Hi and welcome to Dentistry 101. Today we have the pleasure to have Dr. Gisele Neiva talking about Digital Dentistry. Dr. Neiva, it is a Clinical Associate Professor at the University of Michigan School of Dentistry and she's the Director of the Graduate and Restorative Dentistry program. So, Dr. Neiva, it is a pleasure to have you here. Thank you. My pleasure is to be here. Thank you. Okay. So, we just saw a small video about your program and can you really describe a little bit better about what's with the video and the technology involved in that video? Sure. So, what you saw in the video was basically demonstration of different types of equipment that we use pretty much day-to-day for clinical care. Basically, they are scanners. So, then we capture the intra oral geometry of teeth or how teeth can be modified. Then that information goes to a computer program that has the capability of not only digitize that information but also, play with that information or distort it or morph it, so, as to best fit the future. Inform the future crowd for their patients. So, we use that pretty much every day to farm restorations and we have the capability of delivering them on the same day. So, the technology that you saw on the video are pretty much what we use in the program. In the Graduate program. Okay. How did that technology change your day-by-day work? Okay. Definitely, when we decided to make that decision and to incorporate technology into teaching and into clinical dentistry, we wanted to make sure the technology was going to help us expedite things, make things more efficient, and more precise and better. So, that's what we've been able to accomplish. So, it was definitely a learning curve. Every time introducing something new, obviously, there is resistance from the staff and the faculty that don't quite dominate the technology. The students always jumping at it because it's new and they almost are learning these days with these abilities were exposed so much. It definitely didn't come in to make things more complicated but rather simplify our day-to-day operations. The whole process and workflow for restoration for the patients. Okay. This new technology or this emerging technology, how did it change the patient perspective itself? Okay. So, we're very fortunate to have a group of patients that seemed to be very intrigued by it. So, there is no resistance whatsoever. If you imagine if anything when you ask anybody any lay person about the dentistry, most people really don't have good experience. They relate experience such as goopy impressions, temporaries they fall off, and the teeth are sensitive. So, these technologies they eliminate all of that because instead of a goopy impression material that you have to almost choke on, you have a slim digital camera that rapidly capture the image. Then there is no need for a temporary. So, that artificial piece of material that is placed in your mouth and not always fit exactly how it's supposed to, and sometimes gets dislodged. So, there is no need of that because reservations after they're scanned they are digitized and the information is sent then to subtractive mail. You mail them in-house, takes about only four to five minutes. Then we adapt it to the tooth and do any final adjustments and submit. So, the patient walks out of the door in an hour and a half with the final product. So, none of the goopy impression, none of the temporary they may fall off in a parking lot. So, in the last thing that we've been successful in recording and actually even publishing about how this restoration actually cause these teeth not to be as insensitive because I guess the two structures then is exposed to saliva, to bacteria. So, they're sewed in the same day. So, those are the aspects of the patients tend to observe and appreciate very much. Okay. Besides that technology we saw in the video which other emerging technologies can you show us or discuss with us? So, this is a very volatile field. Think about how often do you update your phone? Very often. That's right. So, things are changing every other week, every other day. There's new inventions coming down the pike faster than it can't even catch up with but the trends are- We know there is common use of digital 3D printers for multiple applications. We don't so much use that for dentistry quite yet. It's not because the digital printers are not developed. It is because the dental materials are not to the quality that can withstand oral environment. So, I feel like the research in this field is going to go towards developing the materials that will withstand into oral environment, and the printers are going to become more accurate and precise. There's also in my bucket list there's always a wish as a dentist that we get the capability of reading of what happens underneath the tissue. So, I know that there are some talks about this, and technologies that can see through without exposing patients to radiation. So, there is an inordinate amount of different lines that have been developed, and are in developing stages for that respect. It's all very interesting and also that the University of Michigan, the School of Dentistry is one of the top research institutions in the country and we value a lot research. So, my question to you is really how these new emerging technology will impact the clinical research? So, the impact has started some years ago and is going to continue. It's basically because once you incorporate these different workflows, there's always areas that can be improved and expedited. There are so many steps along the way, they can be perfected. At the end of the road, what we've been doing for most of the time is materials testing. So, there's a limited number of high-strength ceramics, that are fabricated for this kind of application, so they come in monolithic blocks of ceramic, that's centered in an industrial process. There is a variety of different sources of material. So, it could be zirconia base, plastics, composites. Each one of them handles differently, mills at a different pace. So, the algorithms learnt are going to be perfected in optimizing. Also, the clinical handling of the ceramics versus the composites are different. So, there's so much that can be done, because when these materials were introduced, it didn't come along in a kit. You use this material with this finishing, and this is the result you get. So, we're still having to experiment with different things as far as trying to come up with the best final result, not only for the looks of it, but also for the fit. So, I think for the efforts that we have placed in Michigan for our clinical studies, have been into fit and accuracy of using these technologies for patient care. Okay, very interesting. With all of this technology, do you think the relationship between the dentist and the patient is becoming more impersonal? Interesting that you asked that, because my personal experience is quite the opposite. What I've learned with these technologies, is that in the process of fabricating them, usually the dentist can't interact much with the patient, because patient has their mouth open the whole time, so they can't say much. But with this use of these digital scanners, there is about a 20 minute period in between where the restoration is being morphed and calculated on the screen, and we're adjusting it to fit the patient's dentition, where there's room for conversations. I often ask my patients, "Do you want to go to the cafe, do you want to just sit in the waiting room?" The patients usually say, "No, I want to watch what you're doing." Like, "Oh, okay. Then what did you to do last week?" The next thing you know, "How's your family?" The types of things that we don't do anymore. We used to do in dentistry and got completely dissolved in the business of a day. This forces us to have that 20 minute interaction, where the patient is usually very pleasant and very positive. The assistants contribute, the doctors on the other side comes like, "What are you guys doing here, it seems like you're just chatting here?" So, it becomes a very interesting way of bonding with the patients. So, I actually have the opposite in experience with that. Okay. I think many of our listeners will be people that are interested in the dental profession. I guess they would like to listen from you, what really motivated you to become a dentist. I'd like to give you the answer you're expecting, but it's not because of any one in particular. It was because of my personal experience as a child, having my pediatric dentist. I'm from a foreign country, and in my country when you're ready to make your career choices, you're very young, you're 17 years old. At that time, I had no clue what I wanted to do. You have to pretty much pick from a list. The day came, and I had to make a check in one of the boxes, and I was going down and up on that list. I had no clue. So, then I stopped, and started thinking; who is the person that I thought enjoyed the most, what they were doing day to day, because I figured that's what I'm going to do for the rest of my life. It was my pediatric dentist, because every time I went to the office, the atmosphere was amazing, and he was always happy. He had a big smile, and I don't remember feeling pain there. So, those to me were the things that really matter at that time. So, I chose the Dentistry just because of that. But, it's proving to be, I think it was the right choice. I've never regretted making the choice so randomly like that. Briefly, can you give us an idea, what was your training path to become a dentist? Sure. So, after I started it in a very unusual sort of a way, I expected that, because it was my pediatric dentist that inspired me in a way, that I was going to end up being a pediatric dentist, until I got bitten by a child. That wasn't very pleasant. So, that opened a whole new world, that what am I going to do. I guess my story is, being open to opportunity. I actually, was always really aware of what was current at the moment, and where was the best opportunity. So, when I finished my training as a dentist, an opportunity for me to have one year of my BS training in restorative dentistry and aesthetics back in my country. That opened my eyes, because at that time I wasn't sure which way to go. From there, I applied to programs in the US, and restored if there's only a few. When I came to Michigan in Ann Arbor, I knew that's exactly the place I wanted to be. So, then I had a masters. Three-year masters program. Then from there, once you go into the masters career, you pretty much prepare yourself for the academic life. From there on, without much detail, I continued to be involved with teaching. Until later when, in about 2005, I did my second masters in clinical research and biostatistics. So now, everything ties in together, the clinical aspects with the research aspect. Then the application of the digital technologies came about eight years ago, for the clinical research aspect of it. That's very, very exciting for sure. So, Dr. [inaudible] , thank you so much for being here with us today. Thank you. I appreciate it, thank you. I really appreciate the opportunity. Thank you. Thank you all for watching.
