BRACE YOURSELF: As patents
farlnvisalign expire, expect
more options at iower prices.
DENTISTRY GOES DIGITAL
Faster braces, more comfortable crowiis, and other ways technology
is changing your trip to the dentist
computer's c o m p u t a t i o n a l powers, b u i l d i n g
a s y s t e m f o r d e s i g n i n g m e c h a n i c a l parts t h a t
was q u i c k l y a d o p t e d b y t h e aerospace a n d
automotive industries.
T u r n s o u t what's good f o r cars a n d planes
is g r e a t f o r m o l a r s . C A D / C A M m a c h i n e s
started retooling dentistry more than a
quarter c e n t u r y ago, b u t m o s t o f the nation's
By Suzanne Sataline
200,000 or so dentists have been s l o w t o b u y
the equ i p m e n t for t h e i r offices, oiXen because
HERE'S SOMETHING TO GNAW ON: YOUR TEETH
o r t h o d o n t i c w o r k that's o f t e n faster a n d
ofprice.Aleadingmanuiacturer,Sii-ona D e n -
endm-c nature's c n i e l tbrces—all that chewing
longer-lasting than traditional methods.
tal Systems—which recently merged w i t h
a n d gnashing, n o t t o m e n t i o n t h e two h o u r s
M u c h o f the w i z a r d r y revolves a r o u n d
D e n t i s t i y I n t e r n a t i o n a l t o become D e n tsply
spent grazing t h r o u g h an $8 b u c k e t o f p o p -
c o m p u t e r - a i d e d design, or CAD,and
Sirona—says i t s office C A D / C A M systems
c o r n diX.Star TrekBeyond.
computer-aided manufacturing, C A M .
are i n 16 percent o f U S practices, u p f r o m 10
L u c k i l y , science is
helping more dentists—and patients—boldly
C A D is a s y s t e m t h a t d e s i g n s d e t a i l e d
percent a decade ago. Systems start a r o u n d
t w o - or t h r e e - d i m e n s i o n a l models o f p i i y s i -
.$80,000 a n d c l i m b t o n e a r l y $130,000. B u t
T h e same t e c h n o l o g y t h a t h e l p e d h u -
cal objects; C A M lets specialized c o m p u t e r s
i n d u s t r y specialists a n d area p r a c t i t i o n e r s
mans design car b u m p e r s a n d airplane
c o n t r o l , m o n i t o r , a n d adjust t o o l s a n d m a -
expect the n u m b e r o f C A D / C A M owners t o
wings can r e t o o l teeth. D e n t i s t s are n o w
c h i n e r y t o p r o d u c e t h e parts. T h e c o n c e p t
growas m o r e n e w dentists, t r a i n e d t o use t h e
u s i n g d i g i t a l t e c h n o l o g y t o p l a n a n d create
was b o r n i n 1963 w h e n c o m p u t e r scientist
technology i n school, o p e n practices.
inlays, onlays, veneers, crowns, bridges,
I v a n S u t h e r l a n d c o m b i n e d t h e d i s p l a y ca-
" I n m y m i n d , t h e r e is v i r t u a l l y n o d o w n -
dentures, f u l l - m o u t h r e c o n s t r u c t i o n s , a n d
p a b i l i t i e s o f the c a t h o d c - r a y t u b e w i t h t h e
side t o t h i s , " says G a r y H a c k , a d e n t i s t a n d
go w h e r e they've n o t always gone before.
JULY 2016 * WA3HINGT0NIAN
159
O
GREAT S M I L l i S
N O R T H B E T H ES DA
PERIODONTAL GROUP
BOARD-Cl-RTiriliD
PLiKI()I)()NTISTS&
DI:NTAI.IMPI.AN 1
SPECIALISTS
Wc p r n i K i l y providi: stiitL'-of-lhu-arl
dental i m p l u n l ;ind p e r i o d o n t a l care
to i"om m i l nitics w i t h i n \ h i r y l a n d
and sLirniundin;^ art'as, i n c l u d i n g DC
and N o r t h e r n Virginia. T h e scopo ol'
DENTAL TECH: Computers
and 3-D imagery have mad
dental worl< more accurate.
o u r ser\ii:e.s includes d e n t a l i m p l a n t s
(ini.iudin<i M l - o i i - ' l , T e e t h - i n - a - D a y , a n d
z v g o m a t i c iinplant.s), (^T scans, surgical
anti non-surgical pcTiodnntal t r e a t m e n t s ,
associate professor o f endodontics, periodon-
t h e t r a y i n t o s m a l l m o u t h s , says J i l l
tics, and prosthodontics at the U n i v e r s i t y o f
B r u n o , a C l i e v y Chase o r t h o d o n t i s t .
p e r i o d o n i a i (ilaslic surgery (gLim g r a i l s ) ,
M a r y l a n d dental school w h o trains b u d d i n g
B r u n o n o w uses a h a n d h e l d digital scan-
and advanced r i d g f a n d
dentists i n the technology. "It's more patient-
n e r t o take 3 - D images i n seconds. S u c h
sinus a u g m e n t a t i o n s .
friendly, m o r e accurate, m o r e flexible. I t is
scannei's n o t o n l y e l i m i n a t e the goop, h u t
t h e w a y e v e i y t h i n g is moving."
they provide a m o r e precise map of a m o u t h .
The learning curve f o r some o f this
T h e y also l i m i t the i m a g e - t a k i n g to a s m a l l
t e c h n o l o g y c a n b e steep, h o w e v e r , a n d
area, c o m p a r e d w i t h t r a d i t i o n a l x - r a y s ,
some dentists, i n c l u d i n g those i n p r a c t i c e
thus h e l p i n g m i n i m i z e radiation ex^iosure,
f o r decades, m a y n o t t h i n k it's w o r t h w h i l e
says Peter R i n a l d i , a cosmetic dentist at the
to i n v e s t t i m e t o l e a r n t h e e v e r - c h a n g i n g
W a s h i n g t o n C e n t e r i b r Dentistry.
t e c h n o l o g y , experts say.
Still, C A D / C A M isn't the only digital
i n n o v a t i o n h e l p i n g professionals r e m a k e
smiles. Here's w h a t to expect at the dentist.
DR. K H A L I D C H O U D H A R Y
D R . JOAN H O W A N i r /
11921 R o c k v i l l e Pike, S u i t e 407
Rockviilc, M D
24().-(S3.0775
northbethcstiaperio.com
160
i
WASHINGTDNIAN * JULY 201B
EXPECT FEWER SURPRISES.
INCLUDING WHATYOUR TEETH
WILL LOOK LIKE
T h r e e - d i m e n s i o n a l i m a g i n g also i m -
DENTAL WORK WILL
BE MORE COMFORTABLE
proves diagnosis and t r e a t m e n t i n c o m -
F o r m a n y years, i f a d e n t i s t w a n t e d t o
dentists a n d lessening the chance t h a t
i n s e r t a n i n l a y (a f i l l i n g ) o r a c r o w n (a
s o m e t h i n g w i l l need t o be r e d o i i e .
p l e x cases, e l i m i n a t i n g g u e s s w o r k b y
cap t h a t f i t s o v e r a t o o t h ) , she w o u l d
These days, aprocedure such as an i m p l a n t
d r i l l a t o o t h t o r e m o v e decay a n d shave
may start w i t h a cone-beimi CT scan, a device
it d o w n to make r o o m for the restoration.
akin to a 3 - D x-ray, that captures the face's
She'd t h e n place i n t o t h e p a t i e n t ' s m o u t h
b o n e a r c h i t e c t u r e as w e l l as t h e l o c a t i o n
a tray or m o l d filled w i t h materia! that
o f t e e t h a n d gums. T h e images are used t o
o o z e d a r o u n d t h e t e e t h u n t i l t h e gii m m y
create a 3-D model that shows a p a t i e n t h o w
stuff started t o stiffen. T h a t i m p r e s s i o n
his teeth w i l l lookonce the procedure is com-
w o u l d be s e n t t o a l a b t o b e f i l l e d w i t h
plete; i t also helps guide the d e n t i s t t o w a r d
liquid-stone material and allowed to
t h e precise l o c a t i o n a n d angle o f a b r i d g e ,
h a r d e n for 45 m i n u t e s , c r e a t i n g a replica
croviaa, o r i m p l a n t , says H . R y a n K a z e m i , an
of the m o u t h .
o r a l and maxillofacial surgeon i n Bethesda.
One b i g p r o b l e m ? T h e goop. M a n y
" I t a l l o w s y o u t o see t h e t h i c k n e s s o f
p e o p l e gag o n t h e alginate i n t h e i r m o u t h s ,
the bone s t r u c t u r e " to d e t e r m i n e h o w a
a n d d e n t i s t s can have a t o u g h t i m e f i t t i n g
r e s t o r a t i o n is g o i n g t o ( i t , says H a c k . " I t
has h c c o m e a n i n c r e d i b l y a c c u r a t e w a y
to ensure t h a t the lab-made r e s t o r a t i o n fits.
as l o n g - l a s t i n g as r e s t o r a t i o n s d e s i g n e d b y
of designing crowns."
Between tliose visits, patients weai"tempor:uy
l i a n d . Yet c o m p u t e r - c r a f t e d d e n t i s t i y c a n
Dentists and o n i l surgeons say the technol-
d e n t a l caps. I f a d e n t i s t o w n s C A D / C A M ,
c o m e at a cost: T h e fake t e e t h can look, w e l l ,
ogy also allows for m o r e accui'ate p o s i t i o n i n g
i n c l u d i n g a m i l l i n g m a c h i n e , he can use t h e
fiike. M a c h i n e s d o n ' t k n o w t h a t t h e i n c i s o r
and sizing, so there's less chance a dentist w i l l
d i g i t a l i m p r e s s i o n t o m i l l the r e s t o r a t i o n
o n the r i g h t m i g h t be a d i f f e r e n t shade t h a n
h i t nerves a n d scrape nearby teeth, t h e r e b y
w i d i i n an hour, i n tlieoiy, patients canget fixes
the one o n the left. T h e d i g i t a l p r o d u c t s
r e d u c i n g d i s c o m f o r t as w e l l as potentiiU side
i n one v i s i t a n d forgo temporary restorations.
m i g h t be fine f o r back m o l a r s , b u t t h e y d o n ' t
effects s u c h as i n f e c t i o n , a w k w a r d bites, and
T h e n e w t e c h n o l o g y hasn't c h a n g e d t h e
always w o r k w e l l f o r f r o n t t e e t h . That's w h y
p r i c e o f r e s t o r a t i o n s such as c r o w n s . T h e
m a n y dentists s t i l l p r e f e r h a n d - d o n e resto-
initial investment to buy and t r a i n o n t h e
r a t i o n s b y t r a i n e d lab t e c h n i c i a n s .
dissatisfaction w i t h one's appearance.
C o m p u t e r s are t r a n s f o r m i n g o r a l s u r g e i y
as w e l l b y p r o v i d i n g graphics f o r i n c i s i o n s
e q u i p m e n t i s c o s t l y , so i t d o e s n ' t m e a n
W l i e n R i n a l d i p e r f o r i n s a f u l l - m o u t h re-
a n d i m p l a n t s . L a s t fall, the F o o d a n d D r u g
p r a c t i c e s s p e n d less b y d o i n g t h e w o r k
c o n s t r u c t i o n a n d designs a n e w s m i l e w i t h
A d m i n i s t r a t i o n approved the X- Guide Surgi-
t h e m s e l v e s as o p p o s e d t o u s i n g o u t s i d e
veneers, "a m a c l i i n e can do that, b u t it doesn't
cal N a v i g a t i o n System, a c o m p u t e r i z e d siu^-
labs. M o s t offices, t h o u g h , s t i l l s h i p t h e i m -
k n o w [the p r o p o r t i o n s o f ] t h e patient's hps;
gical device t h a t gives an o r a l surgeon a S-D
ages t o a lab t o m a k e r e s t o r a t i o n s . M i l l i n g
i t doesn't p u t i n i n t r i n s i c colors—the blues,
video guide w h e n m a k i n g cuts and seating an
e q u i p m e n t is expensive and can take t i m e
the oranges, the tans, i n a person's t o o t h . It's
i m p l a n t . " D i g i t i i l t r e a t m e n t is m o r e precise,
for employees t o m a s t e r and use.
m i l l i n g o u t o f a b l o c k o f ceramic. T h e artistic
m o r e p r e d i c t a b l e , a n d h a s less c o m p l i c a tions," K a z e m i says.
Still, some dentists expect m a n y m o r e
p a r t o f r e s t o r a t i o n is lost."
o f t h e i r colleagues t o b u y i n - h o u s e m i l l i n g
m a c h i n e s , because costs m a y d r o p as u s e
accuracy, less p a t i e n t t i m e , q u i c k e r t u r n -
BRACES CAN BE MADE TO O R D E R AND CAN WORK FASTER
a r o u n d t i m e , " says R i n a l d i .
C o m p u t e r s have reshaped o r t h o d o n t i a . T r a -
becomes m o r e w i d e s p r e a d . " Y o u get m o r e
CROWNS WILL BE
•ONE MORE QUICKLY
G e t t i n g a c r o w n usually uwolves at least t w o
Researchers r e p o r t that most o f the m i l l e d
d i t i o n a l m e t a l braces—the k i n d u s i n g w i r e s
visits—one f o r t h e i m p r e s s i o n and a n o t h e r
p a r t s are n e a r l y free o f defects a n d c a n be
a n d brackets—can cost $5,000 t o $8,000 f o r
- 1 0 AM
WEEKDAYS
947FRESHFM.COM
JULY 2D16 * WASHINETONIAN
161
( i U E A T iJMlLHS
• MD.PLLC
CITY SMILES
A m a r l c o ' s Most E x c u p 11 o n ul SiniltiG
t r e a t m e n t s s t r e t c h i n g 24 t o 3 0 m o n t h s , says
B r u n o . C o m p u t e r - d e s i g n e d , clear t o o t h
aligners such as Tnvisalign cost about $7,000,
but t r e a t m e n t t i m e has been reduced b y as
m u c h as e i g h t m o n t h s . I n some cases, patients wear the Jiligners for j u s t ayear.
T h e advantage over traditional m e t a l
b r a c k e t s lias b e e n s u b s t a n t i a l : T h e i n i t i a l
i n s t a l l a t i o n a n d r o u t i n e t i g h t e n i n g of
Get the beautiful smile
you've ahways wanted
in one, comfortable visit.
o l d - f a s h i o n e d braces c o u l d be p a i n f u l a n d
s o m e t i m e s c a u s e d m o u t h sores o r i n j u ries, especially f r o m b r o k e n wires. W i t h
this n e w m e t h o d , instead o f going to the
o r t h o d o n t i s t t o get their wires tightened,
p a t i e n t s get n e w aligners i n the j u a i l about
Call us to schedule
your consuKation.
e v e r y t w o weeks u n t i l t h e i r teeth have
moved to the desired position.
W i t h t r a d i t i o n a l braces, t o o t h decay f r o m
inadequate b r u s l i i n g a n d flossingwas a problem. Patients w e r e o f t e n t o l d to avoid eating
p o p c o r n , pretzels, nuts, apples, ajid corn o n
the cob. B u t aligners can be popped out w h e n
eating and for t h o r o u g h teeth cleaning.
I
H a c k says t h a t t h e a b i l i t y to r e m o v e the
102.223.6300 I www.cttysmiiesdc.com
19 18th St. NW, LL-50 Washington, DC 2 0 0 0 1
devices c a n lead t o s l o p p y c o m p l i a n c e for
some patients—aligners can't w o r k i f they're
s i t t i n g o n the counter.
T h e aligners are a p p r o p r i a t e for patients
w i t h m i l d t o m o d e r a t e l y crooked teeth,
B r u n o says. I n o t h e r c i r c u m s t a n c e s , she
opts f o r m e t a l : " I n m y o p i n i o n , braces
are s t i l l t h e g o l d s t a n d a r d , especially w i t h
a d u l t s . " T r a d i t i o n a l o r t h o d o n t i a is prefei^able w h e n t e e t h a r e severely c r o w d e d ,
e s p e c i a l l y w h e n s o m e t e e t h n e e d t o be
p u l l e d t o make r o o m for others t o shift.
WASHINGTON'S VARIETY OF THM
M e t a l braces also are best w h e n the p a t i e n t
80s, 90s & TODAY!
has a n over- o r u n d e r b i t e .
For
p a t i e n t s w h o c a n use a l i g n e r s ,
m a n u f a c t u r e r s have adapted t h e techn o l o g y t o a i d t h e s h i f t i n g process. W i t h
I n v i s a l i g n , d e n t i s t s affix t o the teeth
small, clear buttons that attach to the
alignment trays—adding tension and
m i m i c k i n g t h e r o l e o f w i r e s a n d bands i n
m e t a l braces—a m e t h o d t h a t p r o d s t e e t h
to s h i f t m o r e e f f i c i e n t l y .
"The s t r a i g h t e r y o u r t e e l h arc, t h e
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ConncflwitliWASH-FM:
h e a l t h i e r t h e y are, the l o n g e r y o u can keep
t h e m , " B n r n o says.
A l i g n Technology, t l i e maker of Invisalign,
h o l d s m a n y patents, a n d t h e f i r s t b a t c h is
e x p e c t e d to e x p i r e i n t h e c o m i n g years, at
w h i c h p o i n t some analysts expect the tlotidgates t o o p e n f o r c o m p e t i t o r s to offer t h e i r
o w n devices, i n t u r n b r i n g i n g d o w n prices.
DENTURES FIT LIKE THEY SHOULD
\s w i t h braces, deiitiii-e.^ have been t r a n s "orined b y d i g i t a l t e c h n o l o g y , at a t i m e
Did you know that
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ivhen t h e p r o f e s s i o n is g r a p p l i n g w i t h
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:he p r o b l e m s o f t o o t h loss.
A b o u t 2 5 p e r c e n t o f A m e r i c a n s age
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F o r t u n a t e l y , d e n t u r e s c a n n o w he
Jesigned a n d m i l l e d b y c o m p u t e r s
from
l y g i e n i c p u c k s o f a c r y l i c . B e n j a m i n O.
iVatkins I I I , a D C p r o s t h o d o n t i s t special-
T r o u s s e a u
zing in cosmetic and implant dentistry,
ikens (he process t o M i c h e l a n g e l o h e w i n g
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dcdicoted to the Art o f R o m a n c u
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3-D PRINTING IS THE NEXT
=RDNTIER-BUT IT'S NOT
THEREYET
Three-dimensional printers might reshape d e n t i s t r y e v e n f u r t h e r . B u t at t h i s
l o i n t , t h e level o fdetail necessary t o r
PET
RKSOBT
n a k i n g c e r a m i c d e n t a l restorations hasn't
•eached professional standards. H a c k says.
As t h e t e c h n o l o g y i m p r o v e s , t h e costs
i f 3-D p r i n t e r s should drop. Keeping t h e
v o r k i n - h o u s e w o u l d get d e n t a l devices—
;uch as o r t h o d o n t i c aligners—into m o u t h s
•aster, f r e e i n g p a t i e n t s f r o m m u l t i p l e
/ i s i t s , says B r u n o . B y c o n t r o l l i n g e v e r y
i t e p o f t h e process, a d e n t i s t w o u l d have
n o r e c o n t r o l t)ver t r e a t m e n t , a l l o w i n g a
iiidcourse c o r r e c t i o n i f needed.
The same 3-D technology could one
lay h e l p p a t i e n t s w i t h j a w defects r e s u l t n g f r o m cancer o r trauma. "Hopefully in
he f u t u r e , w h e n t h e r e a r e b u r n v i c t i m s
)r t r a u m a , t h e y ' l l b e able t o m a k e b o n e s
,0 p u t h a c k i n t o t h e s e p e o p l e ' s b o d i e s , "
3 r u n o says.
She and h e r patients are w a i t i n g : "People
h i n k so l i t t l e o f t h e m o u t h . It's r e a l l y t h e
beginning o f the body."
C3
LUXURY. LOYALTY.
LICKS.
K O A K I U N G - G R O O M I N G - DAY CAM1' • T K A 1 N I N G - S W I M M I N G
Suzanne Sataline
oho has hadl3
:he's
is a writer in New York
teeth pulled. On Twitter,
@ssataline.
SPRINGFIELD & DULLES
ROCKVILLE COMING SOON
888.475.3580
WWW.OLDETOWNEPETRESORT.COM
JULY SniB * WASHINGTONIAN
163
I ' l j i m i l !J, cji I
JASON A. COHEN, D D S
General, Cosmetic & Implant D e n t i s t r y
W h a t sets Dr.Ja.son A . C o l i c i f s Dental I'nicticc apart
f r o m otliers is t l i a l at his office they are c o m n i i t e d
to Trcatinj;; Y o u r Family L i k e Family. " W c are veiy
SPECIALIZATION
Cuiupreliensiv*- iLxains. Rejiular
I lyf^iciie, hiijiliirils, (Cosmetic
Dentistry, Invisalign
careful to treat y o u r family like we w o u l d treat o u r
o w n . We make sure everyone fceis comfortable i n
owr office." I n a d d i d o n to a rcgidar tlentai liygicnc
p r o g r a m a n d oral cancer screenings, D r . C o h e n also
provid&s ( i c n c i a l Dentistry, ])orcehiiii c r o u i i s a n d
veneers, dental i m p l a n t .services a n d Invisalign.
" I liavc always been detail-oriented and maintained
technical
excellence w l U i i n m y ])ractice. We arc
constantly taking courses to stay current o n all die
latest nuitcfials and teclmi(|ues."
DESIGNATIONS.
AFFILIATIONS A N D AWARDS
Acadcniy ot'Cluricra! DcutiNtr)', the
Aiiitricaii Denial AssDciatioii, the
M D Slate Detital AssociadiHi, the
D . C . Dental Society and die
SoLitlieni M D Dental Sciciety
5530 W i s c o n s i n Avenue, Ste 560
Chevy Chase, M D 20815
301.656.1201
cosmeticdds.com
ENDODONTIC ASSOCIATES
"The Face o f E n d o d o n t i c s "
E n d o d o n t i c Associates consists of'a grou}) o f highly
trained
dentists w h o have l i m i t e d
dieir
to E n t l o i Ion tics { R o o t Canals). For more
jjractice
dian 4
SPECIALIZATION
Expert DianHoslic Services, N o u
Surgical Root Canals, Surgical Hoot
Canals, Oro-facial I'aiu
decades, F n d o d o n t i c Associates have been p r o v i d i n g
exccpdonal
a n d expert
endodontic
services
to
icsidents o f M a i y l a n d , D C and northern V i r g i n i a . We
take p r i d e In o u r w o i ' k a n d are c o m m i t t e d to excellence
w i d i y o u r dental liealdi as o u r j t r i i i i a i y concern. O u r
practice utilizes stale-of-Uic-art equipment
a n d we
adhere to the strictest infection c o n t r o l giildellnes
as set forth by die Office tor Salety a n d I l e a l d i
A d m i n i s t r a t i o n ( O S I I A ) . We l o o k forwarti t o serving
y o u a n d welcome y o u to any o f our 4 locations.
DESIGNATIONS.
AFFILIATIONS A N D AWARDS
American Denial .Association, Anieri
can .As.soLJalion oflCndodontists, M I
State Denial A.s.sociiilinii, Soudiern
M D Dental Association, Patuxcnt
Dental Society
California, M D | College Park, MC
C l i n t o n , M D | Waldorf, M D
301.868.5500
myrootcanaldoc.com
DR. ROSELYNE GICHANA
Falls Church Pediatric Dental Center
D r . Roselyne G i c l i a n a is a graduate of the Unlverslt)'
O f Pennsylvania School O f Dental M e d i c i n e , where
she
receivc<l h e r Doctorate
n i Dental M c t l i c n i e .
She wa.s dieii a (Jllnlc;d Fellow at die 1 l a n ' a r d School
of D e n t a l M e d i c i n e w h i l e concurrently nnclergoing
training In a (reiieral Practice Residency at d i e
B r i g l i a m and W o m e n ' s 1 l o s p l t a l . She d i e n eoinjjletcd
her specialt)' training i n pediatric dentistry at d i e
George
Washington
University
and
Ghildrcifs
N a t i o n a l M e d i c a l Gcnler, A s part o f her t r a i n i n g ,
D r . (Jlchana learned to care l o r c h i l d r e n w i d i special
needs, such as physical a n d mental disabilities.
SPECIALIZATION
Pediatric Dentistry
DESIGNATIONS,
AFFILIATIONS A N D AWARDS
Diploinal of'tiie Aineri(.:an Board of
Pediatric Denlislry, American Academy of Pediatric Denlislry, American
Denial As.socialinn, Virginia Dental
Association, Norilicrn Virginia Dental Society, and Muiyland Academy
of Petliatric Dentistry.
6400 A r l i n g t o n B l v d , Suite 80
Falls Church, VA 22042
703.533.5511
[email protected]
IG'^
WASHINRTGNIAN * JULY 2016