By Danny Chan
From addressing headaches and migraines to TMJ pain to obstructive sleep apnoea, the dentist developed his own methodology and Mandibular Advancement Device (MAD) to treat a multitude of health problems – some of which are cases that he says have commonly been misdiagnosed or areas where dentists have trouble understanding the full extent of.
He is Founder and Principal Dentist of Wholistic Dentistry, a Queanbeyan practice which philosophy is predicated on the view that “the current perception of the dental field, viewed both by medical physicians and the broader community, is narrow and does not reflect the true capacity that dentistry can offer patients.”
Dr Da Cruz believes that dentists have much to offer in the diagnosis and treatment of fundamental structural issues in the human body that affect the nervous system and the rest of the body. He is currently involved in non-invasive dental treatment, focusing on interrelated conditions of malocclusion, TMD and sleep disordered breathing using functional appliance therapy. His work is facilitated through use of the Splint, Orthopaedic, Myofunctional dental Appliance (SOMA).
Based on occusion signalling as well as growth and development patterns, the appliance was created to correct issues pertaining to translation of the lower jaw. Central to the clinician’s treatment philosophy is the need to calm the nervous system and relax muscles. SOMA as well as the integrated, single-phase treatment approach – developed in collaboration with Dr John Diamond – is unique to Dr Da Cruz’s work.
As someone who frequently operates outside the purview of general dentistry, the holistic dentist adopts cutting edge technology to help stay ahead of the curve. The tech savvy dentist owns a fully equipped in-house lab powered by Sirona Cerec McX5, in addition to the KaVo Key Laser 3, Seiler Revelation Dental Microscope, MyRay cone-beam flatbed unit and ICAT cone-bean x-ray that he has been using for over 13 years.
The latest addition to his diagnostic toolbox is the Green 21, Vatech’s top-end cone-beam innovation that he purchased in 2018. Dr Da Cruz says the unit’s top-notch image clarity and large FOV makes it one of few CBCTs out there that can rise to his exacting diagnostic demands.
“You need a large FOV that allows you to see more of the neck, which is important in my field. The issue is not necessary the airway or sleep apnoea but it could be a neck issue, TMJ or a big tongue so it helps to see all of it in crisp detail.”
The Green 21 offers a wide range of selectable FOV that helps to limit patient radiation exposure, and allows users to capture only the region of interest. Users can select between 21x19, 17x15, 17x11, 12x9, and 8x8 fields of view. The large 21x19 FOV is designed for complete diagnostic imaging, covering the airway as well as ENT regions.
For his type of work, Dr Da Cruz says the image quality of a cone-beam machine is non-negotiable. One of the reasons he picked the Vatech x-ray unit has to do with the Korean company’s superior optical sensors, which is constructed from in-house components – all the way from CMOS design to viewer software. The Green 21 utilizes a proprietary 49.5 um high-resolution x-ray sensor, which makes it one of the finest pixel and highest resolution CBCTs available on the market today.
Dr Da Cruz relates how in just one year of using the Green 21, the machine already helped with the early detection of a patient’s tumour. “From the clear image, I could detect that she had bone loss which led to further investigation and discovering the tumour.”
“It’s so gratifying to know that you’ve made a difference to someone’s life, especially in this case because she went on to have twins,” he beams, “plus this was a peculiar jaw problem with potential for misdiagnosis.”
Besides top-notch sensors, the dentist attributes Green 21’s high resolution images to the ease with which patients are positioned with minimal movement during capture – thanks to a sturdy and patient-friendly chin-holder – and 64-bit image processing capability. The latter feature greatly improves anti-aliasing and scaling with far more accurate rendition, as compared to 32-bit images. Having invested in six new computers that can support this advanced imaging feature, Dr Da Cruz says the financial outlay was well worth the returns: “It literally pays for itself.”
One of the key features of the multi-modality CBCT is its ability to automatically generate up to six images – Panorama, PA Ceph, Lateral Ceph, SMV Ceph, and Waters' View Ceph – in one scan. With a few simple clicks, the system can capture images for craniofacial, maxillofacial, and orthodontic treatment planning.
“Not only does the (Green 21) help you to formulate treatment plans more accurately, it practically sets up the conversation with your patient.”
“When patients cannot visualise the treatment plan, you need to do it for them. The quality of the images therefore becomes an integral facet of this conversation.”
It also helps to have an in-house unit when attending to overseas or interstate patients that simply do not have the time to shuttle between the practice and an imaging centre. The convenience factor is a major plus for Wholistic Dentistry’s visiting implant surgeon, who can access the x-rays on the spot and make decisions on the fly.
The Green 21’s volumetric analysis and measurement tools are indispensible for documentation and making accurate comparisons over time, whether for showing patients or teaching other dentists. A powerful tool for airway volume analysis, the Green 21 features the 2-click airway region selection; automatic airway volume measurement; as well as simultaneous analysis for both TMJ.
“The type of research and clinical work that I do is rather new. Proper case documentation is very important for establishing the feasibility and success rates of my treatments, some of which are presented as case studies in my lectures.”
“The Green 21 is essential for advancing evidence-based dentistry in my practice as a remarkable teaching and communication tool.”
Dr Da Cruz’s success dealing with complex cases – some of which were referred to him after having received little or no help elsewhere – has attracted interest from the orthodontic and broader dental communities in Australia, India, China and the US, where he recently held a two-day speaking seminar with progressive orthodontist Dr Barry Raphael in New Jersey.
“Beyond surgical treatments, dentists can provide treatment for conditions previously thought unconnected to dentistry – as my work in the last 43 years would testify. I’ve been treating my practice like a research lab over the years accumulating a string of success stories showing positive results from repeatable treatment modalities.”
Happy with his purchase decision and Vatech’s customer support, he adds:
“Whether to investigate the airway, neck, jaw or teeth, I want the best quality x-ray machine that provides long-term comparative metrics for my work now and into the future.”
“The Green 21 has been – and will be – that machine for me.”