Dentistry Today — August 2011

Inside this issue

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1. Page 12

   The General Practitioner's Challenge With all the associated demands and high expectations of being "the" expert, it can be a challenge to be a specialist in any field. Our specialists in dentistry have to successfully manage complex cases on a routine basis. Certainly, the steady stream of challenging cases provides the intellectual and technical challenge that a specialist has been trained to expect and want, but the demands required must be exhausting. That being said, practicing as a general practitioner (GP) carries its own set of unique and special challenges as well. The GP, practicing in today's highly dynamic work…

2. Page 14

   Ready or Not, Here They Come Amazing. I mean, it's really amazing that such an omission could happen. It is not difficult to teach and it is vital information that could save a life. And with our aging population, the likelihood of it occurring climbs ever higher. Yet, it remains neglected. What is this omission? It is the number 3 cause of death and the major cause of disability that is serious and long term: cerebrovascular accidents (CVAs) or, as more commonly known, strokes. These moments when blood vessel blockage, caused by a clot (ischemic stroke) or by pressure from…

3. Page 16

   continued from page 14 • Sudden trouble with seeing out of one or both eyes. This can include double vision, blurry vision, "things look dim," or loss of vision. • Sudden trouble with walking or keeping one's balance. • Sudden loss of coordination, including dizziness or clumsiness. • Sudden severe headache with no known cause. This can be the worst headache of one's life and can feel like someone thrust a knife into one's head. The common response of the victim is to wave it off or to deny it. Be ware! If you notice any of these symptoms, then…

4. Page 18

   Dentistry Today.com Providing you with news and information from the industry leader in clinical content. Visit Our Site Today! The CROWNING Technique of the Week Golden Dental Solutions Dr. Richard Golden of Detroit, Mich. is interviewed and demonstrates the revolutionary new Physics Forceps on the ABC television broadcast of The Doctors. Dr. Golden is the inventor of this tooth extraction product and shows the ease of use for patient comfort in tooth extraction. The national broadcast of this product in May 2011 has added to an already successful marketing campaign with Golden Dental Solutions. For more information, visit the Web…

5. Page 20

   From the April/May 2011 Issue DESENSITIZER GEL Heraeus Kulzer Gluma Desensitizer PowerGel is a new, one-step, gel-forma desensitizer that allows for accurate control and placement to reduce or eliminate dentin hypersensitivity. It provides the same level of desensitization as Gluma liquid but also offers better handling, easier control, and greater accuracy due to its unique gel consistency and green-color indication. For more information, call (800) 431-1785 or visit heraeus-kulzer.com. FREEinfo, CORDLESS HEAT SOURCE Brasseler USA The EndoPro270 is the most advanced powered heat source on the market. Utilizing an ergonomic design and the newest in cordless heating technology, it delivers…

6. Page 22

   NEW PRODUCTS METAL CAST PARTIALS Assured Dental Lab XMetal Cast Partials offer patients a practical and affordable choice. Frameworks are more detailed; therefore, it is more accurate and their look more natural. Also, with a perfect fit, there is less chair time required, and dexes are virtually unavoidable. All castmetal partials are nonallergic (nickeland beryllium-free), and offer unsurpassed memory, easy adjustment, and beautiful polishability. For more information, call (877) 283-3351. FREEinfo, CAD/CAM SPRAY Vision USA Emitting a microthin particle size that allows scanners to read surfaces accurately, SCAN MAN CAD/CAM Spray covers the reflective surfaces of die stone models, alloy,…

7. Page 24

   Spotlight File/Obturatio System Expected to Set New Standards in Root Canal Shaping Procedures TULSA, Okla—DENTSPLY Tulsa Dental Specialties introduces WaveOne, a reciprocating file and obturation system expected to set new standards in root canal shaping procedures. It is an M Wire Ni Ti file powered by the e3 Torque Control Motor with reciprocating motion—a rotation technique that reduces file breakage while requiring only one instrument per root canal in most cases. Shown to decrease total shaping time by up to 40% compared to traditional rotary techniques in continuous motion, WaveOne is developed for single use, removing the risk of cross…

8. Page 26

   Attachment's Self-Aligning Feature, Retention, Durability, and Low Profile Cited ESCONDIDO, Calif. When a case requires an overdenture bar, Zest Anchors' LOCATOR Bar Attachment provides the same self aligning feature, superior retention, exceptional durability, and low-profile design as the LOCATOR Implant Attachment. Its innovative ability to pivot increases the attachment's resiliency and tolerance for the high mastication forces an attachment must withstand, while its unique dual retention innovation that includes inside and outside retention options—plus lasting performance. The LOCATOR Bar Attachment offers 3 options for the fabrication of a resilient attachment on an implant-supported cast alloy or milled titanium bar: (1)…

9. Page 28

   With 20,000 Units Restored, Simplified Implant Restoration Protocol Establishes Its Efficacy LONG ISLAND, NY–Doctors have found that with Town & Country Dental Studio's SIMPL–Simplified Implant Restoration Protocol–they can restore more implant cases in less time and at a lower cost with predictable, clinically superior results. And with more than 20,000 units restored, SIMPL implant restorations now have a success factor of less than 1%. Utilizing Atlantis CADI CAM abutments, SIMPL eliminates the need to supply implant parts, saving time on ordering, stocking, and shipping, and being milled by computer improves fit and function. There is no expensive gold or palladium…

10. Page 30

    Spotlight Instrument Effectively Addresses Challenges Practitioners Face When Working With Composite Resins SAVANNAH, Ga - Brasseler USA introduces the ET 3000, the first device to effectively address both stickiness and lack of flow, 2 of the biggest challenges practitioners face when working with composite resins. Utilizing a specific frequency and range of oscillating motion, the ET 3000 (patent pending) eliminates the frustrating stickiness and "tug back" of composite resins and increases the flow of composite resins up to 30%, enhancing your ability to achieve the cavity adaptation and surface anatomy you desire. For more information, call Brasseler USA at (800)…

11. Page 32

    Snoring/Sleep Apnea Appliance's Tongue-Repositioning Feature Cited TONAWANDA, NY-Great with CPAP, the appliance is easy to insert, maintains its shape, and is offered in one size that fits most patients. No impression is necessary. For more information, call Great Lakes Orthodontics at (800) 828-7626 or visit the Web site greatlakesortho.com. FREEinfo, Carlson Bridge "Winged Pontic" Kit Prelaminations within the ScanDisk allows easy color-coding for quick-to-step attachment applications. Or, just go one way: join the future of Neo-buccal Dentistry! $269.99 VALUE INCLUDES 3 CB prefabricated Hand Crafted "Winged Pontics," CB-WP-Silane, 4.5 pm CB-Composite, Scan Disk with user agreement, step-by-step insertion instructions and…

12. Page 33

    Lip Balm Offered as Promotional After-Care Gift MENTOR, Ohio Lip Balm Express offers high quality lip balm made fresh to your order with a blend of natural ingredients and long-lasting flavors. And you can have your practice information custom printed on each lip balm label, making it a great promotional after-care gift. Orders are shipped within 5 days. For more information, call Lip Balm Express at (866) 214-9978, e-mail sales@lipbalm express.com, or visit the Web site lipbalmexpress.com. FREEinfo, Polishers Added to Rotary Instrument Line CUYAHOGA FALLS, Ohio Recently added to Cohlete/Whaledrnt's Alpen Rotary Instrument line, Alpen polishers, high-performance silicone and…

13. Page 34

    Restorative's High Strength and Ability to Achieve Excellent Clinical Results Cited MILFORD, Pa DENTSPLY adhesive glass ionomer restorative, a breakthrough in self cure Caulk's ChemFil Rock Advanced Glass Ionomer Restorative, a breakthrough in self cure materials, features a proprietary zinc reinforced formula that provides up to 25% higher strength than other conventional glass ionomer restorative. It also achieves excellent clinical results without the need for cavity conditioning or final coating. With its optimized formula, ChemFil Rock also provides a less sticky, more packable consistency, and the bulk placement results in easier and faster clinical placement. It is available in an…

14. Page 36

    Disposable High-Speed Handpiece's Capabilities and Infection-Control Benefits Cited KALAMAZOO, Mich.—Azenic's DHP Disposable High-Speed Handpiece, engineered with exceptional cutting efficiency and unique ergonomic design, offers all the performance of a metallic high-speed handpiece with the convenience and infection-control benefits of a disposable handpiece. It is designed for single patient use and will successfully perform in a variety of clinical applications where the clinician may elect to complement his or her current handpiece sum of handpieces with a reliable, disposable alternative. Available in a convenient, unit dispensing box of 12, the DHP is individually wrapped in its own sterilization pouch and ready…

15. Page 37

    Fluoride Varnish's Delivery System Provides Fast, Simple, Mess-Free Application SOUTH JORDAN, Utah- Ultra dent Products introduces Flor Opal Varnish White, a fluoride varnish with the innovative SoftEZ tip delivery system that provides fast, simple, mess free application. The tip features a unibody design that avoids fiber shedding and tip clogging, and its bristles are integrated within the body of the tip, providing a platform for an even coat of varnish. Additionally, the delivery system's syringe is flexible, fa cilitating reach to difficult to access areas. Flor Opal Varnish White's syringe-to-syringe mixing sys tem ensures a consistent, even dose of fluoride…

16. Page 38

    NEWS/TRENDS Industry News Ken Clarke Appointed General Manager of OralDNA Labs Brentwood, Tenn-based OralDNA Labs, a leader in advancing wellness in dentistry through salivary diagnostics and a subsidiary of Quest Diagnostics, announced recently that it has appointed Ken Clarke as general manager. He will report to Dermot Shorten, vice president, office of the chairman. "As one of the founders of OralDNA, Ken has invaluable firsthand marketplace experience," Mr. Shorten said. "He understands the high potential of this business and is focused on its continued growth." Prior to the creation of OralDNA in 2008, Mr. Clarke provided strategic planning and project…

17. Page 39

    NEWS/TRENDS ADA Foundation Hires New Executive Director Gene R. Wurth, JD, MBA The board of directors of the American Dental Association (ADA) announced recently the appointment of Gene R. Wurth, JD, MBA, as the its new executive director, effective this past July 1. Mr. Wurth will manage the ADAF, the charitable arm of the ADA, which secures contributions and provides grants for dental research, education, access to oral healthcare for underserved populations, and assistance for dentists and their families in need. "The ADAF is proud to welcome Mr. Wurth, who brings a tremendous amount of valuable experience in fundraising and…

18. Page 40

    Meetings/Seminars ADA Annual Session Returns to Las Vegas, Looks to Future The ADA announces its 152nd annual session and world marketplace exhibition, to be held at the Mandalay Bay Convention Center in Las Vegas from October 13 to October 15. The ADA Annual Session brings together leaders in dental practice, research, academia, and industry to present hundreds of continuing education (CE) courses throughout 3 days. It will also feature more than 500 exhibiting companies, and the 2011 distinguished Speaker, former US Secretary of State Condoleezza Rice, PhD. The Annual Session offers attendees the choice of more than 260 continuing education…

19. Page 42

    Dental Treatment During Pregnancy Every day, dentists across the country decide whether or not to provide dental care to a patient who is pregnant. On the one hand, they realize the patient needs to maintain her good oral health, especially if she has periodental disease. On the other hand, dentists traditionally have lacked the scientific evidence to make informed decisions about the possible effects of dental care, if any, to the developing child. The lack of data has caused many dentists to err strongly on the side of caution, especially during the second trimester when the fetus's development accelerates and,…

20. Page 44

    The Power of Genomics In this age of relatively inexpensive DNA sequencing and genomics—the comparative study of genes across species—scientists for the first time can parse the evolutionary record of genes and their proteins and assemble remarkable genetic insights. In oral biology, one of the most fascinating of these unfolding genomic stories involves dentin matrix proteins (DMPr) and dentin sialophosphoprotein (DSPP). Both belong to a currently small member family of noncollagenous, extracellular proteins. These proteins seem to play an important role...in the production of bone and dentin. called SIBLINGs, short for "small integrin-binding ligands and, N-linked glycoproteins." These proteins seem…

21. Page 45

    In First Impressions, George Freedman, D.D.S., gives readers a brief summary of products that have recently been introduced to dentistry, based on his clinical experience. Opalescence Oh! Ultradent Products Tooth whitening remains the single most popular dental treatment procedure for patients, period. It is safe, predictable, and for the bottom line of the practice, lucrative. Since patients are highly motivated by the media, ads, and the omnipresence of over the counter (OTC) bleaching products, the dental team's principal task is to stay informed about the latest techniques and products so as to be able to properly advise patients. It is…

22. Page 46

    dentalCEtoday.com ORAL MEDICINE Test 140 Salivary Diagnostics in Medicine and Dentistry: A Review Herbert I. Bader, DDS The rationale for the use of saliva as a diagnostic aid for diagnosis, treatment planning, and an adjunctive aid for risk assessment has been the subject of numerous studies and reviews in the literature.1-4 In 1990, Mandel discussed the use of saliva for diagnostic purposes in a seminal article in the Journal of Oral Pathology and Medicine. Projects supported by the National Institute of Dental and Craniofacial Research have made enormous progress in identifying and categorizing human salivary proteins. This has resulted in…

23. Page 48

    Salivary Diagnostics in Medicine... continued from page 42 via salivary diagnostics becomes an important tool in these efforts. PANCREATIC CANCER A unique diagnostic antibody known as the salivary transcriptome has been discovered to exist in encapsulated form in saliva. The transcriptome and microbial biomarkers found in saliva have been shown to be significant in the differentiation and early detection of pancreatic cancer. This is a significant step forward in the battle against the fourth leading cause of cancer death in this country.17 ORAL CANCER The need for noninvasive, accessible, and highly effective diagnostic methods has led to the investigation of…

24. Page 50

    Figure 5. Sample report showing periodontal pathogens detected—their levels. Figure 6. Sample report (page 2) reviewing patient diagnosis and treatment suggestions. Figure 7. Report of DNA test for human papillomavirus. Salivary Diagnostics in Medicine... continued from page 48 found in the plaque biofilm at, and below, the emergent margins of the teeth.16 The virulence factors and antigenic properties of the cariogenic microorganisms initiated a response by both the innate and adaptive immune systems, setting into motion a number of cellular and humoral responses. The ensuing sequence of events results in the release of a number of inflammatory mediators and enzymes,…

25. Page 52

    CE Test 140 Expiration date of this CE article is August 1, 2013. To submit Continuing Education answers, use the answer sheet on page 53. Circle the letter corresponding to the answer you believe is correct, detach the answer sheet from the magazine, and mail to Dentistry Today Department of Continuing Education. Or, use our easy online option at Web site dentalceetoday.com. This article is available for 2 hours of CE credit. The following 16 questions were derived from the article Salivary Diagnostics in Medicine and Dentistry: A Review by Herbert I. Bader, DDS, on pages 46 through 51. Learning…

26. Page 54

    Interdisciplinary Management of Implant Overdenture Therapy INTRODUCTION The management of complicated dental problems often requires an interdisciplinary approach to diagnosis, treatment planning, and therapy. Staging interactions among multiple providers and processes is critical to an optimal therapeutic outcome. The dental patient presented here required thorough diagnosis and treatment planning, as well as careful orchestrated interdisciplinary management to arrive at a successful treatment result. PATIENT PRESENTATION AND EVALUATION A 61 year old female presented for dental evaluation and treatment of her failing natural dentition (Figure 1). The patient indicated having seen a dentist in the last several years, suggesting that none…

27. Page 56

    Interdisciplinary Management... continued from page 54 rication of maxillary and mandibular implant supported overdentures was planned. PREOPERATIVE THERAPY Paraocclusal record bases were fabricated on the patient's dental casts. A central bearing device (Jaw Recorder [Global Dental Impression Trays]) was then attached to the record bases in preparation for interocclusal registration procedures (Figure 9). Next, clinical evaluations of the planned vertical and horizontal maxillomandibular relationships were accomplished. An intraoral marking stick was used to place a dot on the tip of the patient's nose and anterior prominence of the chin. Sitting upright in the dental chair, the patient was instructed to…

28. Page 57

    Next, the carefully trimmed interocclusal record was used to mount the mandibular cast against the maxillary cast in the articulator. In order to account for the dentoalveolar extension and gummy smile associated with the patient's chief complaint and affection for her dental appearance, diagnostic calculation of optimal tooth position within the patient's smile was made. This consideration, in turn, in impacted planned surgical intervention and space management in the mandibular arch. Locating the proposed mandibular incisal edges at the superior margin of the resting mandibular vermillion border, and using the average vertical height of mandibular incisors, the vertical position of…

29. Page 58

    IMPLANTS this reorientation of posterior denture teeth, encroachment on the normal physiologic function of the cheeks and tongue muscles needed to be avoided.6 A functional vestibular impression was made by injecting a rigid VPS (Aquasil Ultra Heavy [DENTSPLY Caulk]) into the maxillary buccal and labial vestibules. The patient was instructed purse her lips outward and forcibly smile, open wide and close. This sequence of oral movements was repeated several times until the VPS registration polymerized. The functional vestibular impression was removed and inspected (Figure 14). Using the same process, a second functional impression was made of the mandibular buccal and…

30. Page 60

    IMPLANTS extended were subtractively adjusted by grinding with conventional acrylic resin rotary instrumentation. The definitive impression procedure required multiple placements of the impression tray in the patient's mouth. In order to achieve consistently repeatable tray placements, tray stops were developed. Using high viscosity VPS (Aquasil Ultra Heavy), three quarter size circles of material were placed in the tuberosity and midpalate areas. Additional material was dispensed into the anterior tray (Figure 17c). The tray was seated on the edentulous maxilla and centered over the ridge and implant impression components. The objective was to develop an adequate and consistent space between the…

31. Page 61

    IMPLANTS implant overdentures, consideration was given to the trajectory of the implants in each arch and available restorative space. Despite aggressive efforts to reduce alveolar projection and improve restorative space conditions, there was not enough restorative space to customize data a bar attachment system. Additionally, the lack of absolute maxillary implant parallelism required use of a stud type mechanical attachment system capable of angle correction. For these reasons, the ERA Micro Angled Attachment System (Sterngold) was selected. Using angle correction diagnostic armamentarium provided by the manufactur tional orientation. One by one, each attachment was removed from its respective base, cement…

32. Page 62

    IMPLANTS 2.2). As previously described, the central bearing device was used to make and interarch centric relation record at the patient's proposed OVD. A second mandibular record base was constructed to carry a compound rim in order to accomplish a neutral zone registration (Figure 2). Detailed description of the neutral zone registration technique is provided elsewhere.5 A second maxillary record base with wax rim was adjusted to appropriate contour and used to record repose and high smile maxillary lip positions, record dental midline, and to aid in the face-bow transfer record. The maxillary definitive cast was mounted in a semiadjustable…

33. Page 64

    The "First Implant": Protocol for the GP Part 1, Treatment Planning INTRODUCTION It is the authors' opinion that dental implants have now reached a level where they are an essential part of "conventional" dentistry and should be considered as the first treatment alternative to replace missing teeth. Therefore, we believe that all general dentists should learn to safely and predictably place and restore a single dental implant to enhance patient treatment choices and their practice. However, we also realize that most implants are not placed into ideal receptors sites, ie, the bone of soft tissue contours may not be in…

34. Page 66

    The "First Implant"... continued from page 64 Avoidance of surgery might be an advantage in that situation. However, for improved hygiene and distribution of forces (without the need for prepa ration of adjacent teeth with resultant stress reduction), an implant provides a better option than a partial fixed prosthesis for a single missing tooth. For the FIP, we have chosen areas with a very high success rate. The suc cess rate for replacement of a molar or premolar with a dental implant restora tion has been shown to have a success rate greater than 96%.23 Many clini cians feel that,…

35. Page 68

    The "First Implant"... continued from page 66 more of the major implant organizations such as: the International Congress of Oral Implantologists, the American Academy of Implant Dentistry, and the Academy of Osseointegration. These organizations offer scientific meetings, satellite courses, Web sites, and literature with the purpose of giving clinicians the needed support, resources, and credentialing for further development. Joining these organizations shows that a clinician is committed to the science and art of dental implantology. The informed consent forms and certain legal advice offered by these organizations give a clinician a certain level of medical legal backup. In addition to…

36. Page 70

    70 15th Annual buyers-guide BUYERS' GUIDE . 1 Dental Implant Systems George Freedman, DDS Joe L. Cardon, DDS There are more people older than age 50 years in the United States than under, and this demographic impacts every dental practice. Successful practitioners must concern themselves with the needs and interests of this growing age group. Each different age group has its own specific dental profiles and dentists who provide treatment appropriate to their community's age distribution do well. Those that do not see their patients get older elsewhere. A significant segment of patients with dentures is seeking to eliminate the…

37. Page 72

    Z-Look3 Evo Evolution is Here! www.z-systems.biz Now you and your patients have a choice: WHITE or GREY :: No grey shine through :: 6 years clinical :: No microgap :: Metal free with very good soft tissue response and osseointegration :: Swiss high tech ceramic TZP-A BIO-HIP® :: Z-Look3 – the FDA approved Zirconia implant system z systems® Zirconiumoxide Solutions FREEinfo, on card Z-Systems USA, Inc. 284 Monponsett Street, Suite 208, Halifax, Ma. 02338-1432 Phone 1-877-874-9407, Fax 1-781-754-6565 usa@z-systems.biz, www.z-systems.biz DENTAL IMPLANT SYSTEMS continued from page 70 Style and shape The shape of the implant is dependent upon the manufacturer's…

38. Page 74

    DENTAL IMPLANT SYSTEMS continued from page 72 3M ESPE MDI Mini Dental Implants are minimally invasive and immediately stabilize loose dentures using a go-minute patented protocol. The implants are designed for stability in soft and dense bone, with several attachment designs available for custom retention. In addition, 3M ESPE offers affordable, one day MDI certification seminars led by some of the most experienced mini diameter implant clinicians in the nation. For more information, call (800) 634-2249 or visit jmespe.com/implants. FREEinfo, AB Dental USA i5 implants are conical, spiral, double threaded system implants with deep and especially sharp aggressive threads allowing…

39. Page 76

    DENTAL IMPLANT SYSTEMS continued from page 74 verging roots, and narrow ridges. They are ideally used for congenitally missing laterals, replacement of lost mandibular incisors, provisionalisation during grafting procedures, and maintenance of soft tissue architecture. Developed in conjunction with the NYU Department of Implant Dentistry, these implants are FDA approved for long-term use. They are available in 3.8, 2.4, and 3.4 mm diameters and 3 different lengths. For more information, call (800) 323-3136 or visit the Web site dentatus.com. FREEinfo, Atlas Denture Comfort Implants revolutionize stabilization of mandibular dentures with the proprietary Tuf-Link silicone reline material. Tuf-Link grasps on and…

40. Page 82

    DENTAL IMPLANT SYSTEMS continued from page 76 Vent, featuring the internal bevel/hex platform developed by Dr. Niznick in 1986. Color coding has been added to simplify implant identification and each implant includes a cover screw and 2 mm heal ing collar. The implants have Implant Direct Sybron International's patented microthreads for increased stability and double lead threads for faster insertion. The implants differ in thread design, aggressiveness of their self-tapping features, packaging, and diameter options. For more information, call (888) 649-6425 or visit implantdirect.com. FREEinfo, Pitt Easy implants combine the properties of a tapered implant body and the advantages of…

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