Читать книгу Aesthetic Dentistry - J. Schmidseder - Страница 11

Intraoral Cameras

Originally purely a discipline geared at eliminating pain, dentistry has evolved into a discipline with many different complex treatment procedures. This change is, to a great extent, due to the longer life expectancy of people (see also: The Future of Dentistry, p. 279). The transition from symptomatic treatments to patient-preferred treatments requires extensive patient education by dentists and their staff. Practices in which there is no active patient education have recorded a decline in treatment activity; this is because of the general decrease in caries activity that has occurred in the population. In contrast, practices that provide extensive patient education have demonstrated fast and impressive growth and an increased use of new treatment techniques.

37 Intraoral camera system (e. g., Reveal)

Does not every dentist like to practice state-of-the-art dentistry? For each tooth defect there are various restorative methods that have different prognoses and prices. Therefore, it is important that the dentist shows patients the status quo of their teeth and demonstrates the different treatment options. Intraoral cameras are imperative for these presentations.

Use of Intraoral Cameras

In the late 1950s and the 1960s, different presentation techniques found their way into dental education. Video technology with close-up images was used to demonstrate treatment methods. Nowadays, video technology has become both a teaching and learning tool in all areas of education and training. Numerous training programs—used also in dentistry—are nowadays supported by instructional videos.

Dentists are somewhat restrained in their use of video technology in patient education. A possible reason is that the pain-oriented dentistry practiced earlier, which was primarily therapy-oriented, did not require any detailed patient education. However, because of the changes that have occurred in dentistry, new methods are needed for patient education, including video technology. Since the 1970s, many health-related organizations have developed films targeting patient education. This method of education is meaningful and should be used by all dentists.

38 Computer-based patient information

A patient wishes to have his/her teeth bleached. One can demonstrate the status quo by means of this picture.

Right: Newsletters are not only brochures for the practice, but are also useful for informing patients about certain treatments or as a marketing tool. However, it must be remembered that brochures distributed by the industry are often of questionable value.

39 Computer-generated simulation of the treatment goal

Tooth color can be brightened on the screen according to the patient's wishes. The dentist can then determine whether it is possible to do justice to the patient's ideas using the available methods. If this is not possible, the dentist can demonstrate a more realistic treatment goal to the patient before treatment starts.

In different areas of medicine—particularly in gastroenterology—endoscopes have been used for many years. The first intraoral video camera, the Fuji DentaCam, was developed from these endoscopes in 1987. Even though interest in the camera disappeared soon after its introduction, there were some dentists who realized the potential of intraoral miniature cameras. Since then, many manufacturers have made developments or improvements in intraoral cameras.

Simultaneously, so-called imaging systems were being used in many areas of industry and medicine, with which digital pictures (of houses, cars, faces, etc.) were taken and later processed with the help of a computer. This imaging concept was also introduced into dentistry in the late 1980s and was used to change electronic images of anatomical, oral outlines to be used in treatment planning and in patient education. Although many users assumed that this imaging concept would be an extraordinarily successful method for improved patient education, it has not yet found the acceptance it deserves among users of intraoral cameras.

Patient Education

Dental practices that are equipped with intraoral cameras use them, first and foremost, to show patients their own intraoral images. Video films, watched in the practice or at home, can also be used to promote patient education. These two ways of using video technology predominate in dentistry today.

How Can the Intraoral Camera Be Used to Educate Patients?

Diagnosis and Treatment Planning

Each dentist uses different methods to modify patient behavior and acceptance of treatment plans. The intraoral camera allows the patient to directly observe the intraoral situation for the first time. Thus, the patient can participate directly in the decision-making process as far as the treatment plan is concerned. The dentist or staff can use an intraoral camera to explain any relevant details to the patient. In a dental office with well-trained staff, patient education is usually performed by the staff. This is cost-saving and, furthermore, the staff are often more thorough than the dentist in presenting the instructional aids.

Intensive patient education with the use of intraoral images is recommended because these images show the necessity of a treatment or a particular, selected treatment method. The intraoral camera is a simple, easy-to-use medium for educational purposes. The areas of the mouth requiring therapeutic measures are shown on the screen situated in front of the patient. This relatively self-explanatory method usually leads to acceptance of the proposed therapy.

A diagnostic session which also uses an intraoral camera takes only a little longer than a regular session. Patients taking advantage of such a diagnostic session alter their behaviour and develop, often spontaneously, an astonishing interest in the condition of their oral health. The advantages for the dentist He in having an increasingly active practice and the introduction of new clinical techniques.

The intraoral camera is used primarily for patient education in the dental practice. The integration of an intraoral camera in the diagnostic session necessitates neither radical administrative changes nor other serious alterations.

40 Intraoral video appliances used chairside

The intraoral video camera and the monitor should be installed close to the dental chair so that they can be used without significant time delays.

Cosmetic Imaging

Imaging methods are used to demonstrate to the patient possible modifications, for example, by means of aesthetic dentistry. Moreover, they open up new possibilities for the dentist in aesthetically-oriented therapy. After images of the oral structures have been made, they can be modified electronically. For example, a diastema can be closed, tooth color can be lightened, the visible gingiva can be increased or reduced, a chin remolded, class-III malocclusions altered, etc. These results can consequently be seen by both the dentist and the patient.

If “before and after” pictures are shown, the computer-processed electronic image becomes particularly impressive for patients and often results in behavioral changes. However, use of intraoral images results in significantly greater changes in the routine of the practice than use of intraoral camera does. More time is required for a diagnostic session. Normally, a separate room must be available, and highly motivated and well-trained staff are needed who have sufficient time and creativity to demonstrate the different therapeutic options to the patient.

41 Mobile cart with integrated intraoral video player

The advantage of a mobile cart is that it can be used in several treatment rooms.

During Treatment

The necessity of altering a treatment plan during therapy arises relatively frequently. Generally, many patients cannot accept this. The intraoral camera can substantially improve the patient's acceptance. If, whilst restoring a cavity, a full crown becomes necessary, the reason for the altered treatment plan can be explained to the patient on the spot with the help of the intraoral camera. The result is an improved dentist-patient relationship and increased acceptance.

After Treatment

Nowadays, it is especially important to gain patients' trust, so that they accept the chosen therapy. By using “before and after” pictures after treament has been completed to tactfully demonstrate differences to the patient, the dentist has a reliable way to build up trust and improve the dentist-patient relationship. The intraoral camera is also an outstanding tool for this task.

Documentation

The following section gives examples of situations in which it is necessary for the dentist to take pictures of oral conditions.

Informing Family Members

Frequently, it is not the patient to be treated (child, spouse) or the patient alone who decides how the therapy will be carried out and paid for. Many intraoral camera systems now offer printouts of the oral conditions displayed on the monitor. These printouts can be given to the patient to be take home, thus facilitating the decision as to whether or not to execute the treatment plan.

Insurance Companies

Prints of intraoral conditions, showing the necessity of a proposed treatment, are invaluable for dentists when they are negotiating with insurance companies. An excellent example of this is a patient with a root fracture, of which no radiographic image is submitted, but instead a picture of the current condition in the mouth. Insurance companies can be positively influenced by such pictures.

Dental Picture Archives

The pictures generated by an intraoral camera are excellent for clinical research documentation, patient information, or for documentation of situations that do not (yet) require treatment, but need to be observed further. Some dentists also prepare patient portraits that are attached to the patient records.

The storage of digital image data requires a large memory capacity. As well as the normal disks (Compaq), special ones are available, namely, Zip and Jaz drives, streamer, interchangeable hard disks, and rewriteable CD-ROMs in conjunction with a CD-ROM recorder.

42 Oral images on the monitor

Every dentist is familiar with the problem of showing the patient defects on posterior teeth using two mirrors. Despite the dentist's efforts, the patient, in general, neither recognizes the problem correctly nor understands it. On the screen, the defective amalgam fillings can be demonstrated much more clearly and digitalized radiographs can be used to give added weight to the arguments previously put forward.

Improved Vision During Treatment

There are certain situations in the daily routine of a dental pracatice in which the dentist cannot adequately see the area which is being treated. The intraoral camera enables the dentist to see the area or to freeze a specific image on the monitor which can then be used for guidance during the treatment.

Although learning how to manipulate the camera in order to improve vision during treatment requires time, this pays off later.

Treatment Using Indirect Vision

In some areas of medicine, doctors have already used monitors for some time to perform surgery and other treatments. Some dentists have also gone through this transition, at least regarding certain procedures.

43 Treatment using direct vision

Following the course of the treatment directly in the patient's mouth is often quite cumbersome. Under these conditions, the dentist is often forced to adopt a very unhealthy posture that can result in early wear and tear of the spine.

44 Treatment using indirect vision

In many areas of medicine, treatment is already being carried out using image-generating procedures that use indirect vision. Today, certain methods are already available to dentists as well, enabling them to treat patients via a monitor. The use of an intraoral video camera is a prerequisite for this.

Presently, images on the monitors are two-dimensional, without recognizable depth and width. Therefore, certain procedures are more difficult to execute with indirect vision. Simple procedures suitable for learning the method include adjustments of occlusion, which is of a two-dimensional nature.

The advantages for the dentist are:

—A relaxed upright working position,

—Magnifying eyeglasses are not necessary,

—Enlargement on the monitor can be achieved by zooming,

—Regions that are difficult to access can be viewed.

It is expected that the indirect procedure will develop further in the future and gradually become routine in dentistry. The intraoral cameras of the future will probably be located in the head of the handpiece or the turbine.

Using Videos for Patient Education

Use of video for patient education is the simplest and most advantageous method. It has already become standard practice for a large number of dentists to show short videotapes in the treatment room. These films can be shown in the following ways:

—on the monitor connected to the intraoral camera

—on a standard VCR monitor, similar to a regular TV

—on a special monitor located on the ceiling of the treatment room

In order to reduce the noise level typical for a dental practice, the patient is given headphones. There are numerous opportunities to show the films, for example, during the diagnosis session, at preoperative or postoperative treatment sessions, or during treatment.

If patient education using video films takes place during treatment, the best place to install the monitor is just below the ceiling. By doing so, the patient can be informed during less demanding treatment. It patient education is to be integrated in the routine of the practice, suitable VCRs, monitors, headphones, and tapes must be available.

Cost-Benefit Considerations

Most dentists are worried about the expenses incurred by the intraoral camera, imaging system, or patient education by use of video technology. At first, the cost of purchasing the technical equipment and the tapes appears high, and integrating the equipment takes up a great deal of time. However, dentists should not be discouraged by this. Those who have already beeen using these concepts in their practices for some years confirm that the expense and effort involved pays off within a short period due to the patients' increasing acceptance of the proposed treatment plans.

The following three priorities emerge from the concepts introduced in this chapter:

1. Videos for patient education

2. Intraoral cameras

3. Imaging

Some systems are available that combine video technology and intraoral cameras; other complete systems combine all three concepts in one single system.

45 Video films during treatment

Some patients like to watch a video movie during a treatment. Video glasses and glasses with an integrated monitor help fulfill such a wish. Who would not like to pursue the course of his/her own treatment with a pair of such glasses? This is the concept of virtual reality in dentistry.

Characteristics of Intraoral Camera Systems

Clinical Research Associates (CRA) in Provo, Utah, identified the requirements that an intraoral camera should fulfill (1991). They are:

Manipulation: Only one hand should be needed to operate the camera.

Wide observation field: The camera should be able to view several teeth (a quadrant) simultaneously. This provides better orientation for the patient and makes it easier for the dentist to perform treatment with indirect vision. The ideal intraoral camera should be easy to adjust from close-up pictures of the teeth to pictures of the entire dentition.

Small camera hand-pieces: These should allow distal tooth surfaces and posterior teeth to be visualized.

High resolution: An intraoral camera should have high resolution without noticeable distortion.

Stills: It should be possible to take stills with an intraoral camera at high resolution. A still picture is helpful when analyzing and discussing a particular intraoral condition.

Accurate color reproduction: Poor color reproduction is confusing for both patient and dentist.

Automatic light regulation: Additional light sources to improve the light conditions for the intraoral camera should not be necessary.

Sterilization: An intraoral camera that can be sterilized would be desirable. However, sufficient disinfection is guaranteed by means of plastic foil wrapping.

Printing the pictures: A high resolution is necessary for documentation. The printer should be equipped with a large RAM (16 MB).

Rotation of pictures: It must be possible to rotate a picture by 180 and to change left—right orientation to execute a left-right switch.

Activation of the appliance: The intraoral camera should have a simple “on—off” switch and a short or no warming-up period.

Size of the unit: The smaller the better.

Further aspects: Multifunctional applications are advantageous, i.e., the camera can be networked to additional monitors and connected to other VCR equipment.

New developments are constantly taking place in intraoral cameras, which means that we will see new, improved features on a regular basis.

46 Components of an intraoral camera

An intraoral camera consists of a camera with interchangeable lenses (left) and a device capable of processing the video signals (right).

47 Intraoral camera

The lens of the intraoral camera should be very small, so that it can be used for endoscopy as well as in the oral cavity.

Using Intraoral Cameras

While some dentists use only one treatment room, others use several simultaneously. Ideally, one monitor should be available in each room. Some systems allow the camera to be connected to the monitor or printer in each treatment room. Portable complete systems, easily transferred, can also be used.

Many dentists start off with a simple portable system and then later progress to installing a monitor in each treatment room.

The four most important applications of the intraoral camera include:

—Showing the present condition of the teeth

—Describing the condition of the teeth after treatment, using an imaging system

—Explaining different treatment methods by means of a video

—Documentation

Summary

Different recording techniques are now available, which enable dentists to provide patients with information in a manner which was previously not possible. This obviously contributes considerably to improving patient education. The best known concept in dentistry is the educational use of videotapes and intraoral cameras. The integration of both techniques in a practice should be recommended to every dentist. This increases patients' acceptance of different treatment alternatives that are now offered by modern dentistry.

Imaging systems allow dentists and patients to visualize and judge the planned treatment and its aesthetic impact even before beginning therapy. Imaging systems are less common than intraoral cameras, but they can be of great value when properly applied. The use of video technology can also be expected to spread in the future in indirect dentistry, i.e., the dentist performs the treatment with the aid of a camera and a monitor.

48 Integrated video system with flexible camera

To reduce the disadvantages of a mobile cart (preparation time, installation), and to make use of the advantages of integrated systems, some manufacturers now make the expensive camera the only mobile part of the system. This enables the camera to be used in several rooms with integrated systems.

Recommended Cameras

Several brandname appliances reflect how fast technology is evolving. They all have the required characteristics outlined on p. 32. The following appliances represent the spectrum of developments in intraoral cameras that are currently available. Three of them (Acucam, Reveal, and Cygnascope) have a relatively wide depth of focus and only one lens. This enables the camera to be used in all four of the important areas of application of the intraoral camera.

However, the technological advances in this area are so rapid that it is recommended that all available appliances on the market are checked for the desired characteristics.

Acucam

This camera system has been the market leader for several years. It has been improved continuously. Acucam can be installed as a mobile unit, but it is also available as a multifunctional appliance, so that this camera can be connected to the monitor installed in each treatment room.

49 Comparison of eleven currently available intraoral cameras

Clinical Research Associates in Provo (Utah, USA) performed currently the most extensive comparative study on intraoral camera systems.

7 excellent

5 good

3 acceptable

1 inadequate

(Adapted from: CRA Newsletter, May 1996)

Reveal

This intraoral camera system is relatively new on the market. The manufacturer mainly produces endoscopes for various uses in medicine. Reveal was one of the first companies to make sterilizable, lightweight camera systems that could be combined with an easy-to-use, multifunctional concept. It is also available as a mobile standard unit.

Cygnascope

This is the smallest intraoral camera system available on the market. It can be carried by hand from one treatment room to another. In addition, the camera is currently the smallest available.

Insight

This company is one of the pioneers in the field of digital graphic representation, which has helped this camera concept to increase its versatility and broaden its area of application. It is very useful for both patient education as well as for documentation.