Dentistry Today — April 2021

Inside this issue

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

1. Page 6

   Almost at the Finish Line Beware the ides of March. That time has passed, but we are still not out of the woods, although many states are relaxing restrictions and depending on their constituents to follow common sense. I have a patient who is a weatherman, and I told him the other day that he has been out of business for a year, but things might pick up soon. He did not understand. I told him that for this past year, the idle conversation has been about COVID and not the weather, even right here in this column. At least…

2. Page 8

   Oral Health, COVID-19, and Systemic Considerations INTRODUCTION With COVID-19 lingering for the past year, keeping a strong immune system is more important than ever. However, researchers tell us that a large portion of Americans fall short of the necessary requirements of essential nutrients from food alone. The obesity epidemic in the United States proves that many people have a below average or poor diet. Additionally, as we age, nutrient absorption declines, and medications reduce or even stop the absorption of essential nutrients. According to health.gov, 75% of Americans have diets that are entirely too low in fruits, vegetables, and/or nutritious…

3. Page 9

   ies, low absorption rates, and inexpensive synthetic ingredients and are often packaged in unregulated facilities. Hence, most obstetricians typically do not recommend off-the-shelf prenatal vitamins. CONCLUSION Patients today are reading new studies on nutraceuticals online. Due to the coronavirus pandemic, they're seeking out healthcare professionals who will incorporate more preventive care to maintain good health and a strong immune system. The same vitamins recommended to help relieve coronavirus symptoms are the same ones recommended to maintain oral health, particularly zinc and vitamins B, C, and D. People today want health professionals on their teams who practice prevention while using fewer…

4. Page 10

   Pandemic Fitness for Dentists Uche Odiatu, DMD, discusses how most of us spent more time at home and less time working out this year, and that's on top of our somewhat sedentary jobs as dentists. Q: How can we stay in good physical shape? A: Most people want to get in shape and exercise to get a flat stomach and look better for Facebook. However, exercise is so much more about brain health. There is a neurotransmitter called brain derived neurotrophic factor (BDNF), and it helps all the communications with the 150 billion neurons in our brains. Anyone who is…

5. Page 12

   Chair Appeals to Righties and Lefties Thanks to Easy Switching SAN ANTONIO—Upgrade your practice with Ritter Dental USA's German-engineered Vanguard and Vanguard Smart dental packages. The Vanguard combines the technology of electronics and the smooth movements of hydraulics in Ritter Dental's most popular dental unit. The left and right 360° unit can very easily be switched from right hand use to left hand use. The patient chair is synchronized hand and also offers a 30° swivel. This package comes standard with an upgraded LED operating light and all of the quality and features that you have come to expect from…

6. Page 14

   Microscope Provides Breakthrough Visualization Modes DUBLIN, Calif.—The EXTARO 300 from ZEISS provides breakthrough visualization modes that introduce new applications to microdentistry. From more efficient caries detection to a simpler tooth restoration workflow, EXTARO 300 is poised to revolutionize and differentiate your practice. The integrated HD camera of the EXTARO 300 records wirelessly to the ZEISS Connect App, empowering patient interaction with images and videos directly transferred to your local network. With the ZEISS Connect App, one can show images of past and current patient conditions, as well as highlight areas requiring treatment, enabling patients to make informed decisions. For more…

7. Page 16

   Imaging System Offers Unmatched Patient Experience SAN JOSE, Calif.–Align Technology's iTero Element 5D Plus imaging system in cart configuration is the latest generation of iTero Element scanners and imaging systems. It's a powerhouse of capabilities, suited to improve the practice and patient experience with state-of-the-art computing power, elegant design, and ergonomics. Enhanced, more detailed visualizations with wider viewing angles provide an unmatched patient experience. Powerful computing advancements enable a smoother and more intuitive scanning experience. The system is ergonomically designed to conform to best practices scan. The integrated intraoral camera eliminates the need for a second device while enhancing patient…

8. Page 17

   Small Endodontic Device Easily Pierces Into Orifice Entrance RANCHO CUCAMONGA, Calif.—The JW17 Signature and Standard Series Microendodontic Explorer from DoWell Dental Products is finally back and smaller than ever. While the microscope has turned on the lights for many dentists, tiny and often calcified canal orifices often must be felt before they're actually seen. Almost every clinician performing endodontics learned using the classic DG16 explorer. And every clinician knows that the DG16 endo explorer is so large it often blocks small canal entrances. However, the JW17 is so small in diameter that it easily pierces into the orifice entrance, identifying…

9. Page 18

   Introducing a New Digital Imaging System INTRODUCTION It was in the early 1990s when Dr. Gary Carr, a leading endodontist, effectively introduced the surgical operating microscope (SOM) into dentistry in this country.¹ In reality, the use of the SOM in academic endodontics was introduced in 1992 when Dr. Syngcuk Kim went from Columbia University to the University of Pennsylvania (Penn) School of Dental Medicine as its endodontic chairman. Dr. Kim quickly established Penn as the premier training center for the use of the microscope in endodontics. The response was immediate and profound. Everyone understood the need for enhanced magnification and…

10. Page 19

    Calasept® Endoline By DIRECTA Calasept has a very high content of calcium hydroxide (> 41%) giving a high concentration of hydroxyl ions. These generate the high pH value of 12.4 which has a pronounced bactericidal effect, i.e killing of bacteria. "The original!" CALASEPT® Benefits: • Long-lasting and very effective • Direct, quick and easy application • Optimal calcium package • Five indications - only one product • Air tight syringe Indications: • Temporary root-filling • Pulp capping • Pulp protection • Insulation in deep cavities • Stepwise excavation Limited Offer 2+1 PROMO FREEinfo, on card DIRECTA directadental.com Call us Today!…

11. Page 20

    Design Group (St. Louis), the design firm that co-developed the da Vinci surgical robot. OVERVIEW OF THE CONCEPT The EZscope is a digital imaging system that allows the user to orient a digital camera and display an image on a tablet (monitor) for optimum viewing of a dentition or surgical field. The camera is guided by hand to the desired position of viewing. The counterbalanced arm "follows" and builds its position via friction and counterweighting located at the end of the balancing arm. The arm has a 90° range of motion from horizontal to vertical. The vertical post is also…

12. Page 21

    TECHNOLOGY 21 ware with the tablet is also its latest version (Windows Pro too), equipped paneled by our own proprietary soft-ware. This combination allows the system to program many functions. The optic center combines a digital sensor with a very sophisticated lens and also contains the obligatory light source and diffusers. Because of a special ball-swivel adaptor (the Gatti adaptor), the optic center has incredible maneuverability, which makes patient positioning very easy. In fact, the optic center can be positioned below the occlusal plane, shining directly up into the maxillary arch. This is a significant improvement because, as is very…

13. Page 22

    Rare Diamond Offers Distinct Features SANTA BARBARA, Calif.—In keeping with the tradition of listening to clinicians, CJM Engineering introduced TruGrit Trough Refiner, which is a rare diamond. Slow-speed latch-type diamonds are uncommon and, until now, nonexistent with these distinct features. Designed by an endodontist for endodontists and endo-savvy dentists, this unique, 30-mm bur has a narrow shaft with pec metric features that maintain the view corridor and reduce shaft impingement while providing the stiffness required for troughing-type procedures. The perfect companion to the fluted carbide Munce Discovery Burs, the 4-mm diamond portion that tapers down to 0.4 mm at the…

14. Page 24

    Composite Creates Long-Lasting Restorations THE VILLAGES, Fla-With DMF USA's NANOCERAMBRGHT's adaptive, chameleon-like technology, one can easily and confidently create long-lasting, natural-looking restorations that patients won't stop smiling about. For more than 30 years, DMF has developed an innovative manufacturing process that integrates a unique blend of microand nanofillers into the resin matrix, creating an easy-to-sculpt nanohybrid composite for Class 1 to IV restorations. For more information, call DMF USA at (908) 963-8240, visit the website dmpfdental.us, or email info@dmpdental.us. FREEinfo, Desensitizer Changes Method for Treating Dentin Hypersensitivity EDGEWOOD, NY-Parkell's Predicta Bioactive Desensitizer is changing the way clinicians treat dentin hypersensitivity…

15. Page 25

    Toothbrush's Features Stop Unpleasant Vibrations MESA, Ariz.—Swiss brand Curaprox is now offering a BLACK is WHITE Hydrosonic Toothbrush with carbon brush heads. It is gentle and effective with the finest CUREN filaments, as well as an extra pleasant enamel-friendly back, to prevent unpleasant vibrations. The innovative teardrop-shaped design of the brush heads envelops each individual tooth. Even hard-to-reach areas are easily cleaned thanks to CURACURVE ergonomics. It offers 3 intensity levels for up to 84,000 brush movements per minute with a simple, one button option for switching on and off and changing levels. It provides a 2-minute timer and 2-week…

16. Page 26

    Industry News Biolase Launches Waterlase Perio Academy Biolase has launched the Waterlase Perio Academy (WPA) to help clinicians provide periodontal and implant services with improved patient outcomes through the continued adoption of laser technology, according to the company. The WPA will foster peer-led learning with ongoing mentorship from the WPA's leading clinicians, featuring online meetings and case reviews by experts in the field, the company said. The WPA will be open to all periodontists who use Waterlase technology. "Launching an academy devoted to supporting the growth and timely needs of periodontists directly aligns with Biolase's mission of advancing dentistry," said…

17. Page 28

    The Endodontic Triad 'Dead or Alive?' INTRODUCTION "Change is the only constant." The Greek philosopher Heraclitus is credited for speaking one of nature's absolute rules about time and change. However, perhaps because events and things like inventions were slow to change 2,500 years ago, Heraclitus did not mention the rate of change. In April 2021, the rate of change is becoming exponential. In fact, we are at the knee of the exponential technological curve, and the rate of change is continuously increasing. In this article, I have chosen to link the phenomenon of endodontic change from the past, present, and…

18. Page 30

    Figure 2. The Present. Pretreatment and post-treatment radiographic expressions of the Endodontic Triad submitted by 10 respected endodontists: (a) Dr. George Bruder, (b) Dr. L. Stephen Buchanan, (c) Dr. Gary Glassman, (d) Dr. Manor Haas, (e) Dr. John Khadem, (f) Dr. Charles Maupin, (g) Dr. Tom McClammy, (h) Dr. Blake McCray, (i) Dr. Terry Panniuk, and (j) Dr. Reid Pullen. The Endodontic Triad... continued from page 28 locators, and digital imaging, careful and vigilant attention to technical detail produced verifiable success.34 It has been said many times before that we stand on the shoulders of giants, and now future giants…

19. Page 33

    ENDODONTICS 33 and QMix with the EndoActivator for 30-plus seconds per canal. I use a 29- side-venting endo irrigating needle to deliver these agents." ● Shape: "I start with C-files (46, 48, 10) as needed, depending on the size of the canals, followed by PathFiles for exceptionally calcified or curved canals or WaveOne Gold Glider (Dentsply Sirona) for less calcified canals, to obtain a glide path. I finish with ProTaper Gold files (Dentsply Sirona). I determine the master file size with apical gauging vs a onesize fits all technique. For instance, I would tend to instrument larger at the apex…

20. Page 34

    ENDODONTICS fit validated with EAL and a digital image. • Sealer: "Endosequence BC sealer, which is now being marketed by numerous dental companies." 8. Dr. Blake McCray • Clean: "Centirix Wave disinfection 90% of the time and EndoActivator irrigation 10% of the time." • Shape: "ProPaper Gold on every case. Always finish with Fl unless a canal dictates a larger size." • Pack: "Single cone on every case with matching ProPaper Gold gutta-percha." • Sealer: EndoSeal MTA 9. Dr. Terry Pannkuk • Clean: "Chlorox Ultra (8.25% NaOCl) is the mainstay irrigant; alcohol is used to clear between irrigants; 17% EDTA…

21. Page 36

    DENTISTRY TODAY 11th ANNUAL READERS' CHOICE Top 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. Ultradent Products UniCore posts are composed of glass fibers. These translucent and radiopaque posts respond to compressive forces as dentin would, without compromising the durability of the restoration. The gentle taper of each post corresponds to the natural anatomy of the tooth and perfectly matches the post space created by the UniCore Drill. The 5 sizes and colors of UniCore…

22. Page 38

    Top 25 Endodontic Products Aseptico A product with over 30 years of motor manufacturing experience, the 7000 Series Motor is one of the most powerful and comprehensive dental motors on the market today. It features adjustable torque and can be used for implant, surgical, and endodontic applications. Aseptico's worldwide reputation for building strong, dependable dental equipment guarantees reliability and performance for years. Many other features set the 7000 Series Motor apart from the rest, including a dynamometer calibration system that ensures that the motor's torque output is always accurate. Six programmable preset buttons allow for complete personalization. The motor's upgradeable…

23. Page 40

    Top 25 Endodontic Products DiaDent The new Dia-Root Bio Sealer is a highly radiopaque, pre-mixed, and prefilled bioceramic calcium silicate-based MTA sealer in a syringe. It has high biocompatibility to induce hard-tissue regeneration in sites with bone lesion and microbial activity while ensuring the rapid recovery and healing of tissues without causing inflammation. It has low solubility (0.95%) to maintain an excellent seal inside the canal. Dia-Root Bio Sealer also has optimal flowability to ensure easy penetration into lateral and accessory canals. It has a high pH of 12 for antibacterial action. It has long-term stability and superior adhesion between…

24. Page 42

    Top 25 Endodontic Products Angelus USA Splendor SAP is designed to let the clinician adapt the fiber post to the canal flare with a vertically sliding (adjustable) conical sleeve when necessary. The optional sleeve is made of the same radiopaque, fiber-reinforced composite as the post and slides onto the post, covering a pointed, parallel post into a custom-fitted post. Replacing cement with material of high mechanical properties increases the overall strength of the post/core restoration. Splendor SAP offers one of the most economical and simplest ways to do this. It comes in only one narrow size (0.65 mm apical/1.0 mm…

25. Page 43

    B&L Biotech The Superendo Beta Mini Cordless Obturation device is designed for warm gutta-percha techniques. Perfectly complementing the Alpha heat source, it provides simplicity, durability, ease of use, and comfort in a cordless injectable obturation gun. Compact in size, the Beta Mini also is designed for an easier and effortless squeeze of gutta-percha while also being lightweight and ergonomic for all users. With the use of the patented 360° swivel needle, users can change the angle of entry to any canal. The Beta Mini also has a faster heating rate and a 90° angled trigger for an easier grip. One…

26. Page 44

    Top 25 Endodontic Products Brasseler USA The XP-3D Super addresses the shortcomings of traditional NiTi instrumentation and ushers in a new biologic standard of care in endodontic debridement. Featuring Brasseler's exclusive Max-Wire 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 debride virtually every size and type of canal safely and efficiently. It is minimally invasive and offers 3D anatomical cleaning, single-instrument debridement, virtually no stress on the tooth, and high resistance to cyclic fatigue. For more information, visit xp-3d.com.…

27. Page 45

    Top 25 Endodontic Products Vista Dental Products SmearOFF 2-in-1 effectively replaces both commonly used endo solutions: EDTA and CHX. This proprietary EDTA/CHX mix is formulated with wetting agents and surface modifiers. It is the only true 2-step irrigation protocol. SmearOFF removes the smear layer and bacteria. Formulated for superior calcium suspension, lower surface tension, and optimized smear layer removal, SmearOFF clears 27% more dentin tubules than the leading 17% EDTA. It offers the ability to kill 99.99% of bacteria in just 10 seconds with no rinsing necessary. It does not form a precipitate when used with NaOCl, eliminating the rinsing…

28. Page 46

    3D PRINTING 3D Printed Crown Lengthening and Reduction Guide INTRODUCTION Digital workflows are becoming more popular in dentistry, offering benefits such as improving communication, aesthetic planning, patient education, efficiency, and predicting treatment outcomes.1-4 Intraoral scanners and computer-aided design (CAD) tools allow for the development of virtual diagnostic files and 3D printed models. Past studies have shown that digital impressions are equally as accurate as conventional impressions.5-9 Three dimensional printed guides have been used in dentistry for a variety of indications, including implant placements, oral surgery, endodontics, and orthodontics.10 This case highlights an innovative technique utilizing a digital workflow to improve…

29. Page 47

    Virtual smile design and CAD were utilized to fabricate a 3D printed guide.... the lithium disilicate veneers based on the virtual wax-up. The patient was then seen for bonding the veneers to the teeth. Figure 6 shows the close resemblance of the initial virtual smile design to the final veneers. CONCLUSION The benefits of using virtual smile design technology are multifold: communication, predictability, and efficiency. When patients are able to visualize potential treatment options in the context of their own smiles during consultation visits, they are more engaged in their care and more confident that their goals are aligned with…

30. Page 48

    Grafting and Attached Gingiva to Maximize Implant Prostheses Dental implants have obviously become an integral part of many dental practices today. General dentists, often being the first oral professionals to discuss the possibility of dental implants to inquisitive patients, must understand basic concepts for proper diagnosis and treatment planning, predictable surgical placement, ideal emergence profile and smile design, and postoperative patient management. Patients often present to our practices with a basic understanding of dental implants that they have gathered from family or friends or, most probably, from the internet. Some of the information designed for patient education is actually pretty…

31. Page 50

    Guided Ridge Healing With Full-Arch Custom Prosthetics Soft tissue thickness is imperative around implants to promote long-term survival and the prevention of tissues, including bone die back, peri-implantitis, pain, and even implant failure. It has been reported that a minimum of 2 mm of stable keratinized gingiva is needed circumferentially around an implant for the stability of the implant.1 These studies show there is even a direct correlation between bone loss and thin (<2 mm) keratinized tissue on the facial aspect, even when platform switching.2 There are several ways to surgically augment the soft tissue and around these areas before…

32. Page 52

    Guided Ridge Healing With... continued from page 50 completely cover all mandible or maxillary exposed bone as well (Figure 2). The 2 layers should be tucked under the buccal and lingual flaps by a minimum of 3 mm under the tissues. The PRF can be perforated to fit around the abutment for added fixation of the plasma membrane or laid between implants to be held down vertically by prosthetics. The smooth, ovate provisional is then delivered onto the dental implants and fully torqued into place prior to performing any suturing (Figures 3 and 4). The result is that all the…

33. Page 54

    Figure 9. Mandibular implant overdenture, thick flat profile. Figure 10. Soft-tissue comparison (sculpted vs healed without loaded temps). Figure 11. Sculpting. Figure 12. Profile of the upper arch ovate around the implant sites. Guided Ridge Healing With... continued from page 52 1. An ovate, full arch provisional prosthesis 2. The initial incision extends entirely within keratinized tissue 3. PRF covering the exposed bone is tucked both facially and lingually and fixed under the prosthesis by 3 mm on both sides 4. Separate horizontal mattress sutures on the left and right regions of the mandible or maxilla 5. A rigid, fixed…

34. Page 55

    IMPLANTS is a thin, undeveloped ridge profile. When the restorative dentist delivers a concave, uncleansable prosthesis, it is imperative that the patient return for yearly removal of the prosthesis so that it and the tissues can be adequately cleaned. Secondary grafting to achieve the desired amount of keratinized tissue only adds additional time, morbidity, and cost for the patient. Using this modified full arch abutment technique (Figure 12), it is possible to achieve tremendous gains in keratinized volume and thickness while also making the shape of the gingiva far more cleansable and improving long-term stability. There is often little concern…

35. Page 56

    Maxillary Tuberosity An Overlooked Site for Block Grafts Rich in Cortical-Cancellous Bone A well known consequence of tooth loss is the concomitant loss of the supporting alveolus. The literature demonstrates 25% to 63% horizontal bone loss and 11% to 22% vertical bone loss occurring within 6 months after an extraction.¹ At 12 months, as much as 50% reduction in width of the alveolar ridge has been reported.² Ideal implant position is the foundation for maximum esthetics and functional predictability. Many socket preservation therapies have been prescribed. Numerous studies have repeatedly demonstrated that autogenous bone remains the gold standard for its…

36. Page 60

    60 3D IMAGING/CBCT SYSTEMS continued from page 58 frontal mandibular, (9) left/right premolar mandibular, and (10) left/right molar mandibular. For more information, call (800) 323-2690. FREEinfo, Dentsply Sirona ORTHOPHOS SL is a powerful performer with unparalleled image quality. It provides many options, ranging from sharp 2D panoramic images to full 3D volume flexibility. It also offers secure patient positioning for the perfect x-ray front endo to airway. The revolutionary Direct Conversion Sensor converts x-rays directly into electrical signals without the conventional conversion into light, resulting in images with unparalleled definition. Sharp layer technology generates several thousand images during a single…

37. Page 62

    continued from page 60 PreXion With the launch of the Excelsior line, PreXion still has one of the smallest focal points in the industry. The company has also advanced all other core CBCT technologies, including the x-ray tube and the Flat Panel Detector. The new Excelsior CBCT scanner couples the smallest focal spot (0.3 mm) with the following: a voxel size of 0.1 to 0.2, a 1,024 volume size, a 360° gantry rotation, and advancements in PreXion software. Because of these advances, PreXion can deliver 30% lower radiation exposure without compromising image quality. For more information, call (855) PREXION (773-9466)…

38. Page 64

    Saturation of Carious Proximal Tooth Surfaces INTRODUCTION The delivery of 38% silver diammine fluoride (SDF) solution to caries lesions on occlusal and non-contactaxial tooth surfaces is straightforward. However, saturating bacterial lesions infecting contacting proximal tooth surfaces is more challenging. Some dentists use certain types of dental floss or tape for this purpose. This clinical report demonstrates the use of soft dental picks to deliver SDF to contacting axial tooth surfaces with the goal of attenuating dental caries and remineralizing enamel. In a previous study, a freshly exfoliated primary molar that had a mesial surface caries lesion was positioned in dental…

39. Page 65

    Figure 2. Thirty-eight percent SDF solution, shown with dental picks. Figure 3. Soft dental picks with adhering SDF solution. Figure 4. After flossing and air drying, the mandibular posterior teeth were isolated, and picks with SDF were inserted. Figure 5. The SDF-saturated sliceways for optimum fluid coverage. Figure 6. Fluoride varnish was applied. Figure 7. The treatment was completed. The patient then occluded on 2 × 2 in gauze for several minutes. of a soft dental pick (Figure 4). A small applicator tip dipped in the SDF solution was then used to deliver more solution along each sliceway (Figure 5).…

40. Page 66

    Unique Treatment for Missing Lateral Incisors Adontia, the hereditary absence of primary or permanent teeth, is present in approximately 2% of the population and most commonly affects maxillary lateral incisors. Congenitally missing maxillary lateral incisors have been a challenge confronting dentists for a long time. While there are differing treatment modalities for maintaining, preserving, and treating patients, one thing is certainly agreed upon: treatment must be conservative in nature. Dentists have made great strides in how we manage these cases, overcoming both the physical malformations and the impact of patient self-consciousness. We can now achieve clinically pleasing smiles and alignment…

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