Dentistry Today — April 2019

Inside this issue

Excerpts from the issue. Open the digital edition to read any page in full.

1. Page 2

   Modern Instruments and Materials Facilitate Modern Access Design Figure 1. (a) The HyFlex EDM 25/.12 orifice opener, 10/.05 Glidepath file, 20/.05 preparation file, 25/.12 Probe Orifice. (b) The HyFlex EDM 20/.05 preparation file highlights the controlled memory property. Figure 2. Tooth No. 19 Dx: SiP/SAP. Figure 3. (a) Tooth No. 19 "dual-access" or "truss" minimally invasive endo access design. (b) COLTENE Rapid Speedster Micro Cutter US No. 155586 and COLTENE Alpen diamond bur shape 856 for access prep. As endodontic techniques and practices continue to evolve and spawn new paradigm shifts lending to clinical demands of creative dentin-conservation designs, we…

2. Page 8

   Oral Cancer and Endodontics In this month's issue of Dentistry Today, 3 articles have been selected that share important information involving a very important dental arena: endodontics and oral cancer. In the past, we have had authors touch on various aspects related to the many challenges that oral cancer continues to present to the dental profession and to patients. As a profession, in addition to raising the bar with better screening, more accurate and timely diagnoses, and properly planned treatment protocols, we need to be laser focused on the prevention of this dreaded April is Oral Cancer Awareness Month and,…

3. Page 10

   Oral Sex and Oral Cancer It's Our Turn to Talk! Today, in a time where 75% of our illnesses are preventable, and where prevention takes a backseat to disease (including vaccinations for communicable illnesses), we as dental professionals can make a difference. In the future, there may come a time when dental offices will be part of the point-of-care vaccination campaign for a deadly disease run rampant: oral pharyngeal cancer (OPC) from the human papillomavirus (HPV). HPV is the single most prevalent sexually transmitted infection in the United States,¹ and, because of that, HPV-OPC is now considered an epidemic, causing…

4. Page 12

   VIEWPOINT continued from page 10 of viruses called HPV, and most of it is hiding in the back of the mouth, behind the tonsils, in the back of the throat, or on the base of the tongue where neither you nor I can see it. That makes screening for oral cancer very difficult these days, and watching this epidemic grow among our population is frustrating." 2. State the cause with confidence. Lead by example on sensitive health topics with your patients. If you act strange, they will feel strange. Use a professional and matter-of-fact tone. Remember, you are talking to…

5. Page 14

   FOCUS ON: Xerostomia Jo-Anne Jones, RDH, discusses xerostomia, the challenges for patients who suffer from this condition, and innovative solutions that offer increased comfort and improved oral health. Q: How prevalent do you feel xerostomia, or dry mouth, is in today's population? A: Reports of the prevalence of xerostomia, or dry mouth, vary greatly, with a substantial increase incurred from aging. One finding estimated that approximately one-third of the population over the age of 65 experiences xerostomia. The prevalence of xerostomia is far greater than one would consider within certain demographics of our population. For example, it reaches close to…

6. Page 16

   Bio: Dr. Robert A. Conte graduated from the University of Connecticut School of Dental Medicine in 1993 and has been in private practice in Warwick, RI, for the past 24 years. The busy 2-doctor practice is largely restorative based, with CEREC at the core of its everyday activities. In addition, Dr. Conte is a basic and advanced CEREC trainer. He is a beta tester for Dentsply Sirona and several other material manufacturers. He has lectured throughout the country and internationally on the CEREC system. Dr. Conte has a visiting faculty position with Spear Education and cerecdoctors.com in Scottsdale, Ariz. Short…

7. Page 18

   Calaject ★★★★½ (91%) Aseptico | (866) 244-2954 | aseptico.com Consultants' Comments • "Easy to see the remaining anesthetic and listen to the auditory beep for speed/pressure." • "I really liked the small footprint and high-tech look of the unit." • "Easy to set up and load/unload." • "No extra disposable tubing to deal with." • "Every single patient loved it." • "Injections take longer in fast mode than from a standard syringe." • "Modes 2 and 3 did not give me the flexibility to switch speed fast enough." • "Some patients stated that they felt no difference with the Calaject…

8. Page 20

   Perpetual Change Paul Feuerstein, DMD There were eye-opening products that are being used by dental labs now that are actually driving the entire dental industry to new processes and products. The recent Chicago Midwinter Meeting had, as usual, new product introductions from existing companies and new exhibitors as well as existing products trying to catch the attention of attendees. There were a few surprises; one was a bit disappointing. For years, Oral Health America (OHA) hosted its annual fundraiser at the opening night of the meeting. This charity, which started in 1975, helped the underserved population of children by donating…

9. Page 22

   Utilizing the Digital Workflow for Success Restoring Maxillary Central Incisors Gary Kaye, DDS Matthew Goldstein, DDS INTRODUCTION As an early adopter of digital technology in my general dentistry practice, I have spent the last 15 years helping clinicians and laboratory teams learn about digital restorative dentistry and, more importantly, how to implement it in the dental practice. The vast majority of dentists I have encountered believed that the adoption process was both difficult and complicated— the primary reason being that, for quite some time, there were too many barriers to doing so. There were a limited number of options when…

10. Page 24

    TECHNOLOGY FIGURE 4. Scans [TRIOS Intraoral Scanner (3Shape)] of the preparations (teeth Nos. 8 and 9), opposing arch, and occlusion. FIGURE 5. Design of the lithium disilicate (IPS e.max [Ivoclar Vivadent]) crowns for teeth Nos. 8 and 9. FIGURES 6 and 7. Design of the lithium disilicate crowns for teeth Nos. 8 and 9, in occlusion. FIGURE 8. Design of the lithium disilicate crowns for teeth Nos. 8 and 9, occlusal view. FIGURE 9. Postoperative smile. FIGURE 10. Post op smile, showing the lip-line. FIGURE 11. Pre-op and post-op comparison. Utilizing the Digital Workflow for... continued from page 22 create…

11. Page 25

    TECHNOLOGY 25 lucency and shade before selecting the appropriate cement. The restorations were cleaned using a universal cleaning gel (Ivoclan [Ivoclar Vivadent]) and then rinsed thoroughly with water. Next, the intaglio surfaces of the lithium disilicate restoration were etched using a 9.6% hydrofluoric acid etch, then rinsed thoroughly and dried. A universal primer (Monobond Plus [Ivoclar Vivadent]) was then applied to the intaglio surfaces of both crowns and dried. The tooth preparations were isolated and dried, and a universal adhesive (Adhese Universal in a VivaPen [Ivoclar Vivadent]) was then applied (as directed) and light cured. The crowns were cemented (Variolink…

12. Page 26

    Spotlight LED Curing Light's Automated Assistance System Detects Handpiece Movement AMHERST, NY–Ivoclar Vivadent announces the introduction of the new Bluephase G4, the first intelligent LED curing light. Its automated assistance system detects if the handpiece moved during the curing process and the restoration can no longer be cured reliably. Depending on the extent of movement, the Bluephase G4 Polyvision either emits a vibration alert to inform the operator of the error and, if necessary, automatically extends the curing time by 30%, or—if the handpiece moves too much (eg, slips off the tooth)—interrupts the curing cycle by automatically shutting off so…

13. Page 28

    Spotlight Reconfigurable Wireless Light Fits All Loupes and Eyewear Chairside System Provides Patients With High-Quality Treatment PLANO, Texas–DentLight released Nano Freedom2, which is a reconfigurable wireless loupe light that fits on all major loupes and eyewear. It is an upgrade to the Nano Freedom wireless loupe light. It offers the same small LED lamp that has 2 built-in connectors to link to either one battery pod for 20,000 lux intensity or 2 battery pods for 40,000 lux intensity. There's also an option to use a battery pack for all day operation, if needed. The lightweight (5 g) LED lamp fits…

14. Page 29

    Spotlight Cloud-Based Phone System Makes Offices More Efficient LORETTO, Minn.-XLDent's new cloud-based phone system provides a simple solution for dental offices to be more efficient. XLDent has partnered with Mango Voice to offer the best in time-saving and cost-effective features to make one's practice run better. This solution is great for any size practice and helps one easily manage a single location or connect multiple locations seamlessly. State-of-the-art infrastructure ensures excellent performance and voice quality. When paired with XLDent practice management software, smart caller ID automatically retrieves patient information and outgoing calls are easily made with one click. For more…

15. Page 30

    Spotlight Small Apex Locator Offers Ability To Be Clipped NEWPORT BEACH, Calif.–Good Doctors USA, a manufacturer of innovative dental products, announced that its portable apex locator, NEO, has received FDA clearance and is ready for distribution. The lightweight NEO is the size of a smart watch (43 x 43 x 11 mm) and is the world's smallest apex locator. It was designed by a dentist who was tired of having to continually lift up his or her head to look at the apex locator while performing root canals. This small device can actually clip onto a finger ruler. One never…

16. Page 32

    Spotlight Composite Features Impressive Physical Properties EDGEWOOD, NY- Parkell's LC Fill, a new bulk-fill, light-cured composite, is ideal for restoring teeth from the bottom of the prep to the occlusal surface. Formulated with a self-leveling consistency, LC Fill also features impressive physical properties, including low shrinkage, 280 MPa compressive strength, 145 MPa flexural strength, and the ability to withstand occlusal forces. LC Fill is versatile, too. It may be used as a restorative and may also be used to top off LC Base. Use this material for cusp and margin repairs, indirect restoration fabrication, and more. It comes in a…

17. Page 34

    Device Places Dental Materials Precisely and Accurately Into Oral Cavity Spotlight Light-Cured Desensitizer Provides Effective Chairside Solution ENCINITAS, Calif.-Shield Force Plus from Tokuyama Dental America is an advanced, light-cured desensitizer that provides a pleasant, effective, and easy-to-use chairside solution for preventing post-restorative sensitivity and treating hypersensitive dentin. Its Double Block Technology provides 2 layers of protection against sensitivity: The first layer penetrates the dentinal tubules for immediate pain relief, while the second layer forms a protective barrier on the patient's dentin, protecting it from further abrasion and fissure sensitivity. When applied under a restoration, Shield Force Plus can increase bond…

18. Page 35

    Gel Enhances Preventative Care Procedures LANCASTER, NH—Dental Herb Company's PerioSpot is a new, powerful gum therapy gel designed to fight harmful bacteria and inflammation directly at the spot. Formulated with the same truly natural ingredients as Dental Herb Company's award-winning Tooth & Gums Tonic, this sticky gel can be placed directly on the affected site to provide an antimicrobial boost where the gums need it most. PerioSpot is perfect for stubborn inflammation sites or to enhance preventative care after dental procedures. It is indicated for in-office, post-procedure treatment and patient home care. For more information or to request a sample,…

19. Page 36

    Discs Release Effective Level of Xylitol During Sleep To Thwart Dry Mouth SEATTLE—OraCoat's XyliMelts for dry mouth are all-natural, great-tasting, oral-adhering discs that slowly release 550 mg of xylitol and oral lubricant to coat, moisturize, and lubricate a dry mouth, day and night, and reduce the risk of tooth decay. It is the only dry mouth remedy for use while sleeping, when dry mouth is at its worst due to low saliva flow. To reduce caries, XyliMelts slowly release an effective level of xylitol to boost saliva flow. Additional benefits of XyliMelts include (1) a nonionic pH of 8 to…

20. Page 39

    bleeding exposure results, chances for success without endodontics are greatly reduced (Figure 2). After clean-out, the tooth is isolated. I like the Matrix Ring system (Garrison Dental Solutions) for contours and tight contacts. Once isolated, we acid etch, rinse, and blow excess moisture. Next, Hemaseal & Cide (Advantage Dental Products) is applied. This has 4% chlorhexidine, HEMA, and H2O, and it penetrates and disinfects better than any other product I know of. Also, CHX does not traumatize soft tissue like glutaraldehyde. I have done this procedure without Hemaseal & Cide, but my success rate was closer to 60% than the…

21. Page 40

    Industry News Designs for Vision Expands Into New Facility Designs for Vision has expanded operations into its new 67,000-square-foot manufacturing and R&D facility in Bohemia, NY. Located on Long Island's technical-industrial corridor, the site allows the company to increase production to accommodate the demand for its HDI Headlights and Micro series loupes. It also provides the opportunity to increase capabilities including additive manufacturing and CNC turning centers. Its engineered R&D labs are built to the state of the art. Designs for Vision adds, and allow for continued innovation and product introduction. BIOLASE Names Sinclair Dental Its Exclusive Canadian Distributor BIOLASE…

22. Page 42

    Composite and Adhesive... continued from page 40 corresponding author of the study and associate professor of restorative dentistry. "Every time this happens, the tooth under the restorations becomes weaker and what starts as a small cavity may end with root canal damage, a lost Clinic for Patients... continued from page 40 both at home and at the dental office. I treat all of my patients and their parents/caregivers with the utmost compassion and understanding as I do with my own family. I look forward to seeing the positive changes we can make together," Dent said. The foundation notes that most…

23. Page 46

    NINTH ANNUAL READERS' CHOICE TOP 25 ENDODONTIC PRODUCTS Dentistry Today's Readers' Choice Top 25 Endodontic Products, selected on the basis of lead generation, represent some of the profession's most innovative endodontic products. The products appear in no particular order. Brasseler USA The XP-3D Shaper addressed the shortcomings of traditional NiTi instrumentation and ushers in a new biologic standard of care in endodontic debridement. Featuring Brasseler's exclusive MaxWire Technology, the XP-3D adapts to the canal's natural anatomy by expanding once exposed to body temperature. Unlike traditional round files, a single XP-3D Shaper instrument is able to gently deride virtually every size…

24. Page 48

    Top 25 Endodontic Products EdgeEndo The EdgeEndo Platinum is an assortment of shaping and finishing files that set a new standard in safety and canal centering by significantly improving the resistance to cyclic fatigue and flexibility. The proprietary FireWire heat treatment vastly improves the NiTi metallurgy, delivering unmatched strength and flexibility. EdgeEndo was founded on a revolutionary idea of creating superior endodontic products for less and passing the cost savings on to the customers. Staying true to that promise not only defines industry wisdom but has made EdgeEndo one of the world's largest pure NiTi suppliers in 4 years. Founded…

25. Page 50

    Top 25 Endodontic Products MedicNRG USA The new Rider S3 innovative apex locator makes root canal treatment easier, safer, and faster. It is the world's only apex locator that can be mounted on the dentist's existing endodontic handpiece to continuously give the position of the file in real time while pinpointing the precise location of the apical construction. This unique feature eliminates the need to frequently stop and check the file's position. This device can also stand alone on your tray like a conventional apex locator. The Rider's patented Digital Signal Processing (DSP) provides consistent, reliable measurements with 0.1-mm precision,…

26. Page 51

    Endodontic Products Top 25 READERS' CHOICE DiaDent The Dia-X Rotary File System offers heat-treated, premium NiTi construction with extreme flexibility and durability. The resistance to cyclic fatigue is at least 143% greater compared to other nontreated rotary files. With its progressive taper design and superior cutting efficiency, these files offer precision, safety, and reliable clinical results. The Dia-X Rotary File has a convex triangular cross section while reducing rotational friction and contact with canal walls. The heat-treated surface is also coated, providing high corrosion resistance. Dia-X Rotary File's handle has a length of 11 mm, offering improved accessibility to teeth.…

27. Page 52

    Top 25 Endodontic Products DenMat Core-Post is ideal for core buildups in single-tooth restorations. Flexing like natural tooth structure, it dramatically minimizes tooth stress and fractures that occur with standard metal posts. With a coefficient of thermal expansion and modulus of elasticity nearly identical to dentin, Core-Post's exceptional physical properties are key to its strength and compatibility with cement, dentin, and core. The posts are easy to cut and use and are available in carbon fiber for increased posterior strength and tooth-colored glass fiber for anterior aesthetics. Core-Posts are available in 5 diameters, including 1.0, 1.2, 1.4, 1.7, and 2.0…

28. Page 53

    Endodontic Products Top 25 Angelus Dental MTA Repair HP is a bioceramic repair cement that maintains all indications and chemical and biological properties of the original MTA. In putty form, it drastically facilitates its application. Handling was a cause of stress reported by clinicians when using conventional MTA due to its sandy consistency. The enhanced formula with calcium tungstate does not stain the tooth. Setting in only 15 minutes allows treatment in single visits. Its exclusive vials and capsules guarantee a 3-year shelf life. The box provides 25 cases or more. For more information, call (855) FIND MTA (346-3682) or…

29. Page 54

    Top 25 Endodontic Products Essential Dental Systems Tango-Endo is a 2-instrument, safe, economical, and efficient endodontic instrumentation system. Unlike other "reciprocating" systems that eventually move in full rotation, Tango-Endo is truly reciprocating, truly eliminating binding and instrument separation. In addition to being safe and efficient, it also has helped doctors save thousands. Calibration rings provide quick and precise assistance in determining the working length. Tango-Endo eliminates the fear of fracture, helping one complete endodontic cases in a simple and predictable process. For more information, call (800) 22-FLEXI (35394) or visit eisdental.com/tangoendo. FREEinfo, MUNCE DISCOVERY BURS® The Original Troughing Bur™ IN…

30. Page 56

    Better and Faster Root Canal Treatments A Synopsis of the Latest High-Tech Protocols Manor Haas, DDS The success rate for non-surgical root canal treatments has been shown to be high.1 Nonetheless, yet-fingered dentists are always eager to improve their root canal treatments diagnostically and technically. This includes scenarios in which dentists want to better visualize the treatment sites radiographically and intraorally or have the ability to locate calcified canals better. Furthermore, while we obviously want to improve the quality of our root canal treatments, we also strive to perform them faster. This may be especially crucial when dealing with endodontic…

31. Page 57

    determine the true extent of the problem. Clinical problem: Root resorption is noted in a periapical radiograph, but its true extent is unknown. Solution: Take a CBCT scan of the site instead of performing a more painful, expensive, and traumatic surgical flap evaluation. It should be stressed that not all endodontic cases require CBCT imaging. Yet, as demonstrated, when clinical and 2-D radiographic imaging do not provide enough information, 3-D radiographic imaging has proven itself to provide faster and, more With good CBCT imaging, dentists can now diagnose many cases better and faster than before. importantly, better information than any…

32. Page 59

    ENDODONTICS 59 tion during access preparation. Solution: Use a CBCT guided ACCESS-GUIDE (endodontic stent). Enhanced Magnification Once a tooth is accessed, it is important to evaluate it internally for canals, perforations, vertical fractures, and pulp stones. This can best and most quickly be done with the use of enhanced magnification and illumination. That includes quality, high-powered dental loupes with an overhead LED light or, even better, with a dental microscope (Figures 14 to 16). A case in point is the ability to more easily and frequently locate MB2 canals of maxillary molars. This is a canal that dentists notoriously have…

33. Page 60

    Figure 20. Tooth No. 3, with a calcified pulp chamber and apical lesions. Figure 21. View of accessed tooth No. 3 with very low magnification. Figure 22. View via a microscope of a pulp stone inside accessed tooth No. 3. Figure 23. View of the pulp floor groove from MB1 to MB2 under pulp stone. Figure 24. Final tooth No. 3 root canal treatment of 4 canals. Figure 25. Scout .02 and 04 NiTi files (Brasseler USA). Figure 26. WaveOne Gold Glider .02 NiTi file with controlled memory (Dentsply Sirona Endodontics). Figure 27. WaveOne Gold NiTi reciprocating files (Dentsply Sirona…

34. Page 62

    Rotary Negotiation Procedures L. Stephen Buchanan, DDS INTRODUCTION Clinical facts are often obsoleted by progress. When I began designing variably tapered shaping files in 1991, my objective was to create a 20-06 hand file (0.2 mm tip D with a .06 taper) that could cut to length without help from any other shaping instruments. This followed an epiphany I had that cutting tapered shapes in root canals was needlessly difficult because we only had .02 tapered K-files at the time. As soon as I imagined this variably tapered file in my head and understood its potential, I wondered why nobody…

35. Page 63

    versible apical blockage, and this happens while doing everything exactly as taught: irrigating with NaOCl, working a #08 and a #15 K-File to gate between files), and then irrigating again and taking the #15 to length. It's a simple technique to describe but, far too often, the #15 hangs short of length and, when smaller files are taken in, it's discovered that there is an impenetrable apical blockage. The predominant theory explaining these untoward outcomes was that the 50% increase in tip diameter between the #10 and #15 K-Files was too great and that we needed a #12.5 size file…

36. Page 64

    Figure 2. Comparison of chip space in the cross-sectional geometry of square and triangular files. The triangular file is of the same top size but with 57% more chip space, radically improving its ability to cut dentin without apical blockage. Square File Triangular File 57% more chip space! files are forced into this sea of sludge while rotating. Be aware that these files in this applicant are being asked to do the majority of the instrumentation in small canals—perhaps the only instrumentation in many—so they should be placed early and often in multi-canalar teeth. Nearly all 4-canal molars treated in…

37. Page 65

    ENDODONTICS 65 Obturating Beyond Impediments with Conefit Obturating Beyond Impediments with Carriers Figure 7. Obturating beyond impediments with conefit. Figure 8. Obturating beyond impediments with carriers. nal two-thirds of the canal. In the case final position of the carrier than conefit of a canal that is frustrating efforts to methods (Figure 9). negotiate around the impediment, this additional coronal space will CLOSING COMMENTS allow the tips of pre-bent files to arrive The productivity gains rotary files at the impediment still bent enough brought to our shaping procedures to sneak around tortuous canal paths are now being delivered to our negotia-…

38. Page 68

    Technology Supports Success! Our implant editor, Michael Tischler, DDS, speaks with Scott D. Ganz, DMD, about cutting-edge technology for implant dentistry. You have been involved with dental implants for many decades as a surgical prosthodontist, contributing to scientific literature and numerous textbook chapters, helping to hone fine surgical courses, and continuing to be in demand as a lecturer around the globe on a regular basis. What is your motivation? Dr. Ganz: First, Michael, I want to thank Dentistry Today for the years of dedication to the dental industry in bringing such an array of educational articles from clinicians of all…

39. Page 70

    Technology Supports Success! continued from page 68 this concept within the pages of Dentistry Today and other publications in past years. Okay, most clinicians have a clear understanding as to the importance of CBCT in the placement of implants, but other tools are necessary? Dr. Ganz: Well, actually, I'm not done with the first part—it's too important. Even though we have this amazing tool, CBCT, many clinicians still have no real understanding of how to navigate through the software, or how to truly diagnose or treatment plan with or without regard to dental implants. Take, for example, a failing mandibular…

40. Page 71

    INTERVIEW 71 Figure 6. Using an in-house printer with a large enough print bed, it was possible to produce 2 full-scale mandibles, a bone reduction guide, and a surgical drill guide for implant placement (Form 2 [Formlabs]). Figures 7a and 7b. Prior to fabricating a definitive prosthesis, a lab-based tooth design software and CAD application (exocad [exocad GmbH]) prepares a file that can be 3-D printed or milled. sentation of the defect as previously described (Figure 5b). The ability to visualize a 3-D printed model can be appreciated by the novice or expert as it represents a physical replica of…

And 19 more pages — read the whole issue.