Dentistry Today — August 2016

Inside this issue

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

1. Page 6

   An Implant Focus for the General Practitioner In this issue of Dentistry Today, implant dentistry is once again in the spotlight. The month of August also marks the end of the first year since Dr. Michael Tischler was selected to be our implant editor. Michael was chosen for this position because he brings a high level of expertise and passion to the table. For our editorial team, he is a joy to work with. Michael's enthusiasm and dedication—in all he is doing to help our readers get more involved in helping patients with implant options whenever possible—is contagious. Immediately after…

2. Page 8

   Incommensurability in Endodontics The Role of the Endodontic Triad Scientific progress is generally hindered by trying to take the past into account as a way to move forward. Einstein once said that "we can't solve problems by using the same kind of thinking we used when we created them." General Relativity is not an outgrowth of Newtonian Mechanics. The Heliocentric Model (planets orbit the sun) is not an outgrowth of the Geocentric Model (Earth is the center of the universe). These advances in understanding required abandonment of core principles of previous models. They are complete departures from prior models, based…

3. Page 10

   VIEWPOINT continued from page 8 activity in which most scientists inevitably spend almost all their time, is the assumption that the scientific community knows what the world is like. Much of the essence of the enterprise derives from the community's willingness to defend that assumption. If necessary at cost.¹ Normal science is puzzle-solving. In endodontics, the prevailing puzzle is how to best cure or heal lesions, as success or failure is said to depend on it.² Thus, a judgment like "Although well intended, this shaping shift, alone, will never fulfill the biological objectives for success,"³ presupposes that we all know,…

4. Page 14

   FOCUS ON: Hands-On Education Allen Ali Nasseh, DDS, MMSc, opines for the hands-on dental education and training of general dentists to improve their clinical endodontic skills. Q: What's the current state of dental education, and what are the pressures on recent graduates? A: Throughout the years, dentistry has become an increasingly complex discipline. During the past few decades, dental specialties have experienced a technological boom mandating retraining for the recent graduates only to stay current with the rapidly moving trends in clinical practice. As a result, the modern dental school curriculum can barely touch the tip of the iceberg when…

5. Page 16

   NEW PRODUCTS COSMETIC SIMULATION SOFTWARE PreVu Dental PreVu Cosmetic Simulation Software is designed to be used as a marketing, patient education, and case presentation tool. Patients can visualize treatment outcomes—provided via a chairside monitor or as a take-home personalized visual aid—that positively support their decision-making process toward accepting recommended treatment. The software can be used to simulate procedures, including whitening, orthodontics, cosmetic bonding, implants, and more. For more information, call (855) 773-8848 or visit prevudental.com. FREEinfo, ROOT CANAL SEALER Dentsply Sirona Endodontics Made from an enhanced formula of its counterpart, ProRoot MTA Root Repair Material, ProRoot ES Root Canal Sealer…

6. Page 17

   Glidewell Dental Glidewell Dental's Inclusive Tapered Implant is now available in a 3.2-mm diameter; a size that incorporates a narrow-diameter apex and has been designed to ease positioning in areas of limited anatomical space, such as upper lateral incisors, lower incisors, and narrow ridges. With this size addition, the Inclusive Tapered Implant is now available in 3.2 mm, 3.7 mm, 4.2 mm, 4.7 mm, and 5.2-mm diameters. For more information, call toll-free (800) 407-3379 or visit inclusidentalcom. FREEinfo, INTRAORAL CAMERA SYSTEM DrQuickLook Offered with a 60-day money-back guarantee, the DrQuick-Look SD PLUS Intraoral Camera System is multifunctional, portable, and easy…

7. Page 18

   From the April and May 2016 Issues FINISHING SYSTEM Ultradent Products Because of the extreme hardness of newer ceramic materials, effectively adjusting and polishing ceramic restorations can be a major challenge. The Jiffy Universal Ceramic Finishing System addresses this challenge by being the only universal finishing system for high-strength ceramics. It features adjustors and polishers that work interchangeably on porcelain, lithium disilicate, and zirconia. For more information, call (800) 552-5512 or visit ultradent.com. FREEinfo, BASE/LINER MATERIALS TAUB Products Ca-Lok Flowable Adhesive Calcium Base/Liner is a breakthrough in base/liner materials. It is a light-cured, calcium-filled resin with (1) adhesive properties (acidic…

8. Page 20

   CLINICAL REVIEWS THE DENTAL ADVISOR IMPRESSION MATERIAL: PVS Imprint 4 VPS Impression Material +++++ 3M ESPE | (800) 634-2249 | 3mespe.com/us Consultants' Comments • "Good material—better than most VPS materials I have used in the past." • "Quick setting time; patients love how fast it sets." • "I never had retakes with Imprint 4 despite some difficult subgingival preparations." • "Perfect blending of putty and wash materials." • "Bright contrasting colors of syringe and tray materials." • "Some discoloration takes time through the mint flavoring." • "Blue color leaves a residue on gloves and patients' lips." Description Imprint 4 VPS…

9. Page 22

   Spotlight Updated Fiber Post Simplifies Efficient Post and Core Procedures ST. PAUL, Minn— Building on 8 years of clinical success of the original RelyX Fiber Post, 3M's RelyX Fiber Post 3D features an updated design that offers higher mechanical retention to the core build up material due to its coronal 3D macro retentions and maintains a strong bond in the root canal due to its microporous surface. Post position control within the canal is greatly improved as a result of the post's enhanced radiopacity, and in combination with up more than 5,000 3D products, the entire post and core buildup…

10. Page 23

    Articulating Foil Yields Extremely Precise Markings OAKDALE, Minn.–TrollFoil provides a unique diagnostic method for bite registration, yielding extremely precise markings on wet, dry, gold, and highly polished surfaces, and it is mounted on its own frame; no forceps are needed. TrollFoil is manufactured from the thinnest foil on the market—8 μm and carbonate on both sides—and its markings are so accurate that users will find it accelerates the articulating process and eliminates guesswork. Available in blue and red as well as TrollFoil Mini, it is offered in cartons of 100 and 500 pieces. For additional information, call TollDental toll free…

11. Page 24

    Guide Facilitates Shade Matching and Communication With Labs NAPERVILLE, ILL—How well a restoration's pink-tissue aesthetics match a patient's natural gum-tissue color dramatically alters how lifelike and realistic a final restoration will appear once placed in a patient's mouth. The ceramic Chairside Shade Guide 7.0, offered by LSK121 Oral Prosthetics, is an innovative shade-matching tool that enables dentists to acquire their patients' pink tissue and stump color as well as other aesthetic properties. It then allows the dentists to easily and succinctly communicate this information to their laboratory, which will vastly improve the consistency and realism of the results they receive…

12. Page 26

    Spotlight Implant Offers a Strong, Aesthetic Solution for Narrow Anterior Spaces PALM BEACH GARDENS, Fla—Manufactured by Zimmer Dental, part of the Zimmer Biomet Dental Division, the 3.0mm Esthetic Implant is designed to offer improvements over similar commercially available implants, particularly in the areas of strength and primary stability. When compared to select competitive implants of similar diameters, it achieved a 43% higher fatigue strength, and if zero formed exceptionally well in insertion torque and torsional yield strength testing (data on file). For the first time, a concept has been combined to create a precise implant-abutment connection designed to reduce micromovement…

13. Page 28

    Spotlight New Technology Provides Alternative Treatment Plan for Missing Teeth COCONUT GROVE, Fla-Featuring proprietary preparation guides and new Computer-Aided Procedure CAD/CAM technology, the FirstFit Bridge allows you to treat missing teeth without using aggressive techniques that are often associated with traditional bridges and implants. The technology enables you to prep and seat bridges in a single appointment without the need for temporaries, thereby improving chair time efficiency and the patient's experience while reducing costs. Utilize the FirstFit Bridge to treat patients who are missing teeth but have been left without treatment because of cost concerns and fear of pain. You…

14. Page 30

    Dry Mouth Nightguard System Offered TONANWANDA, NY-New from Great Lakes Orthodontics, the Americo Dry Mouth Nightguard System is designed to protect teeth from the effects of abnormal dry mouth and prevent permanent periodontal damage during sleep desiccation of the upper and lower appliance trays are fabricated to fit comfortably and hold a specially formulated gel that increases salivary flow to protect tooth enamel. The gel contains xylitol, an anticarogenic agent that consistently maintains moisture around the teeth and gums throughout the night, reducing dental decay, plaque formation, and bacterial growth while decreasing the risk of oral infection. The system includes…

15. Page 32

    Offset Implant Guideposts Offered Spotlight Strip Provides a Sinus Graft Solution With No Chance of Particulate Migration HOLLIS, NY–Implant Ltd, innovator of the OsteoGen Bone Grafting Plug, introduces the OsteoGen Strip, a sinus graft solution with no chance of particulate migration. Sinus grafting has never been easier, especially around immediately placed implants. The strip combined purified bovine Achilles tendon collagen with bone graft crystal particulates, and since the crystals are contained by the collagen, there is no risk of particulate migration or perforation of the Schneiderian membrane. The strips are adaptable for use outside the sinus as well and can…

16. Page 33

    Popular Core Build-Up Material Improved With Better Flowability, Strength, and Aesthetics Biocompatible Sealer's Healing Properties and Ease of Use Cited ENGLEWOOD, NJ—Infused with zirconia, LuxaCore Z-Dual composite core build-up material offers exceptional physical properties that now include better flowability, strength, and aesthetics. With the most dentist-like curability in its category, clinicians get precise margin preparations with less sticking. The result: excellent fit, a long-lasting restoration, and the best possible care for the patient. It's no wonder why the LuxaCore brand is one of the most trusted names in core build-up materials. It is available in natural, blue, and light opaque…

17. Page 34

    New Universal Bonding Agent Yields Predictable, High-Quality Results CUYAHOGA FALLS, Ohio—Coltene's new ONE COAT 7 UNIVERSAL, a versatile, state-of-the-art, self-etch bonding agent, may be used for high-quality, predictable results for self etch, selective etch, or total-etch adhesive restoration techniques. With ONE COAT 7 UNIVERSAL, a single drop of liquid bonds light-curing filling material easily and efficiently. And with only a single bonding layer, it provides consistently high bond strength and excellent marginal sealing and integrity. A new, ergonomic triangular 5-mL bottle allows for ease of use and precise and economical dispensing (up to 300 uses per bottle). Also offered are…

18. Page 35

    Spotlight Units' Exclusive Endodontic Imaging Mode Facilitates Diagnostics and Treatment Planning ROSELLE, ILL—The Planmeca ProMax line of 3-D imaging units are designed to capture the smallest anatomical details with precision, and they feature an exclusive imaging mode for endodontics that offers high-resolution images with a 75-μm voxel size. Facilitating precise diagnostics and endodontic treatment planning, the imaging mode also uses a noise-optimizing filter and Planmeca's innovative artifact removal algorithm, which removes shadows and streaks from the 3-D image such as those caused by metal and root fillings. The Planmeca Adaptive Image Noise Optimizer removes noise from CBCT in ages without…

19. Page 36

    CELLERANT BEST OF CLASS TECHNOLOGY AWARDS 2016 Presenting Cellerant's Inaugural Best of Class This year, the "Best of Class" Technology Awards have transitioned with Dr. Lou Shuman from the Pride Institute to his new company, Cellerant Consulting Group. The committee and its independence as always remain constant. Since 2008, this group spends each year reviewing and evaluating new products that come to the marketplace. Some have brought novel approaches to the dental community, others enhance existing technologies, and some specific products just continue to excel in each category. One of the realities is that sometimes there was no winner in…

20. Page 38

    CELLERANT BEST OF CLASS TECHNOLOGY AWARDS Zipwhip Zipwhip | (855) 947-9447 | zipwhip.com In this mobile society, people want to speed up and simplify communication. There are jokes galore of people staring at the same table, texting each other since it is more efficient than true conversation. Patients who want to give or receive information from a dental office often want quick results. A message to the office about a new appointment, a cancellation, billing, or even a dental problem can be sent faster and more efficiently in some cases by sending a text as opposed to listening to options…

21. Page 39

    CELLERANT BEST OF CLASS TECHNOLOGY AWARDS Dentrix Ascend Henry Schein | (855) 232-9493 | dentrixascend.com Cloud-based software is not new to dentistry. Many products have already landed, and more are about to be launched, but at this time, Dentrix Ascend has captured the Best of Class attention. Its features rival the popular, server-based Dentrix product, but its cloud base allows many faster and better integrated sections. Patient communication, electronic claims, insurance eligibility, billing, custom reporting, and digital imaging are all included in this product and are visibly updated often. Since there is no server, there are no eliminated update discs…

22. Page 40

    NEWS/TRENDS Industry News FDA Approves OraVerse for Pediatric Dental Patients Aged Three and Older Septodont announced recently that the FDA has approved the change of the minimum age requirement for OraVerse from 6 years old to 3 years old. The approval comes as the result of a Phase IV, multicenter, randomized, double-blind study for the safety and efficacy of OraVerse in pediatric patients ages 3 to 5 years old. Administered by dentists immediately following routine procedures such as fillings or crown preps, OraVerse rapidly reverses the lingering numbness of the lip and tongue from local dental anesthetic. To view full…

23. Page 42

    NEWS/TRENDS Touro College continued from page 40 Jewish heritage, a suspicion that was confirmed—and apologized for—66 years later by the school. Though Dr. Brickman eventually graduated fourth in his class at the University of Tennessee's dental school, the incident spurred him to research similar incidents at Emory, and his efforts played a major role in exposing anti-Semitic episodes in Emory and several other schools around the country. "In accepting this honor, I do so for the young men who had to go through this and for double that number who never even got the opportunity," said Dr. Brickman. In wishing…

24. Page 43

    NEWS/TRENDS Researchers Develop Regenerative Dental Fillings Action Hailed by Royal Society of Chemistry As "a New Paradigm for Dental Treatments" Researchers Kyle Vining, DDS, PhD, a Fellow in bioengineering at the Harvard School of Engineering and Applied Science, and Adam Celiz, PhD, BSc, a Marie Curie Research Fellow at the University of Nottham in the UK, have developed The filling works by stimulating stem cells to encourage the growth of dentin, allowing patients to effectively regrow teeth. regenerative dental fillings that allow teeth to heal themselves. Hailed by the Royal Society of Chemistry as "a new paradigm for dental treatments,"…

25. Page 46

    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. EVO.15 Electric High Speed Handpiece Bien-Air High-speed handpieces rotate burs very rapidly for the effective and efficient removal of tooth structures. Air-driven handpieces revolve up to 500,000 times per minute, while electric ones typically operate at a maximum of 200,000 rpm. Electric handpieces, however, produce better torque (essential for cutting speed and control) than their air counterparts, regardless of the bur speed. The push-button chucking system is the simplest and most effective means for changing…

26. Page 48

    Sterilizers SciCan The BRAVO is a fractionated vacuum sterilizer that incorporates pre-vac (to remove air) and post-vac (to ensure a dry load every time) cycles to ensure the perfect steam penetration for any load. It offers the perfect blend of speed and capacity with the total cycle times, including drying, which is set at about half the time as other conventional chamber autoclaves. The SciCan Dri-Tec system ensures a perfectly dry load every time. For more information, call (800) 572-1211 or visit scican.usa.com. FREEinfo, Tuttnauer USA The EZPlus Series Sterilizer offers all of the benefits of the EZ Series: closed-door…

27. Page 50

    dentalbuyersguide.com BUYERS' GUIDE 20th Annual Implant Systems George Freedman, DDS The expiry of many of the original implant patents, the rapid increase of implant manufacturers, and the increased competition among them has decreased fixture and accessory costs, benefiting patients and dentists. Approximately 65% of all dental implants placed worldwide are sold by lower cost manufacturers. Fortunately, some insurers, recognizing that implant therapy has a single payout with a long-term benefit, have begun to offer partial coverage. [IMAGE: Four dental implant fixtures of varying designs shown in brown/bronze color] While most North American dentists offer implant services to their patients, the…

28. Page 52

    continued from page 50 (indirect method), the copings are removed after the tray and then, repositioned in the impression. Abutment Design The abutment design serves as the facilitator for the restorative procedure. Bicon Dental Implants The Bicon SHORT implant design comprises plateaus, sloping shoulders, and a bacterially sealed, 1.5° locking taper implant to abutment connection. With the plateau design, cortical like bone forms around and between each plateau, which allows for the routine use of 5.0 mm short implants. The sloping shoulder provides the necessary room for bone to support interdental papillae that is gingivally aesthetic. Bicon's 360° universal abutment…

29. Page 54

    IMPLANT SYSTEMS continued from page 52 including a new 3.2-mm narrow-diameter option for tight interproximal spaces. The 3.2-mm features a conical internal hex connection, while larger diameters share 2 standard internal hex platform sizes, minimizing the number of system components and simplifying inventory and restorative options. For more information, call (800) 497-3379 or visit hahnimplant.com. FREEinfo, Hiossen ETIII SA implants are born from pure, medical grade titanium. The unique sandblasting and acid etching technique materially forms a uniform, 1.3 μm micropitt, creating an ideal roughness of 2.5 to 3.2 μm. The 1.5° tapered body establishes excellent initial stability and helps…

30. Page 56

    IMPLANT SYSTEMS continued from page 54 design, locking taper connection, and the absence of a microgap between abutments and implants are just a few of the aspects that distinguish the KAT implant system from the competition. For more information, call toll-free at (877) 528-7078 (toll-free) 425-698 or visit katimplants.com. FREEinfo, MIS Implants Technologies The C1 Implant System, with a 6-position cone index and unique conical connection, minimizes micromovements and eliminates bone resorption. The system features platform switching, which provides clinicians with ample soft tissue for aesthetic considerations. C1's unique thread design encourages initial stability at the coronal third and rapid…

31. Page 58

    continued from page 56 enable "active" directional changes for optimal positioning, while macroscopic grooving and the unique Tit/Nite surface enhance osseointegration and soft tissue response. Nobel|Active is recommended for clinicians experienced in implant placement. For more information, call (800) 322-5001. FREEinfo, OCO Biomedical The patented Dual Stabilization dental implants achieve a biomechanical lock at placement and are engineered to stimulate bone growth. The patented implant body design from 2.2 to 8 mm provides a treatment option for virtually any clinical indication. A simple, 2-step surgical protocol along with complete restorative packaging makes this system simple and economical to use. OCO…

32. Page 62

    continued from page 58 a blossom thread design at the apical portion and microthreads at the abutment end for ease of bone cutting. This implant can be used in areas where conventional implants can't be placed or in place of conventional implants. The simplicity of this system, along with its strength, OSSEAN coating, and immediate stability, is superb. For more information, call (877) 508-8325 or visit shatkin@i51.com. FREEinfo, Sterngold The MOR implant can be used for denture connection or crown and bridge fixation. It is a self-tapping, small diameter, one-piece implant with a 1.8-mm ball attachment that is intended for…

33. Page 64

    Planning for Implant Dentistry Michael Tischler, DDS Since its invention and the ability to look at the human body in a 3-D perspective, advancements have made it practical for clinicians to either own a CBCT or have access to a mobile CT unit. Scan times and radiation levels have decreased substantially, making CTs safer and more practical to have in a clinical setting. This month's Implants Today topic focus is on cone beam computed tomography (CBCT) planning for implant dentistry. In 2013, Implants Today Advisory Board member Dr. Scott Ganz and I authored a 3-part article series in Dentistry Today…

34. Page 65

    IMPLANTS TODAY 65 clinician can have access and discuss with a patient by having a CBCT machine right on premises, offers many benefits that are sometimes overlooked when looking at ROI. As an example of the efficiency brought to the table by having this technology readily available, a CBCT can be taken on a new patient and the clinician can then review the information and offer a treatment plan at the first visit. It is not only impressive to the patient but also offers a large convenience factor. In my practice, experience, having an on-site CBCT has led to an…

35. Page 68

    Figure 4. Post-extraction CBCT software image (SimPlant) showing cross sectional, panoramic, axial, and 3-D view. Figure 5. Example of a Misch classification fixed prosthetics 3 (FP3) showing prosthetically reproduced pink gingiva. Figure 6. Virtual anatomically correct implants on a maxillary and mandibular CBCT software plan. Figure 7. CBCT software plan showing an FP1 implant positioned superior to the inferior alveolar nerve. CBCT for Full-Arch Implant Dental... CONTINUED FROM PAGE 66 management concepts that must be considered from a treatment planning, surgical, and prosthetic standpoint. When treating entire arches for tooth replacement, a comprehensive treatment plan that involves many aspects of…

36. Page 70

    CBCT for Full-Arch Implant Dental... continued from page 68 without a guide can assist in not only ideal positions but also in choosing the ideal width and length of dental implants. Many CBCT software programs allow for virtual placement of accurately represented implant fixtures into a CBCT plan (Figure 6). Often with FPs+, sinus grafting is needed in maxillary cases CBCT scans are indispensable to gauge sinus anatomy and diagnose presurgical pathology. In the mandible with FP+ cases, implants are often placed distal to the mental foramen. CBCT scans can offer an accurate assessment of the inferior alveolar nerve position…

37. Page 71

    When performing dental implant surgery in a nonguided manner, the extraction sites can be a visual aid in combination with CBCT information. CBCT scan for overdentures will also help gauge the anatomy in the anterior maxilla and mandible and offer information on alveoloplasty needs, incissal canal anatomy, presence (or not) of pathology, and more. A CBCT scan will also offer information on bone anatomy so that the clinician can gain incissal angulations for implant placement. Nonguided implants are preferred when overdentures are supported by implants that are not connected by a bar. An important aspect of overdenture treatment planning is…

38. Page 72

    Custom Abutments and Monolithic Zirconia Aesthetic, Cementable Solutions for Complete Edentulism INTRODUCTION Ara Nazarian, DDS Patients facing the loss of their natural dentition have more treatment options than ever before. The traditional complete denture is the standard of care for the fully edentulous patient, is slowly but surely giving way to fixed and removable full arch implant restorations as their superior stability, function, and aesthetics become more well known. Furthermore, prosthetic materials have advanced in leaps and bounds, and monolithic zirconia can now be milled for fixed full indications. By moving beyond acrylic and its vulnerability to wear, chipping, staining,…

39. Page 74

    Custom Abutments and Monolithic... continued from page 72 matter) is essential as it allows for the creation of margins that are gingival or just slightly subgingival, which enhances crown retention, cervical soft tissue margins, and the final emergence profile.56 The precision and flexibility in prosthetic positioning allowed for by custom abutments also make it easier to achieve a passive fit for the restoration and correct for divergent angulation of implants. The following case report features a full-mouth reconstruction using cementable full-arch BrusZir bridges (Glidewell Laboratories) over Inclusive Titanium Custom Abutments (Glidewell Laboratories). The treatment protocol for this type of restoration…

40. Page 75

    Figure 11. Postsurgical radiograph exhibited healing abutments in the maxillary implants and temporary abutments in the mandible; except for the distal-most implants in the molar regions that did not achieve sufficient primary stability for loading. Figure 12. The patient returned 4 months after surgery. Note the excellent gingival tissue health. Restoration design would be a challenge due to the patient's crowded smile and uneven jaw resulting from a prior accident and reconstructive surgery, so the precision and versatility of dental CAD/CAM technology would be essential in producing an aesthetic outcome. Treatment Planning CBCT images utilizing the CS 8100 3D (Carestream…

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