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Digitization is changing the face of dental care

Parents who worry that their kids play too many video games, and fear they’ll end up living in a basement bedroom forever, may want to know about Evolution Dental Science in Cheektowaga.

It turns out those computer geeks who get lost in “Call of Duty,” “Fallout” and other role-playing games tend to be very good at helping to build bridges, crowns and dentures in the modern dental world.

It is a digital world, after all.

“Their skills and hand-eye coordination are fantastic for what we do,” said John Orfanidis, Evolution’s chief technical officer and third-generation dental entrepreneur.

During the last three years, Evolution Dental has retooled its 12,000-square-foot, Aero Drive manufacturing building, which stands with its back to the Buffalo Niagara International Airport. The company continues to make many dental appliances in more traditional ways – including those that stay fixed in the mouth and those that are removable – but advances in computer technology, 3-D printing and computer software have streamlined the job of improving smiles.

Patients once could expect to see a dentist seven to 10 times to get X-rayed, measured, poked and prodded so their dental appliances could be built to fit just right.

Digitization in many cases has cut the number of visits to two or three.

“The more efficient it becomes, the less expensive it will become,” predicted Mark P. Lazzara, Evolution’s director of strategic business development. “It’s also more precise.”

Evolution makes dentures, partials, inlays, veneers, bridges and crowns – everything that involves getting teeth back into someone’s mouth – for about 250 dental offices in Western New York and 750 others across the country.

It uses a color-coded system for orders that come in to its building: Orders for removable appliances go in the yellow bins; Southern Tier in-hospital work in the purple bins; implant orders in green; ceramic and other orders in black. Most of the digital work comes through email, limiting paperwork.

“We are moving into doing things where many doctors are sending files by computer instead of sending impressions,” Orfanidis said. “Doctors are not using goo – impression material – anymore. They’re using cameras.”



Traditionally, the dentist would take impressions, a custom tray would be created and then another visit would be required for a more specialized impression, Orfanidis said. Then a base plate would be made with wax to measure the bite registration, midline and smile line. Back in a lab, technicians would place teeth in appropriate positions and then the device would go back to the dentist for a “try in,” to see if more changes were necessary. Then it was back to the lab for a rewaxing, then back to the doctor for more fine-tuning and then back to the lab for finishing.
“Now we’ve developed ways to digitize one aspect of it – a base plate,” Orfanidis said. “If the doctor has the appropriate equipment, we can do that in two visits.”

It can cost $30,000 or more to bring chamber and intraoral scanners into an office, he said, but prices have fallen considerably during the last couple of years. Dentists can take images of a patient in their offices and, sometimes even in real time, talk with a dental technician at Evolution or similar manufacturing site about how to best to fasten a screwlike implant into a patient’s jawbone.

Much of the digital work at Evolution involves capping an implant with a crown or building a bridge to address toothless gaps on a patient’s gums, said Tim Genco, 20, a digital removable specialist – and video game enthusiast – “although now we can digitally re-create the mouth and build a denture off that, too, and perfectly fit it into the patient.

“Instead of having to set everything by hand,” he said, “we can make a lot of the changes digitally. It’s exact, extremely precise, because it’s digital. We have everything down to the micron, which is thousandths of a meter. We can get exactly to where we want the mouth adjusted. If we need bone reduction, we can simulate that digitally. We can do all sorts of things.”

Dentists can send Genco and his digital colleagues images they can move in a variety of directions to get the best sense of a patient’s facial and oral structure. How upper and lower teeth rest together. How each tooth is, or could be, set in the mouth. Software automatically calculates the mathematical parameters that will provide the best fit and placement for a crown, bridge or prosthetic tooth. The pieces, gums and jawbone can be set at different colors, helping to refine the fit.

“Because of a gamer’s skill being able to see that three dimension on a two-dimensional screen, it really helps them in decision-making,” Orfanidis said. “When you show them dental, it’s amazing how much easier it is for them to pick up and understand line angles and shapes.” That’s important, he said, because every mouth is different. “We’re trying to set up and process a system for something that’s going to be different every single time.”

Then a mock-up of a crown or denture can be created in three dimensions, using a 3-D printer – a process that can take up to eight hours.

After this, the implant specifications can be transmitted to one of five milling machines, which can cut a tooth or series of teeth from a disc of zirconium, which they call “a puck” at Evolution. The milling blade cuts the prosthetic teeth 20 percent larger than their ultimate size because the rest of manufacturing process will harden and shrink them by one-fifth.

Danielle Thompson is among those who finish the digital and traditional pieces by hand.

“There’s the digital portion but we still have Danielle and her skills letting it look awesome,” Orfanidis said.

Workers can take a denture, set the teeth to spec and make everything look as natural as possible, right down to root lines on the gums, said Thompson, 30, of North Tonawanda, who favored art above other classes while in high school. She said it takes 20 minutes to a half-hour to create a wax mock-up.

After a try-in, when the dentist is certain the fit is just right, the wax denture is put into a mold to cast, the wax is melted out and the space is filled with acrylic. Then more fine-tuning and smoothing “make it look really natural,” Thompson said.

Evolution holds on to digital files so if a patient loses or breaks a denture or appliance, it can be replicated and replaced within 24 hours, Orfanidis said.

Evolution Dental Science owner Andy Jakson said the the process remains an artisan form despite changes in the process.

“If you’re a full-time artist, the skill levels you have are still absolutely necessary to do digital,” Jakson said. “It’s different. But digital art is still art. You still need the touch, the feel, the ability to understand the process. We’re not just making the same screw over and over again and you can get to a position where you’ve got this down pat. This is really about making a custom screw every single time, understanding where that screw is going and how it’s going to be used.”

The work also can be very rewarding.

“When you change a smile, it becomes a confidence thing,” Genco said. “It changes your life.”

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