A Glimpse of the Future Today – Changes in Dentistry

Dental technology is changing. New ideas, equipment and materials, many based on new technologies, fill the specialist dental magazines. While many of them are still in the development stage, it is worth outlining some of the equipment you may see in private practice or in a dental hospital. Most will not be available in NHS general practice for some time, if ever.



New filling materials, however, will be universally available. Tooth-colored filling materials with similar properties as the substance of a tooth will not be long delayed, probably developed from the line of products that have evolved from the nose tiles of space shuttles. They will be based on the ‘sticky dentistry’ principle. This will enable amalgam to be phased out. But initially they will be expensive. This is a fundamental point in the development of dental equipment and materials. In business generally, costs and prices fall with increasing volumes of sales. But dentistry is a limited market, so the more expensive equipment will almost certainly remain expensive, and out of the reach of NHS dentistry as it is currently constituted.



Personal computers are the classic example of increasing volumes of sales reducing prices, almost while you watch. Many dentists already chart on a computer, and some are on-line to the NHS authorities. But computers may well have another, more direct use. Computer-aided design and manufacture (CAD-CAM) is a well-established industrial process in which engineering design and manufacturing phases are merged using computers. Experiments with such a system, modified to allow a dentist to make ceramic crowns in the surgery as he or she works on the tooth, are now well under way, with more than a little success. An EU-funded study is experimenting with the uses of ‘virtual reality’ in this area of dentistry. This would enable a dentist to work on a tooth – but away from the patient – with a tiny robot clamped to the tooth, actually doing the physical work.



Lasers are being used in a very limited number of private practice dental surgeries. As they can be focused and manipulated to different strengths, they are being used to ‘dissolve’ decay and seal teeth. In theory they could also be used in root canal treatments and gum surgery. Vibrationless, and painless (even in the absence of anaesthetics), they would represent a radical break­through if their capital and running costs were not prohibitively high. In an experiment in Tayside, ten dentists are using a new water-absorbing laser (the teeth do not heat up), but the equipment costs $40,000.


Implant Techniques

Implants cannot be performed on the NHS, mainly because the public purse will not meet the expense, even in part, but also because so few dentists are qualified to visualize, plan, make and fit them. However, one addi­tional problem has been a lack of appropriate visualiz­ing techniques – ordinary x-rays are not acceptable. This argues that ultrasound and magnetic resonance imaging (MRI) might find a place in ‘dental implant centres’, which are surely not that many years away. In the mean­time the pan-oral x-ray machine, which provides a flat­tened full mouth x-ray picture, is used in implants, along with other x-rays taken at non-traditional angles.



Pan-oral x-rays have been used in hospitals for many years, and indeed are used extensively in orthodontic departments. While some general dental practices are starting to use them, a simpler version is to add an attachment to standard practice modern x-ray machines which virtually turns them into wide-angle cameras. When the pictures are tacked together a pan-oral x-ray is obtained. A further advance in imaging technology is real-time imaging. Although it looks like, and is interpreted like, an x-ray, in fact it is another computer technique.

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