This is the
philosophy and practice of detecting and treating decay as early
as possible, of removing as little tooth structure as possible,
and of making the smallest possible restorations that are aesthetically
pleasing and long lasting. No needles, no drill, no numb mouth!!!
is this cutting edge concept of “microdentistry”, and why is
is just what it sounds like: making a dental restoration AS
SMALL AS POSSIBLE. Because of the fact that we cannot replace
your decayed tooth structure with healthy tooth structure, only
an artificial filling, we want to remove only the decayed areas.
We also want to catch decay as early as possible.
If we catch
it early enough, we may only prescribe a highly concentrated
fluoride toothpaste to remineralize the lesion, so that it does
not require a filling. However, for those times when a restoration
is necessary, we want it to be as small as possible. This is
where the Waterlase dental laser really shines.
It cuts so microscopically
and precisely that we are able to remove the decay, with very
little removal of healthy tooth structure. I often wear magnifying
glasses when I use the laser, it is so precise. In addition,
because the laser sterilizes as it cuts, etches the tooth as
it cuts, and does not leave an organic smear layer when it cuts,
the fillings done with the laser should last longer than those
done the conventional way.
does this mean for the patient?
It means a break
in the traditional cycle of dental disease and restoration.
What I mean is this: In the past, a child would get a small
cavity in one section of the groove of his lower first molar.
This decay would be drilled out, and all of the grooves on the
biting surface of the tooth with it, to place a non-bonded,
silver-mercury amalgam filling.
In his late
teens, the dentist would see a small cavity starting in between
that tooth and another. Rather than fluoride therapy, the dentist
would put a “watch” on that tooth. Sure enough, at age 20, that
tooth would need another filling, this time involving two surfaces
of the tooth, the biting surface, and the interproximal (in
Again, the tooth
would be restored with a non-bonded, silver-mercury amalgam.
At age 30, some cracks developed in the tooth as a result of
the amalgam not being bonded. This time, the patient bites down
into a slice of pizza, and fractures a portion of the tooth.
At this time, the fracture goes into the nerve of the tooth,
and our fictional patient needs a root canal, a post, and a
going smoothly until he hits 45, and the crown gets loose, and
he bites down on something, and the post fractures the root.
Now the tooth has to be extracted. The only decay he ever developed
on this tooth was a small filling in the biting surface of the
tooth, and a cavity between the teeth that might have been remineralized
with the use of a concentrated fluoride. The eventual loss of
the tooth really came about because our methods of dental restoration
removed too much healthy tooth structure, and did not protect
what was left.
Now think of
a new scenario. An eight year old girl comes into our office
with a small area of decay on her lower first molar. Using the
laser (with no anesthesia) we remove ONLY the small area of
decay, then we clean out the plaque and stain from the rest
of the grooves in the biting surface of the tooth. At this point
we place a very small, bonded filling in the decayed area, and
a sealant over the rest of the tooth. The sealant is basically
a bonded filling that seals the grooves of the tooth closed,
so that cannot become decayed.
When she is
16, we see a small area of decay starting in the enamel between
her teeth. We prescribe a concentrated fluoride toothpaste (only
available from a dentist), and we see that area of decay disappear
by her next check-up. At age 20 we see a little bit of breakdown
at the edge of the filling.
The area is
quickly roughened up with the laser, and re-bonded. Fast-forward
to 40 years old, and that tooth still only has a small, one
surface filling. No crack, no root canal, no crown, no fracture,
no extraction. The less we take from your tooth, the better.
is the wave of the future. Probably by the time I retire in
30 or so years it will be considered to be the standard of care.
We believe that it should be the standard of care now, and that
our patients deserve only the best that modern dental technology
has to offer. Ask yourself if you would rather be a part of
scenario #1 or #2. I know which one I would pick for myself,
my family, and my patients.
Air Abrasion" ?
(a technique of MicroDentistry) is a fine, gentle spray of an
air-and-powder mix that removes decay. So fine and accurate,
in fact, that it allows the dentist to target only the decay,
leaving healthy tooth structure intact. Compared to cavities
prepared using the conventional dental drill, this means the
smallest possible fillings and stronger restored teeth.
air abrasion removes decay, how is the cavity filled?
This is the
beautiful part - literally! The dentist fills the cavity with
a tooth-coloured, non-mercury filling, making the entire tooth
strong, long-lasting and resistant to decay.
Does Air Abrasion Hurt?
By controlling the speed and intensity of the powder and air,
your air abrasion dentist can make the procedure virtually painless.
suitable for all decay?
Deep decay still requires more conventional treatment. Air abrasion
is best for early decay and for sealing the pits and fissures
on the biting surfaces of teeth. Before sealing, pits and fissures
are tested for decay using the DIAGNOdent laser. Early decay
is tooth rot, so why wait for it to spread or for cavities to
get bigger before treating them.