New technological advancements in dentistry and orthodontics may not be coming out every day or even every week, but it often seems that way to the Central Florida professionals whose jobs require them to rely on their years of experience while also being open to the latest developments to impact the field. Like in all branches of medicine, there have been significant changes over the past decade that have led to better outcomes while increasing comfort and convenience, and more are on the horizon.

“I’m usually the one in charge of testing out all the new toys [at our practice], and I love it,” says Dr. Roberto Gil of Winter Garden Smiles. “But it is challenging as well—every time you bring in new technology, there is a learning curve and time that you have to set aside for troubleshooting. But once everything is in place, it’s fun and rewarding. It has been great to get this new technology and help the patients out in an easier and faster way.”

Orlando Family Magazine spoke with dentists and orthodontists across the region to learn more about the latest advancements affecting various specialties.

Pediatric dentistry

“Minimally invasive” is a term that has been used frequently in medicine in recent years, often referring to surgery that uses small, precise incisions compared to the larger ones of the past. In dentistry, the idea is to use techniques that help protect and restore teeth with minimal intervention.

“I think it’s so important to have pediatric dental procedures that are as short and as positive as possible, and less invasive procedures help to ensure that,” says Dr. Domenic Aloise of Maitland Pediatric Dentistry. “Minimally invasive procedures are generally tolerated much better with children. The more positive the dental visit, it helps to strengthen the relationship between the child and the pediatric dentist.”

He cites silver diamine fluoride (SDF) as one example of a minimally invasive technique, which he describes as a gel that is used on a small cavity or one that is just starting out in order to arrest the cavity without any drilling or filling. Dr. Aloise and Dr. Danielle Recine of City Beautiful Pediatric Dentistry also both sing the praises of Curudont, a regenerative treatment that strengthens a tooth from the inside out when cavities start to appear.

“It’s basically a non-invasive, drill-free peptide that you can apply to early cavities that don’t need to be drilled,” Dr. Recine says. “The peptide contains fluoride and hydroxyapatite, so it will attract minerals from your saliva and from your toothpaste and deposit them back into the tooth and try to make it stronger so we can avoid having to drill the cavity.”

Another tool that helps prevent pain for children is the Soan from NuSmile, which replaces a traditional shot for numbing.

“It’s an electronic anesthetic delivery device, and 99.9% of the time it’s painless and the children don’t even realize they’re technically getting a shot,” Dr. Aloise says. “My goal is to make going to the dentist as painless as possible while making it fun, and this device has revolutionized my practice and pediatric dentistry in general. Children who are fearful at the beginning of the procedure come out giving high-fives to everyone, and the parents are relieved. It’s a different technique of numbing and it has a lot fewer side effects as well.”

While not especially new to the field, laser frenectomies to repair tongue and lip ties are not readily available everywhere, but City Beautiful Pediatric Dentistry specializes in the procedure.

“For newborns, if moms are having a hard time nursing because the baby has a lip or tongue tie, we can do the release to make feeding easier in the early postpartum stage,” Dr. Recine says. “In the early childhood years—3, 4 and 5—if there are any speech or sleep issues, we can sometimes release the tongue to help with that. And then in older teenagers with lip or tongue ties who are getting braces, we can help act as an adjunct to orthodontic treatment.”

General dentistry

At Winter Garden Smiles, Dr. Gil and the rest of the team have been utilizing several innovative or nontraditional methods, including SDF for their pediatric patients, Botox to help relieve the symptoms of grinding teeth, and 3D printing to manufacture temporary replacements for broken dentures.

“We’ve also been placing a lot more implants using 3D imaging,” he says. “By seeing everything better and planning everything easier and more precisely, we’ve been able to do those cases in house, saving the patient a trip to the specialist.”

Perhaps the tool he is most excited about is an artificial intelligence (AI) software program that scans all patient X-rays to highlight possible cavities, infections or other areas of concern that require a closer look from the dentists.

“It gives me peace of mind knowing that my associate and I are not missing anything,” Dr. Gil says. “When we pull up the X-rays, it immediately lights up the screen and tells us to take a second look at a certain area. Then we go in and check everything closer at those sites. Even the hygienists love it, because it even shows tartar buildup and stuff like that.”

Orthodontics

In more than three decades as an orthodontist, Dr. David Lach has seen braces transform from “one size fits all” to tailored options that fit each individual specifically.

“Now we’re able to truly customize braces—they fit you and only you, and therefore we’re able to move only the teeth that we want to move and not all of the teeth, like the old-fashioned braces did,” he says. “That’s what took so long before; you had two or three years of treatment, and you ended up having to un-move teeth that you inadvertently moved. Now we’re able to pinpoint and map out each tooth precisely and with a high degree of predictability, so all of the multiple readjustments are no longer necessary.”

He believes in conducting in-depth interviews with patients to get to know them and understand which treatment plan will work best. The options include traditional braces, colored braces, pain-free braces to control the soreness, and self-tightening braces in which treatment can be completed in less than a year.

“Some people do well with aligners; for instance, we have night-time aligners now that you only have to wear at night,” Dr. Lach adds. “It’s a wonderful option for children whose parents were worried about them losing the aligners or about compliance issues. Now they can snap them in at night, take them out in the morning, brush their teeth and go to school like normal. It’s all done while they’re sleeping.”

Dr. James Wortham of Wortham Orthodontics explains that the field has focused on minimally invasive procedures for some time, but the advancements continue to improve outcomes.

“We have adapted and implemented the use of self-ligating brackets in our practice,” he says. “Although the concept has been around for decades, advancement has allowed braces to be more user friendly and [has allowed] for more efficient treatment to be provided with a more consistent, high-quality result with the least [amount] of discomfit for the patient.”

Co-owners Sam Patel and Dr. Paiyal Popat of Imagine Orthodontic Studio, along with Patricia Marquez, business, community and employee engagement lead, laud the practice’s commitment to always seeking better ways to improve the patient experience, often through the use of technology.

They utilize cone beam computed tomography (CBCT) for enhanced X-rays, and all of their offices have the ability to make retainers through scans and 3D printers, which helps reduce cost.

“Now, whenever a patient loses their retainer, they don’t have to go digging through the trash,” Dr. Popat says. “They can just give us a call and we have their files, so we can 3D print their model and make a new retainer for them within a couple of days and prevent their teeth from shifting further.”

Two years ago, the practice introduced the Imagine Synapse Dental Pain Eraser, a unique tool the size of a pen that uses electric pulses to desensitize nerves in treatment areas.

“It’s not invasive in any sort of way—it’s not breaking the skin—but for 30-60 seconds, just applying that high-frequency vibration to the teeth will allow the root and the nerve to be numb for 24 to 48 hours,” Patel says. “That solves probably the largest complaint with braces, which is when you go and get your wires tightened, there is soreness around your teeth and it’s difficult to eat chewy foods. You can apply the Dental Pain Eraser quite freely without any nervousness of it damaging your oral cavity or mouth, and it will reduce the severity of that soreness so that you can continue to eat the foods you love.”

The Dental Pain Eraser and the Imagine Cleaning Pod, a state-of-the-art cleaning solution for dental devices, are available for only about $100 each, Patel adds.

Like Imagine, Sakowitz Smiles Orthodontics has been using intraoral scanners and 3D printers for years to replace the molds of the past and make it easier for patients needing retainers or aligners. More recently, Dr. Scott Sakowitz has adopted the use of DentalMonitoring, an AI-powered remote monitoring program in which treatment progress for aligners or braces can be tracked from anywhere, using a mobile app and a special scan box attachment for a smartphone that produces high-quality images.

The platform can help determine, for example, whether a patient can progress to the next aligner tray, or must stay in the current one a little longer because a certain tooth is not moving as expected.

“That customization was really impossible to do before without bringing the patient to the office for every single tray to get that level of precision,” Dr. Sakowitz says. “A big part of it is AI, because AI is used to help analyze and flag which of these scans has an error with the tracking of a tooth. The human eye can detect changes that are pretty subtle, but AI is just so much better. If it’s off by a fraction of a millimeter, it’s going to flag it and say, ‘This tooth is not fitting right, let’s give it some more time.’ 

“DentalMonitoring is, I think, the greatest thing that’s happened since the scanners and the 3D printing.”

As for what’s next, Dr. Sakowitz is encouraged by a new machine that will make it even easier to manufacture retainers and aligners from suitable plastics in dental offices, and expects it to be widespread in the next several years. As with any developing technology, he and the rest of the professionals interviewed stressed the importance of gathering data, studying research, speaking with colleagues from local groups and organizations like the American Dental Association, and weighing the benefits for both patients and staff.

“What I really look for is not being around in that first round of testing but focusing on when there is some adoption out there, and I can see that some people have already begun to develop protocols and have an understanding of the right way to utilize the technology,” he says. “That way, if something goes wrong and we need to troubleshoot, I have a resource to go to.”

Adds Dr. Wortham: “I determine that advancements in technology are best implemented when they provide a clear improvement to the patient in comfort, efficiency and/or result. I answer the simple question: Would I treat my own child in this manner?”