As a leading dental group practice, we always strive for the best quality of care using the most innovative technology for our dental and medical care. In order to better accommodate many of our patients, we started to incorporate advanced endodontics (Complex Root Canal Treatment) in our office. We researched for various types of dental microscopes to improve our quality of care. One brand stood out above the rest: Zeiss, an internationally technology leader operating in the fields of optics and optoelectronics. Since it’s formation in 1846 in Germany, Zeiss has transformed into a large, research-oriented company that distributes a host of optical products across the world and is well known by almost every surgeon as the best of the best when it comes to optical accuracy. Early in 2019 we decided to add the Zeiss dental microscope to our office to join our growing list of advanced technology.
For over a century, we as dentists have used various different materials to take molds (impressions) of the hard and soft tissue in the oral cavity. Many patients had no choice but to put up with it, while others suffered through gagging or left with a snack – otherwise known as extra dental fluff in their mouth. Advances in dental technology came out with other ways of doing these impressions digitally- one of the first was Sirona CEREC. Some brave dentists immediately jumped on board thinking it was the greatest thing since sliced bread. These advanced machines were used to create dental restorations, such as crowns without the use of that dental “GOOP” abhorred by so many patients. I held back during that time, because I did not want to be the first to experiment with this technology without seeing a reliable track record. Not long after, a major flaw was soon discovered…These machines were not as accurate as the dental “GOOP” or standard PVS impression material, causing many patients to return to those dental offices with inadequate dental restorations, such as leaky margins or recurrent decay. Years passed by and the technology gradually improved to the point where certain companies were able to dramatically improve the accuracy. The American Dental Association recently published an unbiased study showing the following:
I realized why so many patient’s complained about having problems with other dental offices who do “Same Day Crowns” by Sirona CEREC in their own office. These Sirona CEREC machines used to take digital impressions and mill dental restorations such as crowns were faulty because their accuracy were the worst out of the six main intraoral scanners on the market. The accuracy of CEREC is even worse than than the best dental “GOOP” PVS impression, which has an accuracy of 10-20 µm (microns). After review of the ADA literature, obviously one digital scanner stood out: 3Shape TRIOS. Not one wanting to base my knowledge on just one study, I dived deeper and found that study after study the 3Shape always came out on top. A few months later, we purchased the 3Shape TRIOS Cart in August of 2017 and many patients were ecstatic. Having the most advanced/accurate digital scanner in the world, we try and use it for most of our dental and medical procedures today. However there are times when we have to go back to the standard dental “GOOP” material because of difficulty accessing the area and or distortions due to contaminants such as oral debris and bodily fluids.
Sunday, February 26, 2017
On Friday 2/24/2017 I volunteered for the ADA Give Kids a Smile Program at a preschool in Monrovia. Unfortunately I was the only non-staff volunteer dentist to participate. I know for a fact that they were doing mass emails to find other dentists to volunteer – I just feel an indescribable sadness because I was the only person to respond …
We provided oral examinations, oral hygiene instructions, and gift bags for over 72 kids from the ages of 2-5 years old. What I found interesting was that although a few number of kids needed proper oral hygiene instructions, I found no children with existing carious lesions. It was a far cry from 1999-2000 when I was volunteering at the USC Mobile Clinic; back then with those kids over 75% were in need of immediate dental work. Monrovia was obviously a much more affluent area than the cities that we visited with the USC Mobile Clinic. It’s days like these that remind me the stark differences in oral health between the impoverished areas and the more economically developed cities. While some of the reasons are a result of access to care, I believe the majority are the results of financial constraints.
Sunday, November 15, 2015
Recent advances in technology has allowed many dentists to apply 3D Cone Beam CT imaging to patient care in private practice. I took the plunge late in 2014, investing in one of the top rated 3D Cone Beam CT scanners in order to improve the quality of dental care for my patients. While most hospitals will charge around $1000 for a single scan, we charge only a small fraction of that cost. Less than one percent of the dentists in the world have this technology – in fact none of my current fellow cosmetic and general dental colleagues in my known network have one of these machines (as of November 2015). I’m sure most dentists may think it highly impractical to allocate such a large monetary sum towards technology that will not give an immediate return on investment. However in my humble opinion, the peace of mind that I am providing the best dental care for all my patients outweighs any monetary reward.
I have been very impressed with the accuracy of our imaging technology thus far. Below is a sample case of one of the methods of how we utilize our 3D Cone Beam CT in our practice. In these images we are maximizing both the length and diameter of each implant, thereby improving the retention and therefore the longevity of the implant. Please note the close proximity to the IA and mental nerve. Without this technology, many dentists may run the risk of damaging a nerve when placing implants of this size.
In February 2015, Dental Products Reports, one of the nation’s leading dental magazines interviewed our office to discuss our thoughts on this technology. More information can be found at
On April 27th, 2014, I had the rare chance to volunteer at a free dental clinic serving the volunteers that help run some of the medical/dental free outreach clinics. It’s rare when we receive the opportunity to help those that help others…I think we as humans get so involved with the donation of funds and services to others in need that we forget about helping those people who make it possible for us to do so. This was the very first free clinic geared towards helping the actual volunteers. To no surprise the oral health conditions of our fellow volunteers were excellent. The only services that I preformed that day were exams and cleanings. Nonetheless it felt great being able to give back to those who give…
Monday, August 26, 2013
After finally moving into our new facility, I compiled an inventory of dental supplies and equipment that I no longer needed. Estimated net worth of these items based off of comparative sales equates to over $4500.00. Once we were settled into our new office, I contacted Loma Linda School of Dentistry and arranged for a pick-up for my donation. For those other dentists, who do not realize, Loma Linda has international outreach missions of free clinics that are in dire need of dental equipment and supplies. Loma Linda runs these missions through NASDAD (National Association of Seventh-day Adventist Dentists) Should anyone wish to send in a donation please contact them at: 909-558-8187
The following month I was contacted by the director of the Tzu Chi Medical Foundation about their very first free medical and dental clinic in Orange County. This organization has been operating various mobile clinics throughout Southern California and Mexico for over a decade. I immediately made arrangements so that I would be able to volunteer and donate my services.
Upon arrival on 8/25/2013 in Santa Ana, I noticed that while there were a lot of patients in the waiting area, the numbers were not anywhere near what I am used to experiencing in the free clinics in San Bernardino and Mexico. Perhaps the population in Orange County were not as financially strapped and therefore did not need as many of these free services? I was immediately ushered into the mobile unit and assigned to perform surgical extractions and fillings.
What I felt was nice, was that they assigned 1-2 assistants to help me with my dental surgeries. Normally the doctors at free clinics receive 0 – 1 assistants – so this was a pleasant surprise. These assistants were also volunteers – the lady in the photo is a retired molecular biologist, while the gentleman was an engineer. Because this was Tzu Chi’s very first free clinic in Orange County, it took the organization almost an hour before we were able to see patients. Therefore we started around 10 am and ended at 2:30 pm. Even though the duration of this free clinic was shortened, I was still able to see about 12 patients, all with procedures such as scaling and root planning, fillings and surgical extractions. In general, I did notice that the oral health of patients here in Santa Ana were definitely in better condition than that of the patients in the San Bernardino and LA counties. However regardless of the conditions of their teeth, all these patients were in need of dental work, and all of them were very grateful that we provided them with our services.
Posted by Dr. Brien Hsu at 1:04 PM
Wednesday, May 23, 2012
Recently we had a break-in at our construction site for our new facility. The burglars basically stole some materials and cut out copper piping, medical gas piping and electrical wiring in the building. When we reported the crime to the Rancho Cucamonga Sheriffs Dept, we found out that these incidents have been very common especially during these times. It’s frustrating because the amount of money the thieves made from selling the copper and metal was nothing compared to the repairs we would have to do for our office. Luckily my partners and I have insurance and most of the damages should be covered… It just puts yet another delay on our anticipated move date.
FYI : for those patients who are not aware yet, we are moving to a new dental office in the same shopping center in the next few months.
It’s interesting, the theft occurred earlier in May and I thought to myself our economy most be getting worse … if people would go that far to make a buck. Yet last week-end, I went to volunteer at another free-clinic in San Bernardino and I was prepared for a long day with long lines of patients…
I was shocked the lines were short and the work needed by many of the patients were quite minor. I saw about 16 patients and was done early in the afternoon. When I left that day, I felt great – not only because I was able to help people who cannot afford dental care, but the place being less packed translated into what I believe is a sign that the economy is getting better…which means all my patients who have suffered losses the past few years may finally be seeing the light at the end of the dark financial tunnel!
In the month of October 2011, a colleague and I visited the American Dental Association Convention in Las Vegas at Mandalay Bay. It never ceases to amaze me as to how may dentists and auxiliary staff attend these annual sessions. Every year the ADA rotates the site for this convention – and this year it happens to land in Las Vegas. The typical set up of these large annual meetings are the first floor containing exhibits on new dental technology and materials and on the floors above, classes are held for dental related continuing education. This year there must have been over forty thousand attendees … perhaps many of them here because they wanted to gamble afterwards?
In total I spent 2 days at this convention – which I felt was not enough. Visiting the many booths help me upgrade all my necessary dental materials such as my dental composite materials and prepared me with a list of many other dental upgrades to come in our new office that was currently under construction. The classes I took up on the 2nd and 3rd floor, as always, were helpful in broadening and improving my knowledge on my dental surgery skills and education.
Posted by Dr. Brien Hsu at 9:13 PM
Saturday, December 17, 2011
A patient came in about a month or so ago, having sensitivity to cold on several upper and lower teeth. The symptoms started roughly about one year ago. One dentist had recommended doing fillings on several teeth, while another even recommended a root canal and replacing several fillings. Looking for a third and final opinion the patient sought out my services. After x-rays and several tests, I determined that no fillings or root canals were necessary. I advised the patient to stop using any form of whitening toothpaste and prescribed a medicated paste to apply daily for a few weeks. On their follow-up appointment, the patient no longer had any more symptoms of sensitivity. They were thankful that I had saved them a lot of money by not doing any fillings. My response was, “Money you can always replace, but tooth structure cannot be replaced once they have been drilled on. While I’m happy you saved some money, I feel even better that you were able to save your tooth structure.”
So how was I able to determine that there was no need for fillings or even a root canal? The tests and x-rays did not show decay or faulty fillings and after conversing with the patient, I discovered that they had been using a new whitening toothpaste for about one and a half years. I could not be certain that this was the main cause of the patient’s problems, but from my past experience with many other patients having similar symptoms, I decided to proceed with stopping the usage of all whitening products and to prescribe the medicated paste. And just like many of my other patients the problem was solved.
I find that, with the on-going trend of desiring whiter teeth, a craze for whitening products is developing – everything from over the counter take home kits to special whitening toothpastes. Many patients have been experiencing sensitivity to cold after using these products. Most of these patients have less dense or thinner enamel and the chemicals that manufacturers use to whiten teeth are in essence damaging the tooth structure. These same chemicals have been modified by various companies and are now being used in all whitening toothpastes. Luckily if caught in time, these symptoms are reversible by following some simple protocols. It makes me wonder sometimes, what will happen in the future as more and more of these cases become more prevalent? Slowly I am seeing the number of whitening toothpastes increase in the market, while the number of regular toothpastes diminish.