FEBRUARY 25—MARCH 3, 2008

High-Tech Tooth Care

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Kevin Ireland had his gums fixed twicea few years ago. His first treatmentinvolved peeling back his lower gums

with a scalpel to excise bacteria and stitchinghim up, an uncomfortable and painful experience for the 50-year-old manager ofa Utah dinosaur park. While his gumswere healing, his perio dontist receivedtraining in a new laser technology that targets diseased gum tissues withoutharming healthy ones. So the treatment ofhis upper gums a few weeks later was virtually pain free.

Such high-tech advances are trans-forming how patients experience oral care,in some cases shortening their time in thechair and in recovery. Less invasive implants, digital imaging, and new uses oflasers are also removing some of the anxiety and discomfort often associatedwith dentistry.

It can be easy to get caught up in the “geewhiz” factor of dazzling new technology,though, and dentists sometimes offer procedures that are neither essential norcost effective. So each patient should develop a solid, trusting relationship with a dentist, says Gene Antenucci, aspokesman for the Acad emy of GeneralDentistry, especially before shelling out forunfamiliar treatments. “It’s also importantfor the patient to ask questions and to dosome outside research,” he adds, when adentist recommends a costly servi ce.

Ireland’s perio dontist was one of a number who have begun laying asidescalpels in favor of the laser-assisted newat tachment procedure, or lanap, a noveltreatment for infected gums that the Foodand Drug Adminis tration approved in2004. The pulsing laser can distinguish bycolor between healthy and diseased gumsand zaps away only bacteria and infectedtis sue, which has a darker pigment thanthe surrounding healthy gums.

lanap helps connective tis sue andbone form between the gums and teeth,according to a study in the Decemberissue of the International Journal of Perio dontics and Restorative Dentistry.“There were also signs of a regenerationof dis eased root surfaces in all lanap-treat ed teeth,” says Raymond Yukna, thestudy’s lead author and director of ad vanced perio dontal therapies at theUni versity of Colorado School of DentalMedicine. In theory, that means there isless chance of the infection returning.

The laser’s heat also seals the gums witha “thermal blood clot, creating a physicalbarrier to any bacteria or tissue that couldre-create gum pockets,” says Sam Low, anasso ciate dean of the University of FloridaCollege of Dentistry and vice president ofthe American Academy of Perio dontology.

Still, lanap is unlikely to fully replacetraditional gum surgery anytime soon.The laser therapy isn’t demonstrably superior to surgery, reseachers recentlyreported in the Journal of Periodontology.Insurance will typically cover either procedure, so patients won’t necessarilypay more for lanap.

Lasers are also taking part in cos metictreat ments. Laser gum revision, for example, can reshape the gum lines inmuch the same way perio dontists havetraditionally done with a scalpel. So, patients with a gummy smile or long- orshort-looking teeth can achieve a moreproportioned look, says Joseph Zelig, aNew York City-based cos metic periodon-tist. “Think of the gums as a frame arounda painting,” he says. “If the frame is broken, the painting won’t look good nomatter how expensive it is.” The laser cauterizes the gum tissue, minimizingpain and bleeding and shortening recovery.

Mini-implants. Lasers aren’t the only gamein town. Advances in miniature dentalimplants are making the replacement ofdecayed or missing teeth with denturesmore palatable. “Mini-implants are designed for patients with limited bone intheir jaws who have trouble holding intheir dentures,” says Antenucci. In contrastto conventional implants, which must beanchored in the jaw and take severalmonths to fuse with bone, titanium mini-implants can be inserted in a single visitand don’t require cutting the gums. And

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while conventional implants cost $1,250to $3,000 per tooth, mini-implants can bejust half that. Neither is typically coveredby insurance.

Digital impres sion technology, anotherrecent advance, is taking the goo out ofdentistry. Crowns, bridges, and otherrestorative prosthetics require an impres-sion of a patient’s teeth in order to fit correctly. This usually involves a paste orputty that takes several minutes to set. Buta “virtual” impres sion removes the discomfort from that wait. In the newprocess, a digital camera scans a portionof the mouth and creates a 3-d image thatprecisely reflects the size and position ofeach tooth. Dentists with certain equip-ment can then produce a custom-tailoredprosthetic on the spot. Others send the image to an off-site manufacturing facility, an approach that may take a cou-ple of weeks but offers patients a wider se-lection of materials, like gold and porce-lain. Some dentists may build the cost ofthe equipment and processing into theprice of the restoration, making the workmore expensive than conventional restora-tion work, which remains most dentists’only offering.

When Martha Zeeman, 40, of Lake Forest,Ill., got fitted for a crown four years ago,she could barely tolerate the impres sionpaste because of her strong gag reflex. Sowhen she needed three crowns last fall, shebecame one of the first patients to receivea virtual impres sion using the recently approved iTero system. “There was nomore unpleasant taste and definitely nomore gagging,” she says. l

Dentists are trying out lasers and other newtechnologies.

Copyright © 2008, by U.S.News & World Report, L.P. Abridged with permission.For subscriptions to U.S.News & World Report, please call 1-800-436-6520. Visit U.S.News & World Report on the Web at www.usnews.com.

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