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Dentistry takes wing: aerospace technology good for the teeth.

Anyone who has had orthodontia, or even reconstructive oral surgery, has fond memories of entire series of X-rays and the sensation of dental molding compound congealing around clenched teeth, which only results in an inexact anatomic capture of your tooth position and form. Inevitably, with all these images and models, the practitioner is found at least once staring at one's dentition, with a look of concern and consternation flickering across their face. Then the orthodontist returns to pushing teeth around by directional force exerted with wires and bands. Dentists continue to "fit" crowns by asking patients if they have pain when they bite down. If they do have pain, the dentist saws and grinds a bit here and a bit there, and tries again.

The problem lies in the fact that aligning a patient's dentistry is far removed from aligning the front end of a car. Regions peripheral to the mouth have a direct effect on oral configuration. Each patient has subtly different dentofacial musculature, chewing patterns and hinging of the lower jaw. Consideration must also be given to an adult patient's preworn, precollapsed, physiologic and balanced dimensions.

Getting a model

Traditionally, dentists have planned and delivered patient care using two-dimensional data--radiographs, photographs and cephlometric tracings--to define normality, characterize pathologies and predict growth. The plaster casts can only approximate tooth positions by relation to each through other external reference points. The use of true three-dimensional, volumetric patient data would provide precise diagnosis, treatment planning and eventual treatment.

The new modeling tool, nicknamed "virtual mouth" technology, has been achieved, thanks to two dental practitioners, Drs. Randy Muecke of Atlanta, GA and David Leever of Tampa, FL, who enlisted the aid of experts in aerospace engineering at the Georgia Tech Research Institute (OTRI). It's no accident that this particular department at the school became involved--both fields require materials that are strong and resilient, sleek and extremely well designed. Muecke, who specializes in restoring teeth, and Leever, an orthodontist, had patented DentAART, computerized software that will help orthodontists accurately calibrate movement of teeth, and which can help precisely design and speed manufacturing of restorations and replacement teeth. But they needed the help of GTRI researchers to confirm Leever's mathematical proof of the technology.

They then contracted with GTRI to develop a digital version of DentAART, including individualized patient functional movement. Jeffrey J. Sitterle, GTRI's chief scientist and an expert in sensing systems and computer simulation, was brought into the project at this point to lead the research and development efforts. In the resulting process, measurements made from at least three high-resolution X-rays or a computerized tomography (CT) scan are fed into a computer. Specialized software generates a precise 3D digital image of a patient's mouth. Based on this 360-degree image, dentists can design a complete treatment plan to help them know exactly how they need to move and restore teeth. Restorations can be precisely calibrated to the bite pattern of the tooth to be replaced. Then, improvements in materials processing and fabrication can rapidly produce a crown or restoration that orthodontists simply glue into place. The data could even be applied to creating a rendering by a rapid prototyping machine, which wo uld produce less discomfort than traditional molds.

Further applications

Sitterle and other GTRI experts took the idea another step, offering a way to computerize the method and create a system for multiple applications. Use of this technology (for which GTRI is seeking several patents) will allow dentists, orthodontists, technicians and dental labs to design and test treatments virtually in a computer, resulting in treatments that are accurate, fit correctly the first time, and move patients in and out of the chair quickly--a blessing for both the patient and the dentist, Sitterle says.

As a further development, GTRI launched the Dental Technology Center (known as DenTeC) in July 2001. The program is guided by Sitterle. Six faculty members are already involved, and plans are under way to invite a number of additional researchers to join. The center is focused on four broad areas that draw research expertise from a number of disciplines--materials, applications of advanced manufacturing, automation of processes and instrumentation. Among Sitterle's other proposed projects, with roots in aerospace engineering, is an air abrasion instrument that can erode minor tooth decay. By understanding how to control the flow of air, researchers can design a pneumatic tool that removes small spots of decay, then shoots in a spray of sealant. Such a device could be easily used in schools to help children who don't see a dentist regularly. Another tool under consideration is a multispectral sensor that can detect oral cancer. Sitterle is also thinking about designing stronger, sleeker and quieter dental ins truments, and ergonomic dental chairs.

There's no end to what can be done to improve dentistry--a field that has been behind the curve technologically, Muecke says. Sophisticated procedures, such as crowns and reconstructive work, need equally sophisticated methods to encourage patients to visit the dentist actively. The new virtual mouth technology, in turn, will help dentists, experienced or not, as well as any physicians having to work with the human face, to "completely capture a patient's anatomy--producing the required diagnostic information--and utilize this for the patient's best interest as never before possible," remarks Muecke.

The collaboration with Georgia Tech has helped dentistry advance towards that goal. "It's exciting, because knowledge used in other fields of science and industry is now being applied to dentistry," Muecke says. "The approach has already produced some breakthroughs." He also observes that it is likely that the new imaging will make a trip to the dentist "a lot more affordable to many more people."

For more information:

Circle 395--DentAART, or connect directly to their website via the Online Reader Service Program at www.rsleads.com/205df-395

Circle 396--Georgia Institute of Technology, or connect directly at www.rsleads.com/205df-396
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Author:Mandel, Richard
Publication:Medical Equipment Designer
Date:May 1, 2002
Words:975
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