NEW TECHNOLOGY IN DENTISTRY WITH BOTOX , LASER ,STEM CELL ...................ETC

1. Dr. Arti

3. Advance in diagnosis
Advance in treatment
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CAT scans
Digital X- ray
RVG
Intraoral Camera
Digital Photography
Botox therapy
Ozone therapy
Steam cell therapy
Laser treatment
Sedation dentistry
Painless anesthesia
NTI-tss Device
Air abrasion

4. INTRODUCTION
• New dental technology offer better solutions for traditional oral health
problems than ever before. The trend in dentistry is utilizing technology
to make dentistry more comfortable, durable, efficient and natural-looking
for the patient as possible. Patients and their dentists benefit from newer
techniques that are less invasive and more dependable than the years of
past.
• Procedures that formerly took multiple trips to the dentist or required
multiple health care providers can often be performed in the comfort of
one office by one qualified provider.

7. Botox therapy
Ozone therapy
Steam cell
Laser treatment
Sedation dentistry
Painless anesthesia
NTI-tss Device
Air abrasion

8. How Does Botox Work
Botox is a trade name for botulinum toxin, which comes in the form of a purified protein. Botulinum
toxin A . The mechanism of action for botulinum toxin A is really quite simple. It is injected into the
facial muscles and, within a few hours, it attaches itself to the nerve endings of the motor muscles,
thereby affecting the nerve transmission to these muscles.
It takes anywhere from two to ten days to block the nerve transmitters which innervate the muscles
where it was injected.
There is no loss of sensory feeling at all during the time that botulinum toxin A is effective.
Once these motor nerve endings are interrupted, the muscles cannot contract. When the muscle
does not contract, the dynamic motion that causes wrinkles in the skin will then cease. The only
reason there are wrinkles in the skin in the first place is because the muscle is moving underneath
it, thereby these are called dynamic wrinkles.
Approximately three to ten days after treatment, the skin above these motor muscles becomes nice
and smooth. The effects of Botox lasts approximately three to four months depending on various
factors including the amount of botulinum toxin A injected, metabolic activity of the patient and
lifestyle choices, which may cause the Botox treatment not to last as long. When the patient sees
the wrinkles reappear, the patient needs retreatment.

9. TMD cases & oromandibular dystonia
Myofacial pain cases including treating trigger points
Masseter & temporalis hypertrophy
Gummy smile
Treatment of angular cheilitis
Orthodontic relapse and depressed orthodontic
appearance
Reducing muscle hyperactivity for retention of
removable prosthodontics
PAIN RELIFE IN HEAD AND NECK

10. MYOFACIAL
PAIN
MYOFACIAL
PAIN WITH
2NDRY TMD
BRUXISM
TMD’S
TRISMUS
OROMANDIBULA
R DYSTONIA
MASSETER &
TEMPORALIS
HYPERTROPHY
HEADACHES

11. It is excessive grinding of the teeth and/or excessive clenching of the
jaw. Bruxism is an oral parafunctional activity’ i.e., not an activity related
to normal function such as eating or talkingBruxism may cause tooth
wear, and may even cause teeth to break and dental restorations to be
repeatedly lost or damaged
•
THIS SUBSET OF MOVEMENT DISORDER IS CATEGORIZED AS A FOCAL
DYSTONIA THAT INVOLVES THE MUSCULATURE OF THE MASTICATORY
APPRATUS AND LOWER FACE . IT MANIFESTS AS DISTORTED ORAL
POSITION AND FUNCTION, RESULTING OROFACIAL DISFIGUREMENT
AND DYSFUNCTION.
Temporomandibular disorders (TMDs) refers to a group of disorders
affecting the TMJ, masticatory muscles and the associated
structures.These disorders share the symptoms of pain, limited
mouth opening and joint noise.

12. It is largely regarded as a cosmetic facial
deformity based on excess muscles bulk.
Muscles activity also may occur
Spasm of the jaw muscles, causing the mouth to remain tightly
closed

14. • Both masseter muscles received 50 units each under EMG guidance.
Similarly, both temporalis muscles were injected with 25 units each.
Subjects were assessed at 2-week intervals for 8 weeks.
• Outcome measures included subjective pain by visual analog scale (VAS),
measurement of bite force, interincisal opening, tenderness to palpation,
and a functional index based on multiple VAS.
• Results: showed a significant (P =.05) difference between the preinjection
assessment and the four follow-up assessments.
• No side effects were reported.

15. • BoNT-A products are routinely used in patients with bruxism,
and treatment often is provided through bilateral injections into
the masseter and temporalis muscles .
A practicing clinician must understand proper dosing in these
circumstances, as too much BoNT-A can paralyze the mastication
muscles and interfere with a patient’s ability to chew and speak

16. • BoNT-A also can be used to treat sialorrhea via injection into
the parotid and submaxillary salivary glands, which inhibits the
stimulation of the cholinergic receptor. This use of BoNT-A to
treat sialorrhea does not treat any muscles, but it does result
in saliva reduction.
• However , this treatment must be done carefully as too much
BoNT-A can result in chewing difficulties, dysphagia, and
xerostomia.

17. • Five units of botulinum toxin were injected under EMG guidance in
distal masseter, proximal masseter and temporalis, bilaterally.
• 24 hrs postinjection, the dystonia of the masseter and temporalis
muscles were sufficiently relieved to allow passive opening of the
patient’s mouth, decrease the tongue biting and permit oral
hygiene.

18. • 20 mouse units of botulinum toxin directly instilled into
the affected muscle(s) followed by a further 100 mouse
units after a two week interval. Quantification of effects
on contour were recorded using laser scans,
photographs and ultrasound scans. Functional effects
were monitored using bite force measurements and
electromyographic recordings. Results show a
significant rapid reduction in muscle bulk with minimal
impairment of function although a transient weakness of
facial muscles was seen following 4 of the 20
treatments. Conclusion: From this study it appears that
botulinum toxin is a safe, simple, effective treatment for
masseteric hypertrophy.

19. •
Our muscles play a huge role in where our teeth line up. Following
orthodontic therapy some patients teeth will relapse and this may be
due to placement of that individual’s musculature.
• Many patients have an over active mentalis muscle that often causes
relapse of the teeth and may cause spasm of the muscles.
• Botox gives us the ability to reduce these spasms and contractions
allowing for limited relapse following orthodontic treatment.

20. Temporalis
TWO TYPE OF INJECTION
SUPERFICIAL
Superficial
injection
are
administer
ed into the
thinner
upper
region
DEEP
MASSETER
• Approximately five diffuse
injections are recommended
preferably targeted to area of
height activity on EMG, greatest
muscle bulk, and or greatest
discomfort . Care must be taken
with anterior & superior injection
of this muscle because diffusion
of botulinum toxin to the
zygomaticus major muscles
nearby may result in an adverse
cosmetic effect, specifically
preventing the patient from
raising the corner of the mouth &
thus causing asymmetric smile

22. Dose (depend on muscles size, pain & activity (fig-1)
Location of injection : Directed at teigger/tender muscles
Many clinician prefer to inject where is syptomatogy “chasing the pain”
Agonist muscles : Temporalis ,masseter & medial pterygoid are agonist
jaw closing muscles, both are lipsiaterally & bilaterally
If all of the muscles are not injected, there is chances of faliure

23. Needle size : small gauge needle , preferably 30 & 27 gauge needle is tolerable
for the large muscles
EMG guidance is recommended for the specific muscles penetration
Adjunctive anesthesia : topical local anesthetic is applied before injection,
always helpful ( EMLA ANESTHETIC CREAM)
For muscles already in pain, preinjection with local anesthetic solution
BOTULINUM FOLLOW -UP

24. Site
1
2
3
4
5
6
7
8
M. zygomaticus major at its point of origin
M. zygomaticus minor at its point of origin
M. levator labii superioris alaeque nasi
M. levator labii superioris at the orbital
Margin
The modiolus, at a distance of 0.5 cm from
the corner of the mouth
M. risorius 2 cm from the corner of the
mouth
M. depressor labii inferioris at 0.5 cm from
the corner of the mouth
M. depressor labii inferioris at a distance of
1 cm from the white line transition
Botox Dose
Range
Dysport Dose
Range
3–4 U
1-2 U
1–2 U
9–12 U
2–6 U
2–6 U
1–2 U
2–6 U
3–4 U
9–12 U
3–4 U
9–12 U
3–4 U
3–4 U
9–12 U
9–12 U

25. 1. GUMMY SMILE
2. ASYMMETRY CHEEK

26. 1. slim kinetic and hyperkinetic
platysmal
bands arise
Injection of platysmal bands: please note the samll
papules that arise after the very superficial injection

27. Gummy smiles
Establishing esthetic dental lip lines and smile lines in esthetic dentistry
cases as an alternative to gingivectomy, crown lengthening, and veneers
Treatment of angular cheilitis
Eliminating “black triangles” between teeth after periodontal and implant
treatment that did not preserve the papilla
Reestablishing lip volume for proper phonetics (in addition or as opposed
to teeth lengthening with fixed or removable prosthodontics)
Adding lip and perioral volume around the mouth for retention of
removable prosthodontics

28. gingivectomy

29. Introduction
Subluxation is an injury to the tooth supporting structures. The
incidence of pulp necrosis is shown to be near 15% after this
injury, so all subluxated tooth must be monitored (Celik & Cehreli,
2008). When it occurs, endodontic treatment should
start as soon as possible.
Ozone is a very reactive gas that shows strong antimicrobial
properties. The gas oxidates and destroys bacterial cells walls
and citoplasmatic membranes (Nagayoshi et al. 2004; Cardoso et
al., 2008; Huth et al., 2009). Ozone also increases the oxygen
supply to all cells, enhancing cellular metabolism and stimulating
tissue repair

30. CASE REPORT
• To assess whether ozone
is effective in arresting or
reversing the progression
of dental caries
• An 18-year-old girl was
referred to the clinic by her
orthodontist with no
complaint of pain, just the
presence of a large
periradicular lesion in the
maxillary central left
incisor. Ten years ago she
had a falling that resulted in
a subluxation trauma in this
tooth.

31. Conclusion
The antimicromial and
bioestimulation properties of
ozone, proven by the
literature, have a great
potential to be incorporated
to endodontic therapy, even
in traumatized tooth

32. Introduction
•
THE DENTAL STEM CELL NICHE In biology of the tooth the discovery of dental epithelial stem cells in
continuously growing teeth has been a recent breakthrough
•
The niche for the adult stem cells of these teeth is formed at the region of the apical end in
tooth development. The region possesses a commonly specialized histologic structure for
the maintenance of adult stem cells and the production of various progenitor cells
producing dental tissues
•
Based on histological and molecular biological studies, a new concept that the eternal
tooth buds producing various dental progeny are formed at the apical end in the
development of continuously growing teeth, and coin a new term of “apical bud” for
indicating this specialized epithelial structure.
•
ACTIVIN is as essential early mesenchymal signal in tooth development that is required
for patterning of the murine dentition. Studies show that activin βA is expressed in
presumptive tooth germ mesenchyme and is thus a candidate for a signaling molecule in
tooth development.

33. Nerve block under local anesthesia
Tooth bud is inserted through a small incision into the
gum
Recall the patient after 4 to 5 weeks
Take x-ray (radioopacity show at apical area)
Formed tooth fused to the jaw bone
As the tooth grows, it releases chemicals that
encourage nerves and blood vessels to link up with it
Change is inevitable, but for a dentist
the original skills will play the major
role & the new techniques will ensure
the success of the treatment. keeping
in mind the benefits for the profession
a dentist should be aware of the
developments & be ready for future.

34. A laser is a device that emits light (electromagnetic radiation) through a
process called stimulated emission. The term laser is anacronym for light
amplification by stimulated emission of radiation.
Laser light is usually spatially coherent, which means that the light
either is emitted in a narrow, low- divergence beam, or can be converted
into one with the help of optical components such as lenses.
NO PAIN
SMILE
ESTHTIC
CONSEVATIVE
LESS REDUCTION
STRESS FREE

35. • Incision, Excison,
Vaporization, Ablation,
Hemostasis
• prosthodontics, restorative,
and esthetic procedures
(bleaching)
• Gingivectomy
• Gingiviplasty
• Gingival troughing
• Frenectomy
• Decontamination, Aphtous
Ulcer , Drain Abscess
• Opeculectomy, Surgical
uncovering, Enamel exposure
• Root canal treatment
• 1991 Soft Laser
• 1993 Nd:YAG Laser
• 1993 Kinetic Cavity
Preparation
• 1994 CO2 Laser, Argon Laser
• 1996 Laser welder
• 1997 Nd:YAP Laser
• 1998 Er:YAG Laser

37. Painless Anesthesia is an automatic injection
device developed especially for painless
injections and is therefore very suitable for
children and nervous patients.
Painless Anesthesia has an award-winning
design which alleviates patient anxiety and
features SmoothJect™ which enables a truly
painless injection.

38. sedation dentistry a patient remains conscious during
treatment, able to respond to questions or requests from the
dentist, but in a totally relaxed state and relieved from any
anxieties.
•
•
•
•
•
•
•
Patient relaxation
Increased comfort
Movement control
Patient co-operation
Control of gag reflex
Little or no memory of treatment
Time saving - Fewer appointments needed

39. Nitrous oxide sedation dentistry,
also known as inhalation
sedation, is the most commonly
used method for patient
relaxation in dental offices.
Dentists use nitrous oxide, also
known as “laughing gas”, to
provide more comfortable and
painless treatments
IV sedation dentistry is a method
of conscious sedation, and
should not be confused with
sleep dentistry which is closer
related to general anesthesia
(unconscious sedation). With IV
sedation dentistry a patient
remains conscious during
treatment, able to respond to
questions or requests from the
dentist, but in a totally relaxed
state and relieved from any
anxieties.
Oral sedation dentistry is one of the
techniques used by modern dentists
to help patients who experience
anxiety and dental fear in order to get
proper dental care.Oral Sedation
involves the administration of
sedative drugs taken from the mouth
in the form of a pill or liquid, to
achieve a state of relaxation and
make dental procedures a
comfortable.
General anesthesia offers the
deepest form of sedation that
can be used to provide
relaxation and analgesia during
dental procedures. General
anesthesia use in dentistry is
actually necessary only in
special circumstances and it is
reserved for a very limited
number of cases such as very
anxious children, extremely
phobic or patients with special
needs, or extensive dental
surgery procedures.

40. • Air-abrasion is a great dental advancement over the dental drill as it
allows precise removal of decayed teeth without the use of a local
anesthetic. The air-abrasion system uses blasts of pellets of air and
aluminum oxide to treat tooth problems such as cavities.

41. NTI-Tss device
• The NTI-tss Device is used for patients who suffer from
TMD and migraine headaches. The device eliminates
the need for more invasive surgery and can help with
problems associated with Temporomandibular Joint
(TMJ) discomforts. The device can be molded to fit teeth
and is effective at reducing the pains associated with
TMD.