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Dr Nick DDS

Technology

Dr. Nick has provided personalized dental care to thousands of families. Our patients come from near and far to experience the warm, individualized care we provide. We pride ourselves in utilizing the most modern equipment and methods available.

Welcome to the Future of Dental Medicine!

In order to provide nothing but the best to our patients, our office uses state-of-the-art technologies in all of our procedures. These new technologies allow us to detect dental concerns at the earliest stages, treat your dental issues with precision, and provide stunning and customized restorations which mesh both esthetically and functionally for your particular case. When you visit our office, you can be confident that you are receiving the finest and most advanced dental care available. A flagship example of one of these technologies follows:

CEREC CAD/CAM Technology

Dr. Nick Yiannios D.D.S. has produced more CEREC CAD/CAM restorations than any other dental practice in Northwest Arkansas. Adept dental CAD/CAM usage not only allows the patient to spend less time in the office (porcelain crowns and veneers can be created the same day instead of over multiple visits with typical dental practices), but also results in less tooth structure being removed (meaning more of nature is kept, hence fewer potential problems over time). CEREC is one of our flagship technologies.

This dental CAD/CAM technology allows the creation of high quality all-ceramic crowns, veneers, inlays and onlays ON-SITE the SAME DAY by Dr. Nick Yiannios. Normally, such restorations take at least 2 weeks to be made in a dental laboratory and at least 2 visits to the office before the permanent prosthesis is put in place permanently. With CAD/CAM, a special infrared camera is used to take a picture of the tooth in need of repair and then computer software is used by Dr. Nick Yiannios to design the restoration from the picture.

The final result is then fused to the tooth with bonding materials and matches beautifully! Dr. Nick Yiannios is an expert in CEREC CAD/CAM Technology. Many years ago he authored a book explaining and visually demonstrating the capabilities of this technology by an adept operator (himself) which you can view here for more information.

Diamonds in a milling chamber carve the restoration out of a solid ceramic block of a color and size that matches your tooth, and then Dr. Nick Yiannios customizes the final result by applying stains and then a glazing material which is permanently fused to the restoration in a high temperature glazing oven.

When Do We Not Use CAD/CAM?

 little is left of the tooth is black looking because of an old root canal: Since these are all porcelain and translucent, the darkness can show-through.  Sometimes a lab made restoration with an opaque material under the porcelain to block out the darkness beneath may be indicated in these types of cases.

Almost never…!

Advantages of CAD/CAM to the patient:

Single visit procedure: no need to take a 2nd or 3rd day off of work or school. 1 visit is all it takes, typically 90 minutes per tooth, only ~15 of which is spent in your mouth. The rest of the time you are relaxing or watching us create your tooth in the virtual world and then subsequently in the real world.

  • Dr. Nick Yiannios is in complete control of the final result: because the crown or veneer is designed beside you with the computer software, Dr. Nick Yiannios has complete control over how it will look and fit, whereas laboratory made restorations are being made by a technician who has not ever even seen the patient. In addition, tiny improvements that mean a world of difference as to the fit of the final result can be made instantly since the patient is still sitting right there!
  • No nasty molds of your teeth: instead, a picture is taken!
  • No temporary restorations: Ever have a crown or veneer done the normal way? Chances were it was loose, leaky, sensitive, looked off, tasted badly, etc. Not any more with CAD/CAM.
  • Less tooth removed in many cases!  No more grinding a tooth away for a crown.  With CAD/CAM, there are far more conservative possibilities, meaning more natural tooth structure is retained!
  • Only one set of local anesthetic injections: Remember, it’s all done in one visit!
  • VERY accurate seal means less sensitivity: CAD/CAM restorations are typically accurate to within 50 microns, which is 5/100 of a millimeter. A good laboratory crown can achieve a similar fit ONLY IF the mold was accurate and did not distort. Remember, there is no impression or mold or outside laboratory with CAD/CAM.
  • Chairside customization: All CAD/CAM’s in this practice are stained and glazed in the office to beautify and increase their strength.
  • Imperceptible edges: these restorations fit and blend in so well, you will not be able to feel or see the edges!  Dr. Nick Yiannios often leaves much more of your natural tooth structure than would be possible using conventional methods resultant of the aforementioned statement.
  • No gray edges at the gum line: because there is no metal in this fix, there is no metal to show through along the edge of the crown at the gum line.
  • Far less breakage: As of April 2015, our office has created over 7,000 CAD/CAM restorations, with only 4 fractured restorations over our 10 years of providing this amazing service.
  • Teeth that are oftentimes not restorable with a crown can sometimes be saved: As long as you have some enamel on your tooth, we can almost flat-top the tooth and expect success with a bonded all-ceramic CAD/CAM crown.
  • Beautiful porcelain veneers can be created the same day: Wow! Not possible otherwise. Not to mention the subtle nuances associated with the looks and shapes of your front teeth that can be tweaked while you watch, interjecting your own input along the way!
  • Onlays and Inlays can be created that same day for your tooth: A dentist without CAD/CAM is bound to prescribe a crown to fix a tooth because it is less likely that your temporary will fall off. A crown removes more tooth structure than say an onlay. Common sense dictates that the less of mother nature that is removed in a surgery, the better. An onlay or inlay is preferable to a crown as less tooth structure is removed.
  • X-rays can visualize underneath the restoration: Most lab crowns have metal underneath. X-rays can not penetrate metal. CAD/CAM restorations have no metal, only porcelain, and X-rays do penetrate porcelain. This allows your dentist to more readily catch a problem underneath your prosthesis over time.
 

 

Digital Imaging

At Dr. Nick Yiannios’s practice, long gone are the days when chemical processors and relatively high dosage X-ray arms are used to image the tissues of the oral cavity. Instead, low radiation, handheld digital Nomad’s® are used as the operator stays in the room with the patient as the x-ray images are exposed against a small digital sensor.

Resultant of this, a much quicker and convenient workflow for radiographic imaging is involved. These 2-D digital x-rays are used for normal tooth and bony tissue imaging typically needed for diagnostic reasons, including assisting in the identification of cavities between the teeth, abscessed tooth roots, faulty dental work, and bone levels as they relate to periodontal/gum disease.

2-D PANORAMIC X-RAY IMAGING

A quick low radiation screening of both jaws, the tooth roots, the TMJ’s, the sinuses and other hard tissue components of the head and neck. Often used to help with orthodontic diagnosis, simpler wisdom tooth issues, and a generalized screening of any missing or extra teeth in the pediatric dental patient, this type of film is typically indicated in younger patients.

3-D CBCT HARD TISSUE IMAGING

This amazing in-office technology allows Dr. Nick Yiannios to visualize, in 3 dimensions, any hard tissue within the digital CBCT sensors range, including bone, teeth, roots, sinuses, etc.  Used as needed to image difficult cases related to: impacted wisdom teeth, the TMJ’s and their associated structures, root canal issues that evade visualization per normal 2-D imaging modalities, future dental implant treatment planning, and any confirmation of aberrant pathology that is detected per history, exam, or preliminary 2-D imaging.  Modern CBCT is a greatly reduced version (in regards to radiation exposure) of medical CT, in that the physics and technology used to generate the image is much simpler than the medical CT imaging counterparts.  For instance, Dr. Nick Yiannios uses this modality routinely to study the temporomandibular joints in his “TMJ” patients.  Within the 3-D image, Dr. Nick Yiannios can have an undistorted view of any hard tissue, with the added ability of being able to virtually measure and manipulate the placement of potential implant placement.  Imagine a non-surgical confirmation that there is enough room in the bone for an implant screw, which clears potentially dangerous and problematic anatomical structures such as the sinuses, arteries and nerves of relevance.

3-D MRI SOFT TISSUE IMAGING

There are times when diagnosis of a “TMJ” patient requires imaging of the soft tissue cartilage within the temporamandibular joints to definitively diagnose a given TMJ patient’s problem(s).  These cases are referred out to an imaging center and involve a radiologist’s interpretation before Dr. Nick Yiannios can combine the MRI soft tissue results with the CBCT hard tissue results.  Dr. Nick Yiannios has been personally trained by one of the world’s experts in maxillofacial radiology and TMJ surgery, Dr. Mark Piper in regards to 3-D imaging interpretation of the TMJ’s.

 

Laser Dentistry

Dr. Nick Yiannios uses two types of lasers to provide state-of-the-art dental care in our practice. A dual wavelength ErYAG and NDYAG laser known as a Fotona Lightwalker, and a soft tissue diode laser called the Ivoclar Odyseey which works at yet another wavelength.

Dr. Nick has several lasers because the different wavelengths provide completely different treatment options, including, but not limited to the following:

  • Cavity removal from both baby & adult teeth, often without a shot or a drill!
  • Recontouring of the gum tissues
  • To treat snoring
  • To plump lips without the addition of filler!
  • Removal of pathology within the mouth
  • To improve imaging of crowns, bridges, implants and veneers before robotic CADCAM procedures
  • To assist with various soft tissue and bony surgical procedures
  • As an aid to increase the success rate of root canal therapy
  • To remove old ceramic crowns intact without a drill
  • To stop bleeding
  • To numb a tooth or teeth
  • To treat TMD patients
  • To effortlessly & cleanly uncover dental implants
  • To aid with treating headaches of muscular origin
  • As an adjunct for orthodontic treatment
  • To help speed healing after extractions and bone grafts
  • For bloodless frenectomies
  • To aid with facial aesthetic treatments around the mouth
  • Cold sore treatments
  • Aphtous ulcer treatments
  • To speed up in-office bleaching

Air Abrasion Technology

NO MORE DRILL? I’M THRILLED!

Many people fear the sound of the dental drill (technically called a handpiece) when they visit the dentist. These drills are used to remove cavities, old fillings, prepare teeth for crowns, veneers, etc. What if I told you that there exists a technology that doesn’t require the whining drill to accomplish some of these procedures? No, I’m not talking lasers, though they do exist and can circumvent the drill sometimes. I’m referring to a technology known as air abrasion.

Air abrasion is basically a tiny little wand that propels miniscule particles of a substance known as aluminum oxide (27 microns in diameter; 27/1,000 of a millimeter wide) under high pressure. These particles use kinetic energy rather than mechanical energy (as a bur spun by a drill does) to gently “blast away” small cavities. The neatest thing of all is that many smaller cavities can be removed painlessly with no local anesthetic! This is possible because the particles generate very little friction when they gently remove the decayed tooth structure. Burs generate huge amounts of friction, which heats up the tooth structure. This is why local anesthetic is usually required when a conventional drill and bur are used. Less friction with air abrasion spells no pain and no anesthetic the majority of the time!

Air abrasion is akin to a sandblaster. If you have ever watched some one sandblasting wood or stone, there is no cracking along the perimeter of the cut. This is possible due to the kinetic energy produced by the sandblaster, which generates much less friction than a drill. The normal drill and bur are akin to an electric drill and a screw. Have you ever carefully watched a drill sink a screw into a piece of wood? Numerous cracks radiate out from the center of the hole that the screw is creating as it is drilled into place. This is what happens when burs hit teeth. They tend to radiate cracks outward from the center, which can turn into problems for the tooth over the years as the cracks weaken what is left of the tooth.

Air abrasion is typically used to remove small cavities. Anything medium to large generally requires the use of the dental handpiece and the burs as the softer, larger cavities are not amenable to removal via the tiny particles under pressure.White or composite fillings are bonded into these very small and conservative holes. This bonding process is typically painless and only takes a few minutes.

Air abrasion technology being used to gently “puff away” a small cavity of a permanent molar tooth.  Kinetic rather than mechanical energy is utilized to remove the problem, usually without the need for anesthesia or a drill.

ADVANTAGES OF AIR ABRASION:

  • Allows us to treat multiple areas of the mouth in the same visit since little to no anesthesia is required.
  • Greatly reduces the need for anesthesia for smaller fillings
  • No pressure, sound, heat or vibration is generated
  • Minimally invasive; less tooth structure is removed than with normal conventional drilling
  • Reduces chipping and micro-fracturing of tooth structure, preserving more healthy tooth structure
  • Allows the dentist to penetrate porcelain crowns as needed without destroying the old crown, as oftentimes happens with the conventional drill bit
  • Can remove old composite white fillings, often without any anesthesia

DISADVANTAGES OF AIR ABRASION:

  • Larger, softer cavities are not amenable to this modality as the powder will not remove grossly softened tooth structure
  • Reserved for the use of smaller cavities
  • Will not remove old silver amalgam fillings

Air abrasion is particularly well suited for children who have new, smaller cavities on permanent teeth, since the process is so conservative. Adults too can benefit from the minimally invasive nature of this modality. A dental patient who religiously sees their dentist for regular checkups and presents with a tiny new cavity is the perfect candidate for air abrasion. In addition, the metal-free white fillings that are placed in these smaller holes tend to outlast the more invasive, larger fillings necessary after the use of the drill. This is due to the smaller surface area of filling being exposed to chewing over time.

Do all dentists use air abrasion in their practices? No, but they should!

Because oral health matters,

Dr. Nick Yiannios

T-Scan, JVA, and RMG Technologies

WHY IS THE GETTING THE BITE RIGHT IMPORTANT?

The importance of bite relation (occlusal analysis) cannot be over-emphasized in the dental practice setting. The placement of fillings, crowns, bridges, bite splints, implants, veneers, onlays, inlays, dentures; just about anything we do in dental medicine demands a proper spatial relationship between the temporomandibular joints (TMJ’s) and the oral cavity, not to mention a proper relationship between the maxilla and the mandible. Ignorance to the occlusion, or bite, can create havoc for the patient, creating problems ranging from sensitive teeth, to root canal therapy, to temporomandibular disorder (TMD or “TMJ” as it’s known widely), and even certain types of chronic headaches.  Traditionally, a colored ribbon of paper known as articulating paper is used by the dentist to check the bite. The use of this thin paper is problematic though, as it only qualifies where the bite is “high”, doing nothing to quantify/show how much or how hard…

T-SCAN®

An instrument borrowed from the world of engineering known as the T-Scan® allows a dentist to do just that, QUANTIFY how hard or how much the teeth touch, in 3/1,000 second increments (IN TIME).

The T-Scan® digital occlusal analysis is used in Dr. Nick Yiannios’s office as needed to augment treatment relating to CEREC® insertions, fillings, implant restorations, and in particular, to assist in the novel Occlusal Adjustment procedure known as ICAGD to accomplish DTR for muscular TMD treatments.

JVA

Joint vibration analysis is a painless, digital screening tool to measure the health of the TMJ’s. It resembles a headset that is placed over the patients’ temporomandibular joints that “listens” for vibrations that might be emanating from the joints, which are characteristic of joint pathology, or lack thereof. These vibrations can be correlated against known vibrations from the scientific literature to give Dr. Nick Yiannios a rapid assessment of the state of health of that patient’s TMJ cartilage that is ~90% accurate, in minutes!  This is significant, because the cartilaginous disk that sits between the lower jaw bone and skull bone (the TMJ-we have a right and a left TMJ located just in front of our ears), when damaged, can have a devastating effect upon dental treatment.  Damaged TM disks can be directly related not only to the bite, but potentially painful muscular manifestations, leading to unpredictable dental treatment outcomes.  Most in dental medicine do not have a true understanding of this fact.  Having a full appreciation for this fact, Dr. Nick Yiannios uses the JVA on all of his regular patients. Akin to a blood pressure reading in your physician’s physical exam, we track your JVA readings over time at every dental checkup, which helps to identify problems before they manifest themselves.

The Joint Vibration Analysis headset which detects frictional interactions between internal cartilaginous surfaces in the TMJ’s and converts the information into quantifiable data in software which can be cross-referenced and used as an indicator of TMJ health.

EMG

Electromyography is a painless, highly accurate, and objective digital tool that Dr. Nick Yiannios uses to measure muscular activity in the chewing muscles. Surface electrodes are placed over the target muscles so that the tiny little currents that muscles create can be measured, allowing us to analyze chewing sequences and patterns just like neurologists and researchers do.  This is a totally painless and safe procedure. 

Why are muscles important in dental medicine?  For multiple reasons; muscles:

  • Break teeth
  • Can cause pain in the orofacial region, such as headaches
  • Can damage the cartilaginous TMJ disks
  • Must be in a balanced state or problems will potentially arise over time

EMG allows us to measure certain chewing muscles accurately in microsecond increments, allowing us to accomplish evaluations of oral-facial pain that normal dentists can only dream of!

Placement of EMG skin-surface electrodes over pertinent muscles of mastication. No current is generated. The tape electrodes simply sense for minuscule changes in microvoltage outputs generated in the target muscles as they change during function as the lower jaw functions.

TSCAN/EMG LINK

Tscan technology synchs with EMG (muscle electromyography) technology down to the microsecond enabling Dr. Nick Yiannios to measure instantaneously changes in muscular output relative to miniscule changes in the bite. This combination of technologies is the ultimate TMD treatment aid when the cause of the joint problem is muscular in origin, which it usually is… Click here to watch YouTube videos that Dr. Nick Yiannios has created about the use of the Tscan/EMG link for the treatment of TMD patients in our practice.

SO WHAT IS DTR, ICAGD, AND NEURAL OCCLUSION?

These are treatments for muscular TMD issues that DO NOT rely upon traditional splints and acrylic appliances. These treatments are a new, more definitive way of addressing TMD issues by creating a permanent physiological change in patients with confirmed stable and adapted joints (via digital metrics such as JVA and 3-D imaging), rather than the temporary change that splint appliances create. Dr. Nick Yiannios rarely makes acrylic splints that the vast majority of dentists do, but rather relies on the following protocols when indicated for muscular based TMD issues, in a patient with a pair of objectively confirmed stable and adapted TMJ’s.

DTR stands for Disclusion Time Reduction. This is the process whereby “interferences” or “speed bumps” in the way the back teeth from the top jaw interact with the opposing teeth from the lower jaw, during function, are precisely removed with data gleaned from the Tscan/EMG link. This process decreases muscular output, relaxing the muscles of mastication (via instantaneous confirmation with EMG), which typically alleviates many TMD symptoms. Years ago, Dr. Nick Yiannios was personally trained by the creator of this new process, researcher Dr. Robert Kerstein of Tufts University, and is considered an expert in this process. Dr. Nick Yiannios is also a beta tester for Tekscan, the company that created the T-scan technology.

Isolite

Isolite® Dentist. What is so important about a soft, plastic block that creates a vacuum, pours oodles of fiberoptic light upon the operative field for better visualization, and comfortably fits in your mouth during dental treatment?  Modern dental materials are typically tooth-colored porcelains or composites (white fillings), and they both share one characteristic:  they require a dry field for optimum fusion/bonding to tooth structure.  Even the humidity in ones breath can compromise this dry field requirement, let alone any saliva that might enter the procedural field.  Enter the Isolite®, a single use, disposable, fiber optically lit, dry field technology that helps to ensure predictable modern restorative dental treatment.  The vacuum (which envelopes an entire half of the mouth) also expedites dental treatment by keeping the cheeks and tongue out of the way, so that the dentist can accomplish more treatment per unit time so that the patient spends less time in the dental practice.  Additionally, when old mercury amalgam fillings are removed in the course of dental treatment, the vacuum theoretically helps serve to protect both the patient and dental personnel from the toxic mercury vapors created upon its removal, since the powerful vacuum envelopes the entire perimeter of the tooth being worked on.

 

Dr. Nick Yiannios uses this technology on just about every patient. This includes the placement of white/composite fillings, CEREC® CAD/CAM porcelain crowns and veneers, air abrasion procedures, dental implant placements, oral surgical procedures; just about everything he does. The advantages to the patient are tremendous: safety, predictability, comfort, and better visualization. Though this single use technology is quite expensive, Dr. Nick Yiannios will not perform his dental work without it for two main reasons:

  1. He wants everyone protected
  2. He wants his work to last!

Step into the future of dentistry.

Patient Visualization

We will provide objective, honest and scientifically based treatments based upon proper diagnoses, and always inform the patient of alternatives, keeping their desires ahead of our own.

Intraoral and extraoral photography: Dr. Nick Yiannios uses USB enabled miniature cameras to display to patients any problems that might be going on in their oral cavity.

This technology captures amazingly clear images directly to the dual monitors in the dental treatment room so that the patient and the doctor can review them immediately together. Dr. Nick Yiannios also uses professional digital SLR cameras and mirrors to take superbly high quality images for his esthetic and cosmetic work. These images allow him to more accurately mimic the exact “look” that a tooth has when he customizes a CEREC® crown or veneer in the office while staining and glazing the restoration, on site, that day. We also use the digital SLR’s to document the condition of a patient’s bite to help diagnose “TMJ” and bite issues as well.

Virtual modeling: Dr. Nick Yiannios uses this software to demonstrate to the patient various anatomy relating to the head and neck. Particularly useful for patients with oro-facial pain and “TMJ” problems, Anomalous Medical, LLC software allows total customization of the virtual model, allowing us to mimic the patient’s problems virtually when combined with our 3-D imaging and other objective modalities.

Videography:  For years, our practice has been recording and uploading patient case studies to the World Wide Web. Dr. Nick Yiannios has compiled and edited every one of the videos himself, which demonstrate everything from our CEREC® CAD/CAM restorations, to root canals, to digital implant placement, to our TMD treatments.  On YouTube, our channel, drnickdds, houses over 100 of these videos.

Microscope Dentistry

Why use a microscope in dental medicine? Simply put, many of the things that we are evaluating and treating are small, so small, that many times we must visualize with a high-output, high-magnification LED-powered surgical microscope to affect the most effective treatment for our valued patients. ENT’s, neurosurgeons and other medical specialists who routinely deal with minute surgeries, have been using high-powered magnification for decades, though few dentists have followed suit, unfortunately, in Dr. Nick Yiannios’s opinion. The increased visualization and information gleaned from the usage of a microscope results in more precise, deliberate, and improved patient treatment outcomes.

 

Dr. Nick Yiannios routinely uses his Carl Zeiss microscope for endodontic (root canal) therapy, and at times pulls it out for restorative and esthetic dentistry as well.  He even has a digital camera and video recorder integrated into the microscope in the event he needs to document the treatment.  You will never see him not using magnification, whether it be through his hi-powered head loupes or the microscope, period.  After all, if he can’t see it, he can’t treat it, and he totally gets that!

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