CBCT Scans in Dentistry - ADA Statement - August 2012

The recent publicity given to the subject of radiation exposure in dentistry and the new CBCT scan technology prompted the ADA's Council on Scientific Affairs to come up with a statement and principles for the safe use of CBCT scans in dentistry.
The statement explains that although CBCT scans produce a higher radiation dose that routine dental x-rays, this dose is significantly lower than the one produced by a medical CT scan.
The dental CBCT units are also capable of further reducing radiation exposure by reducing the area exposed ( also called FOV or field of view).
There have been many measures taken to provide guidance in the safe use of CBCT in dentistry, such as position statements^6,7 and professional guidelines for CBCT use.^4,8 Recommendations for adequate operator education have been published.^1,6
The guidelines state that children are more sensitive to radiation so "Additional considerations should be weighed prior to the exposure of children and adolescents".  Also that CBCT scans should be prescribed only when the diagnostic yield will benefit patient care, enhance patient safety, and significantly improve clinical outcomes.
Another term you may have heard is the ALARA Principle which means “as-low-as-reasonably-achievable” , so the radiation dose for dental patients should be optimized to achieve the lowest practical level for a specific image.
In our dental office, as it should be in general, we try to taylor the recommendations for radiographic images to each individual patient's needs, and patient safety.

Carlos Boudet, DDS DICOI
1840 Forest Hill Blvd Suite 204
West Palm Beach, Florida. 33406
Website: http://www.boudetdds.com
Implant Blog: http://www.palm-beach-implants.com

References

1. Horner K, et al. Basic principles for use of dental cone beam computed tomography: consensus guidelines of the European Academy of Dental and Maxillofacial Radiology. Dentomaxillofac Radiol 2009;38(4):187–195. 
2. Pauwels R, et al SEDENTEXCT Project Consortium. Effective dose range for dental cone beam computed tomography scanners. Eur J Radiol 2012;81(2):267–271.
3. Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106(1):106–114.↵
4. The SEDENTEXCT Project. Radiation Protection: Cone Beam CT for Dental and Maxillofacial Radiology: Evidence Based Guidelines 2011 (v2.0 Final). www.sedentexct.eu/files/guidelines_final.pdf. Accessed May 11, 2012.
5. Ludlow JB, Davies-Ludlow LE, White SC. Patient risk related to common dental radiographic examinations: the impact of 2007 International Commission on Radiological Protection recommendations regarding dose calculation. JADA 2008;139(9):1237–1243.
6. Carter L, et al. American Academy of Oral and Maxillofacial Radiology. American Academy of Oral and Maxillofacial Radiology executive opinion statement on performing and interpreting diagnostic cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106(4):561–562.
7. Joint Position Statement of the American Association of Endodontists and the American Academy of Oral and Maxillofacial Radiology. Use of cone-beam computed tomography in endodontics. www.aaomr.org/resource/resmgr/Docs/AAOMR-AAE_postition_paper_CB.pdf. Accessed July 10, 2012.
8. Academy of Osseointegration. 2010 guidelines of the Academy of Osseointegration for the provision of dental implants and associated patient care. Int J Oral Maxillofac Implants 2010;25(3):620–627.
9. Scarfe WC “All that glitters is not gold”: standards for cone-beam computerized tomographic imaging (published online ahead of print Feb. 3, 2011). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111(4):402–408. doi:10.1016/j.tripleo.2011.01.006.
10. National Council on Radiation Protection & Measurements. Radiation Protection in Dentistry (Report No. 145). Bethesda, Md.: NRCP Publications; 2003.
11. American Dental Association; U.S. Department of Health and Human Services. The Selection of Patients for Dental Radiographic Examinations. Chicago: American Dental Association; 2004.www.ada.org/sections/professionalResources/pdfs/topics_radiography_examinations.pdf.
12. National Research Council of The National Academies, Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board of Radiation Effects Research, Division on Earth and Life Studies. 2006. Health Risks From Exposure to Low Levels of Ionizing Radiation: BEIR VII phase 2. Washington: National Academy of Sciences, National Academies Press; 2006.
13. International Commission on Radiological Protection. The 2007 Recommendations of the International Commission on Radiological Protection (publication 103). Ann ICRP 2007;37(2–4):1–332.
14. National Council on Radiation Protection & Measurements. Structural Shielding Design for Medical Imaging Facilities (Report No. 147). Bethesda, Md.: NRCP Publications; 2004.

FDA Warning On Benzocaine Ointments

Benzocaine  Alert

The FDA has recently published a recommendation and warning against the use of Benzocaine topical anesthetic ointments that could result in a rare condition called methemoglobinemia.  Since their original report in 2006 there have been 29 cases of methemoglobinemia reported and of those, 19 were children, 15 were under two years old.

Benzocaine is a local anesthetic and can be found in such over-the-counter (OTC) products as Anbesol, Hurricaine, Orajel, Baby Orajel, and Orabase.

Mothers with babies that are teething may resort to some of these gels or ointments in an effort to soothe their babies gums, but this can result in the rare but almost always fatal condition.

The FDA rec­ommends that parents and care­givers not use benzocaine prod­ucts for children younger than 2 years, except under the advice and supervision of a health care professional.

The symptoms can be confused with other problems, here is a list of the signs of methemoglobinemia:

• pale, gray, or blue-colored skin, lips and nail beds

• shortness of breath

• fatigue

• confusion

• headache

• light-headedness
• rapid heart rate

If your child has any of these symptoms after using benzocaine discontinue using it and call 911.

As an alternative to ointments, you can use a chilled teething ring or gently rub your child’s gums with a clean finger.

Children present a higher risk, but adults can be affected also.

For the original article by the FDA please see the link below:

http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM306069.pdf

FDA advises consumers to:

• store any products containing ben­zocaine out of the reach of children.

• use benzocaine gels and liquids sparingly and only when needed. Do not use them more than 4 times a day.

• read the label to see if benzocaine is an active ingredient when buying OTC products. Labels on OTC prod­ucts containing benzocaine are not currently required to carry warn­ings about the risk of methemoglo­binemia. If you have any concerns, talk to your health care professional before using them.

Carlos Boudet, DDS DICOI
1840 Forest Hill Blvd Suite 204
West Palm Beach, Florida. 33406
Website: http://www.boudetdds.com
Implant Blog: http://www.palm-beach-implants.com

Is there a relationship between oral bacteria and arthritis or failing joints?

Is Oral Bacteria Responsible For Your Failing Joints?

Dentists have been well aware for several decades that patients that have a prosthetic joint need special precautions¹.  A consultation with the orthopedic surgeon usually results in a recommendation for prophylactic coverage with a large dose of an antibiotic taken one hour before the procedure, and only one dose is necessary².

The precautionary antibiotic prior to the procedure is given in order to protect the patient from transient bacteremia (bacteria in the bloodstream) as a result of the instrumentation, since the mouth harbors many bacteria, and these bacteria can travel through the circulatory system and end up in the joints.  The high level of antibiotic present in the bloodstream reduces the chance of seeding the joints (bacteria creating an infection that will cause damage to the joint that could result in prosthetic joint failure).

A similar recommendation for antibiotic prophylaxis has been used for prevention of bacterial endocarditis³ for decades, but anatomy, microorganisms and mechanisms of infection are different.

Also joints with plates, pins and screws do not need antibiotic prophylaxis, only orthopedic hardware that is bathed by synovial fluid is at risk of developing an infection.

Bacteremias can occur during the course of our daily lives, in the presence of acute infections of the oral cavity, gastrointestinal, urogenital and other systems, and may happen during dental and medical procedures such as dental extractions, colonoscopies, and some urologic and endoscopic procedures.

A recent study shows a possible relation between patients with arthritis and failed prosthetic joints and bacteria found in the oral cavity using sophisticated DNA tests⁴.  The authors conclude that patients with arthritis or failed prosthetic joints should be examined for the presence of periodontal disease and given appropriate treatment if necessary.  The results of this article and others like it give support to the increasing evidence of a relationship between oral bacteria in periodontal disease and systemic disease.

It is our responsibility as dentists to make sure that we do not get so involved in the technical and mechanical aspects of our profession that we forget to look at the health status of our patients.

Bibliography:

1 Ching DW, Gould IM, Rennie JA, Gibson PH: Prevention of late haematogenous infection in

major prosthetic joints. J Antimicrob Chemother 1989;23:676-680.

2 Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements. Information statement. http://www.aaos.org/about/papers/advistmt/1033.asp.

3 Guidelines for the prevention of endocarditis with valvular disease. http://circ.ahajournals.org/content/118/8/887.full.pdf.

4  Identification of Oral Bacterial DNA in Synovial Fluid of Patients With Arthritis With Native and Failed Prosthetic Joints. Journal of Clinical Rheumatology: April 2012 - Volume 18 - Issue 3 - p 117–121

doi: 10.1097/RHU.0b013e3182500c95

Carlos Boudet, DDS DICOI
1840 Forest Hill Blvd Suite 204
West Palm Beach, Florida. 33406
Phone: (561) 968 6022
Website: http://www.boudetdds.com
Implant Blog: http://www.palm-beach-implants.com
Spanish Website: http://www.palmbeachdentist.net/

New Article By West Palm Beach Dentist Carlos Boudet

Chairside Magazine, published by Glidewell dental laboratories Recently published an article by West Palm Beach Dentist Dr. Carlos Boudet in their spring 2012 issue on dental photography.
The article is an introduction to a simple system of intraoral photography that dentists can use to document their cases, show patients their work and promote their practice.
Dr. Boudet also talks a little about camera choices, patient positioning and gives some tips for better pictures.
The system uses a sturdy digital camera from Pentax and describes the basic shots needed for documentation.
Here is a link to the article: An Introduction To Dental Photography .
Dr. Boudet still uses the camera described in the article, but since the article was written, new models of the camera have come out, so look for the new models now.

Carlos Boudet, DDS DICOI
1840 Forest Hill Blvd Suite 204
West Palm Beach, Florida. 33406
Phone: (561) 968 6022
Website: http://www.boudetdds.com
Implant Blog: http://www.palm-beach-implants.com
Spanish Website: http://www.palmbeachdentist.net/

The Best Implant Courses In South Florida

The Best Hands On Implant Courses In South Florida

Where can I find a course about dental implants where I can get some experience in treatment planning and placing implants that won’t cost me an arm and a leg?

I get that question from fellow dentists very often, and I am very fortunate to be able to provide them with an answer.

For more than a decade I have been a member of the Atlantic Coast Dental Research Clinic in Palm Beach County, Florida. A non-profit organization started by area dentists over fourty years ago to provide continuing education for it’s member dentists. Today the The Atlantic Coast Dental Research Clinic membership has increased to well over a hundred and allows the dental professional the opportunity to participate in accredited, hands-on courses in modern facilities with state of the art technology located at the Palm Beach State College campus. The goals of the Research Clinic are to provide an opportunity for continuing education of dentists, hygienists and assistants, contribute to the clinical education of the Dental Assisting students enrolled at the college, and to provide low cost dental care for the community.

The twelve dental continuing education courses presently offered give the participants up-to-date, state-of-the-art instruction in practical procedures which will enhance the dentist’s skills and experience in areas such as Periodontics, TMD, Endodontics, Oral surgery, Prosthodontics, Pediatric Dentistry, Orthodontics, Dental Marketing and more, including two participation courses in dental implants.

I have taken almost all the courses and they are great, but let me talk a little about the implant courses since that is an area that I have a special interest in.

The first course is Implants: The Surgical and Prosthetic Management of the Endosseous Root Form Patient. This is a one-year course designed to teach the general dentist how to place and restore implants. Because implants should be treatment planned and placed with the best prosthetic result in mind, the course exposes the dentist to the treatment planning, placement and restoration of endosseous root form implants and does not involve complicated implant placements, sinus lifts, etc….
The course is chaired by Dr. Roy Blake, a prosthodontist with over 25 years of experience and a great teacher.

The second course is Oral Implantology. The Oral Implantology course is a comprehensive three year program consisting of a one year prosthetic and two year surgical residency. There are 21 full days of instruction consisting of a morning didactic seminar and an afternoon clinical session where the general dentist or specialist can gain experience performing surgical or prosthetic procedures on patients. It is patterned after the AAID Maxicourse. This program is also designed to prepare the doctor for AAID, ABOI, and ICOI fellow/diplomate exams.
Also if research interests you, this may be an opportunity to publish a paper as a coauthor in your subject of interest.

These two implant courses will give dentists the chance to get some experience with actual patients in treatment planning and placing implants in a supervised environment, allowing the participating dentist to feel more comfortable implementing these modalities in their own private practice.

Finally, if you want to verify the low cost of these courses, please visit the ACDRC website at: http://www.acdrc.comhttp://www.acdrc.com

As a disclosure I would like to add that I am a member of the board of directors of the Atlantic Coast Dental Rersearch Clinic.


Carlos Boudet, DDS DICOI
1840 Forest Hill Blvd Suite 204
West Palm Beach, Florida. 33406
Phone: (561) 968 6022
Website: http://www.boudetdds.com
Implant Blog: http://www.palm-beach-implants.com
Spanish Website: http://www.palmbeachdentist.net/

Dental X-Rays And Cancer: A New Scare

Dental X-Rays And Cancer: A New “Study”


It hasn’t even been a year since I wrote an article about a statement by Dr. Oz saying that dental x-rays were related to an increase in the incidence of thyroid cancer.

Now a new study is being quoted saying that there is a higher incidence of meningioma, a benign brain tumor, in people that had dental x-rays and the media is running with it.

The study was based on answers to questions in a survey of over a thousand patients with meningioma. One of the questions asked was whether the patients remembered having dental x-rays taken. The implication here is that x-rays can cause cancer.

In my opinion, this type of study should not even be published, since it does not prove anything, and it only serves to fuel concerns in the general public that, although legitimate, they are often fuel for those that take an exaggerated or extremist point of view.

Let me explain why I say that the study is useless as a scientific paper.

The method by which the study was conducted was a survey where the author asked questions to patients diagnosed with meningioma about their recollection of how many dental x-rays they received during their life including childhood. Also what types of x-rays they received. This type of survey is prone to a tendency of overreporting by the participant. Take my office as an example. I routinely ask a new patient if they had recent x-rays done at another office to avoid unnecessary exposure to radiation and they typically say they had a full series of x-rays, but when we request them, it turns out that they only had two or four bitewings taken.

The study also says that the risk of meningioma rises 3 times more with panoramic x-rays compared to bitewings, but in the same article the author states that panoramic equipment and digital x-rays in use today (which significantly reduce the amount of radiation exposure to the patient) were not available for the participants of the study.

Please watch a news report about the study below:











The reporter correctly describes some of the faults in the reasoning behind the study such as asking persons to recollect the types of x-rays in childhood, getting data from memory and not dental records, subjects exposed to radiation from equipment from 30 years ago. I should add that a the author of the study (I read it!) admits that most data on radiation exposure she found was from exposure to nuclear blasts(atomic bomb) and radiation therapy for cancer, both of which are so much higher than the levels of exposure for diagnostic x-rays that it is ridiculous to even mention it.

I could understand the reason to conduct a study for persons exposed to CT scans of the head and neck, as this exposes them to a higher dosage of radiation and includes the brain, but the study does not involve CT scans, instead it focuses on bitewing x-rays that we as dentists rely on to diagnose cavities. These small x-rays are highly collimated (the beam is focused to a small circle in your mouth) and does not expose the brain or tissues around it to any levels of radiation worth worrying about.

As a dentist, I cannot overemphasize the importance of taking periodic x-rays to detect caries. Those small bitewing films allow me to find decay when it is small and has not damaged the tooth to the point where there is pain or other signs. What this means to the patient is that I can fix the tooth before it reaches the point where they may need more extensive work such as a root canal or a crown.

I should also mention that while reading the x-rays for a "routine" initial examination for my patients, I have discovered cancer in the mouth that the patient was never aware of because it was small and in doing so was able to help the patient avoid the radical disfiguring surgery that would have been needed it the tumor had been allowed to grow. Maybe even saved his life...

I try to be optimistic in my thinking and I think that something good can always be found in everything. This publicity should make us (dentists) more aware of the need to tailoring our treatment to the individual patient and not tend to fall in a routine that may lead to unnecessary exposure to radiation. Dentists should use their judgement in determining how often x-rays need to be taken, as dental conditions are different for every person, and recommend these radiographs only as necessary for diagnosis and treatment of their patients.

West Palm Beach Dentist
Carlos Boudet, DDS DICOI

Website: http://www.boudetdds.com/
Implants Blog: http://www.palm-beach-implants.com/
Spanish Website: http://www.palmbeachdentist.net/

Bibliography:
1. Radiation exposure and dose evaluation in intraoral dental radiology. Radiat Prot Dosimetry (February 2007) 123(2): 262-267 first published online September 13, 2006.
2.American Cancer Society Guidelines for the Early Detection of Cancer. http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.
3.Ionizing radiation exposure. http://fwbmc.com/your-health/index.dot?id=642484&lang=English&db=hlt&ebscoType=healthindex&widgetTitle=EBSCO%20Health%20Library%20Index.
4. Imaging (Radiology) Tests. http://www.cancer.org/acs/groups/cid/documents/webco ntent/003177-pdf.pdf

National Cancer Control Month

April is National Cancer Control Month

Dentists have always taken an important role in early cancer detection, since they are more likaly to see their patients more often than the physician.
In order to increase awarenes of the importance of early detection of cancer, I have written an article in VOXXI, an internet based newspaper/blog site.
Here is a copy of the article:


As general dentists we see patients that are healthy, feel fine and may not go to see their physician unless they get sick. Many individuals do not realize the importance of regular visits to the dentist to help them stay healthy.

One of the many services or added benefits that our office provides is oral cancer screening. As part of our initial and periodic exams, you may notice that Dr Boudet palpates your neck, looks at your throat, at the sides and under your tongue, and many other areas of your mouth that are not just the teeth.

As a Dentist in West palm beach , Dr Carlos Boudet has been providing these services to the community for almost three decades now and in that time has been able to keep his patients healthy by detecting many lesions that would have gone undetected and untreated, resulting in more severe problems for the patient.

Cancer awarenes month was created to make individuals aware of the benefits of early detection. Dentists are in a position that allows them to detect oral cancer lesions early and this makes a big difference in the treatment of oral cancer. Some oral cancer is very agressive and if not detected early can result in damage that can leave the patient disfigured and totally change his quality of life. The same cancer detected early can prevent those disfiguring surgeries and make a tremendous difference in the life of a person.

The most common causes of oral cancer were listed as tobacco and alcohol, but recent research has found a link between the human papilloma virus (HPV) and cancer. The papilloma virus is a virus that produces papillomas or "warts" in squamous epithelial cells that cover the surfaces of many areas of the body, such as the inside of the mouth. Most papilloma viruses produce the benign warts, but there are several of these viruses that are "high risk" because they produce the pre-cancerous and cancerous lesions. The cancerous warts cannot be distinguished from the benign ones by simple visual observation, and the dentist needs to remove the lesion and send it to a pathology laboratory to be looked at under the microscope. A trained pathologist then makes the final diagnosis.

As part of the of modern technology that we have incorporated in our office, we can now detect and remove these lesions with the use of the dental laser in a manner that is most comfortable for the patient. the removal is done without a scalpel, does not need sutures or stitches and results in faster, more comfortable healing for the patient.

Scientists working in biological research have developed two vaccines for the most common cancer producing human papilloma viruses. You may want to go to the american cancer society website if you would like to read about the proposed guidelines for recommending and administering the vaccines. They also have information about the individuals at a higher risk, the cost of the vaccine, insurance coverage and how it is administered.

Yours for healthy living,

West Palm Beach Dentist
Carlos Boudet, DDS

West Palm Beach Dentist Does Porcelain Crowns In One Day

Dr. Carlos Boudet, a West Palm Beach Dentist has been using the latest Cad/Cam technology for several years now to fabricate porcelain crowns in one day.

The Cad/Cam technology that he uses is not new.  It has been available for over a decade, but due to the high cost of the equipment needed to produce these crowns, few dentist are willing to invest in the technology.

Normally crowns have to be made in the laboratory, a process that takes about two weeks and requires the patient to wear a temporary that could loosen or fall out and would require a second visit to remove the temporary, try the new crown and if all goes well, cement it.

Dr. Carlos Boudet also does porcelain crowns in the laboratory for special cases that require it, but for those that want the convenience of not having to take time to schedule a second appointment having their porcelain crowns done in one day is great service.

The equipment that Cosmetic Dentist Carlos Boudet uses is Cerec from Sirona, which was the  first cad cam system to be designed for dentists.  With more than a decade of research and improvements, it is the system with the most experience and best track record in the market.

The way the system works is this:
The dentist prepares the tooth or teeth the same way, but instead of taking an impression with a paste inside a tray, a small camera takes a digital impression and transmits it to the computer, where the dentist designs the crown for the patient.  Once the design is done, it is sent wirelessly to a milling machine that uses diamond bits to carve the crown out of a solid block of porcelain.  Then when the crown is finished and polished, the dentist bonds it in place in the mouth and the whole procedure is done in one visit.

As a general dentist Dr. Boudet provides a variety of services for his patients such as dental implants with many years of experience both placing and restoring dental implants with great success.  Dr. Boudet also provides orthodontic services including Invisalign clear aligners and laser dentistry that increases the comfort and speeds healing in many cases where surgery would be needed.

Dr. Boudet has been providing caring expert dental care for his patients since 1983 in the area of West Palm Beach and adjacent communities such as Palm Beach, Palm Springs, Wellington, Lake Worth, Royal Palm Beach and surrounding areas.

West Palm Beach Dentist
Carlos Boudet, DDS, DICOI
1840 Forest Hill Blvd, Suite 204
West Palm Beach, Florida  33406
Phone: (561) 968 6022

 Website: http://www.boudetdds.com
Implant Blog: http://www.palm-beach-implants.com

New Article By West Palm Beach Dentist Carlos Boudet, DDS

Inside Dentistry is one of the leading monthly magazines for dentists with one of the widest circulation in the United States.  The magazine has published an article by Dr. Boudet on "The Mandibular Bar Overdenture" in the April 2012 issue.  The article describes the details of this well accepted dental procedure from treatment planning to completion including references from the dental literature.
The mandibular overdenture is indicated to correct or eliminate a loose lower denture.  It helps the patient bite comfortably in cases where the lower denture is loose, uncomfortable or unstable.
If you would like to see the article please follow this link:
http://www.dentalaegis.com/id/2012/04/the-mandibular-bar-overdenture
For a link to other articles published by Dr. Boudet, please click here:
http://www.boudetdds.com/articles.htm
Thanks for reading our blog.

Carlos Boudet, DDS, DICOI


Website: http://www.boudetdds.com/
Implants Blog: http://www.palm-beach-implants.com/
Spanish Website: http://www.palmbeachdentist.net/

Technology in Dentistry

Recently I watched a presentation by marketing experts in Dentaltown that listed some of the things that new patients look for when they are selecting a dentist, and I was happy to see that one of the things they look for is whether the dentist is up to date and offers the latest technology in his office.
I don't consider miself a "gadget" person. I evaluate carefully the benefits that any particular technology or "gadget" offers and whether it is of value for me to offer it to my patients.  I don't sell "dentist recommended" electric toothbrushes, pharmaceuticals, etc... and the items I dispense I consider important and necessary for succesful surgical outcomes.
But over the years I have invested in pieces of equipment that are considered advanced technology (quite expensive also, since only a small fraction of dental offices have them) and I do dot consider them "gadgets".  Let me explain some of the benefits of some of these.
The "All Tissue Laser" :  The laser is one of those pieces of equipment that dentists say "there is nothing that I can do with a laser that I could not do with the equipment I already have".  And those dentists would be wrong.  It is true that you can do many of the same things with existing equipment, but there are procedures that are done best with the laser, such as debriding and detoxifying the surface of an infected implant, and closed (no surgical flap) osseous crown lengthening in the anterior region for more comfort and quicker. healing. These are things that you can do in other ways with existing equipment, but I argue that not as well.
Another piece of equipment that has changed dentistry tremendously is the Cad/Cam technology that allows me to offer a patient a beautiful porcelain crown designed and fabricated in my office in an average of a couple of hours, eliminating the need for impressions that sometimes elicit a gagging reflex, eliminating temporaries that may loosen and come out and avoiding the need for a second visit to cement the crown.
Sure, you can get the same crown made in the laboratory and put up with the conventional impression and the temporary and then wait two weeks to spend more time at the dentist for a second appointment, but, I believe that in the not fo far away future all dentists will have to have cad/cam systems in their office.
I could go on, but you get the point.
If you are searching for an experienced, gentle, technologically advanced dentist in West Palm Beach, please visit my website and look no further.
Sincerely,

Carlos Boudet, DDS, DICOI
Website: http://www.boudetdds.com/
Implants Blog: http://www.palm-beach-implants.com/
Spanish Website: http://www.palmbeachdentist.net/