Dr. Nick has provided personalized dental care to thousands of families. Our patients come from near and far to experience the warm, individualized care we provide. We pride ourselves in utilizing the most modern equipment and methods available.
Advanced Technology used by Dr. nick includes the following:
- Complete Digital Dentistry
- CEREC® CAD/CAM
- TMJ MRI & CT Imaging
- Air Abrasion
- 3-D and 2-D Digital X-Rays
- Imaging Using Intraoral Cameras
- Microscope Dentistry
Complete Digital Dentistry
The advantages to the patient are enormous in the digitized dental practice. Modern dental practice management software programs are amazingly complex. Emails and/or text messaging reminders of your appointment, instantaneous encrypted transmission of x-rays and other information to referring specialists and vice versa, storage of all clinical notes ready for instant recall, x-rays and 3-D imaging integrated to compare instantly with other relevant clinical data, tracking images of the teeth or oral pathology over time, archiving digital bite analysis and EMG over time for future comparison, imaging the anatomy of a particular tooth to recall should damage and prosthetic replication ever need to occur, using MRI to track the health of the TMJ disks, for diagnosis, or for predicting treatment efficacy; the list is endless.
Dental practice management software and 2-D digital x-rays.
Force/time data left, concurrent muscular activity right, slaved to each other in 3/1,000 of a second increments. A permanent and precise snapshot of that patients bite in time, forever part of that patient’s digital dental record.
A digital collage of the kinds of data that we look at daily in the digital patient record.
Paper charts, written notes, chemically processed x-rays; these were the standard when I first started my solo practice in 1995. Slow, analog, archaic, fraught with error-this is what I remember about the “olden days”. Comparing the paper chart to the digital chart is akin to comparing an old typewriter to a word processing program like Microsoft Word!
Today, it is a different story. What are the two biggest advantages for this paperless integration in a dental practice for the patient? Efficiency coupled with predictability, so that you can receive the best possible care in the shortest amount of time so that you may return to doing what you do best, whatever that might be (aside from waiting around for your dental work)! Rest assured that your personal, medical, financial and dental histories are safe with us. Our encryption algorithms on our servers are state of the art and we never transfer data of any kind without your written permission.
Welcome to the future of dental medicine!
In order to provide nothing but the best to our patients, our office uses state-of-the-art technologies in all of our procedures. These new technologies allow us to detect dental concerns at the earliest stages, treat your dental issues with precision, and provide stunning and customized restorations which mesh both esthetically and functionally for your particular case. When you visit our office, you can be confident that you are receiving the finest and most advanced dental care available. A flagship example of one of these technologies follows:
This dental CAD/CAM technology allows the creation of high quality all-ceramic crowns, veneers, inlays and onlays ON-SITE the SAME DAY by Dr. Nick. Normally, such restorations take at least 2 weeks to be made in a dental laboratory and at least 2 visits to reach the office before the permanent prosthesis is put in place. With CAD/CAM, a special digital camera is used to take a picture of the tooth in need of repair, and then computer software is used to design the restoration from the picture. Diamonds in a milling chamber carve the restoration out of a solid ceramic block of a color and size that matches your tooth, and then Dr. Nick customizes the final result by applying stains and then a glazing material which are both subsequently permanently fused to the restoration in a high temperature glazing oven. The final restoration is then bonded to the tooth with tooth colored materials and matches beautifully! Dr. Nick is an expert in CAD/CAM Technology. He has written a book which you can view here for more information:
Advantages of CAD/CAM to the patient:
Single visit procedure: no need to take a 2nd or 3rd day off of work or school. 1 visit is all it takes, typically 90 minutes per tooth, only ~15 of which is spent in your mouth. The rest of the time you are relaxing, or watching us create your tooth in the virtual world and then subsequently in the real world…
Dr. Nick and you are in complete control of the final result, because the crown or veneer is designed beside you with the computer software, Dr. Nick has complete control over how it will look and fit, whereas laboratory made restorations are made by a technician who has never seen the patient. In addition, tiny improvements that mean a world of difference as to the fit of the final result can be made instantly since the patient is still present!
No temporary restorations: Ever have a crown or veneer done the normal way? Chances were it was lose, leaky, sensitive, looked off, tasted badly, etc. Not any more with CAD/CAM.
Only one set of local anesthetic injections: Remember, it’s all done in one visit…!
VERY accurate seal means less sensitivity: CAD/CAM restorations are typically accurate to within 50 microns, which is 5/100 of a millimeter. A good laboratory crown can achieve a similar fit ONLY IF the mold was accurate and did not distort. Remember, there is no impression or mold or outside laboratory with CAD/CAM.
Chairside customization: All CAD/CAM’s in this practice are stained and glazed in the office to beautify and increase their strength.
No gray edges at the gum line: because there is no metal in these restorations, there is no metal to show through along the edge of the crown at the gum line.
Far less breakage: As of April 2015, our practice has created over 7,000 CAD/CAM restorations, with only 4 fractured restorations over our 10 years of providing this amazing service.
Teeth that are often not restorable with a crown in a normal dental practice can sometimes be saved; as long as you have some enamel on your tooth, we can almost flat-top the tooth and expect success with a bonded all-ceramic CAD/CAM crown…
Beautiful porcelain veneers on front teeth can be created the same day: Wow! Not possible otherwise. Not to mention the subtle nuances associated with the looks and shapes of your front teeth that can be tweaked while you watch, interjecting your own input along the way!
No nasty molds of your teeth: instead, a picture is taken…
More conservative onlays and Inlays can be created that very day for your tooth: A dentist without CAD/CAM is bound to prescribe a crown to fix a broken tooth because it is less likely that your temporary will fall off when more natural tooth structure is removed. A crown removes far more tooth structure than does an onlay for example. Common sense dictates, the less of mother nature removed in a surgery, the better. An onlay or inlay is preferable to a crown as less tooth structure is removed to resolve the problem. Dr. Nick always removes the least amount of nature possible in a given situation.
CAD/CAM restorations have no metal, only porcelain X-rays can visualize underneath the all-porcelain CAD/CAM restoration: Most lab crowns have metal underneath. X-rays cannot penetrate metal.CAD/CAM restorations have no metal, only porcelain, and X-rays do penetrate porcelain. This allows your dentist to more readily catch a problem underneath your porcelain restoration over time.
Getting the bite right! Since we are creating the restoration(s) on-site using ultra-accurate digital imaging rather than molds, control of the occlusion (the bite) is far more accurate. This is extremely important because bite issues can readily lead to sensitivity, trouble chewing, a subsequently broken restoration, headaches, and even “TMJ” problems over time.
When do we not use CAD/CAM?
When what little is left of the tooth is black-looking because of an old root canal: Since these CAD/CAM restorations are all-porcelain and translucent, the darkness can show-through. In this circumstance, we might need to send off for a laboratory-made restoration that has an opaque substructure which will definitively hide the darkness underneath.
Fillings without a drill? Fotona Dental Laser & Air Abrasion technology in minimally invasive dental medicine
Air Abrasion. No More Drill? I’m thrilled!
Many people fear the sound of the dental drill (technically called a handpiece) when they visit the dentist. These drills are used to remove cavities, old fillings, prepare teeth for crowns, veneers, etc. What if I told you that there exists technologies that typically circumvent the whining drill to accomplish many filling procedures? We use two such technologies: A hard tissue Fotana dental laser, and air abrasion. Both of these techs are used in our practice daily to “poof away” decay, typically without the need for numbing or a drill!
Air abrasion is basically a tiny little wand that propels minuscule particles of a substance known as aluminum oxide (27 microns in diameter; 27/1,000 of a millimeter wide) under high pressure. These particles use kinetic energy rather than mechanical energy (as does a bur spun by a drill does) to gently “blast away” small cavities. The neatest thing of all is that many smaller cavities can be removed painlessly with no local anesthetic! This is possible because the particles generate very little friction when they gently remove the decayed tooth structure. Burs, on the other hand, generate huge amounts of friction, which heats up tooth structure. This is why local anesthetic is usually required when a conventional drill and bur are used. Less friction with air abrasion spells no pain and no anesthetic injections the majority of the time!
Air abrasion technology being used to gently “puff away” a small cavity of a permanent molar tooth. Kinetic rather than mechanical energy is utilized to remove the problem, usually without the need for anesthesia or a drill.
Air abrasion is akin to a sandblaster. If you have ever watched someone sandblasting wood or stone, you have observed that there is no cracking along the perimeter of the cut. This is possible due to the kinetic energy produced by the sandblaster, which generates much less friction, than does a drill with a bur. The normal drill and bur are akin to an electric drill and a screw. Have you ever carefully watched an electric drill sink a screw into a piece of wood? Numerous cracks radiate out from the center of the hole, which the screw is creating as it is drilled into place. This can readily happen when burs cut teeth. They tend to create small cracks outward from the center, which can turn into problems for the tooth over the years as the cracks tend to weaken what is left of the tooth, making them more prone to leakage and fracture.
Air abrasion is typically used to remove small cavities. Anything medium to large generally does require the use of the dental handpiece (drill) and the burs, as the softer, larger cavities are not amenable to removal via the tiny particles under pressure. Many times however, Dr. Nick will use air abrasion to at least start the entry into the cavity before commencing with use of the bur, to mitigate the potential damage that the bur might make from the initial penetration into the tooth structure.
White or composite fillings are bonded into the very small and conservative holes generated via the air abrasion process. This bonding process is typically painless and only takes a few minutes.
Advantages of the Fotana Hard Tissue Laser & Air Abrasion:
- Allows us to treat multiple areas of the mouth in the same visit since little to no anesthesia is required
- Greatly reduces the need for anesthesia for fillings/the vast majority of time no shot is needed!
- No pressure, sound, heat or vibration is generated
- Minimally invasive; less tooth structure is removed than with normal conventional drilling
- Reduces chipping and micro-fracturing of tooth structure, preserving more healthy tooth structure
- Can remove old composite white fillings, typically without any anesthesia
Disadvantages of the Fotana Laser & Air Abrasion:
- Will not remove old silver amalgam fillings
- Will not remove metal or porcelain crowns
- FOTANA and Air Abrasion will not prepare crowns, veneers, or bridges; we need a drill for these procedures
The Fotana and Air abrasion technologies are particularly well suited for patients who have new cavities on baby or permanent teeth, and the process is typically far more conservative and minimally invasive in comparison to the usage of the traditional dental drill. A dental patient who religiously sees Dr. Nick for regular checkups and presents with new decay is a prime candidate for this sort of painless and minimally invasive cavity restoration. In addition, the metal-free white fillings that are placed in these cavities tend to outlast the more invasive, larger fillings necessary after the use of the drill. This is due to the smaller surface area of filling being exposed to the rigors of chewing over time.
Do all dentists use the Fotona Dental Lasers or Air Abrasion in their practices? No, but they should! As a matter of fact, Dr. Nick owns two of both the very costly Dual-Wavelength Fotona Lasers and Air Abrasion units, they are used so much!
3-D and 2-D X-Rays.
At Dr. Nick’s practice, long gone are the days when chemical processors and relatively high dosage X-ray arms are used to image the tissues of the oral cavity. Instead, low radiation, handheld digital Nomad’s® are used as the operator stays in the room with the patient as the x-ray images are exposed against a small digital sensor.
Resultant of this, a much quicker and convenient workflow for radiographic imaging is involved. These 2-D digital x-rays are used for normal tooth and bony tissue imaging typically needed for diagnostic reasons, including assisting in the identification of cavities between the teeth, abscessed tooth roots, faulty dental work, and bone levels as they relate to periodontal/gum disease.
2-D panoramic x-ray imaging
A quick low radiation screening of both jaws, the tooth roots, the TMJ’s, the sinuses and other hard tissue components of the head and neck. Often used to help with orthodontic diagnosis, simpler wisdom tooth issues, and a generalized screening of any missing or extra teeth in the pediatric dental patient, this type of film is typically indicated in younger patients.
This amazing in-office technology allows Dr. Nick to visualize, in 3 dimensions, any hard tissue within the digital CBCT sensors range, including bone, teeth, roots, sinuses, etc. Used as needed to image difficult cases related to: impacted wisdom teeth, the TMJ’s and their associated structures, root canal issues that evade visualization per normal 2-D imaging modalities, future dental implant treatment planning, and any confirmation of aberrant pathology that is detected per history, exam, or preliminary 2-D imaging. Modern CBCT is a greatly reduced version (in regards to radiation exposure) of medical CT, in that the physics and technology used to generate the image is much simpler than the medical CT imaging counterparts. For instance, Dr. Nick uses this modality routinely to study the temporomandibular joints in his “TMJ” patients. Within the 3-D image, Dr. Nick can have an undistorted view of any hard tissue, with the added ability of being able to virtually measure and manipulate the placement of potential implant placement. Imagine a non-surgical confirmation that there is enough room in the bone for a dental implant “screw”, which clears potentially dangerous and problematic anatomical structures such as the sinuses, arteries and nerves of relevance.
3-D MRI soft tissue imaging
There are times when diagnosis of a “TMJ” patient requires imaging of the soft tissue cartilage within the temporamandibular joints to definitively diagnose a given TMJ patient’s problem(s). These cases are referred out to an imaging center and involve a radiologist’s interpretation before Dr. Nick can combine the MRI soft tissue results with the CBCT hard tissue results. Dr. Nick has been personally trained by one of the world’s experts in maxillofacial radiology and TMJ surgery, Dr. Mark Piper, in regards to 3-D imaging interpretation of the TMJ’s. Dr. Nick and Dr. Piper frequently lecture together regarding bite and TMD issues in various conferences and universities, and each own and participate in each others respective teaching institutions, Dr. Nick’s Center for Neural Occlusion, and Dr. Piper’s Piper Education and Research Center. Quite simply, usage of the MRI is the missing link in the practice of dental medicine!!
T-Scan, EMG, and JVA. The importance of bite relation (occlusal analysis) cannot be over-emphasized in the dental practice setting. The placement of fillings, crowns, bridges, bruxism splints, implants, veneers, onlays, inlays, dentures; just about anything we do in dentistry demands a proper spatial relationship between the temporomandibular joints (TMJ’s) and the oral cavity, not to mention a proper relationship between the maxilla and the mandible. Ignorance to the occlusion, or bite, can create havoc for the patient, creating problems ranging from sensitive teeth to root canal therapy to headaches to temporomandibular disorder (TMD). Traditionally, a colored ribbon of paper known as articulating paper is used to allow the dentist to check the bite. The use of this thin paper is problematic though, as it only qualifies where the bite is “high”, doing nothing to quantify/show how much or how hard…
Please note the PINK spike on the computerized 3D rendering of this patients initial bite, signifying that her bite is heavy towards the front. After Dr. Nick adjusted her bite, another digital occlusal analysis was recorded.
Notice the distinct improvement in the stability of this patient’s bite as a result of the use of the T-Scan (R), as signified by the even distribution of force/time spikes and the loss of the pink “high spot” on the 3D graph .
The T-Scan® digital occlusal analysis is used in Dr. Nick’s office as needed to augment treatment relating to CEREC insertions, fillings, implant restorations, and in particular, to assist in the implementation of Occlusal Adjustments in relation to TMJ disorders.
Joint vibration analysis is a painless, digital screening tool to measure the health of the TMJ’s. It resembles a headset that is placed over the patients temporomandibular joints that “listens” for vibrations that might be emanating from the joints, which are characteristic of joint pathology, or lack thereof. These vibrations can be correlated against known vibrations to give Dr. Nick an assessment of the state of health of that patient’s given TMJ that is up to ~90% accurate, in minutes! The JVA is the “poor man’s MRI” in that it gives us a rapid screening of the health of the important soft tissue cartilaginous TMJ disks. Short of an expensive MRI, this is the next best way of evaluating the disks. Dr. Nick uses the JVA on all of his patients at checkups and exams to track this important indicator of dental health, the TMJ disks.
Electromyography is a tool that Dr. Nick uses to measure muscular activity in the chewing muscles when indicated. Surface electrodes are placed over the target muscles and the tiny little currents that muscles create are measured, allowing us to analyze chewing sequences and patterns, just like neurologists and researchers do! This is a totally painless and safe procedure.
Tscan technology synchs with EMG (muscle electromyography) technology down to the microsecond enabling Dr. Nick to measure instantaneously changes in muscular output relative to miniscule changes in the bite. This combination of technologies is the ultimate TMD treatment aid when the cause of the “TMJ” problem is muscular in origin, which it usually is…
So what is DTR and ICAGD?
These are treatments for muscular TMD issues that DO NOT rely on traditional splints and acrylic appliances. These treatments are a new, more definitive way of addressing TMD issues by creating a permanent physiological change, rather than the temporary change that splint appliances create. Dr. Nick rarely makes acrylic splints that the vast majority of dentists do, but rather relies upon the following two protocols, when indicated, for muscular based TMD issues.
DTR stands for Disclusion Time Reduction. This is the process whereby “interferences” or “speed bumps” in the way the back teeth from the top jaw interact with the opposing teeth from the lower jaw are precisely removed with data gleaned from the Tscan/EMG link. This process decreases muscular output, relaxing the muscles of mastication, which typically alleviates many TMD symptoms. Dr. Nick was personally trained by the creator of this new process, Dr. Robert Kerstein of Tufts University, many years ago and is considered an expert in this process. Dr. Nick in 2015 published a chapter in a first edition dental textbook relating to novel, research-based usage of the T-Scan® and related technologies, and presented the pathology known as Frictional Dental Hypersensitivity (FDH) to the dental profession (Yiannios, DDS, Nick. “Occlusal Considerations in the Hypersensitive Dentition.” In Handbook of Research on Computerized Occlusal Analysis Technology Applications in Dental Medicine, ed. Robert B. Kerstein, DMD, 358-428 (2015)). Dr. Nick is also a beta tester for Tekscan, the company that created the Tscan® technology.
ICAGD stands for Immediate Complete Anterior Guidance Development. Basically, the human chewing system is more efficient the faster the back teeth separate when chewing side to side, as we all naturally do. Hence our front teeth should cause a separation QUICKLY (via measurement w/ the Tscan or Tscan/EMG link) of our back teeth based on known values. Sometimes bonding materials are added to front teeth to help assist in a more “immediate” separation than the patient can based on the shape, condition, or position of their natural dentition. This creates huge advantages for TMD sufferers because the muscles of mastication are made more efficient and do not produce excess lactic acid as a result of being overworked and chronically fatigued. It is this excess lactic acid buildup that at least partially creates many TMD symptoms, such as tension headaches, painful and stiff jaw muscles, neck tension, clenching and grinding of teeth, etc. ICAGD is not a mainstream treatment as of 2015, so this is not something that you can find in just any dental practice. In just the past year, there are a growing number of TMD experts who are beginning to see the advantages and effectiveness of this process. Dr. Nick expects that over the next 20 years this will become more practiced and available, but presently, his practice is one of the only places where a patient can have this therapy done. From his experience with this process dating back to 2008, it simply changes the lives of muscular TMD sufferers almost every time!
So what is Neural Occlusion? Neural Occlusion is a novel TMD screening protocol that Dr. Nick created to help him decide whether or not a particular TMD patient might predictably benefit from ICAGD Occlusal Adjustment to accomplish DTR. It involves a combination of numerous technologies (CT, JVA, EMG, TScan®, and MRI) combined with a thorough history, examination, and FDH screening. As of July 2017, there is no other place that a TMD patient might go for this particular type of screening. Dozens of video examples of the Neural Occlusion protocol and DTR via the ICAGD occlusal adjustment process may be found on the practices YouTube homepage:
The Isolite®-a MUST for modern dental treatments! What is so important about a soft, plastic block that creates a vacuum, pours oodles of fiberoptic light upon the operative field for better visualization, and comfortably fits in your mouth during dental treatment? Modern dental materials are typically tooth-colored porcelains or composites (white fillings), and they both share one characteristic: they require a dry field for optimum fusion/bonding to tooth structure. Even the humidity in ones breath can compromise this dry field requirement, let alone any saliva that might enter the procedural field. Enter the Isolite®, a single use, disposable, fiber optically lit, dry field technology that helps to ensure predictable modern restorative dental treatment. The vacuum (which envelopes an entire half of the mouth) also expedites dental treatment by keeping the cheeks and tongue out of the way, so that the dentist can accomplish more treatment per unit time so that the patient spends less time in the dental practice. Additionally, when old mercury amalgam fillings are removed in the course of dental treatment, the vacuum theoretically helps serve to protect both the patient and dental personnel from the toxic mercury vapors created upon its removal since the powerful vacuum envelopes the entire perimeter of the tooth being worked on.
Dr. Nick uses this technology on just about every patient. This includes the placement of white/composite fillings, CEREC® CAD/CAM porcelain crowns and veneers, air abrasion procedures, dental implant placements, oral surgical procedures; just about everything he does. The advantages to the patient are tremendous: safety, predictability, comfort, and better visualization. Though this single use technology is quite expensive, Dr. Nick will not perform his dental work without it for two main reasons:
1) he wants everyone protected
2) he wants his work to last!
Step into the future of dentistry!