HAZARIBAG COLLEGEOF DENTAL SCIENCES &

HOSPITAL

“NEW TECHNOLOGY IN DENTISTRY”

Dr. Arti

OUTLINE (INTRODUCTION)

Advance in diagnosis

• CAT scans• Digital X- ray• RVG• Intraoral Camera• Digital Photography

Advance in treatment

• Botox therapy• Ozone therapy • Steam cell therapy• Laser treatment• Sedation dentistry• Painless anesthesia• NTI-tss Device• Air abrasion

INTRODUCTION• New dental technology offer better solutions for traditional oral health

problems than ever before. The trend in dentistry is utilizing technology to make dentistry more comfortable, durable, efficient and natural-looking for the patient as possible. Patients and their dentists benefit from newer techniques that are less invasive and more dependable than the years of past.

• Procedures that formerly took multiple trips to the dentist or required multiple health care providers can often be performed in the comfort of one office by one qualified provider.

Advance in diagnosis

CAT scans

Intraoral Camera

Digital Photography

ADVANCE IN TRETMENT

Botox therapyOzone therapy Steam cell Laser treatmentSedation dentistryPainless anesthesiaNTI-tss DeviceAir abrasion

How Does Botox WorkBotox is a trade name for botulinum toxin, which comes in the form of a purified protein. Botulinum toxin A . The mechanism of action for botulinum toxin A is really quite simple. It is injected into the facial muscles and, within a few hours, it attaches itself to the nerve endings of the motor muscles, thereby affecting the nerve transmission to these muscles. It takes anywhere from two to ten days to block the nerve transmitters which innervate the muscles where it was injected. There is no loss of sensory feeling at all during the time that botulinum toxin A is effective.Once these motor nerve endings are interrupted, the muscles cannot contract. When the muscle does not contract, the dynamic motion that causes wrinkles in the skin will then cease. The only reason there are wrinkles in the skin in the first place is because the muscle is moving underneath it, thereby these are called dynamic wrinkles.

Approximately three to ten days after treatment, the skin above these motor muscles becomes nice and smooth. The effects of Botox lasts approximately three to four months depending on various factors including the amount of botulinum toxin A injected, metabolic activity of the patient and lifestyle choices, which may cause the Botox treatment not to last as long. When the patient sees the wrinkles reappear, the patient needs retreatment.

BOTOX THERAPY

Botox dental therapeutic uses

▲ TMD cases & oromandibular dystonia▲ Myofacial pain cases including treating trigger points Masseter & temporalis hypertrophy ▲ Gummy smile▲ Treatment of angular cheilitis ▲ Orthodontic relapse and depressed orthodontic appearance▲ Reducing muscle hyperactivity for retention of removable prosthodontics

PAIN RELIFE IN HEAD AND NECK

TMD’S (IT INVOLVING THE OROFACIAL MUSCULATURE THAT HAVE SHOWN EARLY EVIDENCE OF BEIENG AMENABLE TO

TREATMENT WITH BOTULINUM TOXIN INCLUDE )

TMD’S

MYOFACIAL PAIN

BRUXISM

OROMANDIBULAR DYSTONIA

HEADACHESMASSETER & TEMPORALIS

HYPERTROPHY

TRISMUS

MYOFACIAL PAIN WITH

2NDRY TMD

• THIS SUBSET OF MOVEMENT DISORDER IS CATEGORIZED AS A FOCAL DYSTONIA THAT INVOLVES THE MUSCULATURE OF THE MASTICATORY APPRATUS AND LOWER FACE . IT MANIFESTS AS DISTORTED ORAL POSITION AND FUNCTION, RESULTING OROFACIAL DISFIGUREMENT AND DYSFUNCTION.

Bruxism

It is excessive grinding of the teeth and/or excessive clenching of the jaw. Bruxism is an oral parafunctional activity’ i.e., not an activity related to normal function such as eating or talkingBruxism may cause tooth wear, and may even cause teeth to break and dental restorations to be repeatedly lost or damaged

OROMANDIBULAR DYSTONIA

MYOFACIAL PAIN

Temporomandibular disorders (TMDs) refers to a group of disorders affecting the TMJ, masticatory muscles and the associated structures.These disorders share the symptoms of pain, limited mouth opening and joint noise.

It is largely regarded as a cosmetic facial deformity based on excess muscles bulk.

Muscles activity also may occur

HEADACHES

Spasm of the jaw muscles, causing the mouth to remain tightly closed

TRISMUS

• Dose ranges of botulinum toxin

TMD CASES• Both masseter muscles received 50 units each under EMG guidance.

Similarly, both temporalis muscles were injected with 25 units each. Subjects were assessed at 2-week intervals for 8 weeks.

• Outcome measures included subjective pain by visual analog scale (VAS), measurement of bite force, interincisal opening, tenderness to palpation, and a functional index based on multiple VAS.

• Results: showed a significant (P =.05) difference between the preinjection assessment and the four follow-up assessments.

• No side effects were reported.

Bruxism and clenching• BoNT-A products are routinely used in patients with bruxism, and

treatment often is provided through bilateral injections into the masseter and temporalis muscles .

A practicing clinician must understand proper dosing in these circumstances, as too much BoNT-A can paralyze the mastication muscles and interfere with a patient’s ability to chew and speak

Sialorrhea• BoNT-A also can be used to treat sialorrhea via injection into

the parotid and submaxillary salivary glands, which inhibits the stimulation of the cholinergic receptor. This use of BoNT-A to treat sialorrhea does not treat any muscles, but it does result in saliva reduction.

• However , this treatment must be done carefully as too much BoNT-A can result in chewing difficulties, dysphagia, and xerostomia.

Oromandibular dystonia following traumatic brain

injury.• Five units of botulinum toxin were injected under EMG guidance in

distal masseter, proximal masseter and temporalis, bilaterally.

• 24 hrs postinjection, the dystonia of the masseter and temporalis muscles were sufficiently relieved to allow passive opening of the patient’s mouth, decrease the tongue biting and permit oral hygiene.

Masseteric hypertrophy.• 20 mouse units of botulinum toxin directly instilled into

the affected muscle(s) followed by a further 100 mouse units after a two week interval. Quantification of effects on contour were recorded using laser scans, photographs and ultrasound scans. Functional effects were monitored using bite force measurements and electromyographic recordings. Results show a significant rapid reduction in muscle bulk with minimal impairment of function although a transient weakness of facial muscles was seen following 4 of the 20 treatments. Conclusion: From this study it appears that botulinum toxin is a safe, simple, effective treatment for masseteric hypertrophy.

Orthodontic relapse and depressed orthodontic

appearance• Our muscles play a huge role in where our teeth line up. Following

orthodontic therapy some patients teeth will relapse and this may be due to placement of that individual’s musculature.

• Many patients have an over active mentalis muscle that often causes relapse of the teeth and may cause spasm of the muscles.

• Botox gives us the ability to reduce these spasms and contractions

allowing for limited relapse following orthodontic treatment.

Technique • Approximately five diffuse

injections are recommended preferably targeted to area of height activity on EMG, greatest muscle bulk, and or greatest discomfort . Care must be taken with anterior & superior injection of this muscle because diffusion of botulinum toxin to the zygomaticus major muscles nearby may result in an adverse cosmetic effect, specifically preventing the patient from raising the corner of the mouth & thus causing asymmetric smile

TWO TYPE OF INJECTIONSUPERFICIAL DEEP

Temporalis MASSETER

Superficial injection are administered into the thinner upper region

If all of the muscles are not injected, there is chances of faliure

Agonist muscles : Temporalis ,masseter & medial pterygoid are agonist jaw closing muscles, both are lipsiaterally & bilaterally

Many clinician prefer to inject where is syptomatogy “chasing the pain”

Location of injection : Directed at teigger/tender muscles

Dose (depend on muscles size, pain & activity (fig-1)

GUIDE LINES

Needle size : small gauge needle , preferably 30 & 27 gauge needle is tolerable for the large muscles

EMG guidance is recommended for the specific muscles penetration

Adjunctive anesthesia : topical local anesthetic is applied before injection, always helpful ( EMLA ANESTHETIC CREAM)

For muscles already in pain, preinjection with local anesthetic solution

BOTULINUM FOLLOW -UP

1 M. zygomaticus major at its point of origin 3–4 U 9–12 U2 M. zygomaticus minor at its point of origin 1-2 U 2–6 U3 M. levator labii superioris alaeque nasi 1–2 U 2–6 U4 M. levator labii superioris at the orbital Margin 1–2 U 2–6 U5 The modiolus, at a distance of 0.5 cm from the corner of the mouth 3–4 U 9–12 U6 M. risorius 2 cm from the corner of the mouth 3–4 U 9–12 U7 M. depressor labii inferioris at 0.5 cm from the corner of the mouth 3–4 U 9–12 U8 M. depressor labii inferioris at a distance of 1 cm from the white line transition 3–4 U 9–12 U

Botox DoseRange Range

Dysport DoseSite

1. GUMMY SMILE

2. ASYMMETRY CHEEK

1.slim kinetic and hyperkinetic platysmal

bands arise

Injection of platysmal bands: please note the samll papules that arise after the very superficial injection

Dermal fillers in the nasolabial folds, lips, mentalis fold, labiomental folds, and

intraorally are used in:

▲ Gummy smiles

▲ Establishing esthetic dental lip lines and smile lines in esthetic dentistry cases as an alternative to gingivectomy, crown lengthening, and veneers

▲ Treatment of angular cheilitis

▲ Eliminating “black triangles” between teeth after periodontal and implant treatment that did not preserve the papilla

▲ Reestablishing lip volume for proper phonetics (in addition or as opposed to teeth lengthening with fixed or removable prosthodontics)

▲ Adding lip and perioral volume around the mouth for retention of removable prosthodontics

gingivectomy

OZONE THERAPYIntroduction

Subluxation is an injury to the tooth supporting structures. The incidence of pulp necrosis is shown to be near 15% after this injury, so all subluxated tooth must be monitored (Celik & Cehreli, 2008). When it occurs, endodontic treatment shouldstart as soon as possible.

Ozone is a very reactive gas that shows strong antimicrobial properties. The gas oxidates and destroys bacterial cells walls and citoplasmatic membranes (Nagayoshi et al. 2004; Cardoso et al., 2008; Huth et al., 2009). Ozone also increases the oxygen supply to all cells, enhancing cellular metabolism and stimulating tissue repair

OBJECTIVE CASE REPORT

• To assess whether ozone is effective in arresting or reversing the progression of dental caries

• An 18-year-old girl was referred to the clinic by her orthodontist with no complaint of pain, just the presence of a large periradicular lesion in the maxillary central left incisor. Ten years ago she had a falling that resulted in a subluxation trauma in this tooth.

Root canal preparation

Ca(OH)2

Dressing

1% SODIUM

HYPOCHOLRITE

+ENDO - PTC

10% CITRIC ACID

Gaseous ozone

40µg/ml

Methodology Conclusion

The antimicromial and bioestimulation properties of ozone, proven by the literature, have a great potential to be incorporated to endodontic therapy, even in traumatized tooth

DENTAL STEAM CELL NICHE

• THE DENTAL STEM CELL NICHE In biology of the tooth the discovery of dental epithelial stem cells in continuously growing teeth has been a recent breakthrough

• The niche for the adult stem cells of these teeth is formed at the region of the apical end in tooth development. The region possesses a commonly specialized histologic structure for the maintenance of adult stem cells and the production of various progenitor cells producing dental tissues

• Based on histological and molecular biological studies, a new concept that the eternal tooth buds producing various dental progeny are formed at the apical end in the development of continuously growing teeth, and coin a new term of “apical bud” for indicating this specialized epithelial structure.

• ACTIVIN is as essential early mesenchymal signal in tooth development that is required for patterning of the murine dentition. Studies show that activin βA is expressed in presumptive tooth germ mesenchyme and is thus a candidate for a signaling molecule in tooth development.

Introduction

TECHNIQUE CONCLUSION

Change is inevitable, but for a dentist the original skills will play the major role & the new techniques will ensure the success of the treatment. keeping in mind the benefits for the profession a dentist should be aware of the developments & be ready for future.

As the tooth grows, it releases chemicals that encourage nerves and blood vessels to link up with it

Formed tooth fused to the jaw bone

Take x-ray (radioopacity show at apical area)

Recall the patient after 4 to 5 weeks

Tooth bud is inserted through a small incision into the gum

Nerve block under local anesthesia

Laser therapyA laser is a device that emits light (electromagnetic radiation) through a process called stimulated emission. The term laser is anacronym for light amplification by stimulated emission of radiation.

Laser light is usually spatially coherent, which means that the light either is emitted in a narrow, low- divergence beam, or can be converted into one with the help of optical components such as lenses.

NO PAIN SMILE

ESTHTICCONSEVATIVE

LESS REDUCTIONSTRESS FREE

USES TYPE

• Incision, Excison, Vaporization, Ablation, Hemostasis

• prosthodontics, restorative, and esthetic procedures (bleaching)

• Gingivectomy• Gingiviplasty • Gingival troughing• Frenectomy• Decontamination, Aphtous

Ulcer , Drain Abscess• Opeculectomy, Surgical

uncovering, Enamel exposure • Root canal treatment

• 1991 Soft Laser• 1993 Nd:YAG Laser• 1993 Kinetic Cavity

Preparation• 1994 CO2 Laser, Argon Laser• 1996 Laser welder• 1997 Nd:YAP Laser• 1998 Er:YAG Laser

Photographs of laser treatment

Painless anesthesia Painless Anesthesia is an automatic injection device developed especially for painless injections and is therefore very suitable for children and nervous patients. Painless Anesthesia has an award-winning design which alleviates patient anxiety and features SmoothJect™ which enables a truly painless injection.

THECNIQUE

Sedation dentistrysedation dentistry a patient remains conscious during treatment, able to respond to questions or requests from the dentist, but in a totally relaxed state and relieved from any anxieties.

Uses

• Patient relaxation• Increased comfort• Movement control• Patient co-operation• Control of gag reflex• Little or no memory of treatment• Time saving - Fewer appointments needed

Type Nitrous oxide sedation dentistry, also known as inhalation sedation, is the most commonly used method for patient relaxation in dental offices. Dentists use nitrous oxide, also known as “laughing gas”, to provide more comfortable and painless treatments

Oral sedation dentistry is one of the techniques used by modern dentists to help patients who experience anxiety and dental fear in order to get proper dental care.Oral Sedation involves the administration of sedative drugs taken from the mouth in the form of a pill or liquid, to achieve a state of relaxation and make dental procedures a comfortable.

IV sedation dentistry is a method of conscious sedation, and should not be confused with sleep dentistry which is closer related to general anesthesia (unconscious sedation). With IV sedation dentistry a patient remains conscious during treatment, able to respond to questions or requests from the dentist, but in a totally relaxed state and relieved from any anxieties.

General anesthesia offers the deepest form of sedation that can be used to provide relaxation and analgesia during dental procedures. General anesthesia use in dentistry is actually necessary only in special circumstances and it is reserved for a very limited number of cases such as very anxious children, extremely phobic or patients with special needs, or extensive dental surgery procedures.

AIR ABRASION• Air-abrasion is a great dental advancement over the dental drill as it

allows precise removal of decayed teeth without the use of a local anesthetic. The air-abrasion system uses blasts of pellets of air and aluminum oxide to treat tooth problems such as cavities.

NTI-Tss device• The NTI-tss Device is used for patients who suffer from

TMD and migraine headaches. The device eliminates the need for more invasive surgery and can help with problems associated with Temporomandibular Joint (TMJ) discomforts. The device can be molded to fit teeth and is effective at reducing the pains associated with TMD.

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