use for these materials is manufacturing induction cooktops.

Commonly used for temporary restorations, among other things, PMMA materials also have a wide range of uses in other industries. The material can be formulated as a transparent glass substitute under brand names, such as PLEXIGLASS and Lucite, and used to make fish tanks, protective barriers, and other nonglass windows. Additionally, the material is used to make glasses lenses, contact lenses, and intraocular lenses. It can also be used to make furniture, acrylic paints, toys, and much more.

Bisphenol A-glycidyl methacrylate (Bis-GMA):

As 1 of the 2 main components of most dental composite resins, this material is most often used in the dental industry because of its ability to be polymerized to fit and adhere to almost any shape. Still, Bis-GMA is used elsewhere, including as an ingredient in paints and in several industrial processes.

The other main component of many direct dental restorative materials, silica is a naturally occurring silicon oxide that is often found in quartz. In dentistry, it is often a filler in resin materials. As a key ingredient in glass and cement, silica is most commonly used in construction. The material is also used in the production of some cosmetics because of its light-diffusing properties. In food production, silica can be added as an anticaking agent, and the material is also a key component in the creation of semiconductors.

A look at how some commonly used dental materials are put to work in other businesses.

How Dental Materials Get Used By Other Industries 

Noah Levine: How has the COVID-19 pandemic impacted 3D printing in dentistry?

The evolution or the digitization of the dental industry has not stopped. In a certain way, COVID-19 accelerated that, because people started saying, “Let’s not send models and practical stuff around from door to door. Let’s start sending files.” So that helped people get a little more interested in this.

NL: How much future dental lab production will feature 3D printing?

It’s going [be] a big part of it—not 100%, because there’s always going to be the manual work of finishing and maybe some postprocessing. Although we’re also looking into how we can make that more user-friendly. It’s [definitely] going to take [most of] the parts in dental labs.

NL: How is the status of 3D printing in dental labs different from the status of printing in clinics?

 There are a couple things that still need to be changed or adopted. Lab technicians already are 1 step ahead, but to a degree, they still have the fear of the unknown and the idea that digital is difficult, so we [must] make sure they get the right information and make more training available to them.

We see similar things in the clinics, but they’re 1 step behind. In this case, they are almost over enthusiastic. They think of 3D printing as, “I scan it, I print it, and it’s done.” We need to help get them out of that feeling and say, “Yes, that’s true in a sense, but we’re not there yet. You still need to do some designing of the files, then send it to the printer, then postprocess and postcure it.”

There are a lot of manual interactions they tend to forget, so that is something we need to explain to them bit by bit, because then they will come into the phase where the lab technicians are today—the fear of the unknown and thinking it is always going to be difficult. And now we can go back to the training and say it’s not that difficult. But first, it’s not as easy as you expect today.

NL: Will 3D printing end up being primarily used in labs or clinics?

The recently launched DMP Flex 200 brings metal printing to new labs, as this system is capable of quickly producing parts from CoCr and titanium.

There’s a place for 3D printing on all levels. For the smaller parts, [such as] a permanent crown or a veneer, that is an ideal printing workflow you could do chairside. It’s 1 visit—you scan it, you print it, you postprocess, cure it, and you place it. The labs will have bigger works, and at larger manufacturing sites, you can have the metal printing, for instance, but there’s a place for the printer on the clinic side.

NL: How is the growth of group dental practices impacting the use of 3D printers?

They have the advantage of numbers. You don’t buy a printer for 1 print a day; you buy for the routine [and] to continuously start printing and using it. If you have a group practice where you have more patients, of course, it can be more useful to have a printer. For a group practice, consistent workflows become more important. It’s not only about the printer—it’s about the scanner, the software, [and] the materials. It is the integration of the workflow that is important. And they can benefit from that.

NL: What are some of the hurdles that both the technology and the materials of 3D printing need to overcome to be more widely adopted throughout the dental industry?

There is still a lot of room for improvement when it comes to ease of use, especially when you look at what still needs to be done after the scan is completed. You still need to design the restoration, and making the software even easier to use is becoming very important. With our software, we tap into [artificial intelligence] to make it more user-friendly.

Of course, on the material side, we are very open and honest that the denture material out there today…is not yet up to the standard of what the current analog systems can provide. But the color is almost there, [and] the translucency and strength are also getting closer.

On the fixed side, we’re improving with the new CROWNTEC permanent crown material. It’s stronger and it has improved color, but it’s not yet on the same level as traditional ceramics. So, there is still a lot of room for improvement in that side, as well.

NL: Can you tell us a bit more about CROWNTEC?

Dental devices made with CROWNTEC and the NextDent 5100 digital dentistry solution are 30% stronger than those made using previous generation resins.

Well, the biggest step forward in 3D printing is that it’s not temporary. This is something that can last a long time. The material is harder, more translucent, [it fits] better, and patients feel good about the results, so that’s what it’s all about. Because in the end, it’s about esthetics, comfort, better patient outcomes, and that is basically what this material is doing.

 I think it is different applications. Everybody is looking into the orthodontic space, how we can improve there—especially on the workflows—how to make it user-friendly, and maybe even go into direct printing. Of course, denture material will likely become more comfortable for the patient.

With direct materials, we made a big step ahead with CROWNTEC, but it’s not there yet. The challenge is how [to] come closer to zirconia, or even start printing zirconia. So, it’s more and more applications and broader use, in general. That’s the exciting part.

NL: What role does 3D Systems want to play in the future of 3D printing technology?

We always want to be on the forefront. When 3D printing was born, 3D Systems was there. That’s the motivation to keep going. It’s a challenge, but I think we live up to it.

We just launched the DMP Flex 200 metal printer in February, and I underestimated the attention it would get from the market. Of course, we are also investigating a lot with biotech printing, and with the recent investment in Kumovis, we are also working with PEEK printing.

So, [3D printing is changing a lot], not only material-wise but also platform-wise. [Of course], there are many things ongoing, [and] lots of them are still behind closed doors, but you definitely need to keep an eye open. Innovation is not on hold at 3D Systems.

I think milling will become [more and more] obsolete because it’s a proven process, but there is a lot of waste, time, and cost to it. More and more 3D printers are in the position to take over what a mill is doing today.

If you look at the broader picture of 3D printing in an industry, it will never take over 100%. There’s always going to be some limitation. In the future, limitations will [most likely] be more on the cost side. But dental is an ideal market for 3D printing. There are 9 billion people out there, and there are 9 billion different dentures out there. So, it’s unique every time, and when you need to produce a lot of unique pieces, that is what a 3D printer does best.

We see big differences between regions in terms of how fast this evolution and the introduction of digital is happening. That’s very exciting to see, and we try to take what we can learn from one region to see [whether] we can use that in another region.

For the future, from my point of view, materials are where the innovation lies. Bringing the digitization further into dentistry by supporting them with marketing and training will continue to be important, because the pie is still a lot bigger on the analog side.

We still have a lot of potential to assist dental professionals in providing a better patient outcome. That’s why we’re in it. 

Stef Vanneste, vice president and general manager, dental at 3D Systems, speaks with Noah Levine, editorial director of Dental Lab Products®, about what’s next for additive manufacturing technologies and materials. 

Building the Next Phase of Dental  3D Printing

With the recent announcement that the company had purchased teledentistry platform Toothpic, quip is taking concrete steps to bridge the gap between providers and patients. This addition of teledentistry services represents the next step in the company’s vision of creating a network of patients who have all the tools and resources they need to work with their dentist to maintain the best oral health possible.

To learn more about this vision, Dental Products Report Editorial Director Noah Levine spoke with quip Co-Founder and CEO Simon Enever. Here is that discussion.

Can you tell us about quip and the original vision you had when you created quip?

The idea for quip came about after a dental visit I had back in 2012. So, the vision has been around for a long time. What got me excited about entering the industry, and bringing my skill set from my former life as an industrial designer, was honestly the fact that it was about more than 

Personal care is one of the most critical parts of maintaining good oral health. Brushing your teeth well—two minutes, twice a day—flossing, rinsing, and all of the above. However, the provider side is also critical, meaning regularly checking up with a trained professional to look inside your mouth and catch issues early, and of course, fix things if needed. I left that visit wanting to build what was the first, 360º oral care platform to connect at-home care with in-practice professional care.

When I continued to ask dentists why patients don’t do things such as brushing regularly or visiting a professional, the first big insight I had was that people just don't enjoy it. It's a chore at best, and it’s a phobia for many. Realizing this, I knew there was one core thing we could and needed to do, which was to help people better engage and invest in their oral care. We realized that it was going to be very difficult to jump to the most challenging part of an individual’s oral care routine, which is visiting the dentist and a better route was to start with the thing that everyone does: using a toothbrush twice every day, (hopefully!). So, we deliberately started with personal care, and then have begun to gradually layer in additional professional features over time to bring our larger vision to life.

Can you tell me a little bit about what made quip’s recent acquisition of teledentistry platform Toothpic a good fit to keep your vision growing?

 Our acquisition of Toothpic is a huge part of how we're going to accelerate into the next phase of our vision. We have done well establishing ourselves to our customers, and we’re doing the same on the professional side, but we see this as the companion platform that connects the dots between at-home care and professional care. We believe in improving both, and teledentistry is the literal digital connection between the consumer and the provider. 

Moreover, I think people think of teledentistry as simply “I can hop on a video call” or “I can have a chat with a dentist”. While that is one part of it, what it really is, is the provision of care from a provider using digital means, and there are many more ways it can come to life. For example, you can regularly and proactively take a photo of your mouth for review by a clinician, and they will send you a detailed report of how your mouth health is changing over time, from the comfort of your own home, helping to catch issues early and hopefully prevent the need for certain avoidable treatments. This is such a critical stepping stone that we can introduce to our millions of members who use our app and our website. Our membership base is highly engaged and they’re regularly in touch with us, whether that be through brush subscriptions, using the app for rewards, points, and habit tracking, and now there is a new way to interact with a professional that can be a stepping stone to create a better bond between you and your dentist.

How do you envision the typical patient experience with your teledentistry platform?

There's two primary routes that you can take. Number one is photo based – you simply use your smartphone camera, take the requested snaps of your teeth, and those pictures are sent to a dentist in your area. From there, your photos are assessed, and you'll get a report sent back to you. The dentist will tag your photos, describe any potential issues and share recommended treatments, so you can take action accordingly. This might include recommendations on a product to use, changes to some of your oral care habits, or a recommendation to book an in person visit to a provider near you.

The second path is very similar, but it is video based, so you can jump on a video call at any time. The service is available 24 hours, seven days a week. This is mostly used for emergency situations right now, so it is often a digital triage for upcoming in-person care. However, our members are so used to regular routines and regular engagements – there is a cadence to how you should be doing certain activities like changing your brush head or flossing your teeth. So, one of our immediate goals is to motivate our members to use teledentistry for prevention, rather than in a case of emergency. Our goal is to integrate this idea of preventative teledentistry into the core of everything that people are already doing on a daily, weekly, monthly, quarterly, half-yearly basis. We want to get as many people as possible, hopefully, millions of people, regularly, participating in preventative, teledental checkups.

 How do existing dental practices and dental groups make sure that they can engage with this engaged group of quip users?

A practice can proactively enter this space, and not only receive teledental visits from potential new patients in their area but make teledentistry available to their existing patients. What quip is trying to bring to the professional industry is what we built on the patient side. We are trying to build a community – everything that we're now doing is about bringing professional services to our patient community of millions of people and bringing these millions of people to providers. The second phase of what we want to bring to dental professionals that engage in this platform is to enable enhanced care through a proactive and ongoing conversation between patients and providers with more data about what happens in between in-person visits.

Of course, there is also the business side of this, which is being able to help providers make a business line out of regular preventative check-ups. There's a big vision behind all of this, which is that one day, perhaps we can move towards more of a value-based care model. These kinds of tools that really help the provider participate in and gain from giving regular oral care instruction is something that really excites us. And, we're very excited to start telling our story about what we're y trying to do for dental professionals.

What's next for quip, and how do you continue to build out this model you're bringing to the industry?

 We've been primarily focused on the consumer side as we've been building out this platform, and now it is coming to life a bit more visibly to the provider side. Direct to consumer online is still a huge part of our business, but one of the really exciting things has been that we've had so much success entering retail and bringing offline customers into our app and our website where we can more easily help connect them to professional services down the line.

A lot of our efforts in the second half of this year and over the last six months are around how we bring dental professionals into this platform. We’re unleashing these patient tools and working to ensure that we have a really solid professional network on the other. We hope that if we build the right products and the right platform, providers will want more and more of their patients to be engaged with this connected oral care experience.

An interview with quip Co-Founder and CEO Simon Enever about how the home care products brand got where it is today and where it plans to go.

Strengthening Connections Between Dental Patients and Providers to Improve Oral Health

Most of the instruments, technologies, tools, and materials used in the operatory are made specifically for dental use. But sometimes there are tasks that can be handled by a product that wasn’t originally created for dental professionals. With that in mind, here’s a look at 5 nondental products that can be handy to have in the operatory.

Smartphones are the Swiss Army knife of modern devices. And there are many ways to employ these pocket computers in the operatory. A smartphone can be great for accessing a quick reference online or controlling clinical technologies such as lasers or handpieces. Of course a smartphone can also be a terrific camera. However, if you are using a smartphone for clinical patient imaging, that phone should be a dedicated practice device and the images should always be managed in ways that comply with the Health Insurance Portability and Accountability Act.

Although the smartphone puts a screen at anyone’s fingertips, a larger screen can be even more useful in the operatory. Tablets and televisions can entertain and distract patients during treatment, and they also can show patients clinical imaging and other patient education resources.

The noises of dental care are one of the major factors driving patient anxieties around dental treatment. By giving patients a pair of active noise-canceling headphones you create a treatment environment that feels less chaotic and has fewer strange sounds. Whether the patient is watching TV, listening to music, or just using the noise cancellation feature, this can be a great way to help them stay relaxed during treatment. As with anything used in an operatory, it is important to sanitize headphones between patients.

There’s plenty of notation to be done during a dental appointment, although these days most documentation can be done digitally. But having a Sharpie available in an operatory drawer can be very useful. A black Sharpie with a fine tip can be used to “black out” areas of a patient’s teeth to preview what some treatments calling for removal of tooth structure will look like once completed. A Sharpie can be safely used to mark teeth and then the ink removed using alcohol and a cotton swab. Because the markers use alcohol-based ink they do not create a risk of cross-contamination between patients.1 

Commonly referred to as plumber’s or Teflon tape, polytetrafluoroethylene (PTFE) tape can be found at hardware stores and is used to create a seal when connecting water pipes. However, because the material is inert, is resistant to solvents and acids, and can be sterilized in an autoclave, dentists have found numerous ways to put this material to use in the operatory. The tape can be used as a barrier to protect adjacent teeth during restorative procedures. And because it is so thin, it can even serve as a barrier to protect subgingival margins from excess cement when placing implants and crowns. The tape is also used to protect implant screw heads when a screw access channel is sealed to prevent bacterial infection. In endodontic cases where a temporary restoration must be placed, PTFE tape is a great material for sealing the access channel and protecting the tooth from infection. PTFE tape also can be used in the operatory as a spacer and to block out undercuts when capturing impressions.2

1. X marks the spot: Sharpies get thumbs-up for marking surgery sites. University of Alberta Faculty of Medicine & Dentistry. ScienceDaily. October 22, 2008. Accessed May 3, 2022. 

www.sciencedaily.com/releases/2008/10/081021185211.htm

2. Sattar MM, Patel M, Alani A. Clinical applications of polytetrafluoroethylene (PTFE) tape in restorative dentistry. 

. 2017;222(3):151-158. doi:10.1038/sj.bdj.2017.110

A look at some of the most useful products from the consumer products world that can be helpful in the operatory.

5 Nondental Products That Can Be Used in the Operatory

With 2 locations of her Blooming Smiles general dentistry practice in the Chicago, Illinois, area, Gabriela Duraes, DDS, MS, provides a wide range of services. A single day can include everything from doing composite restorations to placing implants to performing root canals. Dr Duraes says her goal is to provide her patients with the best comprehensive care under one roof.

Although she used electric handpieces exclusively when training to be a dentist, Dr Duraes says that since she left her residency a decade ago, she did not use an electric handpiece again until recently. In that time, she says she has grown both comfortable and confident using an air-driven handpiece.

Bien-Air’s Nova is designed to overcome the challenges of a traditional handpiece. The small head and slim handle enhance field of vision and guarantee easier access to the back of the mouth. With the Accu-Spray Quattro Mix system, it focuses 4 asymmetrical air/water sprays on the end of the bur with laser precision. Its stainless steel construction has PVD coating that is 4 times more resistant to shocks and a PVD-coated chuck that doubles the handpiece life. It is the lightest handpiece in the company’s range.

For Dr Duraes, the shift back to using an electric handpiece came from a desire for more power and consistency than she could find in an air-driven handpiece. In the past she had been wary of using electric handpieces because of their increased weight and general bulkiness. When she learned about Bien-Air’s Nova, she thought she had finally found what she was looking for.

“I was also looking for a way to reduce my procedure time without compromising my comfort,” she says. “After searching, I realized that Nova could be what I was looking for, and I was right.”

The effects of switching to the electric Nova handpiece were immediately apparent. Dr Duraes says the handpiece felt comfortable to use right away and has been very easy on her wrist. After using the handpiece for a short time she says her 3 favorite features are its small size, light weight, and impressive power.

The small size of the handpiece’s head and neck surprised her, but the benefits of having such a small handpiece were evident from the moment she first used the Nova in a patient’s mouth. She says the small size allows better access to difficult areas in the oral cavity, and it also makes it easier to treat pediatric or petite adult patients.

“It gives you great access and visibility, which I have never noticed in any other handpiece,” she adds.

At first, the small size of the handpiece made Dr Duraes wonder if the system sacrificed power for size but using the Nova handpiece made it clear that this was not the case. She says it has all the power clinicians expect in an electric handpiece and provides smooth, efficient cutting. In fact, she believes the new handpiece is allowing her to reduce patient chair time while delivering top-notch care.

“Nova was able to make me a more efficient dentist,” she says. “My treatment times are shorter, and I am more productive. Nova never loses power when cutting zirconia crowns or bridges, making the removal of any restoration much faster.”

The fact that her new handpiece not only makes her work easier but enhances the patient experience is a big reason Dr Duraes is such a big fan of the Nova. Because she can see more and the handpiece offers the cutting power she needs, Dr Duraes credits the Nova with helping her cut preps faster and thus reduce the time patients need to keep their mouths open.

Another unexpected benefit from using the Nova handpiece is an increase in patient comfort, according to Dr Duraes. She says the handpiece makes less noise than her air turbine handpieces of the past, and it also doesn’t vibrate as much as some handpieces. This allows patients to feel more relaxed when they’re at her practice.

“Less noise is definitely an overall improvement noticed in my practice,” she says. “Patients’ anxiety is reduced with less noise and vibration also.”

Dr Duraes says she can’t imagine replacing it with anything else any time soon. Although the industry has yet to see the first silent dental handpiece, Dr Duraes says even that innovation might not be enough to get her to move away from the Nova.

“The only way for me to consider a change would be the invention of a handpiece with no noise at all, and even in this hypothetical situation if the handpiece is bulkier and heavier, I would still stick with my Nova,” she says.

Why Illinois dentist Gabriela Duraes, DDS, MS, adopted Bien-Air’s Nova handpiece and why she can’t see herself switching anytime soon.

Up Next: A Small Handpiece With Big Capabilities 

to successful dental treatment, from external lighting and magnification to intraoral and extraoral imaging. When a dental technology offers new approaches to visualizing the oral environment it’s worth taking note. This is certainly the case with stationary intraoral tomosynthesis (sIOT).

A technique for producing 3D radiographic images intraorally, sIOT captures multiple x-ray images simultaneously via carbon nanotube x-ray sources and then processes those images using algebraic reconstruction to produce a stack of 2D tomographic x-ray layers each 70 to 80 µm thick. The technology has the potential to enhance clinical diagnostics and improve other aspects of dental care, says Donald Tyndall, DDS, PhD, MSPH, FICD, a professor in the Division of Diagnostic Sciences at University of North Carolina at Chapel Hill Adams School of Dentistry, who works on developing sIOT technology for dental use.

When discussing the promise of sIOT, Dr Tyndall starts with the history of dental imaging. The first intraoral x-ray image was captured in 1896, and although it is much faster and image quality is vastly improved today, the process is essentially the same. A generator shoots x-rays at a receptor and an images of the insides of any structures in between are captured.

Traditional dental intraoral and panoramic x-rays face the same challenge of trying to capture 3D structures in a 2D format. “In a way, we’re still imaging like it’s 1896,” he says. “We’re collapsing a 3-dimensional object into 2 dimensions, and this leads to issues of overlap. We’re somewhat limited by not so much the technology, but by geometry.”

Dr Tyndall says 2D imaging reamains useful, but 3D imaging truly takes dentistry to a different level when it comes to diagnostics, treatment planning, case presentation, and patient education.

“There are data showing that patients are more likely to accept a treatment plan if they see it in 3D,” he says. “The more the patient understands, the more likely they are to accept the treatment plan.”

Cone beam imaging has made a huge impact on dental diagnostics and treatment planning, but Dr Tyndall notes this 3D technology has limited value in caries detection and there are challenges in imaging around metal artifacts. With sIOT, dentists now have a 3D imaging approach that can address those issues.

Images captured with sIOT technology look similar to a traditional dental x-ray, but because they are digital composites of multiple images, they allow a clinician to look through the depth of a tooth 1 layer at a time instead of viewing a single image comprised of that same information collapsed into a single plane. A sIOT system uses an intraoral sensor and a custom x-ray generator designed to work together to capture multiple images at once.

“We’re staying in the same plane but we’re moving the x-ray source to different locations, and so we’re generating multiple pictures,” Tyndall explains.

Similar to how humans gain depth perception by processing images from 2 eyes set a slight distance apart, sIOT systems create x-rays with depth by constructing an image based on multiple images captured from slightly different distances and angles.

The images can be captured using the same imaging workflow for intraoral x-rays and they can be read with little additional training because they look like traditional 2D x-rays. Additionally, because the tuned aperture CT technology used in the image reconstruction is able to avoid metal artifact interference, sIOT images do not face challenges when imaging implants, orthodontic appliances, and other metal objects.

sIOT does not produce a 3D image that can be manipulated on screen like a CBCT image. Instead it the viewer can move backward and forward through the layers on a plane parallel to the x-ray sensor.

Because sIOT imaging doesn’t superimpose structures on top of each other, the images make it easier to spot defects such as cracks and lesions. Dr Tyndall says this is especially true when it comes to proximal areas because, whereas traditional x-rays often show closed contacts due to overlap, at least 1 layer in a sIOT image is likely to open that contact, reducing the need to retake images. Other imaging advantages include greater visibility of the periodontal ligament and the ability to view buccal and palatal roots separately when examining molars.

Although the sIOT technology provides a lot more information than a traditional dental x-ray, the imaging requires more time and a slight increase in radiation exposure for the patient. Still, Dr Tyndall notes that radiation levels currently required for sIOT imaging are not putting patients at much greater risk than they face from other dental radiograph technologies.

“Think of it as intraoral imaging with slightly more dose, but that slightly more dose means a lot more information,” he says.

Although the technology is relatively new, sIOT is already approved for clinical use in the US. In August 2021 the US Food and Drug Administration announced 510(k) premarket clearance for Surround Medical Systems’ PORTRAY imaging system, making it the first sIOT solution designed for dental use.

The technology can be used for standard radiographic imaging such as bitewings or a full mouth series. In those cases it can provide more information on each tooth than can be provided by a standard x-ray series. Dr Tyndall believes sIOT is a great option for any alveolar imaging, as well as any case where a bitewing or periapical x-ray would be of use. These images can be advantageous for caries detection, periodontal bone assessment, implant site assessment, fracture detection, and more. The fact that the images will almost always capture open contacts can also mean fewer retakes.

“Stationery intraoral tomosynthesis might be another great way of gaining extra 3D information about the teeth and periodontia,” Dr Tyndall says.

Dr Tyndall says he is excited about the future of dentistry with sIOT, and he plans to continue to study the technology’s applications. One thing he sees in the future of sIOT is artificial intelligence integration to make enhance the efficiency of analyzing the information captured by system.

Another technology Dr Tyndall is watching is dental MRI, a new, radiation-free approach to intraoral imaging that is distinct from medical MRI. Although he believes these systems are several years away, he believes dental MRI will be useful for imaging cysts and tumors, as well as inflammation and nerves.

With sIOT already here, and other 3D imaging technologies on the way, Dr Tyndall is excited about the future of dental care. He’s confident that enhanced and varied 3D imaging technologies, as well as other 3D digital dental solutions, will improve detection and diagnostics, enhance treatment planning and case presentation, and help heighten the quality and efficiency of dental care.

“3D won’t be the diving board into the future of radiographic imaging and dentistry. It’ll be in the pool itself,” he says.

Take a Look at Stationary Intraoral Tomosynthesis, a 3D Radiographic Imaging Technology


Advertorial: A New 3D Vision for Dentistry

The dental meetings calendar is a crowded space, but with a great mix of exciting speakers and evening entertainment Henry Schein Thrive Live 2022  set a high bar for future events.

Hosted at the Bellagio in Las Vegas, the event was designed to fit the setting with performances by legendary entertainer Wayne Newton, beloved comedian Jim Gaffigan, and comedian/dental hygienist Carlos Rodriguez, as well as a night out at Club Drai's. But while the entertainment brought excitement to the event, the real heart of Thrive Live 2022 was on the stages for the keynote presentations and the breakout education sessions.

With the main stage hosted by Mike DiTolla, DDS, FAGD, things got off to a lively start right away. But while Dr DiTolla kept things lighthearted, the first keynote presenter Chris Salierno, DDS, was there to help the crowd find their own ways to thrive in the new dental economy. Dr Salierno used data from the American Dental Association's Health Policy Institute to show that while the number of dentists is increasing, demand for dental services is not growing at a similar pace. Alongside this trend is the growing commoditization of dental services which Dr Salierno says drives down prices and profit margins for dentists while devaluing the services dentists provide in the minds of their patients. 

In an interview following his presentation, Dr Salierno explains that to combat these trends, dental practices need to proactively educate their patients about the value of dental care as a part of maintaining their overall health. But he believes this is a challenge faced by all health care providers.

"I would say all health care has a public image problem," he says. "The oral health IQ in America is outstanding compared with other countries."

With this in mind, Dr Salierno believes the real key to thriving in today's dental industry is to figure out who your practice wants to care for, and then to cater to every aspect of your practice to make an amazing dental experience for that cohort of patients. He says this is just as true for large group practices as it is for small, single-doctor operations. Technology plays a role in this specialization, but it should always be adopted with the goal of servicing the practice's target patients. Dr Salierno also expresses hope that oral-systemic connections continue to help the public put a value on their oral health, but he doesn't believe dentists need to make this the only focus of their patient education.

"There’s a value problem, people don’t see the value in oral care," he says. "Reframing oral health as a part of overall health is a great way to add value, but oral health should be valuable in and of itself too."

Other keynote presenters during the event's 3 days included Christine Aadland, DMD who shared her personal story of building and growing her practice. She shared keys to motivation and how her willingness to adopt new technologies and embrace education allows her practice to add new services to meet the demands of current patients and attract new patients.

Jonathan Levine, DMD, was also on hand to present about how he finds inspiration in the way his patients' lives are changed by the care he provides and the way this has spurred him to do work outside his practice giving back to people in need. In his case Dr Levine shared experiences working alongside rock star Lenny Kravitz to provide care to people in need in his native Bahamas.

The celebrity keynote speaker was entrepreneur and fashion industry titan Daymond John. Dr DiTolla interviewed John from the mainstage about how he found success in business, how he overcame obstacles, and the strangest products he's ever been pitched while working on the popular TV show Shark Tank.

The keynote speaker for the final day of the event was Tarun Agarwal, DDS, who shared his approach to improve his practice's success without creating too much more work. He discusses the difference between business and busyness, and the need to adopt technologies that bring down costs for patients and increase profitability for the practice.

Among the breakout sessions, Devin McClintock, DDS gave an entertaining course about the importance of proper protocols for restorative cases, and why the rubber dam can be a key part of the process. With clear videos and images, this rising star on the dental speaking circuit showcased why she is great at communicating the value of seemingly simple and often overlooked parts of restorative techniques.

Another exciting breakout session featured presentations from Wally Renne, DMD, Heidi Kohltfarber, DDS, MS, PhD, and August de Oliveira, DDS, discussed the latest in digital dental technologies. Up first, Dr Renne reviewed the current crop of intraoral scanners and demonstrated that today's scanners are all great systems capable of quickly and accurately capturing digital impressions that can be used for almost any type of case. He then covered chairside mills and the new trend of lab mills being adopted for chairside use. Next Dr de Oliveira discussed 3D printing and the growing applications for the technology chairside. Finally, Dr Kohltfarber discussed the history and science of cone beam scanning and how it is a technology specifically designed for the dental industry.

Alongside the main stage and the breakout sessions, a compact but lively exhibit hall offered a chance for attendees to check out new and forthcoming innovations from a number of dental manufacturers, as well as take advantage of show discounts.

At Henry Schein Thrive Live 2022 attendees were treated to a balance of top-tier education about the latest industry trends, techniques, technologies, and more, alongside performances from renowned entertainers.