Art and science of dentistry

Technological innovation is transforming the cosmetic dentistry industry. So will this negate the need for practitioner creativity or challenge dentists to further their level of dexterity? Bella Blissett unravels the relationship between the two and discovers what the future holds for the patient

If the recession has made us value our teeth all the more, the perfect synergy between shifting consumer desires and scientific development will define the cosmetic dentistry industry in years to come. Invisible aligners, intraoral scanning methods and even one-day implants mean that we’ll soon be able to achieve the natural, understated smile we want in a way that’s faster, less invasive, more accurate and discreet.

But as cosmetic dentists harness this cutting-edge technology, to what extent is the future defined by science and how much will it rely on the artistry of the top practitioners themselves?

“Science is advancing very rapidly, giving rise to a greater variety of high-quality treatments,” says Tif Qureshi, president of the British Academy of Cosmetic Dentistry (BACD). “Yet no matter how impressive technology becomes, without skilled practitioners there will be no way to implement it.”

Something industry experts are unanimous about is the impact the latest CAD/CAM (camera-aided design and computer-aided manufacturing) technology has had on both practitioners and patients. Software such as Cerec 4.0 allows the dentist and patient to collaborate in designing a new smile, making subtle alterations to images of the mouth on screen.

One of the key technologies showing dramatic advancement is the use of rapid prototyping for state-of-the-art lingual braces

This, says Martin Raymond of The Future Laboratory, is crucial given that today’s consumers are considering the psychology, as well as the health benefits, of changing their smile. CAD/CAM technology adds an element of predictability that allows the patient to evaluate the possible social and professional implications of how their teeth will look alongside the costs, providing reassurance before they make the investment.

And if financial considerations are ever-present in our minds, “faster” is the word tripping off patient’s lips as they enter the dentist’s surgery. Certainly, science is facilitating our desire for results within weeks, months or even a single day.

“One of the key technologies showing dramatic advancement is the use of rapid prototyping for state-of-the-art lingual braces such as Incognito,” says Dr Simon Manara of London Orthodontics. “In the past, we relied upon putty moulds to gather information about the patient’s teeth. The use of three-dimensional optical scanning devices has made such a marked difference to the accuracy with which we’re able to make custom-made brackets for the back of each tooth.”

Elleven Orthodontics is even employing the use of robots to create the invisible SureSmile brace, (from £3,500). Although SureSmile archwires don’t actually move the teeth any faster than conventional archwires, the 3D imaging technology used to create the computerised treatment plan is said to reduce treatment time by up to 30 per cent. Instead of a continually evolving plan with frequent adjustments, the teeth move along a more direct path to their target positions.

If speed rather than ultimate discretion is your priority, the new Inman Aligner does mean enduring a visible wire at the front of the teeth. Yet it can be removed while eating and thanks to a spring action coil that exerts pressure on the teeth, it squeezes them into alignment, correcting protrusions in 12 to 16 weeks. Costing between £1,000-£2,000, it’s both a time and cost-efficient way of getting a straight but natural looking smile.

The price and treatment time of having veneers is also falling as science improves. Gertrude Huss, of the Hill Clinic, is one of several specialists using Edelweiss veneers. Made from a laser-treated composite, they are prefabricated veneers that can be matched and adapted to each patient. So instead of waiting two weeks for your brand new veneers to be manufactured by a laboratory, you can walk out of the dentist with a new smile in under three hours. Unlike traditional porcelain versions, the composite is also easily repairable and, at a starting price of around £1,200 for six veneers, (instead of around £3,000), they’re a significantly cheaper option.

Even acquiring completely new teeth can now be achieved in a matter of hours, rather than months, using the All-on-4 implant technique. “In the past, up to eight parallel implants were needed to replace a full set of teeth. After the initial implant surgery, temporary or existing dentures had to be worn for six months, while osseointegration took place and the implants became secure in the bone,” explains Dr Huss. “Now, by placing just two implants at the front and two angled at the back, we can create a secure enough attachment between implant and bone that allows us to attach the new teeth immediately.” The £20,000 price tag needed to cover traditional implants also falls sharply to around £12,000.

Biotechnologists are even working on a vaccine against tooth decay

Add the financial savings to the fact that previously gag-inducing dentist appointments are becoming less painful and more pleasant overall, and it is easy to see why the industry remains optimistic about the future. New intraoral scanning devices such as Straumann’s CADENT iTero are gradually displacing the discomfort of the old solid putty mould system and making for a more time-efficient service. Impression-free dentistry means a new generation of patients will have their records stored on an online Cloud accessible to their relevant practitioner.

“Digital technology means live off-site consultations will also become the norm,” adds BACD communications director, Bertrand Napier. “And when the patient is in the dentist’s chair, new pain control systems such as the Dental Wand – a computer-controlled local anaesthetic that reduces discomfort by producing a more even flow rate during injection – will make the experience less threatening. Scientists in America are even trialling a local anaesthetic nasal spray that numbs the upper jaw.”

Yet, if digitisation is to become evermore widespread, will computer intuition replace the creativity of the dentist? Orthodontist Dr Moira Wong, of 42 The Dental Practice, rebuffs the notion, arguing that digital imagery and electronic data storage will facilitate further collaboration between dental specialists, including the growing number of experts now using their understanding of bone structure to perform Botox® and hyarulonic acid fillers.

This will tie in with the launch of increasingly advanced, imperceptible dental materials and composites. Later this year, Dr Mervyn Druian, at The London Centre for Cosmetic Dentistry, will introduce a revolutionary veneer that is as hard as a diamond yet as thin as a contact lens. Biotechnologists are even working on a vaccine against tooth decay and the inevitable quest to grow functional teeth using stem cells continues, even if we’re unlikely to see the results inside the next decade.

“The biggest trend we’ll see in the near future is ‘progressive dentistry’ replacing the ‘instant smile makeover’ and widespread use of veneers. Practitioners will combine technology and artistry to make infinitesimal changes to teeth in stages, allowing the patient to see that they need less – rather than more – treatment to achieve natural results,” says Dr Qureshi.

Digital technology may reduce the margin of human error, but it requires practitioners to transfer their practical skill to computer-based image alteration methods, in much the same way that magazine art departments have had to adjust to Photoshop.

“Essentially, cosmetic dentistry is a head, hands and heart profession that requires practitioners to demonstrate artistic flair similar to that of a sculptor. Complex new machinery will require dentists to adapt and further their education, and rise to a greater level of skill than ever before,” concludes Dr Qureshi. Which can only be a good thing for us, the patients.