 just three blocks from the ocean in Manhattan Beach, Calif., they took the advice of the experts. They not only built a new and improved practice, they incorporated technology by purchasing a CEREC, which Steven calls “the wave of the future.” 

The Ozers consider themselves early adopters of new technology and say it doesn’t build a practice but can help tremendously.

“We work in a community that is rich with long-standing dentists, and we chose to pursue a technology-based practice to separate ourselves from the status quo,” Steven said. “With updated technology, we set the bar higher for local dentists. To keep their patients satisfied, they need to emulate that standard.”

Steven and Anne are excited about CEREC for the usual reasons. For starters, it makes dentistry more fun and interesting. 

“When we got CEREC it just struck a chord in me,” Steven said. “I had an affinity for it and wanted to learn more. I think this kind of technology can energize and invigorate dentists who have become bored or stagnant in their careers.” 

The technology has been a springboard to other technologies, including GALILEOS, which allow them to do 3D virtual implant planning and use CEREC to its fullest capacity while optimizing implant placement and the restorative workflow. Plus, the technology allows doctors to provide the best possible care. 

“It’s great for patients,” Anne said. “They get numb once and watch a movie while we do their crown and deliver it -all in the same appointment.”  

The Ozers are excited about CEREC for another reason-one that is a complete surprise to them both: They’re excited about the CEREC community. As a mentor for cerecdoctors.com, Steven communicates with other CEREC users online on a daily basis. He also mentors ACCEPT events in Scottsdale and other locations around the United States and in Canada several times a year, in addition to leading a local study club for CEREC users. 

The CEREC community includes a unique subset of dentists who want to learn more about what technology can do and have more of a presence in their profession. Steven describes the CEREC community as “enlightening” because it includes a group of doctors who have a passion for the technology and want to share what they’ve learned with one another. 

“I enjoy sharing my experiences and enjoy working with people who are new to the digital world – to see their eyes open wide. I like that ‘aha’ moment,” he said. “Being a restorative dentist, I would probably say that CEREC has made the biggest impact on my career. I am in no hurry to retire. Maybe someday I’ll work less, but the idea of retiring means giving up all that socialization. I really enjoy coming to work every day.”

From Sept. 17-19 Steven and Anne, along with many other CEREC users, will be in Las Vegas to attend CEREC30. The event is a 30-year anniversary party and celebration of CEREC-a technology that in the past three decades has changed lives, practices and the patient experience. For more information visit cereconline.com

Articles






When doctors Steven W. Ozer and Anne Norris-Ozer built a new dental practice just three blocks from the ocean in Manhattan Beach, Calif., they took the advice of the experts.

Why these dentists believe CEREC is the wave of the future

	Whether it’s at the grocery store or on vacation, we’re all looking for the smartest way to spend our money. We want to make sure that when we decide to purchase something, it’s really going to be the best thing on which we can possibly spend our hard-earned cash.

The same holds true for your dental practice which is, don’t forget, a small business. You need to know that every penny you spend in your practice is a worthwhile use of your funds. If not, your business could be in trouble. With that thought in mind, we reached out to several of the nation’s leading dental consultants and dealer representatives and asked them one simple question … “If a dentist had $10,000 to spend, what should he or she spend it on?” Of course, from that one question came a myriad of answers. 

So many, in fact, that we’ve saved half of them to share with you in our September edition of Dental Products report.

From equipment to training and everything in between, read on to see what advice we were given on how you should spend your money. 

Jana Berghoff, RDH, FAADOM, technology marketing manager, Patterson Dental

With any business, it’s important to start off with a good base. In dentistry, that base is your practice’s technology suite. Everything is built off of this – the way your office operates, the amount of revenue generated, how you communicate with team members and patients and patient care all stem from the technology housed in your office. 

With $10,000, it is important to first implement a proper practice management system. By choosing an integrated system with great customer support, like Eaglesoft from Patterson Dental, you are able to leave the paperwork, insurance forms and payment tasks to the software and focus on your patient care.

Next, you’ll want to select a patient education software. Implementing patient education into your office is one of the easiest ways to increase case acceptance. With CAESY Cloud, hygienists are able to talk about treatment plans with patients by showing easy-to-understand videos, which enables discussion in simpler, more approachable terms. This helps alleviate any fear a patient may have and ultimately creates a strong bond between the patient and dental staff.

Finally, purchase practice marketing software. Without attracting new patients to your practice, you can’t generate new sources of revenue. Select a program like RevenueWell, which helps you market yourself online simply and effectively through better web design, simple SEO tactics and a presence on social media. Similarly, make sure your practice marketing software helps you retain your current patient base. Send out appointment reminders and patient communications, such as birthday cards, to remind patients of your commitment to them.

You can’t build your practice unless you have a solid foundation to start with. With $10,000, purchase these systems to help elevate your practice to the next level. 

A question was asked of me recently… “If a dentist had $10,000 to spend on his or her practice, what would I recommend that money go toward?” I have a few suggestions for that $10,000:

• Training to learn the bells and whistles and key functions of their practice management system.

• Communications training to address every issue in the dental practice, answer important patient questions, discuss effective financial arrangements and handle objections.

• Training to reduce cancelations, improve collections, reduce accounts receivables and increase treatment acceptance.

2) Intraoral cameras and dual monitors for the operatories.

 Intraoral cameras create the visual opportunity for the patient to see the dental concerns in their mouths. These cameras create an environment for those patients who listen with their eyes and help them make decision for quality dentistry. Additionally, I always recommend two monitors in each operatory. One monitor should be behind the patient at the 12 o'clock position to document the dental visit and one should be mounted in front of the patient to offer patient education, discuss diagnosis recommendations and offer patients the opportunity to make informed decisions about their quality care.

 Taking the team out of the clinical and administrative dental office environment opens up the possibility of clarity while learning. Team retreats allow a dental team to think about creative solutions to every day challenges. These retreats can be in town, out of town, at destination locations and much more. The cost of these retreats can vary greatly. I have organized custom retreats in a hotel meeting room, at a local destination, in Ashville and traveling to the Puget Sound and on a cruise to the Caribbean. I challenge dentists and their teams to think “outside the box” to create the practice of your dreams!

Great ROI for a $10,000 investment is the goal, and focusing on only one area of your practice can limit that ROI. Why not consider investing in three areas-with each one linked to your success, improving those links can propel your practice toward your goals. 

Invest one third on continuing education for the doctor, and focus on CE that will add additional procedures to your service mix. Expanding your services adds to your existing base and can attract new patients. Or take CE courses that will enable you to master a procedure that may challenge you. Will this CE improve your quality, speed or patient comfort? If the answer is “yes,” this is the investment for you. 

Secondly, plan to purchase a piece of equipment that will improve service, increase efficiency and be very effective in lifting your quality care. This equipment might be matched to the CE investment, a great one-two punch that can increase the ROI!

The final and equally important third of the investment would be in training and educating your team. Your team members are foundational to everything you do. When you invest in your team, you lift members’ self-confidence and ability to provide the patient care to your standards and expectations. 

A laser-focused approach to a $10,000 investment to increase the success of your practice would be: Tie the doctor’s CE to a matched investment in equipment to accomplish those services and link the training for the team to that same CE and improve their skill set. It’s a three-way win.

As a certified Dentrix trainer, I work with different dental practices every day-from the office that has been using the same software for 10 or more years to the office that just installed it. What I find, however, is that without an organized system for team training, the learning will plateau and the doctor will start to second-guess his or her purchase.

The motivated team member will attempt to self-teach the team with online webinars or tutorials but often with limited retention and implementation. Sometimes doctors will attend a conference and take diligent notes so they can return to the office and teach their team the 30 percent of material they retained from the course while trying to figure out how to implement the new systems within the parameters of their practice. 

So the question is, “What would I spend $10,000 on if it was my dental practice?” Well, an organized, interactive, well-planned and fun in-office team learning day. Don’t get me wrong, I love to attend conferences because you can get a lot of different courses in one place, but if you are looking for something that can make a profound difference in your team’s efficiency, productivity and health, in-office learning is worth the money spent. When you have the opportunity to get hands-on learning and implement it immediately, the retention rate goes through the roof.

If you are going to take my advice and invest in your team’s knowledge base, here are some tips:

• Look for a coach that will ask questions, assess the situation and build an agenda that is created by you with your team’s goals in mind.

• Ask your prospective coach if he or she has experience in creating a learning environment for adults.

• Find out if your prospective teacher will leave your team with resource material they can use when he or she is finished.

As a former team member in a dental practice for more than 20 years, I know the impact in-office coaching had on our practice. Now, as a certified Dentrix trainer, paperless transition coach and speaker, I see firsthand the impact I can make on the lives of the dental team.

Ann-Marie DePalma, CDA, RDH, MEd, FADIA, FAADH

If a dentist had $10,000 to spend, I would recommend team training in technology or other aspects of the 2015 dental practice. Dentists don’t often “value” team technology or other types of training and see it as an expense rather than an investment. This is much the same as the patient who doesn’t “value” dentistry and treatment recommendations. 

Team training improves productivity and consistency while advancing the individual and the practice’s knowledge. In the long run, the ROI spent on team training is greater than a monetary figure. As patients who put off treatment because “insurance doesn’t cover” end up spending more long term, so does the practice/dentist who doesn’t invest in team training spend more in lost productivity and revenue. Time spent in team training is well worth the investment.

If a dentist had $10,000 to spend, I would definitely recommend it be spent on HIPAA compliance-both upfront and ongoing with training and updates. Many dentists have, unfortunately, buried their head in the sand when it comes to HIPAA. The old adage of “what you don’t know can’t hurt you” doesn’t apply to HIPAA. While $10,000 may seem like a significant investment, it pales in comparison to the fines and penalties, which are often multiple hundreds of thousands and can go as high as $1,500,000 for each type of violation.

Here are the areas in which I believe practices should invest:

 Encryption is your only “get-out-of-jail-free card” when it comes to a data breach, and considering that the software is free and you just pay for the IT company’s time, this one is the best ROI of any HIPAA regulation.

HIPAA is very clear on this: You must encrypt any information you send to other offices. Patients will love that you put their privacy and security above all else. Most plans don’t run more than $30-50/month.

They say time is money-no truer words for dental practices. A good local and online disaster recovery plan that reduces downtime to mere minutes is a great investment for dentists.

If your practice is ever audited for a HIPAA violation, this is the first thing they will ask to see.

 No dental practice can get 100 percent compliant so having insurance in place makes a lot of sense.

The best offense is often a good defense. Keeping the bad guys off your network is one way to make this happen.

While the office may not see the immediate ROI, HIPAA protection is a lot like auto insurance: You may never need it, but the one time you do, you’ll be awfully glad you have it!

To make a recommendation on how a dentist should spend $10,000 if that was all the practice had, I would first require a full understanding of what technology, equipment and solutions the practice already has. Because we don’t know any of that information, I’d suggest the practice spend its dollars on marketing and a patient engagement solution. My recommendation includes four specific additions:

• The practice should spend approximately $3,400 on a new responsive-design website (built by a company that knows dentistry). Responsive websites are now Google’s recommended configuration. They show up better on search engines and are friendlier for mobile-browsing and prospective patients. Because mobile browsing has now exceeded desktop browsing, a responsive website is critical to the practice. 

 Next, I’d recommend an Enhanced Healthgrades profile, as Healthgrades is the No. 1 place patients go to find a dentist. Research from Sesame Communications shows an Enhanced Healthgrades profile drives an average of 11 new patient calls per month. This will cost the practice about $1,800. 

To truly engage with patients, the practice should utilize a patient engagement solution like Sesame or Solutionreach to remind patients of their appointments, automate recalls and ensure patients show up for their appointments. Plus, these solutions can be used for driving reviews from patients, e-newsletters and other marketing efforts. The average patient engagement solution will cost the practice about $3,000 for the year.

 With the remaining dollars, I’d suggest the practice hire a dental-specific company to optimize its search engine results. It’s important to be found on the Internet when someone is searching for a dentist in the area. Search engine optimization (SEO) is one way to help your practice show up on search engines like Google and Yahoo. The practice likely wouldn’t have enough left over from the $10,000 to spend on SEO services, but, with the increase in patient volume and practice efficiency, there would be savings in other places that could be put toward additional SEO. 

 Whether it’s at the grocery store or on vacation, we’re all looking for the smartest way to spend our money. We want to make sure that when we decide to purchase something, it’s really going to be the best thing on which we can possibly spend our hard-earned cash.

What $10,000 could do for your practice

	Ask any cosmetic dentist that’s been around for awhile, and he or she will tell you a lot of the most popular treatments are now done in fresh and exciting ways. And while there are new, cutting-edge procedures, there are still a number of mainstays that provide the majority of their work.

The basics-the standards, if you will-of cosmetic dentistry are still the core of the profession. But the way those services are delivered tends to be different than they were 10 or 20 years ago.

“Whitening and full-mouth restorations make up about 70 percent of my work,” observes Dr. Richard Marques, BDS, of Wimpole St. Dental in London. “However, I also do facial esthetics (botox and fillers), gum treatments, dental implants (placement and restoration) and emergency dentistry.”

When patients come in to address one complaint, they must be assessed as a whole. That is, simply bonding or whitening teeth may not be enough to get them to their goal. The doctor must look at the big picture.

“Every patient that I see, we look at comprehensively, from a biological need and the cosmetic stuff,” says 

 in Anaheim Hills, Calif. “Any patient that is a candidate for bleaching, we’ll recommend it. Bleaching is a harmless, wonderful procedure; it’s better than doing restorations if it’s going to generate the same results.”

Today, more than ever, patients expect a higher standard and know what they want.

“The Internet has opened up a whole new world for people,” says Dr. Sam Simos, DDS, a cosmetic dentist at Allstar Smiles in Bolingbrook, Ill. “Back in the day of the Extreme Makeover, when Bill Dorfman introduced the veneer to the world, it seemed like it was only attainable for the very rich and the very famous, and now those are commonplace. We are doing veneers every day. We are doing them on people who are soccer moms and warehouse workers. It’s wonderful because it’s attainable.

Procedures, techniques and, as a result, outcomes have all improved over the years.

For Dr. Ringer, the whole process involves a well-planned design based on modern versions of classic techniques.

“Everything boils down to the evolution of cosmetics over the years,” he says. “Right now, it seems like it’s all focusing on first starting off with an accurate design. Whether you’re going to do something very elementary or very sophisticated with a patient, the ideal thing to do is to have a model dental design for the patient, and we have tons of tools nowadays to develop that. We always start off by looking at their face, seeing how their teeth fit in their face, then creating a design for that and working the steps as what could be done to achieve that.”

Those advancements are due, largely, to material improvements.

 “It’s dictated by the materials we have available,” Dr. Simos says. “It used to be that if we were doing a crown in the front, we would have to take down two thirds of the tooth. Today, because of the materials and how thin they are, we can engineer a crown or a veneer that’s so fingernail-thin and have it be so predictable and bondable that it’s amazing.”

The products and materials available to cosmetic dentists have helped deliver better results for patients.

“There are so many great products out there, and the manufacturers are doing a great job of keeping us very product-heavy,” Dr. Simos says. “Sometimes that’s a problem because sometimes these great products come out and you don’t know how to use them. You don’t know what to use them for.”

“At Wimpole Street Dental, we like to evolve using evidence-based research (EBR) to stay up to date with the latest techniques,” Dr. Marques says. “I have been a practicing dentist for 10 years, and things have changed immensely during this period. One such advancement is the introduction of Icon (microfilling material) by DMG for reduction/removal of white spots for fluorosis or calcification. Another is the improvement in bonding techniques, and we use Adhese Universal. The alginate Hydrogum is incredibly dimensionally stable and an excellent product (also flavored nicely). Temporary materials have also improved with Quicktemp by Schottlander and Luxatemp by DMG-two of the leading products. These come in a full range of shades from dark (A3.5) to bleaching (HBO). When polished and glazed, they look fantastic and can give the patients an idea of the color and shape of the final teeth.”

Without the advancements of new products, cosmetic dentistry would not have developed as fully as it has.

“It all goes back to manufacturers,” Dr. Ringer says. “It’s a business. They want to compete so they want you to buy their products. Somebody always comes up with something that they claim is bigger and better, but you never know.”

The world of composites has certainly grown, but doctors must know how to use the new materials.

“The composites have changed dramatically over the years,” Dr. Simos says. “It used to be at that they weren’t very wear-resistant. Now they are extremely wear-resistant, and they’re wonderfully polishable, and we can make them look like an exact match to the tooth. We don’t have to settle for decreased results. You can expect really great things.”

But it isn’t solely in the hands of the materials. Doctors must know the proper ways to use those products.

“That’s all technique-driven, too,” Dr. Simos says. “You can’t just expect to open it up, take it out of the package and get those results. You have to get the education and know how to use those materials competently and predictively so the patient can benefit from it. I think that’s the key.”

veneers have also undergone an evolution during their existence in the cosmetic dentistry world.

“Initially, when veneers first started, there was a lot of skepticism of, ‘Are they going to work?’” Dr. Ringer says. “In those days, we only had techniques of bonding onto enamel so we were very, very cautious in our preparations and being very, very conservative. We didn’t have the plethora of ceramics that we do today but still there was some phenomenal stuff done.”

Materials have been a huge boon for veneers, and recent innovations make them better than ever.

“One of the biggest things that’s helped is the advent of some other better ceramics. In particular, I like lithium disilicate,” Dr. Ringer says. “The trade name is (IPS) e.max, which has kind of taken the world by storm because it’s beautiful, it’s bondable, you can mill it, you can press it, you can cut back and layer it and you can almost do anything with it other than posterior bridges.”

Bonding agents continue to evolve and improve the process of restoration adhesion.

“Some of the products I love out there now are the self-adhesive, resin cements,” Dr. Simos says. “We use them for bonding our crowns, but we don’t really need to treat the tooth. We can put these bondable cements into the crowns, and they work beautifully. It’s very simple and very easy.”

Bonding agents have developed to the point where they are easier to use and can do more.

“They’re getting a little bit more sophisticated with these one-bottle systems that have everything but the kitchen sink in them,” Dr. Ringer says. “There’s one called Universal that has everything you can find in it. And they’ve been showing really promising results. Same thing with some of the cementing agents. They are having everything in one cylinder so it bonds, it etches, it makes things a little bit more predictable for the dentist with fewer post-operative problems.”

A doctor can examine the patient and figure out what he or she needs. However, successfully communicating that plan to the patient in a way that is receptive to them is critical.

“A lot of people, when they come to you, they say something like they’d like a nice smile, but that can mean a lot of different things to different people,” Dr. Ringer says. “The way I like to present it is to firstly sit with a patient with a photograph of their face and their smile and have them point out where they feel things are deficient and then for me to also point out things that I may see as deficient.”

From there, Dr. Ringer utilizes digital photography and 3D computer modeling before constructing custom provisional restorations.

“I kind of call them prototypes,” Dr. Ringer says. “They are based off of the original design, and those can be modified because they are resin, but the whole key with all of this is before the ceramist actually makes the final restoration, the patient has lived with, seen and approved a shape, design, size and position of whatever they’re going to have.”

It is a lot of work, but it takes the surprise and the uncertainty out of the work.

“What this does is it helps both the dentist, the lab and the patient understand everything so that at the end of the day, there are no surprises,” Dr. Ringer says. “The patient doesn’t say, ‘Oh, you promised me this,’ or ‘I thought I was going to get that.’ It is much more predictable and seamless.”

Dr. Marques utilizes the skills of other professionals in developing his treatment plan.

“A truly personalized treatment plan is key to making a fully informed decision,” Dr. Marques says. “I create a bespoke dental treatment plan that differs for every patient. Pre-assessment of the case and staying within your limits are important. I recommend the use of specialists (endodontic, orthodontic, periodontic) and imaging techniques (CT scans) to provide the best treatment. In the Harley Street area, I am fortunate enough to work with some of the best dental (and health) specialists in the world. This is why I trust them with my own teeth as well as that of my patients.”

For Dr. Simos, having a regular plan is important, but one must also be able to tweak the plan based on the patient.

“What you have to do first is have a system in place, and I don’t think any one system is the magic bullet to treatment plan explanation,” Dr. Simos says. “What I try to do is you have to have a complete system that everyone in your office is aware of and everyone works on so everyone is on the same page-from front desk to the doctor to the hygienists. Everyone has got to be on the same page when you’re presenting a treatment plan.”

“The next thing is you have to be able to read the patient and ask him or her what it is that he or she wants, and then you can talk to that,” Dr. Simos adds. “You have to listen. You have to get out of the one-size-fits-all mentality because everyone is different and has different needs.”

As cosmetic dentistry evolves, so, too, must the doctors. To stay on top of their industry, they must seek out and embrace learning opportunities.

“Constant learning is the key to a successful and fulfilling career in dentistry,” Dr. Marques says. “My upcoming training includes further implant facial esthetic training.”

Also, seek education from a variety of sources to broaden your learning.

“I would strongly advise them to take continuing education courses from independent sources,” Dr. Ringer says. “In other words, not strictly manufacturer-sponsored programs. Education through Spear Education or Dawson, for example. These types of places that are giving really high end, quality education without it being driven by the manufacturer.”

Doctors who are not taking advantage of these opportunities are hurting themselves.

“There are so many continuing education opportunities out there, whether it be the state meetings, local meetings or study clubs,” Dr. Simos says. “Dentists just aren’t taking advantage of those opportunities. The big problem is just getting doctors in the chairs to get this done because they are really busy. My biggest suggestion to doctors would be take the continuing ed. Take as much as you can. You can’t get enough of it because even if you take one pearl away from an hour or two-hour lecture, it’s worth it.”

The standards in cosmetic dentistry look like they will continue to be the bread and butter of the industry, and keeping up on their evolution, as well as being able to communicate their usefulness to patients, will continue to be important.

 Ask any cosmetic dentist that’s been around for awhile, and he or she will tell you a lot of the most popular treatments are now done in fresh and exciting ways. And while there are new, cutting-edge procedures, there are still a number of mainstays that provide the majority of their work.

Whiter and brighter: The exciting evolution of cosmetic dentistry

As the “technology evangelist,” I sometimes lose myself in reading about and researching different aspects of technology. On occasion, I can go down the technology rabbit hole and disappear for hours at a time.

One of the subjects that has fascinated me over the years is stealth. While I “get” the concept, it still amazes me that an object as large as the B-2 Spirit stealth bomber (172 feet wide by 69 feet long) can be virtually invisible to radar.

Obviously, in some cases, stealth is a really good thing. However, in healthcare, it can be a serious challenge. No one likes surprises in dentistry … not patients, not doctors and not staff. Also, as a profession that prides itself on being conservative, wouldn’t it be great to not only see decay before it surprises you but also detect it at its earliest and smallest stages?

We are entering a phase in our profession where the “sharp explorer diagnosis” as the primary means for caries diagnosis will take a backseat to other modalities. While the explorer can still detect carious lesions, those lesions are larger than ones that can be detected by other modalities. This means conservative examination and diagnosis can be more reliably performed through the use of other diagnostic means and devices.

To me, this is a fascinating subject because I feel caries diagnosis has become more like a mosaic. By that I mean I acquire diagnostic info from several different modalities, which are like the mosaic tiles, and then when I step back and view all of the “tiles,” I can see the picture the individual tiles create.

First and foremost, I want to make it clear that my diagnostic process is data-driven. The more information I can get, the better I feel about my decisions. Now, we’ve always been data-driven in diagnosis; it’s just that we may not have really been aware of it. Any time we look at a bitewing, drag an explorer across the occlusal surface or look at a big gap in the margin of an old amalgam on the occlusal of tooth No. 30, we are gathering data.

So when I sit down with a patient to do an exam, I’m using several different modalities to gather data. While I don’t depend on the explorer nearly as much as I used to, it is still used on occasion. I’m also doing my exams utilizing magnification.

My Orascoptic EyeZoom surgical telescopes provide up to 5.0x magnification. Pairing that level of magnification with a bright glasses-mounted LED “headlight” makes it much easier to see the breakdown of the enamel. It’s also not uncommon for me to notice an area of decalcification under a marginal ridge that is indicative of an interproximal lesion. Sometimes these interproximal areas have been noticed on a bitewing and I can confirm during the intraoral exam, and sometimes the areas are discovered by the intraoral exam alone.

It also helps to have an intraoral camera available, as well. While 5.0x is certainly nice, intraoral cameras can enlarge much more than that. Magnification of 28x to 32x is not uncommon, and being able to see images on a monitor from different angles can also make a tremendous difference. The other great feature of intraoral photos is that they can be saved and reviewed at the next periodic examination. This provides even more data on areas that might have been determined not to need restorative at previous appointments. Allowing for a compare and contrast to previous points in time is a tremendous advantage.

However, there are even more ways to evaluate your patient’s condition and generate more data. Once again, I’d like to emphasize these devices are just more ways of gathering data. It is up to the doctor to evaluate that data and determine what course of action (if any) is necessary. Let’s take a look at some of them now.

If you use Carestream for your digital radiography, you should check out Logicon. It is an optional component of the Carestream software. This software performs an analysis of bitewings and helps locate interproximal lesions. It uses a database of confirmed areas of interproximal caries and compares them to the radiographs just taken to see if lesions exist.

There are two different devices from ACTEON that can help generate more data. The first is the SoproLIFE (light-induced fluorescence evaluator). This device functions as two devices in one. It has a series of white LEDs that let it perform the functions of an intraoral camera, and it also can be switched over to violet LEDs that provide visual caries detection.

Under the violet light, caries glows (fluoresces) and this can be seen in the images taken by the device. The glowing areas are often smaller than what can be detected by a sharp explorer, making this (and all the visual devices discussed here) more accurate and more conservative than an explorer. The device is recognized by dental software as an intraoral camera. That means you can store the images and associate them with teeth, allowing you to keep a visual history of changes over time.

The second ACTEON device is the SoproCARE. This functions as a three-in-one device. Like its little brother, it functions as a true intraoral camera and fluorescent caries detector. However, it also functions as a detector of potential perio problems by also having a “perio mode.” The “perio mode” uses a different set of LEDs that allow for the identification and illumination of gingival inflammation, plaque and calculus. When paired with a monitor for patient viewing, this means hygienists can share with patients areas of periodontal concern with pictures that show patients inflammation in their own mouths. Combined with the regular intraoral camera and caries detection modes, this device can do it all. It also interfaces with your dental software to store the images.

The CariVu is a very interesting device. Rather than using fluorescence, the CariVu functions as a transilluminator. It shines an invisible (to the naked eye) near-infrared light into the tooth from buccal and lingual simultaneously. While these two light sources provide transillumination, there is a camera built into the handpiece that allows viewing and capture from the occlusal surface. The result is a very brightly illuminated tooth with a crisp black-and-white image from the occlusal.

The result is that caries, both on the occlusal and interproximal surfaces, can be seen and captured. Also, if the device is tipped to the buccal or lingual it can provide images of those surfaces as well. While it is not a replacement for the bitewing, CariVu can definitely help find interproximal lesions radiographs might miss as well as confirm areas that might be questionable on a bitewing. The infrared energy provides illumination that is right in the “Goldilocks zone” (not too bright and not too dim) so that the tooth is perfectly transilluminated.

The device connects only through the DEXIS Imaging Software, but that allows the CariVu images to be stored and compared side by side with DEXIS bitewings, which is a really nice feature. The system is compact and easy to use.

The Spectra is another fluorescence device. This one only performs one function, which is caries detection. However, it also adds a nice feature. After the Spectra image is saved or “frozen” on the computer screen, a software algorithm is applied to the image. This takes less than a second, and then an image is overlaid on the picture of the tooth. This overlay has the appearance of doppler weather radar. This means it is a combination of blue, red, orange and yellow, with each color corresponding to deeper penetration of the caries causing bacteria. The colors are a great communication tool for patients, and they also provide a great source of information for the practitioner, as it is easy to see the size of the lesion in all three dimensions. This makes restoration more predictable and helps the doctor decide whether anesthetic is needed or not. Like the other devices, the images can be stored in your practice management software and monitored if need be.

By using a combination of the suggestions and devices in this article, a doctor can create quite a few data points. However, there is one more data point I haven’t covered yet that extends to patient history as well. The longer patients are in my practice, the better I get to know them, their habits, homecare, etc. This helps me determine if I restore, remineralize, monitor or something else!

By combining all the info I can, a more complete picture can be obtained that helps me make better clinical decisions. In the end, the question I need to answer is “what is in the best interests of the patient?” That answer lies within as many data points as I can gather.

  As the “technology evangelist,” I sometimes lose myself in reading about and researching different aspects of technology. On occasion, I can go down the technology rabbit hole and disappear for hours at a time. 

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