The Expansion of Digital Technologies in Dentistry with Dr. Mark Z. Yamamoto

Dr. Mark: What I decided to do was talk about new things and a little bit of old things, because people get tired of hearing the same thing, but we have new things all the time. I study them and I teach them. When the new things come out, I have to study them in order to teach them. So, its a continuing process and actually, I enjoy it, I enjoy dentistry so I think I’m very blessed.

So, whats new? Everything digital is expanding rapidly. It is now possible to take images of patients skull and design implant positions. Look at the bone, implant guide, make abutments, and design the crown. One scan and they do it all. Entire dentures can be done by taking a scan of the dentures, taking pictures of the dentures. And, instead of making it the old way, packing it and making base plates, they can grind one out using a piece of plastic.

Crowns and restorations can be done in the office, if you want to purchase $130,000.00 machine. It doesn’t end there, you have to buy an oven, and it takes a lot of expertise, which I’m very happy to let technicians take care of. So, its a choice.

The down side, all of these new technologies are very expensive. Machines cost $130,000.00 plus. Imaging machines, I mean, I can buy one, have it in my office, if I have room for $130,000.00. Rather than do that, I send my patients to the lab, they can have it done for about $100.00, $200.00 cheaper when they go to the lab. Hopefully, the cost will come down a little bit there.

In our office we have a new system now, called Revenue Well and it texts you or emails you, your choice, to confirm your appointments. Some of you have already experienced that, some of you who are patients have already experienced that. Then we have now tried Care Credit Financing, for patients who don’t have a lot of money. They can go to a company that will finance everything, and we get out of the picture of collecting money. Which is very good, because it can become contentious.

Then, of course, I’ve had these little x-rays since ’88, okay ’98, that’s when it came out. This is one of the new types of crowns that we have here, its made out of zirconia, which is the same material as the Yoshi blade that you see on TV. The guy knows all about zirconia, because they make artificial diamonds out of it. It’s very hard, it’s very strong. It’s so strong and hard, that I have to be careful and look at what’s here.

If they have an old style porcelain crown there, I might have to think over making this crown here, because its so strong it might chip this one. Because, the old style chips much easier. So, you have to know the hi-tech, you also have to know what you’re doing with it.

As I made a zirconia bridge, this is what it looks like when you don’t have the bridge. And, this is the zirconia bridge. That’s all zirconia, no metal, people that are talking about metals and things. This is diamond-like. It looks great, very strong, and its excellent for this patient, because this patient is a grinder, he grinds his teeth. These are made specifically for that. All right. I’ve made the old style porcelain bridges for patients, where they’ve destroyed them in about a year. So, I have to make it good, so remake it with different materials.

This is E-Max, this is lithium disilicate, its really beautiful. I do it on anterior teeth, some of you have seen them on my other presentations, where a gal went from 60 to 65, she looks better with the front teeth, that’s E-Max, and its really wonderful stuff. Stronger than porcelain, not as strong as zirnconia, but really, really beautiful. And, its best on front teeth and bicuspids.

What has not changed? The bite has not changed and will never change, your teeth, the shape of the, the way your jaws move, never changes, human being. Making the new restorations fit the bite is the key, because they’re stronger, harder and less forgiving. So, if you’re not really dynamite with the bite, like I am, you can have problems with the new restorations, they can be uncomfortable. I fiddled with this for Mike and Val, this is a bridge that wasn’t done in my office, implant bridge, these are all implant abutments, one, two, three this is a false tooth, that’s why they call it a bridge.

One of them failed, and I believe it failed because the bite was crocked here. When he came in the bite was way off. I had to take this down quite a bit. In fact most of the pressure in his mouth was on this one tooth, so the implant failed and the bone around it was abscessed. So, I had to take it off. You’ll like this Mike, this is a torque wrench.

Audience: Is that 100 foot, pound . . .

Dr. Mark: 25 Newtons. They give it in Newtons. There’s the bridge out, and there’s the torque wrench. Pretty cool, this is what we use now a days to put them on and take them off. This is a case that I’m going to do in a couple of weeks, which is why I won’t be here on our Thursday, the 20th meeting, and I’ll miss Gene’s mixer. This is a case of a patient that had years of TMJ problems anyway. She had wore a night guard, which didn’t do that much good. Then a dentist made her some crowns that didn’t fit right and made her worse. This is her face when she started and this is her face later.

Now, if you really want to look at it, like the women, women know women. But, you look at this depression in her face here, it’s gone and you look at the cap of her head and you tell by looking at the level of her ear lobes. After I fixed her bite, her head straightened up. Her eyes are straighter across. And look at her neck muscles, this is all a concern with if your bite isn’t right, your muscles fight each other.

Remember when you were in high school and you had to do that electronic charge to the frog gastric, an electronic charge at the frog leg and it moved. Well, all of our muscles are the same, humans and frogs, we get an electronic impulse from the brain to the muscles.

It’s very complicated, if you look at the muscles after you skin the face, like I have. But all the muscles contract at the same time, same message from the brain, but if its not coordinated and they’re fighting each other, then you have some swelling here, and you have lack of development here, then you have asymmetry in these muscles that come from the head.

So, there’s a lot going on in one patient all the time and if you’re not super competent at correcting the bite, they’ll never get well. That’s why a lot of dentist that attempt to treat patients with jaw problems, they sound like my wife.

But where was I. Okay, when the patients muscles start fighting each other, they swell, or they become atrophied if they’re not functioning correctly. So, she got well, her pain got better. She’s a lovely person, delightful brain, she’s an Italian Renaissance teacher at Chapman College, she’s a professor. She moved away to Upstate New York and she came back to finish her treatments. You can’t see it here, but it says 10/26/11 and 5/29/12.

In that amount of time there was a bend in her back. I personally couldn’t figure that out, so I had to consult with my physical therapist that treats some of my patients that need physical therapy for their muscles.

If you look at the way her head is positioned too, see how her head is more erect. I didn’t tell her to do anything, I just took a picture. See her chin, now look at that, her breasts look larger because shes standing up straight. Into the was they call that, knockers up. Stand up straight, knockers up, that’s a saying in the woman’s Army Corp. But, she looks totally different, because she relaxed her and the tensions gone from here. It allows these muscles to have normal contraction and straightens up her back. So, that’s my presentation, quick, any questions?

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