Walsh, Laurence J.

University of Queensland eSpace

4 0 -  D e n t a l  P r a c t i c e M a r c h / A p r i l  2 0 0 6
SPECTRUM
T he exciting range of new technolo-gies in dentistry offers a number ofmajor advantages for clinical
patient care. The ability to diagnose and
detect disease at the earliest
stages provides the opportuni-
ty for less invasive interven-
tions, and allows us to con-
serve as much tooth structure
as possible. If caries removal
is required, optical technolo-
gies can provide a number of
benefits for hard tissue proce-
dures such as caries removal.
The following case can be
thought of as a “dental hypo-
thetical” which illustrates how a number
of contemporary technologies can be
applied in everyday dental practice.
A seventeen year old female, who is a
new patient to the practice, attends for an
initial examination. She attends a local
private school, but is new to the area. She
is concerned about the aesthetic appear-
ance of her incisor teeth, and she com-
plains of cervical dentinal sensitivity
affecting the buccal surfaces of several of
the lower premolar teeth (Figure 1). She
has had relatively little experience of den-
tal caries in the past.
Saliva testing with the Saliva Check
Buffer kit (GC Corp) revealed problems in
the resting salivary flow and pH, and a
lifestyle analysis showed sub-clinical
dehydration. This problem was linked to a
relatively high daily caffeine intake, and
her involvement in the school’s rowing
team. Following training sessions she has
an inadequate intake of fluid,
and tends to use acidic sports
drinks excessively. The saliva
testing identifies the underly-
ing problem of dental erosion
that has led to sensitive den-
tine becoming exposed.
A chairside test for real-
time plaque fermentation
was undertaken using the
Plaque-Check+pH kit (GC
Corp), which showed a highly
acidogenic microflora in the samples of
proximal plaque that were tested. This
heightened concerns regarding incipient
proximal caries, and digital radiographs
with the Sopix cordless (bluetooth) digital
X-ray system (Sopro) indicated the pres-
ence of a number of early proximal
lesions on the molar teeth. Assessment of
the proximal surfaces with the periscope
tip of the DiagnoDENT pen (KaVo)
showed that these were not cavitated.
Assessment of the occlusal surfaces by
laser-induced fluorescence using the
DiagnoDENT conical A-tip (Figure 2)
showed incipient fissure caries in the
lower premolar teeth and occult lesions at
the DEJ on several of the molar teeth. The
lateral fissure wall lesions in the premolar
teeth were opened up without the need for
local anaesthetic, using a particle beam
(air abrasion) device (Figure 3), and the
preparations treated with ozone
(Healozone, KaVo) (Figure 4) before
placing a composite resin. A deeper area
of caries on a maxillary second premolar
tooth was opened using a pulsed middle
infrared laser, (Waterlase, Biolase)
again without the need for local anaes-
thetic, in this instance because of biores-
onance analgesia. This removed the
caries and also prepared the area for
bonding an adhesive restoration. One
larger carious lesion was noted on a
mandibular second molar, and in light of
its relative depth, the finished cavity
preparation was treated with photo-acti-
vated disinfection (Savedent, Denfotex)
to kill any persisting “pioneer” microor-
ganisms which may have been present in
the deepest aspects of the tooth structure,
before placing a glass ionomer-composite
sandwich restoration. (Ozone could have
also been used for disinfection).
A homecare program using contempo-
rary remineralization technologies to
achieve sub-surface remineralization of
the early enamel lesions was undertaken
(Recaldent), and a number of lifestyle
changes were advised, using a personal-
ized oral health prescription. Included
in this advice was salivary stimulation
with a sugar-free chewing gum (Extra,
Wrigleys). The erupting third molar teeth
which were judged to be at risk of fissure
caries developing were treated using
tooth surface protection with a high 
Emerging technologies: a hypothetical case study
EMERGING
TECHNOLOGIES
IN DENTISTRY
Presented by
Professor Laurence Walsh
Brisbane 28 April
Sydney 29 April
Melbourne 6 May
For more info, call Dentevents on
(02) 9929-1950 or register at
www.dentevents.com/mtech2006.html
Figure 1. Initial presentation Figure 2. Fissure evaluation
Figure 3. Air abrasion therapy Figure 4. Ozonation of the preparation
4 2 -  D e n t a l  P r a c t i c e M a r c h / A p r i l  2 0 0 6
SPECTRUM
fluoride-releasing glass ionomer cement
material (Fuji VII, GC Corp.). The at-risk
surfaces for dental erosion were treated
by laser-activated fluoride to increase
their resistance to dental erosion.
The unaesthetic areas of enamel
hypomineralization on the maxillary
incisor teeth were treated using enamel
microabrasion followed by GC Tooth
Mousse. This employs subsurface regen-
eration to convert the water deposits in the
hypomineralized areas into enamel miner-
al. A computer simulation of the effect that
this would achieve after 4 weeks is shown
in Figure 6, as a reversion to the optical
properties of normal enamel occurs. By
this stage, the patient’s changes in lifestyle
and diet had led to a reduction in 
plaque fermentation and a corresponding
improvement in her salivary parameters.
The patient’s attention now turned to
the overall appearance of the maxillary
incisors. She is missing both maxillary
lateral incisors, and the adjacent canine
teeth are darker. The two canine teeth
could be treated by in-office laser photo-
chemical whitening (Smartbleach, High
Tech Laser), so that their shade would
match that of the maxillary central
incisors. Small composite resin restora-
tions would then add mesial incisal cor-
ners to the canines to replicate the
appearance of lateral incisor teeth. A
computer simulation of the expected end
result of these two treatments is shown in
Figure 7.
The patient thus far has been able to
have her problems of dental erosion, den-
tal caries, and an uneven incisor smile line
addressed with minimal chairside time,
and without the need for local anaesthet-
ic. This case also illustrates how tech-
niques for diagnosis and detection of
early disease, conservative caries
removal, microbial modification and bio-
photonic technologies can be applied in a
relatively simple clinical case in order to
achieve optimal oral health for the patient,
at minimal biological cost.
It is the author’s view that the use of
these types of technologies will become
more common-place in clinical practice.
Indeed, each of the technologies men-
tioned above is included in the fourth year
dental program at The University of
Queensland School of Dentistry, and
cases very similar to the one described
above have been treated by students, who
are gaining experience using these tech-
nologies. Educational institutions have a
responsibility to train students for con-
temporary practice, and also to prepare
them for the challenges of the future.
There is no doubt that what is regarded
today as a new or emerging technology
will over the course of the decades to
come, form a greater part of the overall
practice of the current dental students and
the practitioners of today.
Prof. Laurence J. Walsh
Prof. Walsh will present information on all
this topics and more at Emerging Tech-
nologies in Dentistry in April and May.
For more information or to register, 
contact Dentevents on (02) 9929-1950 or
info@dentevents.com. Register online at
www.dentevents.com/mtech2006.html
Figure 5. Laser cavity preparation Figure 6. After reversal of hypomineral-
ized areas
Figure 7. After whitening and composite
resin restorations
MORE OPTIONS  LESS BRACES
The MYOBRACE™ is a new concept in
orthodontic treatment, incorporating design
characteristics to align the anterior dentition
and the mandible into Class I. Individually
sized tooth slots and arch size are pre-molded
into a flexible appliance with an active inner
DynamiCore™ for arch development.
Suitable for most children requiring
orthodontic treatment in mixed or
permanent dentition. www.myobrace.com
For more information, call 1800 074 032, or visit
“Why have braces –
Myobrace™ costs less,
and works better!”
EASY TO USE 6 SIZES
Dynamicore™
684ENG 07/05


Emerging technologies: a hypothetical case study

http://espace.library.uq.edu.au/view/UQ:13801/MI_Hypothetical_2006.pdf

Emerging technologies: a hypothetical case study

Abstract

Similar works

Full text

Available Versions

University of Queensland eSpace