Top Dentists 2011: Watch Your Mouth
That’s what dental professionals are trained to do. These specialists do it especially well.
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Dr. Christopher Burns of Dover calls prosthetic dentistry “the last cottage industry” because it is one of the few where practitioners create things by hand.
For this maxillofacial prosthodontist—one of only a couple hundred in the country—that means fashioning everything from a basic crown to, in one especially complex case, a gold frame to support a prosthesis for a patient who lost his upper jaw and most of his facial bone to a rare cancer.
“It’s very customized,” Burns says. “You give patients something that works well, is comfortable, and they like the way it looks.”
Burns came to his work, he says, by accident. As a pre-med student at College of the Holy Cross College in his native Massachusetts, he worked for a genetics professor, studying genes on yeast through an electron microscope. While speaking with a friend who was attending dental school at Georgetown University, “I thought, You know, that might be more fun.”
So Burns headed to Georgetown, where he was also exposed to many types of dentistry. Through prosthodontics, he saw the complications of oral cancer and treated people with cleft palates. He also discovered that he enjoyed making things. “I ended up having to do a lot of my own lab work,” Burns says. An instructor encouraged him to specialize.
After graduating in 1988, he practiced under a prosthodontist in Massachusetts for 18 months, then started teaching at the Temple University School of Dentistry in Philadelphia. While there, Burns started practicing in Dover and Salisbury, Md. He also worked at the Veterans Administration Hospital in Elsmere, one of the first three government institutions in the country to perform implant dentistry.
“I was very lucky that way because we had an early exposure to it,” Burns says. “Having something the body would accept that way was an absolute miracle.”
The miracle was the discovery that bone would bond to the metal titanium—a process called osseointegration—which allowed dentists to insert screws into the jaw that became, in essence, roots that prosthetic teeth could be attached to.
Implants require bone, which some patients lose through infection. Though Burns points out that bone can be rebuilt through grafting, in some cases, bone can be regenerated with the help of special proteins. Hyperbolic oxygen therapy can help regrow bone after a cancer patient’s radiation treatment, which compromises its ability to accept implant screws.
“The great crown and bridge guys of 40 years ago could not have imagined something like this,” Burns says.
That’s not to say the need for crowns, bridges or dentures is yet a thing of the past. Burns often uses a CEREC machine to fashion crowns right in his office. Guided by a computer image of the affected tooth, the lathe-like instrument can cut a replica from a cubical blank of composite material in 20 minutes. (The latest generation of the machine does the same work in six.) Patients don’t need to wear an uncomfortable temporary crown for a week while a permanent fixture is manufactured in some distant lab, eliminating the need for multiple sessions in the dentist’s chair.
Burns is aided by the use of a Galileos cone-beam scanner, which generates 3D images of his patients’ mouths. It provides better information than traditional X-rays, and it reduces radiation, a special concern for cancer patients. Digital imaging and record keeping also allow him to share information quickly via email with other professionals involved in a patient’s care.
(With such state-of-the-art technology, Burns jokes about the 1950s-era chair that remains in one consultation room, a relic from when he bought the office building.)
Burns has practiced in Dover exclusively for the past 17 years. He still teaches, though now at Polytech High School in Woodside, where he treats children who might not otherwise see a dentist. He keeps up with the dental literature and with fellow members of such professional organizations as the American College of Prosthodontics and Academy of Osseointegration.
“Between materials that are more durable and aesthetic than ever and better techniques, these are the good old days of dentistry,” Burns says. “There are big changes in technology coming, I’m sure. But these are the good old days.”
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