Three Dimensional Printing (3-D Printing)

Three Dimensional Printing (3-D Printing) is a technology that is becoming more and more prevalent in today’s world. Jewlery, construction materials, and firearm fabrication are some of the commonly known uses for 3-D printing, but 3-D printing in dentistry has changed the way we perform some common tasks in our office.

Many people have been told that they grind their teeth. A common remedy to grinding is the fabrication of a bite appliance also known as a nightguard, splint, or occlusal appliance. Traditionally, the fabrication of these appliances were done by hand in a dental laboratory. Today in our office we capture digital impressions of your teeth and use computer aided-design (CAD) software to digitally design the bite appliance. We then print it in our office and can have it ready within a day. The two major benefits in fabrication of these appliances in this manner for our patients are:

1. The turnaround time to recieve the appliance is shortened from 3 weeks to 24 hours 2. If your appliance becomes your dog’s favorite chew toy it is very simple to reprint another appliance

Nightguard or bite appliances that have been three dimensionally or 3-D printed.
Bite appliances after they have completed the 3-D printing process.

We also use this techonolgy to design and print models of teeth, surgical guides for implants, and miscellaneous items around the dental office. The printing time for various objects change with the size of the item, but typically most prints in our office take 4-6 hours. The ultimate goal for 3-D printing in our office is to reduce the use of gooey and runny impression materials. Using this technology, gooey impression materials are limited to dentures and certain veneer restorations.

Dental models that are 3-D printed
Dental models that have been removed of residual resin, but are still attached to the printing plate.

Joe Bousaba, DMD

Dental Terminology 101

When you go to the dentist you probably hear your dentist or hygienist rattle off what seem to be random numbers and letters that probably sound like a foreign language. Dental terminology really isn’t all that difficult to understand once you understand a few basic concepts.

  1. Tooth Numbers

As adult humans we have 32 teeth and each tooth is has a number assigned to it. Your upper right tooth (the wisdom tooth) is tooth #1. The numbering system works its way forward along the arch (your two front teeth are #8 and #9) and continues to the upper left wisdom tooth which is tooth #16. Tooth #17 is the wisdom tooth on the lower left side and the numbers increase as they work their way along the arch all the way to the lower right wisdom tooth (#32).

Dr. Joe Bousaba in Richmond, Virginia explains the numbering system for teeth.
Upper arch teeth numbers. This patient has had her wisdom teeth removed therefore she is missing teeth #1 and #16.

2. Tooth Surfaces

Teeth have five surfaces: Mesial, Distal, Buccal, Lingual, and Occlusal (explanations below). These surfaces help us to communicate the location of a cavity or fracture. Often times the surfaces are abbreviated by using the first letter of the surface name. For example, the Occlusal surface is often expressed by the letter “O” for short.

Mesial – The side of the tooth closer to the midline (the midline of the arch is between teeth #8 and #9 on the upper and between #24 and #25 on the lower)

Distal – The side of the tooth away from the midline

Buccal – The side of the tooth facing the cheek

Lingual – The side of the tooth facing the tongue

Occlusal – The biting surface of the tooth

3. Material

There are lots of materials used in dentistry, but the most common materials that we encounter on a daily basis are Amalgam, Composite, Porcelain, and Metals. Amalgams are silver fillings that are a mix of different metals. Composites are tooth colored fillings. Porcelain is a tooth colored material often used in crowns, partial crowns, or veneers. Metals, most commonly gold, are often used on crowns or partial crowns.

These three concepts are the foundation for communication in dentistry. The next time you hear dental terminology such as “MO composite on tooth #12” or “O cavity on tooth #31” you’ll have an idea of what we’re talking about!

Joe Bousaba, DMD

We’ve Resumed Our Regular Hours and Treatment: Our COVID-19 Protocols

The initial rollback of restrictions has begun in Virginia. Doctors, dentists, and veterinarians in Richmond are now seeing patients for non-emergency visits. In our practice, we have resumed our regular hours and are performing regular dental treatment, however, we have changed how we run our day-to-day operations to cope with the continuation of the virus. We are following the guidelines set by the Virginia Dental Association, American Dental Association, and Center for Disease Control. I will not go through all of our changes, but I do want to highlight some of the key changes that will impact your dental visits in the foreseeable future.

1. Your car is our new waiting room

In order to adhere to social distancing principles with other patients coming and going from the office we are asking patients to call us when they arrive in our parking lot. Once we verify that your room is ready and no other patients are in the waiting room we will call you to come into our office. We will have you fill out a COVID-19 questionnaire and take your temperature before escorting you to your room. In maintaining the safety of our team and our patients, if you are deemed high risk for having or having been exposed to COVID-19 we will ask you to reschedule your appointment.

2. We will be wearing masks at all times

Normally we only wear masks while we are in the process of doing dental procedures. While this will still be the case, our entire team is now wearing masks at all times when we are unable to follow social distancing protocols. We are encouraging our patients to also wear their own masks to and from the office.

3. We’re putting an umbrella around your tooth

We use an air and water spray when we are removing cavities for fillings or crowns. This air and water spray mixes with your saliva and floats into the air as tiny droplets known as aerosols. Unfortunately, there is no way to wear a mask and have a cavity fixed, but by using a rubber dam we can get pretty darn close. Custom holes are punched into a sheet of rubber and stretched around the tooth or teeth being worked on. It acts as an umbrella for the mouth (maybe it’s a stretch, but it made for a good tagline). This is beneficial because we are creating a barrier between the mouth and the air/water spray applied to the tooth as it is being fixed.

4. Virtual consultations will reduce chair side conversations

We pride ourselves in taking the time to discuss treatment options and explain dental procedures to allow our patients to be a part of the treatment process. Conversely, we have been advised to limit the amount of face-to-face contact time and reduce the number of patient visits to our office. In order to achieve an equilibrium, Dr. Bousaba is scheduling time for virtual consultations to review treatment plan recommendations, discuss treatment options, or simply to answer questions regarding a specific dental treatment.

Joe Bousaba, DMD

I Have a Missing Tooth: Should I Get an Implant or a Bridge?

The two best options for replacing a missing tooth are a dental implant or a bridge. Let’s start by briefly describing what each option entails. If you look at the illustration below, tooth “a” is on one side of the missing tooth (site “b”) and tooth “c” is on the other side.

A missing tooth can be replaced with a dental implant or a bridge.
Site “b” is missing a tooth.

A bridge involves removing tooth structure on teeth “a” and “c” so that there is room for a ceramic material which will replicate their original contours and esthetics. The ceramic replacing teeth “a” and “c” will be connected by a floating crown which will complete the bridge. As shown in the illustration below, the three unit bridge will be permanently cemented over top teeth “a” and “c” and will replace the missing tooth at site “b”.

Dr. Joe Bousaba may use a ceramic bridge to replace a missing tooth.
A bridge is composed of two crowns that are connected in the middle by a floating tooth. Teeth “a” and “c” have been shaped to accommodate the ceramic material of the bridge.

An implant involves placement of a titanium screw into the jawbone which after it heals functions very similar to the root of a natural tooth. A crown is then built on top of the implant and the final result looks something like the illustration below. An implant at site “b” has no impact on teeth “a” or “c”.

Dr. Joe Bousaba can replace a missing tooth with a dental implant. He has the training, tools, and technology to place and restore the dental implant in his office.
An implant involves placement of.a titanium screw into the jawbone which functions similarly to the root of a natural tooth. An implant crown is then placed on top of the implant to replace the function of the missing tooth.

So now that you understand the basic structure of a dental implant and a bridge let’s talk about the benefits of each.

Benefits of a Bridge:

  • Faster turnaround time: A bridge can be completed within a 3-4 week timeframe over two visits.
  • No surgery: Some people are at a higher risk of complications with surgery given their health or age; no surgery is required in the placement of a bridge.
  • Lower up front cost: If you are to compare the total cost of a bridge to the total cost of an implant, most of the time the bridge will be less expensive up front.

Benefits of a Dental Implant:

  • Independence from neighboring teeth: A bridge permanently connects at least two teeth; if a single tooth in a bridge becomes a problem, the entire bridge is at risk for failure.
  • More hygienic: Cleaning around an implant is very similar to cleaning around a natural tooth. You will not need any additional tools to ensure you are maintaining the site well. Cleaning around a bridge is more challenging because the teeth are connected. You will need to thread a piece of floss under the bridge every day when you clean it.
  • Improved force distribution: Since a dental implant replaces the root of a tooth, the forces put on the implant crown are absorbed in a more favorable manner in comparison with a three tooth bridge that only has two teeth for support.
  • Lower long term cost: Involving neighboring teeth in the form of a bridge has long term consequences that are often overlooked. Nothing is better than a completely natural tooth; every time we remove more natural tooth structure the tooth is worse off in the long run. If we are completing a bridge on teeth that would not otherwise need treatment, we are subjecting them to a shortened life cycle that will inevitably need re-treatment at some point in the future. Due to the fact that an implant is independent from the neighboring teeth, it does not subject the neighboring teeth to treatment that may shorten their overall life span and therefore an implant will be less expensive in the long term.

Joe Bousaba, DMD

What’s the Hype About Electric Toothbrushes?

Shelley Strachan, RDH discussing manual, battery powered, and electric toothbrushes.

One of the most common questions patients ask me is, “are electric toothbrushes really better for my teeth?” My answer is always YES. I find myself recommending electric toothbrushes on a daily basis and am always surprised by how many people have never tried one. For some, it may be overwhelming to pick out the “best” brand. Others are deterred by the price tag of electric brushes when compared to manual brushes. However you can not deny the research that has proven electric toothbrushes to be superior.  

As a dental professional, there are two major factors I look for when recommending any product to a patient. First, is this product approved by the American Dental Association (ADA)? And second, is there reputable research on this product? These things should be considered when comparing “name brand” products to “off brand” products. I trust name brand products because typically that company has achieved the ADA seal of approval, and spent lots of time and money conducting research to prove their product effective.

I like to divide the types of toothbrushes into three categories: manual, battery powered, and electric. When I say “electric toothbrush,” I’m referring to  an electric toothbrush that is rechargeable. A battery powered brush is not considered an electric toothbrush by my standards.

I have to admit, battery powered brushes have been stepping up their game in recent years. Previously, you could not change the brush heads on a battery powered brush which limits their life span. Nowadays I am finding more brands offering replacement brush heads, and sometimes even a refill subscription service. Despite having the ability to change out your brush heads, battery powered brushes are simply not as powerful as an electric toothbrush. Is a battery powered brush better than a manual? Sure. But often times a battery powered brush is simply just vibrating, where an electric brush has more advanced technology.

So what makes these electric toothbrushes so advanced? There are two brushes that I recommend most often to my patients: the Philips Sonicare and the Oral B Pro. The Philips brushes deliver some 60,000 brush strokes per minute, not to mention it functions to direct bubbles in between the teeth and below the gumline. This will leave your teeth cleaner and your gums healthier in the recommended two minute brush time. The Oral B pro has a circular brush head that oscillates to clean around the circumference of each tooth. It delivers around 40,000 brush strokes per minute, and sweeps away the plaque along the gumline. One of my favorite features of both of these brushes is the two minute timer. Most people are really only brushing for about 30 seconds, so the timer helps you brush for the recommended time! 

If there is one thing to take away from all this, it’s that electric toothbrushes are definitely more efficient and worth the investment. I have seen firsthand the improvements in my patients’ oral health after switching to an electric toothbrush. Less tartar and plaque buildup, less bleeding, and happier patients! Who wouldn’t want less scraping during their dental cleanings?

Shelley Strachan, RDH