Modern dentistry – One step backwards, two steps forwards

Dentistry used to be simple, treatment choices were limited and prior to the ‘celebrity smile’ cosmetic dentistry did not exist.
Over the past decade there have been massive technological advances in dentistry and medicine that have forever changed the treatment options for our patients. Included in these advances are implants, guided bone regeneration, milled ceramics and advanced radiographic imaging. Additionally the public’s expectations has dramatically increased for a brighter, whiter more youthful smile.
Personally I think the biggest advancement in recent years is in visualisation, the better I can see what I am doing the better the clinical results achievable for the patient.
The arrival of the operating microscope into dentistry has launched a new era in dental care by improving magnification and illumination. The dentist can now see every detail of the teeth from micro-cracks to hidden decay and infection which in the past meant possibly having to lose the tooth. We can now dramatically reduce the ‘guesswork’ when trying to save teeth.
The operating microscope has now moved from the opthalmic and vascular surgeon to the dentist, bringing all the techniques and advantaged of microsurgery to the dental surgery. We are now able to magnify the tooth by up to 20 times and using special lighting can eliminate the shadows where decay and infection previously lurked. Combining with micro surgical instruments such a super small mirrors and ultrafine dental probes we can now access the previously inaccessible.
So what do I men by – “one step backwards, two steps forward”?
A lot of the conventional treatments were limited by an ability for the dentist to be able to precisely see where the infection was hiding. The patients lips, cheeks, tongue, saliva and shadows hampered the dentist from clearly seeing the teeth almost to the point where he/she was working by feel alone. This is especially true of root fillings where we have to accurately clean shape and seal possibly up to four root canals (each the hickness of a human hair) through a hole that is 5mm in diameter.
Improved vision and precision equals:
Better composite (white) fillings with an improved seal and more natural appearance.
More precise edges on crowns and veneers
Higher quality root fillings and the ability to retreat previously root filled teeth which have failed.
Cleaner root surfaces when treating gum disease
The ability to have high quality video and images of the teeth. This is extremely useful when explaining treatment options to patients and colleagues.
The delicacy of microsurgery improves patient comfort and speeds up healing.

Most importantly we are now able to save teeth that previously have to be extracted and I think I am right in saying that patients generally would like to keep there own teeth rather than have extractions. If we can keep hold our our teeth longer and improve their looks by enhancing the precision of our restorative and conservative treatments the patient can avoid or at least defer the more expensive and complicated treatments such as implants.
I and many in the profession strongly believe that if we can go back and improve some of our older restorative techniques we can not only reduce the need for more costly and complicated treatements. The ten year success rate on a root-filled front tooth and a similar front tooth restored with an implant are both around the 90% mark. It is interesting to note the root-filling can be completed in a few hours and the implant may take up to a year before it is finally completed at three times the cost. This is not an ‘anti-implant’ stance but it makes sense to exhaust all practical restorative options and try and preserve the implant option as our ‘ace in the pack’ to be pulled out when there is no better choice. In addition where possible the use of a surgical microscope, microsurgical techniques and implants all complement each other to produce improved outcomes for our patients
So in conclusion by combining the improved magnification and precision of the surgical microscope and conventional dental techniques we can get the best possible success rates out of our own teeth before we need to resort to more complicated, expensive and protracted treatments. As a foot note if you keep on top of your check-ups and keep the idea that ‘prevention is better than cure’ you wont have to worry too much about advanced surgery, implants, bone grafts etc, etc.

1. Investigate the qualifications of the dentist and disregard advertising claims that seem to be too good to be true. Remember that cosmetic dentistry is not a specialty so beware if a dentist claims to be a specialist in cosmetic dentistry. All cosmetic procedures require time and excellence in operative procedures.
2. Dental practices that have high sales motivation and offer reduction in fees for signing up immediately should raise a red flag also don’t be deceived by office glamour or glitz. Fancy waiting rooms do not necessarily mean high quality work.
3. Never make a decision for a cosmetic procedure on the first visit. Beware if confronted with an urgency to book dental work by the practice staff.
4. Lack of information on dental procedures and the lack of required time for evaluation and planning before beginning the procedure should be questioned. Remember that a conscientious dentist will explain treatment options, indications and contraindications for procedures and required time for completion.
5. When reviewing presentations of past procedures ask if procedures in the presentation were performed by the dentist.
6. Have knowledge of the restorative materials that will be selected for your procedure. Never accept a statement that these are the “state-of-art materials.” Remember the best materials are not the only ingredient for success, it requires the proper diagnosis and restorative team and a clear plan before you proceed with any cosmetic procedure.
7. Do not be afraid to ask questions. Beware of the dentist who does not provide adequate time for questions or explaining and performing procedures
a. Ask about the longevity of the restorative procedure and the time span for replacement
b. Ask if adhesive protocols are utilized in the procedure and if a dental dam is used.
8. Get an independent second opinion before you agree to any cosmetic dentistry.
9. Do not accept changes in the treatment plan unless those possibilities have been discussed prior to the procedure and seek opinions of independent specialist if changes occur with regard to periodontal, endodontic, or oral surgery during a procedure.
10. Do not accept a restoration as finished until viewed in different lighting and observation by an independent observer. (i.e. family member, friend)