Bite Point

MB2 Canals and Global Microscope Magnification

Ah, the canals of Venice, and other places I've never been:

 
Yet I do spend quite a bit of time in those other canals, the very small ones, the ones inside of the roots of teeth that sometimes go awry and give patients pain. 

 

The root canal systems inside of human teeth are very complex.  It's like having a main street, but then lots of side streets and interconnecting avenues that all have to be cleaned up in detail.  And they all curve; no straight lines.  It's most definitely not one simple straight tube that we have to deal with when we are faced with cleaning this system of infected tissue.

Upper first molars are particularly difficult to cleanse.  The above graphic depicts one.  There are often four main canals in these teeth.  The palatal goes off towards- you guessed it- the palate, or roof of the mouth.  The disto-buccal is the one farther back (distal) and towards the cheek (bucca means cheek in Latin).  The  mesio-buccal 1 is the one towards the front and cheek. 

The problems tend to occur around the mesio-buccal 2, or MB2 for short.   This canal is usually very small and difficult to find even in the best of circumstances.  As we get older, or have many procedures done on a tooth over the years, the canals get smaller.  Often so much smaller that they cannot be found at all, which is not good, because if they cannot be found, they cannot be cleaned. 

See:

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2010/09/dental-pulp-calcification-spelunking-in-the-dentin.html

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2011/01/dental-pulp-calcification-and-changes-with-age.html

When using the Global Operating Microscope, I find that the whole game has changed.  Tiny MB2 canals that I struggled to find are now things that I trip over in broad daylight.  Here is an image to show you what I mean:

 

(These video captures show what we see through the eyepieces of the microscope, but they do not at all give the 3-D visceral feel that one gets by looking through the actual optics.) 

The other three canals that can be seen in this image have been enlarged and cleaned up already in the course of treatment.  The MB2 is now readily apparent, magnified, and lit up with the dental equivalent of Kleig lights.  This is a tremendous benefit to our patients, as we can now find (and clean) a much higher percentage of these canals than before we had this device.

 

Global Surgical Microscope- Those Teeth Look As Big As My Car!

This friendly-looking fellow:

 

-who looks a bit like an affable alien who just discovered tobacco products- is our new Global Surgical Microscope.  Here's another view; we have him engaging in some botanical research on the side:

 

This is a magnificent instrument which is designed to allow dentists to work with magnification and vision enhancement and to provide a whole new level of treatment, especially in endodontics, the arena of root canal treatment.  Many endodontists who specialize in that part of dentistry have adopted this technology; we are now one of the first general dental offices in the Philadelphia area to do so.  For this device is useful in most all of the treatments which we perform in dentistry.

Over time, I'm certain to post more images.  For now, let's have a look at an all-ceramic crown at two magnifications.  The crown is still on its die, the model (here in epoxy resin) made from the impression which we take at the first visit:

 
 
Wow!  I had to spend quite some time blowing stray dust off this baby for such a photo and I still didn't get it all!

Here are some views of teeth in situ, as we could say. 

 
Here's a close-up of the edge-wear on that incisor at the top of the image:

 

I've placed composite resin restorations at these magnifications and I can say that what looks good at five times life size looks unreasonably great from a conversational distance. 

These images, grabbed through a video feed, don't even come close to capturing the feel of looking through the eyepieces, which are stereoscopic, after all.  It's very 3-D, very powerful, and very Visceral.

So far, in using the scope, I find my posture to be incredibly relaxing.  The microscope and the mirror do all the work. 

Patients have also commented that the whole dental procedure seems more gentle when performed under the microscope.  This is interesting, as I've just gotten started with it.  So far, I surmise that the actions performed during treament are more focused; more is accomplished with less movements of the instruments, in less time.  This makes sense, because even though there is certainly a learning curve with any new medical technology, I've been consistently faster when using the microscope than not- without trying to be.  In fact, I feel like I'm working more slowly.

Focus.  It all comes down to focus.

At Sukoneck & Wilson, we've adopted a number of new technologies recently, as you can see by looking back through my posts.  This one- this one just might win First In Show.  I certainly look happy using it:

 

The hardest part, actually, is resisting the urge to frequently call out, "Fire one, Kowalski!" like I'm captain of the USS Becuna or something.

 

Let It Be A Wakeful One

"And in my place, what profession would you choose?"
"Ah, that I cannot say. I do not know your circumstances."
"I must earn my bread, like other sons of Adam."
"Well, earn it then in such manner that the eyes of the world shall be upon you; that men and women shall talk of you, and newspapers have your name in their columns. Whatever your profession, let it be a wakeful one; not one that you can follow half asleep."

Anthony Trollope, The Bertrams, 1859 

 

Go. Make a difference.

And Happy 210!

Soprolife Optical Cavity Detection System

Light.

For most of our lives, we live in a realm of "white light", which is the entire visible part of the electromagnetic spectrum.  Yet the white light we see is a very small portion when you consider the entire range:

 
Interesting things happen when we use just a very small portion of this spectrum to accomplish a particular goal.  The key concept here is that any given portion of the spectrum, any wavelength of light/energy, interacts with the medium in which it travels in different ways.  Light traveling through the vacuum of interstellar space travels faster than light traveling in our atmosphere, which in turn travels faster than light traveling through seawater.  Or Woodford Reserve Distiller's Select Kentucky Bourbon.

We can see the effects of the interaction of light in various media even in common things around us, such as the diffraction of light between air and water:

 

I remember reading some interesting things about this over the years.  For instance, when our Navy submarines dive deep, it's very difficult to commumicate with the surface because seawater blocks most forms of electromagnetic radiation pretty thoroughly.  It turns out, though, that a certain wavelength of green laser light, as well as extremely low frequency radio waves (ELF waves!), can get information through to the briny deeps.  So ELF is used, and submarine captains can get new orders, but they come through very slowly.  The bit-rate is like the Internet in 1996 or so, when primitive dial-up reigned. 

In dentistry, light is used for many things.  For over one hundred years, X-rays have been used to "see through" structures in the mouth and look for a dizzying array of pathologies: cavities, root canal infections, bone loss due to periodontal disease, cysts, tumors...  Judicious use of X-rays is of incalculable diagnostic value to us as we strive to achieve and maintain oral health in our patients.

Our Trimira Identifi 3000 makes intelligent use of soft tissue fluorescence in the early detection of oral cancer and other conditions in the mouth:

 

 

Now, there is a new way to examine teeth with light and expand our diagnostic abilities when it comes to cavities, which still qualify for that ugly word "scourge" in our carb-saturated society.  The Soprolife Light Induced Fluoroescence Evaluator (I would have preferred the term "Bat-Light" and hung the device on my trusty Utility Belt but you can't have everything) is new technology that we have incorporated into our practice for the purpose of early detection of cavities.

Here is the Soprolife device:

 

 

And here is a shot of the light that emanates from the device in Caries (Cavity) Detection Mode:

 

How does it work?  Well, it turns our that light at a wavelength of precisely 450 nm (nanometers, in the bluish part of the spectrum diagrammed above) that enters a tooth excites the dentin, the inside structure of teeth.  And you thought science was often boring...  Dentin fluoresces green when it's healthy.  When there's a cavity, it fluoresces a rather angry red.  Here' s a diagram of the effect:

 
 

Here, then, are some images from actual practice in our office.

This is one of my own premolars.  I'm all green and thus cavity-free in the grooves on the biting surface of my tooth:

 

Molars often have deeper grooves, and we see that effect here with just a hint of reddish hue in my molar; this is not a cavity:

  

Here is an early occlusal cavity (in the surface grooves of a molar) showing in deep red (not my tooth anymore):

 
Here is an early cervical cavity (at the gumline):

 

 This photo is of recurrent decay around a composite resin restoration:

 

Lastly, we often worry about the health of teeth under crowns when time passes and the gums recede away from the margin, or edge, of the crown.  The exposed root can be very prone to decay.  This photo reassures us that the tooth is indeed healthy and has no cavity in the visible areas.  The patient may wish to replace this old crown for appearance reasons, but does not have any obligation to due to decay.

 

Overall, we are very happy to have the Soprolife Bat-Cavity Detection Light as part of our high-tech wizardry that enhances the diagnosis and treatment of you, our treasured patients.