Nevada County dentists are ‘going digital’ |

Nevada County dentists are ‘going digital’

Dr. Paul Evans integrated digital dental equipment into his Grass Valley general dentistry practice eight years ago.
Photo by Lorraine Jewett |

Digital dentistry refers to the use of computerized, cutting-edge technologies instead of mechanical and/or electrical tools.

Consider the common crown.

In the past, a cracked or broken tooth requiring a crown took weeks to repair. The procedure included making a model of the tooth using a mold, placing a temporary crown on the tooth, waiting for a permanent crown to be created at a lab, and a second dental visit to have the temporary removed and the permanent crown cemented into place.

Now, using computer-aided design and computer-aided manufacturing (CAD/CAM), crowns are a one-visit, two-hour procedure.

New dental technology

An intraoral camera takes a digital scan of the mouth, a 3-D image of the teeth and gums appears on a computer screen, and the software suggests the shape and size by displaying a virtual crown.

The dentist perfects that virtual restoration and sends it to a “milling” machine that carves the crown out of a ceramic block. After testing the fit while it’s malleable, the ceramic crown is heated and hardened, then cemented on top of the patient’s damaged tooth.

“It does make it nice for the patient because they’re here for a single visit and leave with a permanent crown,” said Dr. Paul Evans, a 14-year dentistry veteran who integrated digital technology into his Grass Valley general dentistry practice eight years ago. “Previous to that, you’d leave with a temporary for a couple of weeks, and return to have the permanent crowd cemented on.”

Dental insurance covers both types of restorations: crowns created by the dentist while the patient waits in the office, and those sent to a dental lab to be fabricated and mounted later.

Because new technologies allow dentists to be more efficient and treat more patients in less time, practitioners who use digital methods usually charge the same as dentists who use traditional methods.

CAD/CAM technologies have also revolutionized the way dentists create and affix implants, dentures, inlays, and bridgework.

There are about 55 practicing dentists in the Nevada County area, including general dentists, orthodontists, periodontists, endodontists, and oral surgeons.

“Most local dental practices are using some form of digital technology, from specialized dental practice management software to sophisticated intraoral cameras and imaging equipment,” said Dr. Sheri Bernadette, President of the Butte-Sierra Dental Society which includes Nevada County.

“The use of the digital x-ray allows us to quickly record and share images with other providers and insurance companies,” she said. “It eliminates our need to process films using hazardous chemicals and requires a lower dose of radiation to the patient.”

Tech makes it easier

Other high-tech options include computerized case presentations, electronic prescriptions, and digitally-based surgical guides. Other technologies available to today’s dentists include special lasers that detect cavities and reduce the use of stitches, scalpels, and drills.

There’s an even more sophisticated type of x-ray available to dentists called cone-beam computed tomography (CT) imaging.

Similar to a medical CT scan, dental CT imaging employs an X-ray machine that revolves around the patient’s head and produces a 3-D view of the mouth: teeth, jawbone, gums, and even nerves.

The dentist can identify cracks in a tooth’s roots beneath the gums, or discover tumors and other diseases that don’t appear on traditional X-rays.

“It’s more diagnostic,” said Evans. “Many times we’re looking at a symptomatic area and can’t see anything. But with the CT scan, we can see things three dimensionally and many times we find things we might not have otherwise seen.”

That technology has also improved the placement of implants.

“We use the CT scan and send it to a lab, where they virtually place the implants and then give us a surgical guide,” said Evans. “We use that to direct the implant exactly as it was designed, so it’s perfectly placed as far as angulation and depth. It’s an awesome feature.”

Integrating tech into practices

Bernadette said the senior set of dental professionals has gravitated toward emerging technologies more quickly than those just entering the profession.

“It’s been interesting to see that the older, more experienced docs tend to be early adopters of new technology,” she said. “I think experienced practitioners see how technology has evolved and they want to remain on the cutting edge of business and clinical practice.

“I also think they may be in a better position to integrate new technology into their practices. They may not still have the burden of huge student loan debt or the debt from the purchase or start-up of a practice. Technology is very expensive.”

“The CAD/CAM units range in price from $20,000 to $150,000,” said Terry Moore, a Field Sales Consultant with Henry Schein Dental, the largest dental dealer in the world. “With the lower-priced units, you can do the digital scan but you have to send it out to a lab for a finished restoration. The higher-priced units allow you to do single-visit dentistry.”

New technologies can pay for themselves over time, by increasing both the efficiency of a dental practice and the satisfaction of its patients.

“You would need to do at least 10 or more restorations a month to get a good return on investment,” said Moore. “I assist forward-thinking dentists navigate the ever-changing dental marketplace, so they can give total focus to patient care, which is their main objective.”

The first dental CAD/CAM system was introduced nearly three decades ago, and its accuracy and speed has improved exponentially since then. The use of digital dental equipment began to ramp up in earnest about 10 years ago.

“This kind of dentistry is becoming the norm,” said Evans. “More and more dentists are implementing it in their practices and dental schools are beginning to teach it. There’s an expectation that we’re entering into more of a digital age.”

Lorraine Jewett is a freelance writer who lives in Nevada County. To suggest a business news feature, contact her at

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