Dentistry Today — AUGUST 2014

Inside this issue

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

1. Page 6

   Riding the Wave In recent years, our August issue has been planned with editorial focus on implant dentistry, and this year is no exception. It has been quite a journey in the time that has passed since 1952, when a dedicated orthopaedic surgeon, Dr. Ingvar Branemark, became fascinated with studying and researching bone healing and regeneration. Now known to many as "the father of modern dental implantology," he placed his first intraoral implant in a live volunteer patient in 1965 as a professor of anatomy at Gothenburg University in Sweden. Since he first clinically observed the adherence of bone with…

2. Page 8

   The New Standard? This decade will most likely bring another great shift in how dentistry is practiced, but will it be a move back in time and back to the basics? In the past year or so, I have personally extracted more teeth and placed more patients in full dentures than in 13 years of practice. More and more patients these days have severe unhealth and dental problems. Just today, I met Don, a severely overweight male patient in his 50s, requesting full-mouth extractions. A medical history review was grim, and according to his paperwork, he was in perfect health.…

3. Page 10

   Colgate PreviDent 5000 ppm ISONLY BOOSTER PLUS 1.1% Sodium Fluoride PRESCRIPTION STRENGTH TOOTHPASTE DESCRIPTION: Self-topical neutral fluoride dentifrice containing 1.1% (w/w) sodium fluoride for use as a dental caries preventive in adults and pediatric patients. Active Ingredient: Sodium Fluoride 1.1% (w/w) INDICATIONS AND USAGE: As a dental caries preventive, for once daily self-applied topical use. It is used in children following supervised brushing of children's teeth and in the following preventive white suspensions for non-carious applications. 1.4 PreviDent 5000 BoosterPlus brand of 1.1% sodium fluoride toothpaste as a general health-related oral cavity compound. May be used in areas where drinking…

4. Page 11

   VIEWPOINT ning and explored and proposed various financial options. We expect our patients to adjust their daily routine to achieve optimal oral health, so why do we not expect the same when dealing with our own business practices? TIME FOR SOME SELF-REFLECTION Going back to my patient Don, I cannot help but think, was he like a window to our professional future? This patient told me that, when he last saw his dentist 8 years ago, he had been presented with a plan to restore his entire dentition and it was going to cost $75,000. At that time, he was…

5. Page 12

   Below is a Letter to the Editor that Dentistry Today received regarding the article, "A Predictable Resin Composite Injection Technique, Part 2," by Douglas A. Terry, DDS, et al, which ran in the June 2014 issue on pages 80 to 85. To comment on the current issue, contact Adrienne Rizzo at arizzo@ . Dear Editor: I read with interest the article by Dr. Douglas A. Terry et al, titled "A Predictable Resin Composite Injection Technique, Part 2," in Dentistry Today's June issue (Volume 33, Number 6, pages 80 to 85). Although this article presents a very interesting and usable technique…

6. Page 14

   FOCUS ON: Prosthodontics Lorin F. Berland, DDS, discusses a patient population that has not taken advantage of new denture technology, urging colleagues to educate this market. Q: Dentistry has certainly gotten a lot of positive media attention in recent years. In spite of all that, do you think there's something missing? A: Yes, I do. While publicity on the latest trends and products in dentistry—whitening, veneers, implants, and the connection between oral and general health—have brought even more people seeking our help, unfortunately, there is a large segment of the population, all over the world, that has been largely ignored:…

7. Page 16

   Visit Our Site Today! Technique of the Week Smile Design Bryan Couch, DDS In this video, Bryan Couch, DDS, completes a successful smile design, placing veneers on teeth Nos. 5 to 12 and Nos. 21 to 28. Dr. Couch begins the procedure with proper tooth preparation followed by 3-D digital impression scanning of the area utilizing Planmeca's Planscan Restorative System. Smile design is completed using PlanCAD design software, and it is milled and seated in office. To watch this video, visit . FREEInfo on Products Categorized by Product Type Dentistry Today has made it easier than ever to access free…

8. Page 18

   From the April and May 2014 Issues IMPRESSION MATERIAL 3M ESPE The fastest-setting impression material on the market, Imprint 4 VPS impression material sets in just 75 seconds thanks to unique, active-self warming technology. Working time is not compromised, so dentists can observe good impression-taking technique and obtain reliable results. The material's superhydrophilicity also contributes to its reliability, further helping it consistently achieve precise details. For more information, call (800) 634-2249 or visit 3mespe.com/imprint4. FREEinfo, GERMICIDAL CLEANER/DEODORANT GC America The improved formula of COE FOAM II, a rinseless, dripless foaming germicidal cleanser and deodorant, (1) kills more viruses, including MRSA…

9. Page 19

   Ivoclar Vivadent Adhese Universal is a new, single-component, light-cured universal adhesive for direct and indirect bonding procedures. It features compatibility with all etching techniques (self-etch, selective enamel-etch, and total-etch). The VivaPen delivery form ensures fast and convenient direct intraoral application of Adhese Universal. The VivaPen delivers up to 190 single-tooth applications, which is significantly more than a traditional adhesive bottle. For more information, call (800) 533-6825. In Canada, call (800) 263-8182. FREEinfo, HAND INSTRUMENT DiaDent Dia Kondensor is a versatile endodontic condenser hand instrument that is durable, lightweight, and ergonomic to reduce hand fatigue. It has double-ended tips with NiTi…

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    NEW PRODUCTS GUTTA-PERCHA Obtura Spartan Endodontics Latex-free Flow 150 Gutta-Percha features a unique nanoformula that produces optimal consistency and smoothness at a lower working temperature for better clinical application. When heated between 145°C and 165°C, it is easily manipulated for a longer period of time without cooling or shrinking. And because it requires a lower working temperature to produce a desirable flow, clinicians will be able to bring a heating plugger deeper into the root canal space for a better 3-D fill. For more information or to request samples, call (800) 344-1321. FREEinfo, POLISHING SYSTEM Garrison Dental Solutions The eZ!…

11. Page 22

    CLINICAL REVIEWS THE DENTAL ADVISOR Super-Snap X-Treme +++++ Shofu Dental | shofu.com Consultants' Comments • "Produced a glass-like finish to composite restorations." • "Much more durable than original disks; ideal for anterior restorations." • "Increased flexibility adapts to tooth contours." Description Super-Snap X-Treme disks are enhanced versions of the green (fine) and red (superfine) polishing disks included in the original Super-Snap system. The X-Treme system contains coarse and medium disks for contouring and finishing and fine and superfine for polishing. The green and red disks are thicker and stiffer to increase durability and tactile feel, and the red disk has…

12. Page 24

    Direct Veneers Just Got a Whole Lot Easier Sigal Jacobson, DMD Many of us still remember the past generation composites. Reproduction of the natural characteristics of a tooth was difficult because of the lack of available shades as well as the less-than-ideal physical qualities of the materials. Since that time, various aesthetic composite resin materials have been introduced that possess exceptional color characteristics and improved physical qualities. Given a composite's advantages, why is direct composite veneering of teeth so frequently overlooked in favor of the porcelain veneer option? One would first assume that the artistic ability needed to reproduce the…

13. Page 26

    TECHNOLOGY . 1 Spotlight Loupes' Ergonomics and Strength Ensure Lightweight Comfort and Long-Lasting Life DUNCANVILLE, Texas–Q Optics Prism Loupes redefine the standard in surgical and dental loupes. Advanced materials and novo-relief design combine to create the most lightweight and ergonomic prism loupe ever introduced, and machined titanium unibody housing allows lenses and prisms to be aligned and affixed in a unique optical cage. Carbon-fiber shrouds provide extreme weight reduction and nose relief for the steepest ergonomic angles, and strength and rigidity of construction ensure lightweight comfort and long-lasting life. For more information, call Q-Optics at (800) 858-2121, ext. 3675, or…

14. Page 27

    The soft chew for Healthy Teeth - Supports Oral pH levels Introducing BasicBites™ BasicBites, delicious sugar free chocolate soft chews, contain Ortek's patented arginine bicarbonate/calcium carbonate AlkaGen Technology™. This groundbreaking technology was developed at Stony Brook University School of Dental Medicine and is based on decades of research in oral biology and saliva chemistry. BasicBites mimic saliva's profound benefits in helping maintain healthy teeth. Breakthrough science The saliva-mimicking technology in BasicBites consists of two main ingredients – arginine bicarbonate and calcium carbonate. Arginine is a common amino acid found in saliva and is naturally present in many foods. Arginine supports…

15. Page 29

    Microscopes Seiler Instrument With more than 68 years of optical experience, Seiler Instrument is a worldwide leader in the field of microscopy. Seiler offers a full line of microscope products, including the newly designed dental microscopes. These microscopes feature an 80,000 lux LED illumination system, apochromatic lenses for superior optical clarity, and a smooth, fluid movement engineered specifically for the dental professional. Seiler microscopes are backed by a lifetime warranty on optics and mechanics. For more information, call (800) 489 2282 or visit the Web site seilermicro.com. FREEinfo, Global Surgical Global microscopes have set the bar for dental microscopy worldwide…

16. Page 30

    Spotlight New Cement Facilitates Creation of Clinically Reliable Veneer Restorations LOMPOC, Calif.-DenMat introduces UltraBond Clear, a light cure resin cement formulated for bonding Lumineers as well as other ceramic or composite veneers. Offered in highly translucent clear and natural shades in a viscosity developed for optimal handling when placing veneers, it is sure to provide the final aesthetics dentists and their patients will love. Formulated with more than 25 years of expertise in successful veneer cementation, Ultrabond Clear offers high bond strength and excellent color stability, resulting in clinically reliable, long-lasting veneer restorations at an affordable price. It is packaged…

17. Page 32

    Spotlight Medical/Dental Artwork Cited for Its Collectibility Attachment Processing Material Features Formulation Based on Clinicians' Input AUSTIN, Texas—The Ronadró Collection offers collectors of fine medical and dental art bronze sculptures and porcelain figurines crafted by the late master artist Ronadró, pictured here with one of his works. Each bronze sculpture is crafted entirely by hand and finished to a warm glow. Doctors, surgeons, dentists, and other collectors of medical artwork have made Ronadró's sculptures and figurines highly prized medical art for additional information, contact NADIA International at ESCONDIDO, Calif.—ZEST Anchors, manufacturer of the trusted LOCATOR Attachment and LOCATOR Overdenture Implant…

18. Page 34

    NEWS/TRENDS Industry News Parkell Adds Industry Veteran to Its Executive Ranks Edgewood, NY-based Parkell announced recently the addition of Steve Paskin to its executive ranks. He will serve as president, overseeing all departments. With more than 30 years of dental industry experience, Mr. Paskin's career path has followed a classic dental executive's arc: (1) sales, (2) product and sales management, then (3) marketing, ultimately leading to the presidency of Sybron Dental Specialties' dental consumables platform. During his tenure with Sybron, Mr. Paskin had a leadership position in almost every one of its business units, including Omco, Kerr, Sybron Endo, Kois,…

19. Page 38

    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. Z-PRIME Plus BISCO Dental Products There has been a rapid increase in the utilization of zirconia and alumina metal oxide indirect restorations. The high strength and physical integrity of zirconia and alumina, even under extreme functional conditions, are well established. The early aesthetic problems of this category have largely been solved. Most importantly for the practitioner, these crowns and bridges can be used with existing techniques of preparation and impression, as well as the more…

20. Page 40

    buyers-guide BUYERS' GUIDE 18th Annual Implant Systems George Freedman, DDS The dental profession is often reluctant and slow to embrace innovations in dental technology and techniques. This pattern has been repeated with implants among general practitioners. It is important to note, however, that the early implant systems were specifically targeted to speediest and were less than user friendly. General dentists were intentionally shut out. Slowly, but surely, the profession has mainstreamed this tremendously useful treatment process. General practitioners now can diagnose and treat the vast majority of implant cases. While the majority of North American dentists offer implant services today,…

21. Page 42

    continued from page 40 BioHorizons This comprehensive line of implants is designed to address all of the clinical requirements in implant dentistry, including immediate loading and full-arch procedures. Laser-Lok surface technology is the only technology on the market today with clinical data that supports reduced bone and soft-tissue loss. Post-market clinical studies have shown that it is more effective than conventional implant designs in reducing bone loss. For more information, visit the Web site biohorizons.com. FREEinfo, BIOMET 3i The 3i T3 Implant is a contemporary hybrid implant with a new, multisurface topography designed to deliver aesthetic results through tissue preservation.…

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    continued from page 42 and double-lead threads for faster insertion. The implants differ in thread design, self-tapping features, packaging, and available options. For more information, call (888) 649-6425 or visit the Web site implantdirect.com. FREEinfo, integrated dental systems The AnyRidge Implant System is used for immediate placement in post-extraction. Its innovative knife-thread achieves excellent initial stability. It has diameters of 6.0, 6.5, 7.0, 7.5, and 8.0 mm. The 5° internal connection and platform switch results in maintenance of crestal bone, which eliminates any possible screw loosening. XPEED surface provides faster and stronger osseointegration, in addition to a safer, acid-free, biocompatible…

23. Page 48

    IMPLANT SYSTEMS continued from page 44 Neodent USA The CM implant system features a variety of body, thread, and cutting groove designs to help clinicians deliver solutions to patterning of all clinical needs and bone types. CM implants feature the NeoForos surface, which was developed through a proven process of sand blasting and acid etching known to positively influence the biologic process of osseointegration. With a single prosthetic interface, the CM Line of Implants offers simplicity and ease of ordering, streamlining the prosthetic planning process. For more information, call (855) 413-8883, visit neodentusa.com, or e-mail info@neodentusa.com. FREEinfo, Nobel Biocare The…

24. Page 50

    continued from page 48 obstruct rotation and migration. Since 1967, Park Dental Research's vision has been to innovate and simplify implantology. For more information, call (800) 243-7372 or visit parkdentalresearch.com. FREEinfo, PerioSeal The PerioSeal Implant System provides today's general dentists and specialists the newest yet most advanced system marketed in the United States for addressing the issues of highest concern to patients and dentists. Its unique design incorporates safety features, lower costs, simple crown and bridge dentistry, and a superior cosmetic outcome. PerioSeal incorporates conventional dentistry principles (ferrule crown attachment) to implant dentistry. For more information, call (888) 446-7126 or…

25. Page 51

    IMPLANT SYSTEMS Z-Systems USA The FDA-approved Zirkolith Zsc is a 2-piece all-zirconia implant. It is the essence of more than 12 years of clinical experience in most porous, highly aesthetic zirconia implants. The Zsc features a patented laser surface technology and straight, 15°, or customizable zirconia abutments. It is highly reliable, boasting a 98% compound implant survival rate and guaranteed success. For more information, call (872) 874-9407, visit the Web site zsystems.com, or send e-mail to usa@z-systems.biz. FREEinfo, ZEST Anchors ZEST Anchors is recognized as a global leader in the manufacturing of overdenture attachments. It pioneered the self-aligning and pivoting…

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    Stabilization of Removable Partial Dentures Maximizing Clinical Success With Small-Diameter Implants INTRODUCTION Steven T. Caldwell, DDS Small-diameter implants (SDIs) are effective in stabilizing removable partial dentures (RPDs) and function to provide a stable "seat" to minimize vertical movement. The natural teeth restrict lateral movements with RPDs, so mini implants are not necessary for this role. SDIs allow the utilization of RPDs even in cases with many missing teeth. Because of lateral movement restriction by the patient's natural teeth, fewer SDIs are required for use with RPDs than with full-denture stabilization. SDIs also allow the elimination of clasps in many RPD…

27. Page 54

    Stabilization of Removable Partial... continued from page 52 ing the appliance. The author has only once been asked to increase retention with a full denture, and never with a RPD. RPD stabilization is not the same as full-denture stabilization. With full dentures, SDIs prevent lateral movement and upward displacement, and provide a stable seat when the patient is biting. As previously stated, the primary role of SDIs used with RPDs is to provide a stable seat to minimize vertical movement. The role of thumb with full dentures is that SDIs take the place of one root-form implant.3 With RPDs, one…

28. Page 56

    Figures 4a and 4b. Three SDIs placed to stabilize broken maxillary RPD. Figures 4c and 4d. Picking up housings in existing RPD with hard (fast-set) pick up acrylic (Secure 3M ESPE). Stabilization of Removable Partial... continued from page 54 • Less lingual-facial bone width is required. SDIs can be placed with as little as 4.0 mm of lingual-facial bone width.2,6 • With the exception of severely atrophied mandibular ridges exhibiting Dr-type bone, ie, primarily cortical bone with minimum trabecular bone, only the cortical plate is pierced with the pilot drill. The SDI then very slowly "threads" its way through the…

29. Page 57

    drill penetration of the cortical plate. The SDI then slowly "bites" its way to depth, much like a wood screw, virtually eliminating the possibility of nerve or vessel damage. • Are as durable as rootform implants if treatment planned and placed appropriately. • Are easily replaced if occasionally lost. The removable partial, or full denture, is then easily repaired to receive a new housing for the SDI. • Use a restorative option most GPs, with training, should be comfortable utilizing in their own practices. References 1. Sendax S, Aparicio A, Edmundo S, et al. How successful are small-diameter implants? A…

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    dentalCEtoday.com Go online to earn credit for reading this CE article. IMPLANTS Sinus Tenting for Posterior Maxillary Implant Placement INTRODUCTION Timothy F. Kosinski, DDS Perceived limitations often exist when considering placement of dental implants in the posterior maxillary area. The maxillary sinus lies under the cheeks, below the eyes, and above the teeth on either side of the nose. These sinuses drain into the nose through ostia on the side of the sinus wall. These holes empty into recesses or meatus­es in the nasal cavity. These meatus are covered by turbinates, which are bony shelves surrounded by erectile soft tissue.1…

31. Page 59

    Perceived limitations often exist when considering placement of dental implants in the posterior maxillary area. Figure 5. Periapical radiograph showing the pilot drill in place. Figure 6. A tissue punch with center guide was used to drill through the gingiva to bone through the periosteum. Figure 7. The punched tissue was easily removed in this flapless procedure. Figures 8 and 9. The final osteotomy former opened the pilot hole to allow entry of the flat tip final drill. grafting of socket sites is not done in preparation for implants at the time of extraction and the socket is allowed to…

32. Page 60

    Figures 10 and 11. The flat tip final drill entered to the depth established by the pilot drill, 1.0 to 2.0 mm short of the sinus floor. Figure 12. The side-cutting drill (OCD Biomedical) was taken to the osteotomy site, gently tapping it into place circumferentially around the osteotomy. Figure 13. A piece of resorbable barrier material membrane about 4 times the size of the osteotomy was carefully tucked up into the osteotomy site with a concave tipped osteotome. CASE REPORT Diagnosis and Treatment Planning Our patient was a septogenarian in good health with a desire to replace a tooth…

33. Page 61

    IMPLANTS implant after elevating the sinus membrane nearly 6.0 mm. Our patient was delighted with the final result. CLOSING COMMENTS The clinical procedure, as outlined here, was done using a flapless technique. It was relatively painless, bloodless, and no sutures were required. Implant stability was achieved, and integration progressed without complication. It is clear that although we had legitimate concerns about placing implants in the patient's maxillary sinus area, techniques now exist that allow the practitioner to have control in directing the final position. to the osteotomy site (Figure 14). Figures 15 and 16 illustrate the use of properly sized,…

34. Page 62

    dentalCEtoday.com Go online to earn credit for reading this CE article. IMPLANTS Are Radiographic Guides Necessary? A Paradigm Shift in Implant Site Assessment, Digital Planning, and Surgical Guide Fabrication INTRODUCTION We were taught in dental school the axiom "failing to plan is planning to fail," and that we must thoroughly plan our treatment and visualize the end-point goals prior to starting treatment. To get there, we were taught (and continue to teach) that additive wax-ups for partially dentate patients and tooth arrangements on stabilized record bases for edentulous patients is absolutely the gold standard in diagnosis and treatment planning. While…

35. Page 63

    LOCATOR OVERDENTURE IMPLANT SYSTEM "The new LODI System offers us a good alternative to 0-ball attachments when the use of a narrow diameter implant is desired. I also like the LODI surgical kit has a Torque snap-on Drill Stops and Torque limit stops out at 70Ncm, which assists in determining the level of primary stability." Steven H. Pratt, DDS, FAGD, FAAiD "I have placed more than 50 LOCATOR Overdenture Implants and this system is exactly what I have been looking for. It is easy to use with graduating drill diameters and multiple length drill stops, as well as paralleling pins…

36. Page 64

    Are Radiographic Guides Necessary?... continued from page 62 required custom abutments and splinted overcontoured restorations, which ultimately led the patient to feel as if a less than optimal result was achieved (Figure 5). Preventing errors in treatment planning, as shown in the previous Figures, can be accomplished by establishing a restorative plan prior to placing implants. Various radiographic visualization methods have been previously described with many reports and techniques involving duplicating the existing or proposed restoration and fabricating a radiographic guide.9-13 Many of these radiographic guides contain markers such as gutta percha,13-15 ball bearings,16,17 metal tubes,18 metal strips,19-20 and barium…

37. Page 66

    Are Radiographic Guides Necessary?... continued from page 64 implant was selected from the library with diameter and length chosen based upon the availability of bone present in the 3-D view. The implant was tentatively placed according to available bone volume with some regard to positioning relative to the dental arch configuration (Figure 8). A virtual restoration or wax-up is added to the implant by clicking on the "restoration" button on the left side of the screen, which automatically takes the user to the restoration feature of the software. The latest version of Invivo Dental (version 5.3, at press time) will…

38. Page 67

    Digital planning for soft tissue-supported implant surgical guides requires a few additional simple steps. also visible air space around recent extraction sites illustrating the healing process associated with an immediate denture. Traditional implant planning with measurement-based CBCT analysis is facilitated with this simple yet intuitive approach for fully edentulous patients (Figure 19). While this traditional approach is facilitated with this simple solution, digital planning for soft tissue-supported implant surgical guides requires a few additional simple steps. Figure 20 shows a mandibular denture with a radiopaque VPS rehne (Green Mobius, Parkell) and soft-tissue separation. The VPS liner shown in Figure 21…

39. Page 68

    Resurfacing Tooth Structure With Ceramic Laminates INTRODUCTION Through adhesive dentistry, we can resurface natural tooth structure to improve aesthetics, function, and dental health. Composite resin can be directly placed in many clinical situations, but this treatment modality requires that the provider be both the clinician and the artist. My experience tells me that composite resin can be expected to last up to 10-plus years when placed with excellence and in correctly indicated clinical situations. Relaminating tooth structure with ceramic materials can result in a more durable and stain-resistant surface. In my practice, patients are informed that they can expect about…

40. Page 69

    reinforced pressed or milled ceramics. It can be pressed or milled and is also monochromatic until layered with a (weaker) surface porcelain. However, the layering porcelains can be applied in very thin layers, increasing aesthetics without significantly decreasing the underlying strength of the restorations. For my patients who desire or need tooth resurfacing, I prescribe feldspathic laminates when oc The clinician and the artistic ceramist combine their talents to create optimal outcomes. clusion is not a major factor in the long-term outlook for the case, and lithium disilicate laminates when heavier occlusal function is or may be a contributing factor.…

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