Glossary

Diabetes mellitus (DM) is a syndrome characterized by disordered metabolism and abnormally high blood sugar resulting from insufficient levels of a hormone called insulin. Individuals with DM suffer from a number of symptoms that can complicate otherwise routine health procedures. In implant dentistry, good diabetic control is a prerequisite to achieving and maintaining osseointegration for implant success. Patients who suffer from DM typically experience a delay in wound healing which may prevent the surgery or implantation site from properly retaining the prosthesis or graft. Due to this, patients with DM are more prone to healing concerns, osseointegration issues, and implant failure. To give dental implants and prostheses the highest rate of success, patients should have their diabetes mellitus well-regulated prior to and following the procedure to ensure proper and timely osseointegration takes place. Patients with well-controlled DM often experience healing, osseointegration, and implant success rates similar to non-diabetes patients.

A diagnostic wax-up is a laboratory procedure in which teeth are created in wax according to a patient’s planned restoration. It may be used to evaluate the feasibility of a proposed plan or to fabricate a radiographic template, a surgical guide, or laboratory guide. In order to complete a diagnostic wax-up, the dental practitioner should carefully and precisely write the wax-up prescription with the details and desired outcome for the technician to replicate. It is then the laboratory’s and technician’s job to ensure that proper tooth alignment, position, and morphology are achieved in the creation of the wax-up. The diagnostic wax-up is an invaluable tool for determining the feasibility of a proposed treatment plan. The model may show that the desired outcome cannot realistically be achieved due to limiting factors that may not be discernible during the examination of the patient. In this way, the diagnostic wax-up prevents unnecessary and unsuccessful procedures from being performed.

Digital imaging and communication in medicine, or DICOM, is a standard of conformity used by the majority of imaging hardware (CT/CBCT) and software manufacturers for the proper handling, storing, printing, and transmitting of information in medical digital diagnostic imaging. It allows the three-dimensional imaging data obtained from different manufacturers to be used in third-party software for the visualization, surgical evaluation, and creation of CAD/CAM models and appliances. In addition, DICOM allows digital diagnostic imaging modalities to be integrated into a picture archiving and communication system (PACS). DICOM is essential in dentistry, periodontology, and endodontics as it allows a patient’s imaging data to be accurately obtained and processed in the creation of a dental restoration or procedure. The images can be distributed to the various practitioners, laboratories, and manufacturers needed to create a fully functional prosthesis or implant with the assurance that all parties involved are receiving and working from the same imaging data.

The making of digital impressions involves the use of intraoral optical scanners to acquire tooth morphology, gingiva morphology, and occlusion in a digital format. Digital impressions are used for a variety of purposes including aiding in the diagnostic and treatment planning phase, fabricating a dental prosthesis, for orthodontic applications, or to fabricate surgical templates for dental implants or oral surgery procedures. Currently, the various chairside intraoral digital scanning devices are based on optical principles such as blue light-emitting diodes, blue laser technology, multiple single images that are stitched together, and continuous acquisition (streaming) of optical images. The optical scanners used in creating digital impressions depend upon a reflective surface and may require a contrasting medium or powder to acquire the surface representation of the tooth morphology. The use of technology to acquire a dental impression improves the speed and accuracy of the impression itself and can increase the comfort of the patient during the process.

Digital radiography is a form of X-ray imaging where digital X-ray sensors (digital image capture device) are used instead of traditional photographic film. Imaging is needed in dental applications to capture a patient’s dentition and oral anatomy prior to tooth repair procedures, implant placements, and oral surgeries. Since imaging is a common practice in dental offices, there are several advantages to using digital radiography rather than photographic methods. One of the greatest benefits is the reduction in the amount of radiation required to produce the needed image. Past radiography processes have exposed patients to higher levels of radiation to produce the same image that can now be created with less exposure. In addition, digital radiography is a more time efficient method as it doesn’t require the chemical processing needed in traditional imaging procedures. Finally, since the images themselves are captured digitally, it is faster and easier to digitally transfer and enhance the final images.

Direct metal laser sintering, or DMLS, is an additive manufacturing process whereby a 200 Watt Ytterbium (Yb) fiber-optic laser moves across a bed of powdered metal melting or welding the metal in very thin layers (about 200um) according to the build protocol. After each solidified layer, a recoater blade evenly distributes new powder across the build platform until the entire build file (STL File) is complete. The process has high resolution and good surface detail. The use of DMLS in dentistry has allowed for the creation of strong and durable bridges, crowns, partial dentures, and dental prosthetics. Such devices are often made of cobalt chrome and can be custom-made for the patient by following a model of the patient’s dentition and oral anatomy. Direct metal laser sintering has been found to produce dental prosthetics with both long-term strength and durability. A potential disadvantage to DMLS is the high cost that is associated with the manufacture of the prosthetics.

A direction indicator is a device inserted into an osteotomy in order to assess its orientation or position relative to the adjacent teeth and anatomical structures. A direction indicator can also be used to verify and assist in achieving parallelism in the preparation of multiple osteotomies or to verify the depth for straight implants. In some cases, a direction indicator may be placed in the site of an osteotomy to slow or stop bleeding. Osteotomies are a procedure in which bone is reshaped or cut and is often done in preparation for or in conjunction with implant placement. To ensure the right depth and angulation is achieved for implant placement, a direction indicator is used to guide the drilling process. Use of a direction indicator during an implant procedure helps to prevent errors which could lead to the loss of primary stability in the bone.

A disc or disk implant is one of the many different types of dental implant hardware that can be used to anchor a prosthetic tooth to. Disc implants are often used for “express” implant procedures, where patients are unable to wait through the typical dental implant procedure. Classic implants often require multiple appointments and surgical procedures, particularly when a bone graft needs to be done prior to implantation of the prosthetic tooth. This can take months, whereas a disc implant can be completed from start to finish in just five to seven days. A disc implant displaces significantly less bone than screw implants, and surgeons are able to maintain bone integrity and perfusion. There are fewer complications during implant surgery with disc implants, and they are highly resistant to pre- and post-operative infections. Smokers are also eligible for dental implants with disc technology, whereas they may not be with classic screw implants.

A distal extension is a type of dental prosthetic device that temporarily replaces one or more missing natural teeth, but not all. Distal extensions are most commonly called partial dentures or bridgework. They are typically removable and are made of false, natural-looking teeth attached to a plastic base that is usually pinkish in color to match the gums. Metal framework is designed to anchor the distal extension to the remaining natural teeth and when in place, look aesthetically pleasing and similar to more invasive types of dental restoration. However, distal extensions need to be removed and cleaned and may be uncomfortable or cause oral injuries if the appliance does not fit properly. They must also be replaced as recommended by your dentist, particularly if they become damaged and broken in some way. While less expensive than dental implants, distal extensions are generally only able to provide temporary aesthetic support.