September 11, 2018
by Dr. Bruno Vendittelli, DDS, D. ORTHO, FRCD (C)
Greetings fellow colleagues! I hope that all of you have had a great summer and are looking forward to fall. I am honored to be the new Orthodontic Editor for the Oral Health Journal. I follow in the footsteps of Dr. Randy Lang, who has left a wonderful legacy. I feel privileged to be part of an impressive board and to serve for the benefit of the readership.
Magnification technology in dentistry has moved quickly and has come a long way. The routine uses of digital photography, magnifying loupes and microscopes, to the use of scanning both digital and radiographic, is now customary in dental and specialist offices alike. In visiting one of my referring offices,
I was impressed by ceiling mounted microscopes in the operatories. I assumed that they were only used for selected procedures, however, I was informed that this particular clinician routinely used microscopes to view and refine restorative preparations and in particular, margins of crown and veneer preparations. He stated “you don’t realize how bad your margins are until you work with a microscope”. Pair this magnification technology with digital scanning and a lab (or milling machine) can fabricate an extremely precise restoration.
Computed tomography is a readily available diagnostic modality. It allows the viewing of anatomy in three-dimensions with the opportunity to magnify using various reconstructive software programs. This becomes a valuable tool for such things as the predictable placement of implants and for locating the position of an impacted tooth. It is now common-place to use this imaging modality to locate an accessory root canal and to diagnose the once elusive dental root fracture.
Digital scanning has moved the peg of dentistry forward within the last 5 years. Scanning eliminates the inherent problems of impression materials such as patient comfort and distortion and allows for the capturing of fine detail with high accuracy. This is valuable in the planning and delivery of restorative and prosthetic treatment. Digital scanning also allows for magnification. I personally use this technology on a daily basis to set up my orthodontic cases. I magnify, move teeth and reassess. With magnification, I can obsess over the minutia of an orthodontic set-up and fine tune the end result.
It is without question that as technology advances, we are able to continue to provide a predictable, high-standard of care to our patients. However, there is a corollary that we should be aware of. We must all understand that the very same magnification technology that has moved the peg forward in dentistry is available to all of our patients – the most accessible one being the smart phone camera. With it, our patients can take their own pictures and magnify them. An ‘imperfection’ that may not have been apparent on a traditional 4 x 6 printed photograph, can now become an “object of obsession”. A patient can magnify, crop, twist and turn an image to their hearts content and often times to the discontent of the treating practitioner. I am sure all of you have experienced a patient who has come in with photos of their teeth, pointing out what is ‘wrong’ with them. I experience this often. I have also had a patient present to me a video of their chewing cycle to show me where a premature contact occurred. The most extreme situation I have encountered was a patient who went out of his way to have a 3-D CBCT scan performed of his skull. He had a resin model printed and the original scan sent to him in 3-D viewer format. I sat with him and his wife in consultation as he proceeded to measure the left and right side of his skull to highlight his ‘severe’ asymmetry. The difference was a mere 2-3 mm.
Advancement in technology is inevitable and the information it provides is powerful. I acknowledge the fact that patient input and information is essential for collaborative care and for patients to make an informed decision about their treatment. Magnification technology, however, has given patients a powerful tool that can be misused. Pair this information with a limited perspective and it can create a recipe for unrealistic expectations. In our current technology driven society, spending the necessary extra time to collaborate and educate our patients will allow us to determine if we can meet the expectations set forth. At times, no treatment is the treatment of choice. OH
About the Editor
Dr. Bruno Vendittelli, DDS, D. ORTHO, FRCD (C) is a Toronto based orthodontist whose practice is Forest Hill Orthodontics. He is a Staff Orthodontist at the Hosptial for Sick Children and an Associate at the University of Toronto, Faculty of Dentistry.