New Technologies Power Capabilities and Profits

Four devices that expanded my cosmetic-esthetic practice

Bridget Sweeney, DDS

When I designed my dream practice 3 years ago after working for 9 years as an associate in a variety of settings, I incorporated every element that I had envisioned throughout the years-from the philosophy and treatment offerings to hundreds of tiny details about the environment. At the Ivory Dental Co. in East Amherst, New York, about 50% of what we do is dentistry with a high focus on cosmetic dentistry and the other 50% involves facial esthetics. We offer the latest cosmetic dental treatments in a luxury spa environment as well as esthetic treatments that accentuate the beautiful smiles we create, providing a cohesive set of services for our patients.

Because having "an open-minded commitment to continuing education, advancing technologies, and an evolving practice" is part of our vision statement, the range of technologies that we employ rapidly changes and grows. All of the technologies we've implemented have provided benefits; however, four devices in particular have significantly shaped my hybrid practice and its success in the last year or two.

A Facelift-Like Effect Without Surgery

When I first opened the practice, we offered neuromodulators (eg, Botox^®, Xeomin^®) for esthetics as well as to treat temporomandibular joint disorders, bruxism, orofacial pain, and migraine headaches. I also offered dermal fillers and thread lift procedures.

While attending an Art of Skin event held by Lumenis, I watched a live demo where they used a device to treat half of a patient's face with dynamic muscle stimulation. Dynamic muscle stimulation technology produces muscle contractions mimicking physiological muscle function, but at a significantly higher frequency and intensity. I was amazed that after only 8 minutes, the treated side of the patient's face appeared toned and lifted when compared with the untreated side. The facelift-like result was far above and beyond anything that I could achieve with my current modalities, while also being less invasive. After the dynamic facial muscle stimulation, radiofrequency treatment was used on the patient to thicken and strengthen the skin's deeper level (ie, the dermis) through the generation of collagen and elastin. And finally, radiofrequency microneedling was performed to stimulate the wound-healing process to regenerate skin cells in the superficial epidermis and improve the appearance of fine lines, texture, crepiness, and age spots. The full treatment took about 20 to 30 minutes.

When the presenter explained that all but the microneedling portion of the treatment could be delegated, I opened our practice's scheduling application on my phone and counted 40 openings in our schedule that month-openings for times when trained team members under my supervision could perform this procedure for patients. I purchased the device that weekend.

Since implementing this dynamic muscle stimulation, radiofrequency, and microneedling treatment more than a year ago, we have seen steady growth both from new and existing patients. As dentists, we are in a unique position to offer such facial esthetic services because our patients already trust us and have built a rapport with our hygienists, who they see every 3 to 6 months for preventive dental care. Implementation was simple because the procedure fit seamlessly into my esthetic recommendations, and I already had many patients who wanted a lifted look. Furthermore, it's also common for dental consultation patients to tell me that they want veneers because they feel that their teeth are getting smaller or less visible when they smile, when the problem lies in part with a fallen lip due to lost volume in the midface or lateral cheeks. To achieve a patient's goal of attaining a "perfect smile," targeting the teeth and what surrounds them is necessary. After dynamic muscle stimulation, radiofrequency, and microneedling treatment, patients may not require veneers to be satisfied, so we can take a more conservative approach to their dentistry. For older patients who have very significant facial thinning, I might still use some filler to achieve their desired results, but I only need half as much because dynamic muscle stimulation, radiofrequency, and microneedling treatment enables their naturally toned muscles to provide significant volume. It also creates a more natural effect over time when compared with the use of fillers alone.

Intraoral Scanning With Near-Infrared Imaging

I think every dentist should have an intraoral scanner, particularly one with near-infrared imaging technology and other advanced features, such as the ability to create simulations for patient education. I couldn't have performed half of the dentistry that I have in the past 2 years without one. Scanners with near-infrared imaging technology can detect carious lesions between teeth before they can be seen on radiographs, lighting them up brightly in their displays.

In addition to providing early screening for caries, such intraoral scanners can save time by improving patient flow. When patients come into our practice, our hygienists perform a "wellness scan." Our technician then reviews the scan and determines which radiographs are needed. Because the scans guide my team to acquire the proper radiographs, I go into every examination knowing what to expect. If I don't have to stop during an examination to order a periapical radiograph, there's a good flow with no backtracking and no running behind.

Another advantage of many advanced intraoral scanners is the ability to automatically track and flag changes over time, which can help us show patients why they need certain treatments, such as realignment. For example, it's common for us to recommend clear aligner treatment for patients who have a collapsed bite and chipped teeth, but they may not be interested. However, when patients receive annual scans, the software of advanced intraoral scanners can identify areas of change and allow them to visualize where their teeth have chipped further because they are out of alignment and colliding. We can also show patients a simulation of what their teeth would look like in better alignment. When patients with alignment problems can see how these problems are causing them to lose tooth structure, they're often ready to commit to treatment.

CBCT Airway Assessments

After our new patients receive a wellness scan, our hygienists take them on a tour of the practice and show them our cone-beam computed tomography (CBCT) machine. The technician explains that in addition to acquiring 3D images of the jaw for implants, root canal treatments, clear aligner treatment, and other procedures, it can image the airway and measure for any constrictions that could contribute to obstructive sleep apnea (OSA). This is used to initiate a discussion about whether patients have OSA or suspect that they might have it.

If a patient suspects that he or she has OSA, we screen for it. We also screen for it when patients require scans for other reasons, like for root canal treatments. We screen clenchers and grinders as well because when the airway is collapsed and the brain triggers an arousal, clenching and grinding can occur prior to the gasp for air. Our CBCT machine allows us to perform an upper airway analysis by measuring the total volume of pharyngeal airway space. Upon completion of the analysis, the software automatically applies a heat map that displays airway constrictions in red. This enables our team to easily show patients what we are seeing and provide education.

Sleep and Bruxism Testing

If patients exhibit signs of clenching or grinding or screening suggests that they have OSA, our next step is to send them home with a user-friendly monitor that tests for both OSA and bruxism during one night of sleep. With the data from this device, which includes both bruxism episode index and apnea-hypopnea index scores, I can tell patients the number of times that they clench and stop breathing during an average hour of sleep.

As dentists, we are not permitted to diagnose OSA, so when the results of screening suggest this problem, I email patients a report that they can show their physicians, who can then make an official diagnosis. We also work with a sleep physician who can make these diagnoses during telemedicine visits. Once patients are formally diagnosed, we can participate in their treatment by providing them with sleep appliances as well as try Botox to relax their muscles and reduce clenching. We retest patients after treatment to make sure that it's working.

On the Horizon

If practice owners do their homework, they can confidently leverage new technologies to expand their capabilities and increase their profitability. Technology needs to fit the vision and workflow of your practice and be properly implemented to be successful. The four devices discussed in this article allowed me to take my practice to the next level, and I'm excited about what's next. I'm interested in acquiring a 3D printer for smile design, an intense pulsed light (IPL) device for perioral esthetics (eg, treating sun damage and acne scars, hair removal), and a 3D facial scanner with software that will enable us to design not only patients' smiles but also their esthetic treatments. If you're excited about new technologies for your practice, be confident. Patients are looking for high-tech practices with expertise, so go ahead and take the leap.

About the Author

Bridget Sweeney, DDS, is the owner of The Ivory Dental Co. in East Amherst, New York. She is also a faculty member at the American Academy of Facial Esthetics.