Dentistry Today — April 2024

Inside this issue

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1. Page 6

   Time of the Season Well, at the time of writing, most of us just lost an hour of sleep and are looking forward to spring. The changes of season are more noticeable in different parts of the country. Being in New England, I see dramatic differences as the weather changes, although the past few winters have not been as drastic as prior years. At least here, we start to spend more time outside—and hopefully it will change the fact that over the winter it became harder to see my shoes when I was standing up. Activities are busier, and those…

2. Page 10

   VIEWPOINT continued from page 8 cal responsibilities remain the same. DENTISTRY, PAIN RELIEF, AND THE OPIOID CRISIS Traditionally, dentistry has played a leading role in developing methods for controlling acute pain and analgesia. The first successful use of ether was by the dentist William Thomas Morton at Massachusetts General Hospital in 1846, leading to a considerable increase in the prevalence of dental surgery. Opioids were widely used to manage postsurgical and acute dental pain in a completely unregulated environment, contributing to the country's first opioid crisis and the passage of the Harrison Narcotics Act of 1914. During the 1990s, dentists…

3. Page 12

   Head and Neck Cancer Former opera singer Kathleen Watt discusses an unexpected diagnosis and her journey back to health. Q: When was your first inkling something required further examination? A: My tumor was discovered during a routine dental exam, as is often the case with serious head and neck conditions. In an idle moment during a laid back ski vacation one January, I offhandedly asked my partner Evie to help me confirm a funny protrusion in the gumline over my back teeth. Hardly noticeable—who knows how long it had been there? It didn't hurt. Probably nothing. We agreed I should…

4. Page 14

   Q&A Dentsply Sirona: Join us in Tackling the Social Side of Sustainability For many people, sustainability means environmental actions to protect our planet. While tackling issues connected to the health of our planet are of the utmost importance, sustainability includes a lot more. Tony Johnson, SVP, Chief Supply Chain Officer at Dentsply Sirona, explains how dental professionals interested in furthering sustainability can also look into supporting local and disadvantaged communities. Pledge for Sustainable Dentistry and seeking out educational materials. Our Sustainability Educational Curriculum and the Sustainability Resource Kit are great places to learn about concrete actions to make a sustainable…

5. Page 16

   Dental Plus USA Restorative Material Ensures Long-Term Durability SOUTH JORDAN, Utah–G CAM is specially designed for permanent dental structures and offers an ideal combination of strength, aesthetics, and longevity, making it an excellent choice for a range of dental applications. With its simplified fabrication process, it presents significant time-saving benefits to dental professionals. Its monolithic nature eliminates the complexity of layering techniques, reducing the time spent on restorative cases. This streamlined workflow translates into increased patient throughput and potential cost savings. In addition, G CAM boasts extraordinary strength, rivaling that of conventional metal-based restorations. Its remarkable flexural strength ensures long-term…

6. Page 18

   TECHNOLOGY J. Morita USA Apex Locator Provides Unique Approach to Endodontic Care IRVINE, Calif–Housed in a brand new, sleek design, the Root ZX3 apex locator, which is the latest generation of the world-renowned apex locator product line with a high-frequency module for canal treatment, offers automatic calibration. It features an overall smaller footprint, yet a larger, high-contrast display screen. Trusted technology, based on impedance measurement, has been independently evaluated to be 97.5% accurate and can be used in wet or dry canals. As an optional attachment, the Root ZX3 HF Module offers an exciting, new approach for canal treatment utilizing…

7. Page 20

   System Reinforces Diagnosis by Using Physical Mirrors QUAKERTOWN, Pa.—The IS Voyager and all-in-one computer was designed to simplify workflow and engage patients with their treatment. With its touchscreen display, you can easily present scans and reinforce a diagnosis by using physical mirrors in real time to pinpoint specific areas in patients' mouths. This allows patients to compare what they see firsthand with the compelling visual evidence on the screen captured from their scans. The IS Voyager trolley now comes with a new backup battery option, allowing clinicians to continuously scan patients without interruptions. This means high-quality images can be captured…

8. Page 22

   Ritter Dental Dental Chair Provides Increased Mobility for Clinicians SAN ANTONIO–The Vanguard Dental Unit features a seamless hydraulic lift with adjustable speed and has the ability to withstand 400 lbs. The unit is ambidextrous with a 30° swivel that provides easy access for the patient and increased mobility for the clinician. The Vanguard includes Dentist and Assistant Delivery. The assistant side features up to 4 instruments and an integrated control panel. The dentist side features up to 5 instruments, including 3 active handpiece positions and an integrated control panel. The Vanguard is available with or without a cuspidor. Some additional…

9. Page 24

   Velopex International X-Ray Film Processors Offer Optional Daylight Loader SAINT CLOUD, Fla—For those dentists who love film, Velopex offers a range of automatic film processors. IntraX is a high-performance intraoral film processor. Films can be viewed wet in 2.5 minutes and dry in 5 minutes—archival in both cases. Compact, easy installation requires no plumbing. Xtender covers a full range of dental films, extraoral panoramic, full skull, and intraoral x ray film. The unit can process dry to dry in 5 minutes and can be loaded continuously. It includes an automatic replenishment unit. The unique film transport system ensures consistently excellent…

10. Page 25

    DiaDent Curing Light Features Innovative Wireless Charger BURNABY, BC, Canada—D-LUX+ is a high-performance, dual wave length, cordless LED curing light. It is durable, yet lightweight; elegant, yet ergonomic. Its high-intensity output of 2,400 mW/cm² and four 10-W LED lamps can efficiently and uniformly polymerize all light-cured materials in the wavelength range of 385 to 515 nm. It comes with a built-in light intensity sensor to provide peace of mind and an innovative wireless inductive charger to eliminate any potential charging contact issues. Designed for comfort, the light probe has an optimal 70° angle to reach all tooth surfaces, including the…

11. Page 26

    PRODUCT FOCUS 3D Imaging/CBCT Systems Dentsply Sirona ORTHOPHOS SL is a powerful performer with unparalleled image quality. It provides many options, ranging from shear 2D panoramic images to full 3D volume flexibility. It also offers secure patient positioning for the perfect x-ray from endo to alway. 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 rotation, giving you dynamic images you can adjust to any situation. For more information, call (800) 859-5977. USE FREE info card,…

12. Page 28

    Bien-Air USA Chair-Integrated Solution Offers Easy Control Through Tablet IRVINE, Calif.—Whether you are planning to upgrade your dental practice with the latest technology or you are just about to start your professional career, iOptimaNT is an all-in-one solution offering the full range of treatment options seamlessly integrated into your dental chair. There is no need for additional equipment anymore because the iOptimaNT lets you perform restorative procedures; endo treatments (including reciprocating mode), and surgical procedures; including implant placement. A piezo scaling function is included as well. Installed directly into the existing dental unit, the system is easily controlled through an…

13. Page 30

    Hiossen Implant Features Body, Threads Intended for Simple Insertion ENGLEWOOD CLIFFS, NJ—The EM Implant is a one-body implant designed for 2 surgical indications—narrow interdental areas and denture prostheses for edentulous patients. EM Narrow Ridge's optimized design and abutment size enable the creation of prostheses without modification. EM Denture's micro thread distributes mastication force throughout the bone structure, making it a perfect choice for immediate loading. With body and threads intended for simple insertion and maximum stability, the EM implant's ability to correct the incisal direction during insertion promotes a high success rate in narrow ridges. A minimally invasive EM surgical…

14. Page 32

    Yourdent USA Intraoral Mirror Provides Easier Visualization in Hard-to-See Areas MAHWAH, NJ–This innovative tool, called theFlipMirror, is revolutionizing dentistry. It is the world's first and only patented, double-sided, dual-position dental mirror that seamlessly flips between a 35° and 90° degree angle. This innovative, new mirror incorporates a hinge that allows the mirror to retract and push tissues, such as the tongue and cheek, thereby providing easier visualization of hard-to-see areas. It's constructed from polypropylene, a high-quality autoclavable material that can withstand heat and pressure. It is preferred by patients to be much more comfortable than a metal mirror. With its…

15. Page 33

    INNOVATIONS SPOTLIGHT C-Root Dental Medical Bioceramic Sealer Produces Faster Apical Healing Fig.1 Immediate Post-op Fig.1 Year Post-Op NEW YORK–Strontium silicate based C-Root SP is a novel, FDA-approved bio ceramic sealer. It has been successfully used for more than 3 years on approximately 500,000 cases with no failed cases reported. Strontium has been used as a drug component for enhancing bone formation and relieving inflammation associated pain. Its effects on speedy apical bone healing and postoperative pain lessening are validated by clinical case presentations. Its (1) good flowability and sealability and (2) antibacterial and osteogenic ability guarantee rapid bone-healing outcomes. It…

16. Page 35

    Tokuyama Dental America Flowable Composite Helps Streamline Restorative Process ENCINITAS, Calif.—OMNICHROMA Flow is the world's first one-shade flowable composite able to aesthetically shade match any tooth color from A1 to D4. Its high strength and wear resistance make it suitable for a wide range of indications beyond cavity lining and minor restorations, giving clinicians the freedom of choice for any direct restoration. With aesthetic properties ideal for cavities shade matching in the anterior and strong mechanical properties to hold up in the posterior, OMNICHROMA Flow offers clinicians the benefits of a one-shade universal composite with the versatile handling one needs.…

17. Page 36

    Industry News Dentsply Sirona Advocates for More Inclusive Measures Dentsply Sirona, the world's largest manufacturer of professional dental products and technologies, advocates for a greater focus on women's equality, representation, and inclusion in the dental industry. The company also reaffirms its own commitment to work toward more diversity, equality, and inclusion both internally and externally. Internally, Dentsply Sirona is committed to achieving global gender pay parity and gender balance by 2025. This commitment includes implementing training to eliminate hiring bias, while also propping up mentoring, coaching, and leadership programs. For instance, the company's Employee Resource Group, DS Women, supports female…

18. Page 38

    Glidewell Symposia Offers Dates Through November Glidewell has multiple dates left on its symposia schedule for 2024. Presented at the state-of-the-art Clinical Education Center in Irvine, Calif, this year's remaining events will feature fast-paced lectures, practical workshops, and live demonstrations. Each is eligible for 12-plus CE credits. The following are the remaining symposium topics for 2024: • June 7 to June 8—Fall Implant Symposium • June 21 to June 22—Summer IOX: The Digital Dentistry Experience • August 16 to August 17—Esthetics: Creating Beautiful Smiles • September 19 to September 21—Dentistry on the Rise • October 18 to October 19—EDI IOX:…

19. Page 40

    DENTISTRY TODAY 14th 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 worldwide reputation for building strong, dependable dental equipment guarantees reliability and performance for years. Many other…

20. Page 42

    Top 25 Endodontic Products Mid America Dental Sales The lightweight NEO, which is the size of a smart watch (46 x 43 x 16 mm), is the world's smallest apex locator (data on file). Designed by a dentist who was tired of having to continually lift up his head to look at his apex locator while performing endodontic procedures, this small device can actually clip onto an included finger ruler, bib, watch band, or anything else. It's always within the field of view. It utilizes 3 bands of impedance to produce fast, accurate readouts. In fact, the NEO has been…

21. Page 43

    Top 25 Endodontic Products J. Morita USA Tri Auto ZX2+ is a cordless endodontic handpiece with a built-in apex locator. Its new-generation Optimum Glide Path 2 (OGP2) mode offers an innovative reciprocating feature that decreases file binding and, when it does occur, dramatically reduces the chance of the file breaking. Patency, glide path creation, and shaping can all be performed with OGP2. OTR technology offers superior safety while efficiently preparing the canal. Continuous rotation is maintained until the file encounters resistance in the curved and difficult part of the canal. Depending on the file load, the motor alternates between forward…

22. Page 44

    Top 25 Endodontic Products EdgeEndo The EdgeTaper 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 defies industry wisdom but also has made EdgeEndo one of the world's largest rotary NiTi suppliers in 4 years.…

23. Page 45

    Top 25 Endodontic Products Angelus SPLENDOR-SAP provides a new era of smart posts, consisting of only one drill, one post, and one sleeve. It is a glass-fiber, single-adjustable post. It is a glass-fiber, single-adjustable post, consisting of only one drill, one post, and one sleeve. It is a universal size for narrow, medium, or wide canals. This solves some of the common challenges for posts by decreasing the inventory of various drill and post sizes. With its exclusive fiber sleeve, SPLENDOR-SAP is able to adjust the post to the canal and not the canal to the post, which results in…

24. Page 46

    Top 25 Endodontic Products DMG America LuxaPost is a transparent, glass fiber-reinforced composite post that reacts to pressure and stress, much like natural dentin. To help meet the needs of dental practices, the endodontic post is radiopaque and already presianized. It combines high quality with ease of use and, because its high flexural modulus (degree of elasticity and rigidity) is almost equal to natural dentin, the use of LuxaPost significantly minimizes tension peaks in the post-cement-root system and dramatically lessens the risk of root fractures. Plus, clinicians appreciate the user-friendly, color-coded system. For more information, call (800) 662-6383 or visit…

25. Page 47

    Top 25 Endodontic Products Essential Dental Systems SafeSiders HF helical flat rotary endodontic instruments are designed with a relieved helical flat that rotates in the opposite direction of the cutting flutes. This relieved helical flat, along with a proprietary NiTi treatment process, provides the dentist with unparalleled root canal treatment. Advanced features include: (1) high resistance to breakage; (2) increased flexibility; (3) self advancing design for fast instrumentation as the apex without being drawn in; and (4) less resistance and easier negotiation of canals. For more information, call (800) 22-FLEXI (223-5394) or visit edsdental.com/safesidershf. ailable in 2 forms, including carbon…

26. Page 48

    Complex Implant and Restorative Planning: A Team Approach INTRODUCTION Complex cases can be challenging for a variety of reasons, such as patient demands, budgetary constraints, clinical conditions, and so on. When facing cases of this type, which many dental practitioners will immediately recognize as typical, a team approach between the dental practitioner and the dental laboratory is best. Along with the basic new technologies at our disposal, the team can aid in eliminating potential challenges to achieving the desired results that satisfy the patient's expectations and budget, while decreasing the practitioner's stress levels. In addition to identifying a solid lab…

27. Page 49

    Figure 1. The patient presented with fractured teeth and periodontal bone loss on the remaining teeth in both arches. Figure 2. The panoramic radiograph following extraction of the natural teeth and implant placement after a 6 month healing period. The restorative phase of treatment was ready to be initiated. A panoramic radiograph was taken to evaluate the teeth and implant present (Figure 1). Evaluation of the radiograph noted recurrent decay on the crowns of teeth Nos. 7 and 27, which had prior endodontic treatment, and a periapical lesion was noted on No. 27. Those natural teeth were in poor condition…

28. Page 50

    Figure 5. Virtual models were imported into exocad (exocad) to start virtual design of the custom abutments and provisional bridges. Figure 6. Virtual design of the abutments for cementable restorations for both arches. Figure 7. Virtual design of provisional restorations to verify aesthetics intraorally. functioning well without the provisionals and was comfortable until her appointment to uncover the implants to initiate the restorative phase of treatment. The patient was scheduled to see the OMIS at 4 months for implant uncovery, wherein the uncovered the implants under local anesthetic and placed healing abutments. The restoration was missing on implant No. 12.…

29. Page 51

    RESTORATIVE into occlusion. Upon setting, the bite registration and provisional abutments were removed as one unit to be sent to the lab. The impressions, bite registration, and implant analogs with copings were sent to the lab (Glidewell) to start the prosthetic fabrication. A lab prescription was sent requesting custom abutments for implant Nos. 3, 5, 8, 9, 11, 21, 24, and 27. Additionally, provisional fixed restorations were requested to fit the custom abutments for Nos. 3 to 15 and 21 to 27. Soft tissue models for both arches were fabricated at the lab utilizing the closed tray impressions sent (Figure…

30. Page 52

    Leveraging the Inside-Outside Bleaching Technique INTRODUCTION Internal bleaching is a highly sought after treatment and a great service to provide to patients. External bleaching differs from internal bleaching in the sense that external bleaching addresses superficial staining, while internal bleaching manages internal discoloration. External bleaching is generally applied to the entire dentition, but internal bleaching may only target one or a few teeth. There are several reasons a tooth may become internally discolored: pulp necrosis, intrapulpal hemorrhage, retention of pulp tissue at the time of root canal therapy, calcific metamorphosis, or internal resorption.¹ Other available treatment options to address discoloration…

31. Page 54

    Leveraging the Inside-Outside... continued from page 52 rior is placed too far incisially, it will cause the cervical third of the tooth to not completely bleach. Alternative RMGs that could have been used are GC Fuji II IC (GC) and BC Liner (Brasseler). The advantage of BC Liner is that it can come in a blue shade, which facilitates better identification of the orifice barrier in case of an RCT re-tx. Next, any remaining core material was removed from the chamber under rubber dam isolation. This step is challenging but perhaps one of the most critical because it can be…

32. Page 55

    RESTORATIVE incise on No. 9 until treatment was completed and a definitive core could be placed. The patient was reinstructed for the bleach to be replaced within 7 days. Clinicians should anticipate that they will be replacing the bleach about every 5 to 10 days depending on patient compliance about 2 to 4 appointments. After 3 rounds of internal bleaching with sodium perborate, No. 9 failed to respond to treatment (Figure 6). All variables as to why No. 9 failed to respond to sodium perborate were ruled out. The expiration date on the material was verified, and a periapical radiograph…

33. Page 56

    Techniques in Site Preparation for Implants Timothy F. Kosinski, DDS Early dental implants were placed in available bone with primary consideration for improving function and chewing ability but with secondary concern for the overall emergence profile. This is certainly not the case in today's modern dental practices, where aesthetics play a major role in patient satisfaction. Many factors are considered when discussing the success of fixtures inserted into hard tissue. This includes proper engineering of the implant itself, surgical protocols and the design of the osteotomy burs. Initial stability and torque, as well as adequate spacing, dictate whether implants can…

34. Page 58

    Allogenic Block Graft Utilized for Pre-Implant Site Development INTRODUCTION Implant dentistry has become a discipline in health care to reconstruct lost soft and hard tissues to facilitate dental rehabilitation. Endosseous implants demonstrate high success rates when placed in an adequate volume of bone.1 Bone resorption is a common sequel after the loss of a tooth.2 Tooth loss is a result of caries, trauma, periodontal disease, perio-endo lesions, or congenitally missing teeth. Several approaches to managing alveolar ridge deficiency have been described, including ridge expansion, guided bone regeneration (GBR), and autogenous and allogenic block grafting.3,4 Autogenous block grafts are considered the…

35. Page 60

    Figure 1. Presurgical site, maxillary right lateral incisor (tooth No. 7). Figure 2. Buccal palatal deficiency. Figure 4. Full mucoperiosteal flap. Figure 3. CBCT image, section view. Allogenic Block Graft Utilized for... continued from page 58 bleeding points were made. A 10- x 10- x 5 mm corticocancellous allogenic block graft (Rocky Mountain Tissue Bank) was securely placed by placing a 1.5 x 10 mm machined TriStar Bone Graft Fixation System (IMPLANET LTD) through the graft and into the palatal bone (Figure 5). After fixation was confirmed, the bony edges were rounded with a No. 6 round bur. Particulate mineralized…

36. Page 61

    Figure 13. Impression transfer pin. Figure 14. Periapical radiograph of the 2-mm healing collar. Figure 15. Healing collar after 4 months of healing. Figure 16. The fixture at 4 months. Figure 17. Titanium abutment. Figure 18. Periapical radiograph of the symmetry/implant. Figure 19. Final prosthesis, a porcelain-fused-to-metal crown (lateral view). Figure 20. The porcelain-fused-to-metal crown (facial view). need to reconstruct a deficiency in hard and soft tissue prior to the placement of dental implants is a common prerequisite.11 Many treatment approaches have been described in the literature, such as ridge expansion, GBR, and autogenous and allographic block grafts.12 The selection…

37. Page 62

    IMPLANTS in determining the amount of bone resorption needed to place an implant in the ideal position. Most importantly, it assists the clinician in making the proper decision on the surgical approach. The patient was prescribed a Cephalexin (Keflex) antibiotic, ibuprofen, and chlorhexidine prior to surgery. The patient in this report was taking the medication Escitalopram (Lexapro). Individuals prescribed selective serotonin reuptake inhibitors have resorption was evident around the head of the screw, the overall volume of the block was sufficient for implant placement. The osteotomy procedure was performed utilizing an osseodenisification method due to lower degree of drill chatter.…

38. Page 64

    ce 2 CE Credits Test 264 dentalCEtoday.com IMPLANTS Surgical Considerations During Osseodensification This article presents cases that were seen and treated at the postgraduate clinic of periodontics at the Rutgers School of Dental Medicine. The treatments used modifications of densification techniques to achieve successful surgical results in rehabilitating patients with preoperative limitations to implant placement. Adam Goldberg, DDS, is a board certified periodontist working in private practice in New Jersey. Dr. Goldberg received his DDS degree from Columbia University in 2018 and completed his periodontal residency at Rutgers University in 2021. Dr. Goldberg presented/moderated the Northeastern Implant Symposium, served as…

39. Page 65

    Figure 1. Preoperative radiograph illustrating adequate height for placement of fixture, indicating transcrestal sinus augmentation and simultaneous fixture placement. Figure 2. Intraoperative photograph of osteotomy preparation illustrating maintenance of buccal lingual dimensions and membrane patency. Figure 3. Immediate postoperative CBCT illustrating encapsulation in bone. Figure 4. Post-op radiograph 12 months following crown insertion. Figure 5. Post-op clinical photograph 12 months following crown insertion. cated successful outcomes at the 12-month followup (Figures 4 and 5). Case 2 A 32-year-old female presented with a grossly mobile No. 8 (Figure 6). The tooth presented with secondary occlusal trauma, severe clinical attachment loss, pathologic…

40. Page 66

    Figure 6. Pre-op clinical photograph illustrating clinical attachment loss due to calculus encroachment on the buccal aspect of root tooth No. 8. Figure 7. Pre-op radio graph illustrating an angular defect on the mesial of No. 8 and radiographic calculus that was most likely causing the vertical defect. Figure 8. Post-op CBCT following extraction and grafting of No. 8 and illustrating the use of narrow-diameter fixture inadequate buccal-lingual width and buccolingual ridge expansion via densification technology. Figure 9. Clinical photograph following full-thickness flap elevation illustrating insertion of a narrow-diameter fixture inadequate buccal-lingual width and buccolingual ridge expansion via densification technology.…

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