Dentistry Today — April 2022

Inside this issue

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

1. Page 6

   Wild World Writing this column a few weeks prior to publication makes it difficult to comment on the goings on in the world, mainly the human and economic impact it is having. Being the optimist, I hope you will be reading this with a sense of dread and a modicum of relief. No matter what, though, these last couple of years and recent events have surely provided our eyes to having personal and business plans for the near and distant future. We were getting complacent with our busy practices, decent incomes, and plans for improving our practices and lifestyles. Now…

2. Page 8

   On Second Thought "I'm having second thoughts," the voice on the other line stated. "This is the second dental student I had talked to in the past few months who repeated the same phrase. 'About what?' I asked. 'About being a dentist,' she answered. And if she were right, that daunting realization would have been an expensive mistake to make. Private dental school education can run as high as $300,000 for 4 years, with the midrange landing slightly below $300,000.' though that's not counting the average undergraduate debt to the tune of an extra $30,000.² The weight of that kind…

3. Page 10

   VIEWPOINT continued from page 8 like at this moment, past the climax of graduation and coming up soon thereafter, life continues to unfold. And it does so beautifully if you only pay attention. Dentistry is our livelihood and can be our hobby, passion, and joy, but dentistry is not life. Defining the limitations and boundaries between life and work will be freeing in the moments of struggle. A healthy separation will reduce burnout, allowing a safety net, a life's place of rest. Yes, the search for Zen may take a moment following the grueling cycle of an academic career, but…

4. Page 11

   DirectaDentalGroup: Taking Steps to Go Green "As we embark into the world of Bioplastics, our Company's vision and mission is to manufacture all of our products with environmentally friendly plastics." —Frank Cortes, president, Directa USA As more attention is paid to sustainability on a global scale, DirectaDentalGroup is striving to find new, more innovative ways to bolster renewable energy and utilize recyclable materials in both its products and packaging. As consumer focus shifts to sustainability, dental teams are joining in by implementing eco-friendly products and practices. DirectaDentalGroup is committed to meeting the increased environmental focus by producing products that have…

5. Page 12

   DirectaDentalGroup DIRECTA topdental ORSING parkell physics forceps RØNVIG TrollDental Sendoline CONTACTEZ ORSING FOCUS J. H. Orsing AB was founded in the 1950's and was acquired by Directa AB in 2014. Orsing became known for one of the world's most popular Saliva Ejectors – The Hygoformic. As we grew our product line, we began working to meet the demand for environmentally friendly, fossil-free products to reduce the carbon dioxide in the atmosphere. Hygoformic®Bio Flagship products Orsing considers environmental sustainability to be of great importance and are committed to making a difference to reduce global warming. For this reason, Orsing stopped the…

6. Page 14

   Zirconia Implants Paul S. Petrungaro, DDS, MS, discusses the incorporation of metal-free dental implants into the contemporary dental implant practice. Q: What are zirconia dental implants? A: Zirconia is a type of ceramic that has widely been used in the dental field for custom implant abutments and crowns/veneers for many years and in orthodontics for posts joint replacements as well. Zirconia implants exhibit high structural strength and have Yttria-stabilized tetragonal zirconia polycrystal to help increase its structural toughness and strength. More recently, ceria-stabilized zirconia/alumina nanocomposite (NANOZR) has recently been introduced and demonstrates very high levels of flexural strength and fracture…

7. Page 16

   Innovative Products, Superior Customer Service, and Direct Pricing Medidenta's Alfred Perez, executive VP of operations, discusses the company's past, present, and future. Q: What does Medidenta celebrating 80 years mean to you? A: Being a part of the Medidenta legacy has been amazing. I have been with Medidenta for the past 25 years. Through relocation, mergers, and acquisitions, it has been a very exciting, fulfilling, and humbling experience. I would have never imagined this is where Medidenta would be all these years later. I am very proud to be part of it all. The relationships I have established with customers…

8. Page 18

   Imaging System Offers Enhanced, Detailed Visualizations SAN JOSE, Calif.–The iTero Element 5D Plus imaging system from Align Technology in cart configuration is a powerhouse of capabilities designed to improve the practice and patient experience with state-of-the-art computing power, elegant design, and ideal 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 how practices scan. The integrated intraoral camera eliminates the need for a second device while enhancing the patient experience and communication. Near-infrared technology aids in…

9. Page 20

   Desensitizer Displays Effectiveness for Virtually Any Clinical Requirement SAN JOSE, Calif.-KoR Complete Desensitizer is a unique oxalate desensitizer that strongly fuses to hydroxyapatite molecules of highly mineralized enamel (96% mineral) and peritubular dentin (92% to 93% mineral) to provide immediate closure of open dentinal tubules. Unlike oxalate desensitizers that simply "clog up" the open orifices of dentinal tubules, KoR Complete reacts with, and fuses to, the hydroxyapatite molecule in tooth structure via a chelation reaction. This forms a durable compound of calcium oxalate mineral crystals fused to peritubular hydroxyapatite? to 12 µm deep within dentinal tubules. In addition to use…

10. Page 21

    CHAIRSIDE WITH DR. K THE SECRET TO MORE EFFECTIVE WHITENING No two patients are exactly the same. So why use just one whitening protocol to treat them all? At KöR Whitening, we recognize that each patient presents a different whitening challenge and that's why we developed a full line of whitening systems to meet your patient's individual need. And KöR Whitening is the first whitening system in the world to maintain potency of its entire line of whitening gels by constant refrigeration from the instant of manufacture until being received cold-packed at your office. Dr. Rod Kurthy #1 Proper Product…

11. Page 22

    Lasers Showcase Latest Advancements in Technology ALBUQUERQUE–Utilizing the latest micro-pulsed technology, an advanced articulating arm delivery system, and the latest RF technology, DEKA CO. lasers from Diamond Dental Supply represent the latest advancements in laser technology. DEKA Dental Lasers has a range of lasers available and is now offering a new fractional handpiece for applications in sleep medicine as well as facial aesthetics. DEKA is part of ELEn., which is the only company in the world to manufacture medical and industrial lasers. ELEn. is also the only CO2 laser manufacturer that produces its laser systems as well as its laser…

12. Page 24

    Metal Refining Service Showcases Cutting-Edge Science WOODSIDE, NY–Scientific Metals provides a wide variety of precious metal services, primarily for the dental and jewelry industries. The company accepts solids such as crowns, bridges, PFMs, PFGs, inlays, casting sprues and buttons, as well as grindings, floor and bench sweeps, carpets, and filters. Each lot is melted one at a time, and a sample is taken via capillary action through a narrow glass cylinder called a vacuum pin tube. This method is the gold standard and the preferred method for sampling. It is superior to drill samples as the sample is taken from…

13. Page 26

    Aspirator Efficiently Absorbs Aerosols Near Source HELSINGBORG, Sweden—Hygotip XL Bio from Directa-DentalGroup's Orsing division is an environmentally friendly aspirator fitting 16-mm systems. It is manufactured from autoclava­ble, bio-based plastic made of sugar canes. Unlike conventional plastics in which fossil raw materials, such as oil and natural gas, are used, sugarcane is a completely renewable resource. The large diameter of 16 mm offers a high suction capacity and is more efficient to absorb the aerosols near the source. The sturdy design works as a tongue holder and allows for the retraction of the cheek, providing good accessibility. It is patient-friendly thanks…

14. Page 28

    Make Accurate Master Impressions in One Appointment Joseph J. Massad, DDS Joseph Thornton, DDS Mostafa El-Sherif, DMD, MSc D, PhD Richard June, DDS Sam Strong, DDS Swati Ahuja, BDS, MDS Figure 1. Massad overdenture/partial low temp trays. Figure 2. Tray handle. Figure 3. Internal projections. Figure 4. VPS material dispensed along the intaglio surface and the peripheral extent of maxillary tray. Figure 5. Impression tray evaluated. Figure 6. Definitive impression. The accuracy of an impression not only depends on the impression material and the manipulative techniques employed but also on the impression trays utilized. Recently, there have been significant advances…

15. Page 30

    Industry News New exocad Shop Introduced for DentalCAD Software Users The brand new exocad shop has been introduced as an additional way for current DentalCAD perpetual license users to purchase upgrades or add-on modules, accompanied by installation and configuration support. This service is available for all customers of participating exocad resellers. The web shop was developed to offer customers and resellers greater purchasing flexibility and support. Benefits include: • Global access, 24 hours a day, 7 days a week • Quick and easy access to available upgrades and add-on modules • The ability to directly calculate the upgrade price for…

16. Page 32

    Nocturnal Teeth Grinding Can Damage Temporomandibular Joints Sleep bruxism can have several ill effects on health. In a study conducted at the University Clinic of Dentistry of the Medical University of Vienna, it was discovered that certain tooth shapes and tooth locations could lead to temporomandibular joint (TMJ) problems. The subject of the research was the interaction of 2 factors in bruxism.... Around 15% of the population grind their teeth while they sleep. It's particularly common in young people. Researchers led by Benedikt Sagl have now investigated whether sleep bruxism can also have a negative impact on TMJ structures. Their…

17. Page 35

    Traumatic Pulp Exposures: An Exposé INTRODUCTION There are 5 important questions to consider prior to treating a traumatic pulp exposure (see Table 1): Question 1: How long has the exposure been present? Short answer: The longer the exposure has been present, the higher the likelihood for bacterial contamination of the pulp. However, as long as the pulp is still vital and the patient's symptoms don't necessitate root canal therapy, vital pulpal treatments can be utilized. Question 2: Is the patient symptomatic? What are the pulpal and periapical diagnoses? Short answer: The pulpal and periapical diagnoses will dictate treatment. For example,…

18. Page 36

    Vital pulp therapy (VPT) techniques are means of preserving the vitality and function of the dental pulp after injury resulting from trauma, caries, or restorative procedures. VPT procedures have traditionally included indirect or direct pulp capping and partial or complete pulpotomy (Figure 1). VPT includes the removal of part of the pulp, allowing the rest of it to remain vital and functional. We assume that by removing a small portion of the superficial inflamed pulp, the remaining pulp remains healthy. When the pulp is exposed, bacterial invasion can be resisted by both the patient's immune system present within the pulp…

19. Page 38

    Traumatic Pulp Exposures: An... continued from page 36 crown fractures, and re-entering of the pulp at a later time is not necessary as long as the pulp remains vital.7-15 HEMOSTASIS Sodium hypochlorite is an antimicrobial solution that provides hemostasis, disinfection of the dentin pulp interface, biofilm removal, chemical removal of the blood clot and fibrin, and clearance of dentinal chips along with damaged cells at the mechanical exposure site. Therefore, sodium hypochlorite can be used to disinfect the exposure site during a pulpotomy prior to restoring the pulpal wound (saline or chlorhexidine can be used as well).16 A cotton-soaked pellet…

20. Page 39

    ENDODONTICS 39 Table 3 Concussion Tooth is tender to touch and/or percussion but without displacement or abnormal mobility. Pulp is usually vital. Subluxation Tooth is tender to touch and/or percussion and is mobile but not displaced. Pulp is usually vital. Extrusive luxation Displacement of the tooth outward or incisally. Pulp can be vital or necrotic depending on extent of luxation. Lateral luxation Displacement of the tooth in a lateral direction and usually associated with a fracture of the labial cortical bone. Pulp can be vital or necrotic, depending on extent of luxation. Intrusive luxation Displacement of the tooth inward and…

21. Page 40

    DENTISTRY TODAY 12th 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. Aseptico A product with 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 world-wide reputation for building strong, dependable dental equipment guarantees reliability and performance for years. Many other…

22. Page 42

    Top 25 Endodontic Products Angelus SPLENDOR SAP produces a new era of smart posts, consisting of only one drill, one post, and one sleeve. It is a glass-fiber, single, adjustable post, meaning it has a universal size for narrow, medium, or wide canals. This solves the common post challenge by decreasing the inventory of various drills and post sizes. SPLENDOR SAP allows the adjustment of the post to the canal and not the canal to the post, which enables the absence or minimal removal of the dental structure. The result avoids decreasing root structure resistance and increasing the retention between…

23. Page 43

    Top 25 Endodontic Products DenMat Core-Post is available in 2 forms, including carbon fiber and increased strength and tooth-colored glass fiber for anterior aesthetics. It exhibits high fatigue and tensile strengths and has a modulus of elasticity comparable to dentin. It flexes like natural tooth structure and dramatically minimizes tooth stress and fractures that occur with standard metal posts. Core-Post offers carbon fiber and glass fiber posts that are easy to use and use. It also comes in 5 diameters, including 1.0, 1.2, 1.4, 1.7, and 2.0 mm. For more information, call (800) 433-6628, visit denmat.com, or email info@denmat.com. FREEinfo,…

24. Page 44

    Top 25 Endodontic Products CLINICIAN'S CHOICE Dental Products MACRO-LOCK ILLUSION X-RO posts ensure restorative longevity and unsurpassed strength while also providing excellent aesthetics and outstanding radiopacity. With a flexural strength of 1,800 MPa, and an elastic modulus close to dentin, the MACRO-LOCK ILLUSION X-RO absorbs stress and prevents post fracture and stress on the root, especially in lower incisors. Further, several design enhancements ensure unmatched micro and macro retention to the cement and core material. Composed of euro radiopaque fibers, MACRO-LOCK ILLUSION X-RO features cocoradial illusion technology, which turns the post's color transparent upon seating. For more information, visit clinianschoice.com.…

25. Page 45

    Top 25 Endodontic Products Vista Dental Products SmearOFF 2-in-1 effectively replaces both commonly used end 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…

26. Page 46

    Top 25 Endodontic Products COLTENE ParaPost Taper Lux is a tapered, translucent aesthetic post system designed for use in long, narrow canals and for canals prepared with the crown-down greater taper file technique. The system can be used with self-, dual-, or light-cured materials for fast cementation. Taper Lux posts reflect the natural hues of the tooth and eliminate shadows through composite restorations and at the gingival/crown interface for enhanced aesthetics. The post's undercut, rounded head design reduces stress points and locks in composite core materials. A high percentage of unidirectional fibers gives the posts excellent strength. Color-coded with easy-to-remove…

27. Page 47

    Top 25 Endodontic Products Venta Endo The most difficult and time-consuming part of the endodontic procedure is starting the root canal preparation, but Venta Endo has a simple and effective solution for this tedious task. By rethinking the way one holds and manipulates the initial file, a difficult task becomes an easy one, thanks to the Endohandle. This new pen-grasp grip on the file keeps fingers out of the way. It provides more control and offers a clear, microscopic view of the orifice to easily find the canal. For more information, visit ventaendo.com. FREEinfo, Fairfax Dental The Stabllok Pin is…

28. Page 48

    Heat-Treated NiTi Endodontic Files All You Need to Know About the Latest Generation INTRODUCTION In the early 1990s, the use of nickel-titanium (NiTi) alloy to manufacture engine-driven instruments for shaping root canals moved endodontics to a different level. Practitioners, universities, and companies started unprecedented cooperation to understand the countless advantages that adopting this unique metal alloy could provide for the evolution of the instrumentation technique. As a result, the last 3 decades have seen an explosion in the development of NiTi endodontic file systems, and tremendous progress has been made. Improvements in metallurgical technology allowed the development of various new…

29. Page 50

    Heat-Treated NiTi Endodontic... continued from page 48 the original canal path.14-17 The major limitation of controlled memory (CM) instruments is that the martensitic alloy phase expression requires less load for deformation, meaning that the unwinding of CM files can be experienced more often, particularly in the initial inspection phase of instra mentation with small diameter files. In addition, predominant martensitic alloy phase expression under torsion has a high angular deflection to sustain great rotation before fracture (Figure 5); however, the torque needed to deform and fracture these instruments is lower than with austenitic instruments.18-22 Furthermore, highly flexible martensitic alloy phase…

30. Page 51

    ENDODONTICS 51 [Figure 7 shows three vertical diagrams with color gradients representing heat distribution in files - labeled with "100% austenitic" on left, "transitional R-phase" in middle, and "100% martensitic" on right, with corresponding visual representations below] Figure 7. Genius Proflex file examples of the 3 different heat treatments applied. Small diameter files (purple) received a more austenitic heat treatment, intermediate files (blue) received a more martensitic treatment, and larger files (gold) received the higher martensitic heat treatment. [Figure 8 shows three file diagrams with heat treatment zones marked and colored indicators showing different phases] Figure 8. As a result…

31. Page 52

    An Answer to the Gray Screw-Hole Conundrum INTRODUCTION Gray! That confounding color has betrayed dentists for years as we have attempted to cover holes and post holes. It seemed that regardless of what we used, be they opaques, dentin shade composites, or a multiple shade technique, we ended up with an unfortunate gray cast surrounding the hole. Now we finally have an answer! By now, every dentist should have used, or at least heard of, single shade composites. They have proven to be incredibly useful during the pandemic, and they have many benefits. The obvious advantage has been predictability in…

32. Page 54

    An Answer to the Gray Screw-Hole... continued from page 52 Natural (Ultradent Products) and CompoSite Polishing Paste (Shofu Dental). CASE REPORTS Case 1: Post-Hole Solution A 55 year old female had endodontic treatment on tooth No. 3 through a 3Y zirconia crown. She appeared at the office to have a post-core restoration placed. The distal canal was wide, and a #3 Flexi-Post (Essential Dental Systems) was placed and cemented using TheraCem cement (BISCO Dental Products) (Figure 1). The initial preparation had adequate tooth structure remaining, and a decision was made to use OMNICHROMA as the core material. The tooth was…

33. Page 55

    RESTORATIVE CASE 3 Figure 13. Pre-op view of screw holes in implant crowns Nos. 19 and 20. Figure 14. Two millimeters of plumber's tape was applied over the implant screws. Figure 15. One millimeter of OMNICHROMA BLOCKER in teeth Nos. 19 and 20. Figure 16. Finished case showing teeth Nos. 19 and 20. CASES 4 AND 5 Figure 17. Nobel Biocare screw hole in tooth No. 30. Figure 18. Tooth No. 30 following OMNICHROMA placement and Occlusinator bur contouring. Note the excellent color blend. Figure 19. Tooth No. 18 screw hole in tooth No. 18 with minimal anatomy. Figure 20.…

34. Page 56

    An Innovative Digital Workflow for a Full-Mouth Reconstruction INTRODUCTION The field of prosthodontics and restorative dentistry commonly deals with complex restorative reconstructions. Alongside an increased demand for full-mouth rehabilitations because of multifactorial causative elements,1-3 a systematic approach is necessary to ensure proper diagnosis, planning, and treatment execution.4 Historically, conventional methods have achieved successful treatment outcomes.4-6 However, certain drawbacks have been noted with tooth-supported restorations, including extended chairside time, frequent adjustments, and extensive laboratory and patient communication in order to achieve predictable, functional, and aesthetic outcomes.7,8 With the emergence of computer-aided design and computer-aided manufacturing (CAD/CAM) technology, the use of digital…

35. Page 57

    anterior provisional restorations. Trim and finish the provisional restorations using the same protocol discussed above (Figures 15 and 16). 3. Refine occlusion with the provisionals in maximum intercuspation (MIP) and exclusive movements as needed. Take an intraoral, "pre preparation" digital impression of the maxillary and mandibular provisionals. 4. Remove the intraoral provisional restorations except for 2 to 3 opposing provisionals in each arch, which will act as a common landmark. Virtually, trim away the provisionals (except the ones that have been kept as a common landmark) on the intraoral scan for the final preparation scan. Retract the gingival margins around…

36. Page 58

    RESTORATIVE FIGURE 1. Smile-line assessment and aesthetic parameter analysis. FIGURE 2. Pretreatment digital photographs for virtual analysis: patient smile. FIGURE 3. Pretreatment digital photographs for virtual analysis: intraoral frontal view, maximum intercuspidation. FIGURE 4. Virtual wax-up based on the aesthetic parameters and proposed new OVD. FIGURE 5. Three-dimensional printed resin model of the virtual wax-up design. FIGURE 6. Three-dimensional printed model of the preplanned tooth preparations in the maxillary arch. FIGURE 7. Three-dimensional printed model of the preplanned tooth preparations of the posterior area in the mandibular arch. FIGURE 8. Three-dimensional printed tooth reduction guide for the maxillary arch. FIGURE…

37. Page 59

    Figure 13. Three-dimensional printed maxillary anterior provisional shells seated on the prepared resin model. Figure 14. Maxillary occlusal view of the inserted relined provisional shells in the anterior and posterior segments on the right side and try-ins with palatal support on the left posterior segment. Figure 15. Mandibular occlusal view of the inserted anterior provisional shells. Figure 16. Mandibular occlusal view of the posterior segment try-in supported by the provisionalized anterior segment. Figure 17. Definitive layered zirconia restorations. Figure 18. Maxillary occlusal view of the inserted definitive prosthesis on the day of delivery. Figure 19. Lateral smile view in maximum…

38. Page 60

    Re-examining the Past and Looking Toward the Future It's hard to believe that I began my dental implant career 36 years ago. I became interested in this procedure called "implants" while in my second year of dental school after watching a program called That's Incredible. There was a dentist on the show presenting this incredible. I don't have a recollection of whom that may have been. I went back to the dental library to find some information, but there were limited resources. I asked some of my faculty about information on implants and was directed to Dr. Paul Mentag, who…

39. Page 62

    A Comprehensive Surgical Guide Classification System INTRODUCTION Since their introduction, dental implant treatments, and the materials and technologies associated with their placement procedures, have expanded significantly. Digital radiography and cone-beam computed tomography (CBCT) have been incorporated into the planning process. Computer assisted design and manufacturing (CAD/CAM) and 3D printing help streamline the protocols executed during scheduled treatment appointments.1 Combined, these technologies also help to realize advanced and comprehensive approaches to prosthetically driven implant treatment planning, resulting in more predictable outcomes for patients and greater efficiency for clinicians and the treatment team overall. One of the ways in which these advancements…

40. Page 64

    Figure 1. Colloquially referred to as "free-hand" implant placement, the absence of any constraints on the osteotomy drill or implant during placement is classified as a Type 0 physical constraint. Figure 2. An example of a guide classifi cation Type 1a. It is a suck-down system, which is limited in scope to visual guidance because it lacks any actual physical constraint of the osteotomy drill or implant driver. Figure 3. Type 2 guides only constrain the pilot drill, are typically printed or milled, and feature a pilot guide sleeve that accepts the 2.0 mm pilot drill. Figure 4. Type 3…

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