Dentistry Today — August 2013

Inside this issue

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

1. Page 8

   Why Don't General Dentists Place More Implants? At a recent lecture that I gave at a major dental meeting, I asked the few hundred dental professionals in attendance, "How many of you restore dental implants?" It was no surprise that approximately 90% of the audience raised their hands. My next question to them was, "How many of you surgically place dental implants?" I could estimate that not even 9% of the hands went up. This group, mostly general dentists (GPs), is reflective of just about every lecture that I have given in North America in the last 20 years. For…

2. Page 10

   VIEWPOINT continued from page 8 surgical procedure for placing an implant is much easier than that of second molar crown prep. Dental implant placement is very similar to screwing a screw into a very hard wooden board. Some people are going to scream at me for the simplicity of that analogy but, truth be told, if you are placing an implant into cortical bone, it is not all that different. Of course, you need to know the anatomy involved, as well as the proper choice of equipment to make it seem easy, but the actual physical and clinical procedure is…

3. Page 12

   Dentistry Today.com Providing you with news and information from the industry leader in clinical content. Visit Our Site Today! CONNECT WITH US! Technique of the Week Class II Composite Restoration Darren Simpson, DDS Darren Simpson, DDS, of Downers Grove, Ill, demonstrates the use of BISCO's TheraCal IC as a light-cured, resin-modified calcium silicate-filled liner, designed for use in direct and indirect pulp capping. TheraCal is used as a protective base/liner under composites, amalgams, cements, and other base materials. In this video, watch as Dr. Simpson completes a Class II resin-based composite restoration. See it today on our homepage, . NEW…

4. Page 14

   FOCUS ON: Implant Complications Carl E. Misch, BS, DDS, MDS, PhD (hc) discusses implant complications. Q: What is the most common cause of implant complications? A: Dentistry is a unique aspect of medicine, blending science and art form. Some aspects of the dental field emphasize the art form, as in dental aesthetics. However, the dental laboratory technicians are largely responsible for the final aesthetic result and they do not have the title of doctor. The primary reason the term color is applied to the dental profession is not a result of the art form; it is because of the dental…

5. Page 16

   From the April and May 2013 Issues ROTARY FILES Coltene HyFlex CM (controlled memory) rotary files are changing the DNA of NiTi files. The files are manufactured utilizing a unique process that controls the material's memory, making the files extremely flexible without the shape memory of other NiTi files. This makes the file follow the canal without creating undesired lateral forces on the canal walls. For more information, call (855) COL-ENDO (265-3636) or visit hyflexcm.com. FREEinfo, C&B REMOVAL INSTRUMENT Golden Dental The WAMkey crown-and-bridge-removal instrument is designed to be faster than cutting and splitting the crown, and safe for patients.…

6. Page 18

   Shield Force Plus +++++ Tokuyama Dental America | (877) 378-3548 | tokuyama-us.com Consultants' Comments • "Effects are immediate." • "Great product! I am interested to see how well it works over time." • "Effective when used under composites." • "A smaller brush would allow more precise application." Description Shield Force Plus, a one-component, light-cured desensitizer, is indicated for the treatment of hypersensitive dentin and for the alleviation or prevention of tooth sensitivity after tooth preparations. It contains resin in an ethanol solvent and a monomer that interacts with the calcium in the dentin. It infiltrates and seals exposed dentinal tubules…

7. Page 20

   Spotlight Chair Combines Ergonomic Design and High Technology With Flexibility and Value MALVERN, Pa.- DentalEZ Group's new NuSimplicity patient chair features an ergonomic design that allows dental professionals to freely maneuver while keeping patients calm and relaxed. Its narrow tapered back allows patients to be reclined close to the operator's knees, eliminating problematic reaching and twisting while providing optimal oral cavity access. Additionally, its base plate design allows closer placement of operator stools to provide superior access to the patient. Dual location touchpad controls are conveniently located on both sides of the chair's upper backrest, offering dental professionals easy access…

8. Page 22

   Spotlight Innovative New Curing Light Eliminates Batteries Ultrathin Veneer System's Popularity and High Quality Cited ORANGE, Calif.-Kerr Dental's Demi Ultra is the first and only cordless curing light without a battery. By utilizing state-of-the-art ultracapacitors to store energy, it can be re-energized much more quickly—without the need to over replace a battery. Ultracapacitors, long proven in the aerospace, automotive, and medical industries, are now compact enough for use in dentistry. In addition to more rapid re-energizing, the U-40 ultracapacitors in the Demi Ultra are distinguished by their greatly improved longevity compared to lithium-based batteries used in other curing lights. The…

9. Page 24

   Spotlight New, Feature-Laden Ultrasonic Unit's Versatility Cited ALGONQUIN, ILL-Obtura Spartan's new Spartan Wave Piezo Electric Ultrasonic Unit, used in conjunction with Obtura Spartan's wide variety of ultrasonic tips, provides a complete system that clinicians can use for preparation of root canals, retrograde preparation, and gutta percha condensation in addition to scaling and root planing. The unit is compact in size but abundant in features, such as (1) its AutoSweep technology, which locks in optimal frequency, eliminating the need to fine-tune power settings, and (2) its variable water adjustments, which provide users with the ability to control water flow as it…

10. Page 26

    Spotlight Digital Radiography System Is Fast, Easy to Use, and More Comfortable for Patients MELVILLE, NY–Air Tech majestically introduces the all-new ScanX Swift, a chairside digital radiography system that is fast, easy to use, and more comfortable for patients. Using flexible, cordless phosphor sensors, it delivers exceptional diagnostic clarity. Fitting on the operatory countertop and producing images in seconds or less, it yields a larger image area, greatly reducing the need for retakes. And workflow with it is virtually identical to film. It's the same easy technique but with sharp, high-contrast digital images in a fraction of the time—with no…

11. Page 28

    Spotlight Diode Laser Combines State-of-the-Art Technology With iPod Touch Operating System WEST JORDAN, Utah–CAO Group's new Precise SHP Diode Laser System perfectly pairs state-of-the-art diode laser technology with the cutting-edge operating system of an Apple iPod touch. The first laser utilizing an iPod touch to receive US FDA clearance for a variety of procedures in dentistry, it complements the advances in everyday dental procedures, including tissue cutting, tissue management, periodontal treatment, tissue therapy, pain management, teeth whitening, and more. The system offers live customer support through FaceTime, unlimited updates, and instant access to training videos and procedure demonstrations. It is…

12. Page 30

    Ultrasonic Insert Now Offered in Thin-Tip, 30-kHz Design PLYMOUTH MEETING, Pa—Premier Dental Products now offers its Big Easy ultrasonic insert in a thin-tip, 30-kHz size. The insert is ideal for removing light to medium debris. The tip's thinner profile allows greater access into subgingival pockets as well as tight interproximal areas. Big Easy inserts, compatible with most magnetostrictive handpieces, feature a wide diameter shaft and silicone grip manufactured from medical-grade silicone that provides maximum comfort and control with decreased hand fatigue. Introductory end-user offer: until September 30, buy any 2 Big Easy ultrasonic inserts and get one free. For more…

13. Page 31

    Ultradent's UltraSeal XT hydro Composite Sealant Technique UltraSeal XT hydro is a light-cured, radiopaque, fluoride-leasing composite sealant. Thanks to its hydrophilic chemistry, it eliminates the need to desccate the tooth to prevent it with a drying agent, allowing clinicians to get their patients effective treatments even faster. Additionally, its flouroscing properties overcome the difficulty of checking long-term marginal retention because its integrity is fully viewable under black light. Available in both Opaque White and Natural shades, UltraSeal XT hydro is 59% filled resin and has less polymerization shrinkage than competitive sealants on the market. Its characteristic thixotropic nature provides the…

14. Page 32

    NEWS/TRENDS Industry News Ultradent Products Celebrates 35th Anniversary South Jordan, Utah-based Ultradent Products marks its 35th anniversary this month as an international dental supply and manufacturing company, growing from a family-run operations small business to the global leader it is today. Dan Fischer, DDS, Ultradent's founder, invented and patented Astringdent, his groundbreaking hemostatic solution, in 1976 as an answer to the need for a tissue management product that achieved more rapid, profound hemostasis. His desire to market this product and to continue to develop more advanced dental solutions led to Ultradent's creation, setting the pace for a succession of products…

15. Page 34

    In First Impressions, George Freedman, DDS, gives readers a brief summary of products that have recently been introduced to dentistry, based on his clinical experience. Sof-Lex Spiral Finishing and Polishing Wheels 3M ESPE Polishing is a relatively simple and straightforward process in dentistry. It involves the progressive application of a series of abrasive materials to the surface that is to be polished. Typically, each abrasive material has a finer grit than the previous one, eliminating the striations left on surface. Eventually, a smooth and glossy surface is achieved that feels enamel-like to both the instruments and the tongue. This even,…

16. Page 36

    ce Test 164 dentalCEtoday.com IMPLANTS Confronting Controversial Issues in Dental Implant Therapy, Part I Confronting controversies in implant dentistry is necessary in order to develop clarify with respect to those clinicians have when treatment planning dental prostheses. As new information appears in the literature which conflicts with ingrained ideas, therapists may be left in a quandary concerning which tests should be applied to patient management. Therefore, it is essential to assess current data from multiple studies to determine the status of therapeutic options. In this 2-part article, 5 subjects related to implant dentistry are addressed to help clarify certain controversial…

17. Page 37

    LOCATOR OVERDENTURE IMPLANT SYSTEM NO MORE COMPROMISE! Until now, choosing a narrow diameter implant often meant a sacrifice in attachment performance and ultimately patient satisfaction. Introducing the LOCATOR® Overdenture Implant System (LODI) featuring LOCATOR, the world's leading overdenture attachment. 2.5mm Cuff Heights 4mm 3.4mm Diameters 2.9mm Included with each implant The unique two-piece coronal design of LODI, not found with O-Ball mini implants, is a critical feature that optimizes patient satisfaction. The LOCATOR attachment is seated after implant placement making case planning, implant surgery and restoration easier and allowing for replacement if wear should occur throughout time. LODI is manufactured…

18. Page 38

    Confronting Controversial Issues... continued from page 36 sult in bone resorption and deosseointegration at the bone-implant interface.11,14 However, it is not possible to identify a precise force threshold that initiates bone loss around an implant because there are many confounding variables: loading conditions, prosthesis type (splinted or splinted), abutment angulation, bone type, duration of destructive overload, etc. With these concepts in mind, various types of prosthetic constructs that experience increased stress during function are examined with respect to several perspectives: long-term survivability, biological, and technical issues. UNILATERAL SHORT SPAN CANTILEVERS OF DENTAL IMPLANTS An implant supported cantilevered fixed dental prosthesis…

19. Page 39

    IMPLANTS pontic cantilevered off 2 implants demonstrated a high survival rate (Table 4).27-34 Five studies27-28 that spanned 5 years were included in a systematic review.35 The survival rate for (ICFDFs) at 5 years was 94.3% (95% CI: 84.1 to 98%) and after 10 years, it was 88.9% (95% CI: 70.8 to 96.1%). Three other investigations, not included in the systematic review because they did not meet all the inclusion criteria, exhibited survival rates of 98%52 to 100%.51,53-54 (Table 4). Table 4. Clinical Recommendations for Restoring Teeth With Increased Crown-to-Implant Ratios (CIRs)2 1. Restore posterior regions so that incisal or canine…

20. Page 40

    IMPLANTS when a crown's height is increased from 16 to 20 mm, there is 50% more force on an implant. However, the central question concerning this short vertical calculation relates to how this affects clinical outcomes. Prosthesis Survivability and Bone Loss Around Implants Prosthetic constructs with increased CIRs for one to a have a high survivability rate (Table 3).4,5,51 Pertinently, studies that included restoration with CIRs of 2 also demonstrated high survivability (Table 3).2,34,45,51,85 Three additional studies which evaluated cantilevered prostheses reported mean CIRs of 6, 7, 8 and 7.6 and 6.67 and their retention rates (5 years) respectively were…

21. Page 41

    Test 164 Expiration date of this CE article is August 1, 2016 To submit CE answers, use the answer sheet below or use our online option at dentalcetoday.com. This article is available for 2 hours of CE credit. "The following 10 questions were derived from the article "Confronting Controversial Issues in Dental Implant Therapy, Part 1" by Gary Greenstein, DDS, MS, et al on pages 58 to 40. Learning Objectives: After reading the article, the individual will learn: (1) that there are abundant data to indicate that despite increased stress associated with certain types of prosthetic constructs, the survivability, technical…

22. Page 42

    Direct Custom Implant Impression Copings A Method for Accurate Impression of Highly Shaped Peri-Implant Gingiva Todd R. Schoenbaum, DDS Implant treatment in the aesthetic zone benefits significantly from the use of a well-designed screw-retained implant provisional restorations. This protocol allows the clinician and patient to evaluate the periodontal response to the implant treatment before proceeding to the definitive restorations. SOFT-TISSUE CONSIDERATIONS Following maturation of the soft tissue around the implant and provisional (generally 3 to 6 months following the last surgical procedure), the gingiva should have attained a natural and aesthetically acceptable state. The gingiva should have a reasonable appearance…

23. Page 44

    IMPLANTS [Figure 1. The implant body, copings and impression copings are quickly attached. With the screw used slightly loosened, an attempt to rotate the body is made to quickly verify that the screw is properly indexed. The screw post is then tightened.] [Figure 2. Low viscosity, dual-polymerizing resin cement is gently injected into the area around the impression coping. [BISCO Dental Products] was used for this case.] [Figure 3. A portion coppula is lightly held in place to ensure that the resin reaches to the full depth of the peri-implant sulcus.] [Figure 4. The resin is connected across the pontic…

24. Page 46

    buyers-guide BUYERS' GUIDE Dental Implant Systems George Freedman, DDS After a slow start in the 1980s, implant therapy has exploded on to the dental scene in the past decade. Implant awareness has spread beyond the profession into the patient domain. The allure of functional and aesthetic dentition for those totally and partially edentulous has warned the public's perception of implants. Fortunately, the dental profession has been able to adapt technologies and techniques from the medical and aerospace domains to improve the clinical and functional outcomes of implant cases. It is estimated that 10% to 15% of seniors wear at least…

25. Page 48

    DENTAL IMPLANT SYSTEMS continued from page 46 of implant procedures in many practices. In spite of the slow adoption, today, the majority of North American dentists offer implant services. The rapidly increasing number of implant manufacturers has allowed fixture and accessory costs to stabilize through the past few years, and even decrease in some cases. Competition, as always, works to the benefit of the practitioner, and ultimately the patient, making implant treatment more affordable, and renewed function and aesthetics a reality. Some (too few) insurers have also seen the light, having realized that implant therapy is often a single, limited…

26. Page 50

    continued from page 48 The XIVE Implant System offers the surgical and prosthetic versatility needed to achieve outstanding and predictable results. The innovative thread design and preparation technique ensure outstanding primary stability in all bone classes. The 3-piece XiVE 3.0 is designed especially for clinical situations with limited space and allows for prosthetic flexibility. The comprehensive range of prosthetic concepts provides practical and reliable solutions, even for complex indications. The unique template provided with each implant simplifies fabrication of a temporary. For more information, call (800) 531-3436 or visit xiveimplants.com. FREEinfo, Glidewell Laboratories Inclusive Tapered implants combine RBM surface technology…

27. Page 52

    continued from page 50 Titanite surface enhance osseointegration and soft tissue response. NobelActive is recommended for clinicians experienced in implant placement and it's one of Dentistry Today's top 25 implant products. For more information, call (800) 322-5001. FREEinfo, OCO Biomedical OCO Biomedical is the worldwide leader in immediate load dental implant technology. Custom healing components can significantly improve gingival esthetic contours inCLUSIVE TOOTH REPLACEMENT SYSTEM The patient presented with a fractured anterior tooth. The patient wore a flipper, which served as a transitional appliance throughout the healing phase. After extracting the tooth and placing the implant, Inclusive delivered a custom…

28. Page 56

    continued from page 52 ventional dentistry principles (ferrule crown attachment) to implant dentistry. For more information, call (888) 446-7128 or visit periosal.com. FREEinfo, Ritter Dental USA The Ivory Dental Implant System is affordably priced, yet designed to meet the standards of the most experienced implantologists. Made in Germany, the implant line features self-tapping threads and a nanosurface for quick osseointegration. Two models provide a complete solution for most surgical applications. The Ivory Implant System has excellent clinical success rates and is supported by Ritter's surgical instruments. For more information, call (855) 892-8111 or visit ritterdentalusa.com. FREEinfo, Sterngold The acid-etched dental…

29. Page 57

    Aesthetic Zone Challenges: Restoring the Dark Tooth, Part 2 Using Elective Orthodontic Extrusion to Modify Gingival and Bone Levels Eliot Mechanic, DDS, BSc This is part 2 of a 2-part article series. Part 1 of Dr. Mechanic's article was published in the June 2013 issue of Dentistry Today and can be found in our archived articles at the Web site . INTRODUCTION The restorative dentist is sometimes presented with a patient displaying a dark line or a discoloration surrounding the gingival margin of a crowned tooth. Often the entire porcelain crown cannot mask the discolored underlying preparation, and the entire…

30. Page 58

    AESTHETICS more, these restorations have a marginal fit of 4-5 to 175 µm, comparable to the best cast gold restorations. CASE REPORTS Case 2: Using Orthodontic Extrusion to Realign Gingival and Bone Levels The use of elective orthodontic extrusion of teeth as a means to modify gingival and bone levels has been well documented. Forced orthodontic eruption is a technique for soft and hard tissue augmentation based on osteophysiologic and orthodontic principles. It was first described in the literature by Heithersay3 and Ingber.4 Depending on the forces exerted, orthodontic extrusion is able to alter the position of the gingiva and…

31. Page 59

    The patient chose to attempt whatever it would take to try to preserve the natural tooth, and to keep it as long as possible. Clinicist Protocol A bis-acryl provisional (Luxatemp [DMG America]) was fabricated from a pretreatment template (AFFINITY Crystal [CLINICIAN'S CHOICE]) and permanently cemented to the existing tooth preparation using a one-step resin cement (Emphase GAC [Dentsply]). Dentsply GAC orthodontic brackets were placed from premolar to premolar on the molar. Copper NiTi wire low-intensity extrusion forces of 15 g were placed on the targeted central incisor to move the margin and the surrounding gingival tissue initially approximately 10 mm…

32. Page 61

    Conquering a Difficult Case, Part 2 Lithium Disilicate as a Restorative Solution for Amelogenesis Imperfecta This is part 2 of a series of articles defining ways to simplify treatment of complicated cases. Dr. Auster, president of the New York affiliate of the American Academy of Cosmetic Dentistry, discusses a systematic way to create beautiful cases built to last. Peter Auster, DMD INTRODUCTION Dentistry presents us with challenges every day. Our professional comfort zone defines how well we deal with these challenges. The more we learn and grow as clinicians, the more comfortable we get at attempting difficult tasks and the…

33. Page 62

    AESTHETICS beyond what they learned in dental school in order to instill confidence when deciding "where to go from here." The AACD emphasizes "responsible aesthetics" and minimally invasive dentistry for creating long-term, beautiful restorations. This is an essential starting point for the journey toward excellent, comprehensive care. 6. After reviewing the information gathered from step No. 5, a consultation with dental specialists who will be involved in treatment. 7. A discussion with a knowledge-able laboratory technician about restoration design and material preferences and limitations. 8. Treatment of acute issues (eg, initial removal of gross decay and immediate periodontal and surgical…

34. Page 64

    AESTHETICS dentition and establish her new bite. She was doing very well with the upper alignment and had no significant symptoms in her teeth, muscles, or joint. Modified shoulder preparations were completed with care not to overprepare the proximity of pulp horns in her young teeth. Teeth Nos. 22 to 27 and No. 31 were prepared for pressed lithium disilicate (IPS e.max Press) crowns, and teeth Nos. 28 to 30 and Nos. 19 to 21 were prepared for bilayered zirconia bridges. The preparation guides established the minimum reduction necessary, especially in the lower anterior teeth. The provisionals were cemented as…

35. Page 65

    Management of a Maxillary Second Molar INTRODUCTION Successful root canal therapy requires a thorough knowledge of both the external and internal anatomy of root and its canal morphology. Extra roots or root canals, if not detected, are a major reason for endodontic failure. Maxillary molars show considerable anatomic variation and abnormalities with respect to the number of roots and root canals. Traditionally, the maxillary second molar has been described to have 3 roots with 3 or 4 root canals, with the fourth canal commonly being found in the mesiobuccal root (MB2). Pecora et al5 investigated the internal anatomy of 370…

36. Page 66

    ENDODONTICS floor wall junction. An additional orifice was located immediately buccal and in line with the orifice of the palatal canal orifice. 2) Further removal of dental shelf beginning from the orifice of the mesiobuccal canal and moving toward the orifice of the palatal canal with ultrasonic microabrasion (Fg FT) [E-D Tg] [SonoAce, A Division of ACTEON North America] clearly unveiled the orifice of an additional canal. Though the offices of the palatal, additional, and mesiobuccal canal were in the same line, the orifice of the additional canal was far closer in proximity to the palatal orifice rather than to…

37. Page 67

    ENDODONTICS 67 (Cmicdent) and EDTA (Glyde File Prep [DENTSPLY International]). Master cones were selected by placing cones corresponding to the size of the finishing file used to the working length and was confirmed radiographically (Figure 7). The canals were dried with absorbent points (ProTaper [DENTSPLY Maillefer]) and single cone obturation was performed using ProTaper gutta-percha (DENTSPLY Maillefer) with AH Plus resin sealer (DENTSPLY Maillefer). The tooth was then restored with a posterior composite resin core (Peo [3M ESPE]) (Figures 8 and 9). The patient remained asymptomatic during follow-up period. DISCUSSION In the maxillary molars, the most commonly encountered extra canal…

38. Page 68

    The deviation of MB2 orifice from its usual location may be attributed to the fusion of the roots as seen here. Molar root fusion is one of the commonly found anomalies in the development of root morphology. Root fusion is found more frequently in maxillary than in mandibular molars. It is more common in the third molars, followed by second molars, and less often in the first molars, in both arches. When fusion occurs, they usually exhibit a bilateral symmetry and have shown a sexual prediction: toward females. Fusion can occur in the apical, middle, or cervical one third of…

39. Page 70

    Sterilizers SciCan The STATIM G4 is the same renowned and trusted autoclave it has been for more than 20 years but now boasts a new contemporary look and connectivity that is the first of its kind. The G4 technology will change the way you interact by providing a direct channel of communication through the Internet to you, or anyone you desire. It is still powered by SciCan's signature steam technology to provide sterilization and dryness at speeds faster than conventional chambered autoclaves. For more information, call (800) 572-1211 or visit scican.com. FREEinfo, Porter Instrument The Kershaw Sterilizer System ensures that…

40. Page 72

    One-Step In-Office Immediate Dentures INTRODUCTION This article continues the introduction of an innovative technique to fabricate complete dentures in one visit (in about one hour), without the need for a dental lab. In my previous article in Dentistry Today,¹ I discussed the overview of the complete denture technique and how it is used for full dentures for the currently edentulous patient.² It is a technique that is intuitive and easy to learn, efficient and profitable for the dentist, and economical for the patient. You, as the dental practitioner, will be able to increase your patient base and income by capturing…

And 11 more pages — read the whole issue.