Interview with Dr. J.
Richard Shih
Originally from Taipei, Taiwan, Dr.
Shih studied at the Kaoushiung Medical University (B.D.S.)
and the Northwestern University College of Dentistry where
he received his D.D.S. On the Dean’s List at N.U.., he
followed with a Implant Residency at Oral and
Maxillofacial Surgery of Montrofiol Hospital in Bronx,
N.Y.
From 1993-2000, he served as Head Clinical
Dental Surgeon of Upland Dental Center. He has been in
private practice in San Diego since 2000. He was a
part-time Clinical Instructor in UCSD Medical School.
In
order to give his patients the most thorough and best
treatments, he is not only certified in Invisalign
(clear orthodontics) but also certified in an
advanced patented braces system, a revolutionary
breakthrough technology which would finish most Ortho
cases in less than one year. As it cuts most treatment
time in half when compares with traditional braces system. In dental Implantology, he is
one of the sixty elite dentists in United States for
Ankylos implant system. With over 17 years of clinical
experience, Dr. Shih is well respected by his
peers. |
Q: What have been the
most exciting and interesting advances in dentistry in the last 10
years?
DR. SHIH: Several exciting developments
occur to me:
The first is
bleaching and whitening -- procedures have improved dramatically
in just the last few years.
The second is the diagnostics,
in the diagnostic tools we use -- particularly advances in the use
of digital films to detect cavities.
A third is implants --
the techniques have evolved to a point where everything is highly
predictable, to the order of 95% or greater. And the materials
used in doing implants have vastly improved.
Q: Tell us first
about advances in teeth bleaching and whitening.
DR. SHIH:
In the past, whitening was a time consuming process, one part of
which was take-home gel trays that the patient did at home over a
period of weeks to achieve results. LumaArch is a whitening system
that is only one 90 minute appointment and brightens your teeth 5,
6, 7 sometimes 12 shades brighter than the shade you currently
have.
LumaArch combines a whitening gel with a special blue
plasma arc light. This procedure is done in-office. Results are
immediate.
As a clinician, it’s very fulfilling for me to see
a patient’s reaction to their teeth whitening experience. Its
usually one of renewed confidence and excitement, which in our
profession we don't see a lot of. Whitening is a harmless procedure
in which you can walk out in 90 minutes and feel better about
yourself. It’s a fun problem to solve as a dentist. It's a positive
experience on both sides.
Q: Some people wonder whether bleaching is
completely safe.
DR. SHIH: Safety in tooth whitening is a
number one priority. It has been studied extensively for the past
5-7 years. The LumaArch procedure does not have any deleterious
effect on the hard tooth substance or any irreversible effects on
the soft tissue as best we know.
The concentration of
solutions in the LumaArch procedure is equal to the products used
for the take-home tray kits. LumaArch uses 15% concentrated
peroxide. It is the combination of the gel with the blue plasma arc
light that makes whitening extremely effective.
With
whitening, the teeth themselves are not "eaten away" by the acidic
nature of the peroxide. The surface is only affected in that the
stains which are existing on the surface area are allowed to be
bleached out by the effervescence of the peroxide that is activated
by the proprietary blue plasma arc light.
I, myself, have
been a LumaArch patient and am very happy with my result. My shade
difference was 9 shades. I went from a B3 to an A1.
Q: What about the effects of
LumaArch on fillings and other dental work?
DR. SHIH:
LumaArch whitening will only lift off surface stains. It will not
change the inherent color of the tooth restoration.
If you
come to us for a brighter smile and you are happy with the end
result of the whitening, that may perhaps prompt you to make changes
in your existing dental restorations. In most cases, restorations
last about 10 years. If a restoration is reaching the outside edge
of that time period, you may want to change it.
But a lot of
restorations are in the back regions of the mouth and if you don't
have an extraordinarily wide smile, you won't see them. If the
restorations can be seen when you talk or smile, ideally you should
change them out once your tooth shade has been whitened.
As
far as the filling restorations are concerned, if you have tooth
colored fillings, you might get them to be a little bit lighter.
However, they are susceptible to re-staining again. You may want to
change them to porcelain inlays and onlays, which are lab-fabricated
restorations. They would replace the existing fillings to match your
tooth shade exactly.
Q: How
do porcelain veneers work and what are their
advantages?
DR.
SHIH: Veneers are made of porcelain
and are of eggshell thickness, anywhere from 0.3 to 0.5 millimeters
in profile. They are positioned over the facial surface of the
tooth, or what you see as tooth when you smile (the front parts of
your teeth). They are fragile when they are not cemented in place,
but once they are cemented to your teeth, they are very resilient to
fracture.
Q: They look exactly
like natural teeth?
DR.
SHIH: Yes. The reason that people do them is to enhance their
appearance so they look better than your natural teeth or your
previous dental work. Many people get them for cosmetic reasons,
others because they are not willing to go ahead with adult
orthodontics. Let's say the patient had a rotated or malaligned
tooth. That malalignment can be remedied using the prosthetic
procedure of porcelain veneers rather than sit through years of
orthodontics.
With properly placed veneers, you cannot detect
the margin (where the tooth ends and the gum begins) of the veneer.
They are strategically placed 0.5 mm below the gumline so they are
not detectable. The cement used when the veneers are permanently
placed is the same color as the tooth. You will not, as a lay
person, be able to detect them.
Q: Are veneers always
done for several teeth?
DR. SHIH: No, a veneer could be done for
one tooth. For example, if you have particular staining or a
malalignment of a tooth a veneer can be matched with your
surrounding natural teeth.
Q: Why do they look better than bonding and
caps?
DR. SHIH:
Veneers look better because there is no metal substructure behind it
which gives them a natural refraction of light, just like natural
teeth. There is no opacity (flatness) in color as there is in
bonding materials. Also, typically, with crowns or bridgework, once
you have a little recession of the gumline, you see that black line
at the gumline from the ceramic-metal, which, for most people, is
unsightly. So veneers are a lot better from a cosmetic point of
view.
Q:
What are people most often seeking when they come in for cosmetic
dentistry ?
DR. SHIH:
Most people's concerns have to do with color of their teeth and
typically once they've had tooth whitening, then they become
concerned about an area or tooth that has not responded to
bleaching, perhaps a preexisting crown, in which case we change it.
They are encouraged to make changes based on their whitening
results.
Q: How do digital imaging
and the advances of imaging help your work? How exactly do you use
them?
DR. SHIH: These diagnostic tools ultimately
mean quicker and more efficient treatment for the patient. The
accuracy of digital film reduces guesswork significantly. Treatment
outcome is more predictable and thereby successful thanks to these
advanced diagnostic tools.
Digital films replace old
fashioned film x-rays. They are quicker to develop and need 90% less
radiation to expose the digital sensor (which has replaced the x-ray
film). I then bring the image onto a computer screen where the
patient and I can discuss the diagnosis together. These images can
be magnified, colorized, and we are able to measure exactly the
amount of decay.
I also use an imaging system called Columbia
Scientific SIM/Plant? Treatment Planning software. In combination
with a digital CT (CAT scan) scan, the software presents a
3-dimensional representation of the patient’s facial aspects, more
importantly the jaw area. Treatment, such as dental implant surgery,
can be done on a computer model prior to working on a patient. I can
test various scenarios and actually perform them on the computer
model (a 1:1 ratio actual size model of the patient), allowing me to
consider all the options in an effort to find the optimal treatment
for the patient. I engineer a treatment plan from that model and
make a blueprint of the case.
Q: For what type of treatment do you most
often use the planning software?
DR. SHIH: Dental implant surgery. It’s
important to know what the jawbone structure is. The program gives
us an accurate 3-dimensional picture of what the jawbone is like.
This allows us to know where we need to do any enhancement,
augmentation or building of jawbone structure before we perform any
type of treatment. Ordinary x-rays do not suffice for this type of
treatment. The software optimizes treatment plans, reduces risk and
promotes successful treatment outcomes.
Q: What exactly is a
dental implant? How does it work? Many people have heard the term
but don't know the details.
DR. SHIH: A dental
implant is an artificial titanium tooth root placed into the
jawbone. When the implant is healed, an implant crown is screwed on
top of it or cemented on top of it. It is non-removable and can
support the load of a biting force just like your natural teeth.
Your natural teeth are held by alveolar bone. This is the
type of bone from which the jawbone is made. The implant needs the
support of that bone just as a natural tooth does. When teeth are
missing, over time, bone in that area becomes lost. We need that
residual, alveolar bone to place an implant into. If that alveolar
bone is not there, then we place synthetic bone, prior to placing a
dental implant.
Alveolar bone is not just of medical
concern. It is of cosmetic concern as well. If the bone is not
there, the face may have a tendency to have a sunken-in look.
The imaging diagnostics I spoke of before allows me to see
what condition the jawbone is in for placing dental implants. I am
able to see situation at hand, determine the various options, and
choose optimal treatment for the patient, all before initiating
treatment. The patient then is confident about treatment and
enthusiastic about the results, because the ultimate judgment a
patient makes, aside from pain, is whether or not the outcome is
esthetically pleasing. Fine practitioners recognize the importance
of allowing these diagnostics tools to help them. This is an
important adjunct to the doctor’s skills.
Q:
Have the methods of doing implants
changed?
DR.
SHIH: The technique and the implants we are using today are far
superior to what we had 15 years ago. There have been remarkable
refinements. The design and surface texture of the implant has been
treated. Historically it was never treated.
You want the
implant to stick to the bone. This phenomenon is called
osseointegration. You don't want any other type of tissue, other
than bone, around the implant, and so the dental industry has gone
through different ways of increasing that surface area. We are up to
acid etching the implants to a certain level or surface blasting the
implants to increase the surface area with calcium phosphate. That
seems to have an advantageous effect in that the implants can now be
loaded (meaning the artificial tooth can be placed on the implant)
sooner than they normally would have in the past.
We are now
loading implants after about two months as opposed to before, where
we had to wait 6-9 months before they were loaded. The patient that
comes to us now may not know the difference, that it once took 6-9
months, but he or she certainly benefits from improved
procedures.
Q: You take on complex and difficult cases. It's
something of a specialty for you. How do you approach treatment for
such a patient?
DR. SHIH: Many disciplines may need to be
involved. Complex work is necessary when a patient has many
different dental issues. For complex problems, you need a treatment
plan to define the appropriate mode of treatment, which may or may
not include dental implants. But diagnostic imaging definitely helps
us map out a plan, much like an architect would, a foundation for
something to build on.
This "blueprint" that is created from
the software is vitally important because you want to try to mimic
nature. If you consider that a patient has lost his/her own natural
teeth, you’d be foolhardy to believe that you can do a whole lot
better than nature did, so you aim to replicate what nature would do
in terms of engineering.
Q: How has dealing with
complex procedures changed for patients that have a multitude of
problems?
DR. SHIH: When a person has a whole series
of problems, we implement all of these wonderful new advances in
diagnostic imaging and call on other colleagues who specialize in
other branches of dentistry to help the patient.
There are
complex cases that may require root canal therapy, periodontal
therapy, implant therapy as well as cosmetic and crown and bridge
therapy all at the same time. We must devise a plan that makes sense
for the patient, one that will be efficacious and highly predictable
because patient is going to have a lot of "chair" time.
Yes,
we do those long, complex cases. We hope we don't have to, but it is
an event that occurs on a regular basis, more often than I would
like to see. If the preventative measures were truly effective, if
people visited the dentist on a regular basis, they could perhaps
prevent a lot of complex problems.
Most people try
to avoid the dentist because they think it will be a painful
experience. I believe strongly that we have learned to deal with
pain management in a much more prudent fashion.
People do
themselves a disservice by waiting to come to the dentist until let
they end up with a series of problems. By that time, pain is usually
what provokes the patient to make an appointment. They have avoided
visits because of the pain fear and now they are in pain when they
come to us.
We have the ability to restore them and manage
their pain, but they have to be willing participants during the
course of treatment to have their proposed outcome come to fruition.
It is very important to win their confidence to do so. Therefore, I
feel strongly about all of the technology I use, it gives me more
information to be very sure about a patient’s case.
Q: What advances do you
think we'll see five years from now, and what about ten years from
now?
DR. SHIH: As
far as restorative materials, what your crowns, veneers, inlays and
onlays are made of, I think we are going to take leaps and bounds to
create better materials that will be less problematic to the patient
once they are inserted in the mouth.
Hopefully in the
future, I don't know how soon, we will be able to generate enamel
and dentin, which is what tooth is made of. Potentially we could
replace teeth with tooth substance rather than with a foreign
substances we now use. Rather than do a filling with porcelain or
gold alloy materials, we will do a filling with bioengeneered
enamel.
Q: Fillings would
have then evolved from metals, glasses and ceramics to bioengineered
enamel?
DR. SHIH: We're
replacing bone, why can't we replace tooth substance? Or the whole
tooth? Why not develop a whole tooth for that site? That is further
down the road than five years. In the near future, I do believe we
will have computer generated restorations that are done chair side.
Rather than taking a goopy, foul-tasting dental impression, we will
be able to put a scanner in your tooth, (incidentally we are doing
so right now, however, not to the level of degree of success that
we'd like), an infrared scanner would take an impression of the
tooth or teeth in your mouth, and an hour later, the computer would
generate or make a restoration out of porcelain.
That is
already here and it will be refined to the point where every dental
office should have one in place within five years.
What that
means to the patient is less waiting. You would theoretically sit
for an hour, go have lunch, come back and your restoration will be
done, rather than coming back a week from now, while the technician
in the lab creates the restoration and you get the final restoration
back in two or three visits.
I think that is where the
direction of dentistry is going. The preventative measures in
dentistry will improve a lot more than they have in the past.
Perhaps etiology may have a part to play because we are dealing with
microbes. If we could get a handle on the microbes that are
attacking our dental structures and apparatuses (the gum tissue and
bone), and attacking enamel through decay, we would then become
"molecular biologists." We would control and manage the habitat that
these microbes live in (our mouth). We would no longer be
"dentists." That would certainly be an interesting paradigm
shift.
Q:
What other advances have there been?
DR. SHIH: Other
advances have been in pain management. The anesthetics we are using
today, the small gage needles and the use of topical anesthetics
have vastly improved. The way that we manage the patient from start
to finish is a lot different than years ago where a person would
have to sit "white-knuckled" in a chair to have a procedure
done.
I strongly
believe that a patient should not feel anything during the course of
the procedure. That is the worst thing I remember when I had my own
dental work done. I keep that in mind, because I don't want my
patients to have the experiences I had when I went to the
dentist.
Pain management has been developed to the point
where very little pain is experienced at all. As with anything,
there is always a risk you take with any procedure that you do and
we try to minimize that risk. Pain management has improved vastly
and I’m very pleased about that.
Q: How did you become
interested in dentistry as a profession?
DR. SHIH: Like a lot of people, who become
dentists, I was influenced by high school guidance counselor who
helped me to set up a program leading to the profession. And I've
always had scientific and technical bent.
It seemed like an
interesting profession when I was high school.... and it has been.
I'm constantly attending conferences here and abroad, taking
continuing education courses, reading dental journals, talking to my
colleagues who are still in academia to find new ways to help my
patients. It helps keep me interested.
Dentistry is a social
and educational experience. I am privileged to be able to be a part
of this. I am passionate about performing to the best of my ability.
J. Richard
Shih, D.D.S.
General Orthodontics, Implant and Restorative
Dentistry
?2000 Dr.Shih
& Associates, All Rights Reserved