Dentistry Today — August 2017

Inside this issue

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1. Page 3

   Load fast, finish fast The AnyRidge patented knife-edge thread and XPEED S-L-A with nano calcium ion surface treatment deliver faster cell proliferation, immediate stability, and fast osseointegration. And our MegalSQ stability meter provides a guide for optimal loading decisions and the confidence you need to load faster or immediately. Match thread diameter to bone density for maximum stability This allows for immediate or faster loading, fewer office visits, the ability to perform more cases, and to realize faster payments. Core Diameter (mm) Thread Diameter (mm) Length (mm) 2.8 3.5 8.5, 10, 11.5, 13, 15 3.3 4.0, 4.5, 5.0, 5.5 7,…

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   Special Focus on Implants When Dr. Michael Tischler and I got the go-ahead for the Implants Today section from our publishers a couple of years back, we realized that an important focus for the readers of Dentistry Today would need to be placed on implant dentistry. With the general practitioner (GP) foremost in mind, we are making a concerted effort to bring implant topics that matter most to the practicing clinicians who want to grow their businesses and expand their services by providing the latest in implants, implant restorations, and implant-supported prostheses. GPs are in a unique position to offer…

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   Blueprints for Success With Implants In many of my presentations, I often state that we are the architects and engineers of the oral cavity. This has been a common theme throughout my career on the podium and in many publications regarding dental implant reconstruction. Let's put this concept in perspective. If you were building a new dental office and found a building with lots of space with a walk, would you start moving equipment into the space, running wires and pipes, hanging lights, dividing the space with new walls and doors, and so on without a plan? Of course, you…

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   VIEWPOINT continued from page 10 is beyond biology to replicate nature, we can often use the expertise of the dental laboratory technician to simulate missing structures with prosthetic solutions. However, does technology allow clinicians to better appreciate both surgical and prosthetic outcomes before the scalpel touches the patient? The desired morphology, function, and esthetics of the proposed tooth replacement should ideally dictate the position of the implant. The implant must also be sufficiently placed within the alveolus to limit micromovement and surrounded with adequate bone volume to achieve osseointegration. In my opinion, sufficient bone volume is essential for long-term functional…

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   Below is a Letter to the Editor that Dentistry Today received in response to the article, "Single-Unit Cement-Retained Implant Restorations: Strategies, Protocols, and Techniques" by Todd R. Schoenbaum, DDS; Richard G. Stevenson, DDS; and Alireza Moshaverinia, DDS, MS, PhD; which ran in June 2017 on pages 64 to 68. The original article can be found on dentalCEtoday.com. Dear Editor: The recent article by Schoenbaum et al in the June issue of Dentistry Today that dealt with cement-retained versus screw-retained implant crowns and splint-bridges was an excellent review of the tremendous advantages of cemented versus screw retained implant crowns. The abutment…

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   What's New on Fresh, New Weekly Content Dentistry Today Comes to You Dentistry Today delivers fresh content to your inbox twice a week with our Monday Industry eNewsletter and Friday Product eNewsletter. These weekly bulletins provide readers with news updates, including timely feature articles such as clinical stories, interviews with experts, new product interviews, and more. If you do not currently subscribe to one or both of our eNewsletters but would like to, please fill out the form online at enewsletters. FREEinfo Now Online Access Product Info Anywhere With Dentistry Today's product information page, it's easy to access information from…

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   FOCUS ON: Composite Material Advancements Sam Simos, DDS, focuses on advances in composite resin materials for today's dental practices. Q: How do dentists choose a composite material? A: Surprisingly, across the country, when asked how dentists choose the composite material they are using, few can point out any one reason. Most say that it is what they have been using for years. Some say that a sales rep or colleague suggested it. Only a handful will talk about esoteric the chemical and physical properties inherent in a specific material. In fact, few dentists are able to name one physical or…

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   Living in the Material World Paul Feuerstein, DMD ...larger, more robust [3-D printers]...open up more possibilities...[and] can print multiple units (such as models) at the same time with increased speed. I have discussed 3-D printers earlier this year, including the compact, affordable desktop unit from Formabs—the Form 2. However, there are larger, more robust units that are arrival at dental laboratories and large dental offices which open up more possibilities. These larger 3-D printers can print multiple units (such as models) at the same time with increased speed. The costs are plummeting, and a very professional unit can be had…

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   Spotlight Amalgam Separator Offers Proven Reliability and Improved Function NORTHBOROUGH, Mass.—In order to stay compliant with the recently passed EPA "Dental Rule" regulation, dental practices must utilize an amalgam separator, which is essentially a mercury collection device that sits in the line between the operator and vacuum pump. And, thanks to Solmetex and its NXT Hgs amalgam separator, this crucial task can be completed with proven reliability and improved function. The new NXT Hgs also includes a practice waste solutions amalgam bucket in the same shipment box for recycling of all contact and noncontact amalgam, chairside traps, and amalgam capsules.…

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    Spotlight Teeth-Straightening System Offers Improved Features That Simplify Invisalign Experience SAN JOSE, Calif.–Invisalign Go, a streamlined system of aesthetic teeth straightening designed especially for the general dentist, offers new, improved features that simplify the Invisalign experience, including case selection, treatment planning, innovative progress assessment, and a convenient referral routing system. With Invisalign Go, you can determine if a patient qualifies for clear aligner treatment—all during chair time. This is made possible by proprietary Invisalign Photo Uploader iPhone App, where you take photographs of your patient, which are directly downloaded to the Invisalign Doctor Site, where the case assessment results will…

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    Spotlight High-Speed Scanner Allows Users to Capture Scans in a Smooth, Uninterrupted Manner ATLANTA – Whether doctors require an intraoral scanner for restorative, orthodontic, or implant borne restorative applications, the CS 3600 can meet their needs. High-speed, continuous scanning allows users to capture scans in a smooth, uninterrupted manner, while the scanner's Intelligent Matching System makes it easy to fill in any missing information from any location in the dataset. The CS 3600 features 3 autoclavable, interchangeable tips—normal and side oriented—that can be used based on the unique anatomy of a patient's mouth. The side-oriented tip features the shortest tip…

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    Spotlight Posts Fill Void in Root Canal, Improve Strength of Unit SOUTH JORDAN, Utah–Ultradent Products introduces Unicore Accessory Posts, part of the UniCore Post and Drill System. Designed for the general dentist and endodontist, UniCore Accessory Posts work to fill voids in the root canal, improving overall strength of the post-and-core unit. The posts were created to be placed in the root canal alongside a master post, such as the UniCore Post. Adding accessory posts allows for much better adaptation in the case of flared and oval canals, eliminating the need for an additional drilling procedure. UniCore Accessory Posts feature…

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    Attachment System Offers No Compromise to Prosthesis Strength or Aesthetics CARLSBAD, CALIF.—With the LOCATOR F-Tx, Zest Dental Solutions introduces a new way to think about fixed full arch restorations that addresses the inherent limitations of conventional screw-retained and cemented solutions, such as (1) the need for screw access channels or (2) the potential for subgingival cement when attaching the prosthesis to the abutments. Fixed for life, patient yet easily removed by the clinician, the LOCATOR F-Tx is a simplified fixed attachment system for full arch restorations that offers no compromise to prosthesis strength or aesthetics. Optimized for efficiency and timesavings…

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    Sectional Matrix Ring Designed for Use With Short or Malpositioned Teeth SPRING LAKE, Mich—The Compo-Tight 3D XR Sectional Matrix Ring is an ultraretentive matrix ring designed for use with short or malpositioned teeth, including areas between the canine and first bicuspid. The enhanced, Soft Face silicone ensures true matrix band adaptation, which reduces the flash and finishing time, while improving contacts. While the 3D XR ring was designed for use with difficult dentition, clinicians will find that it works well with standard height teeth. For more information, call Garrison Dental Solutions at (888) 437-0032 or visit garrisondental.com. FREEinfo, Carbon-Based Toothpaste…

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    Versatile Unit Performs 2-D Panoramic/Cephalometric Exams, 3-D Cone Beam Scans OXFORD, Conn.-The i-Max Touch is a truly versatile unit that can perform 2-D panoramic exams, 2-D cephalometric exams, and 3-D cone beam scans. This 3-in-one and evolving concept (panzeph/3-D) has found many supporters in the dental profession. It comes with a total of 18 programs (including TMJ, bite wings, maxillary sinus, frontal and lateral ceph, carpus, etc) in 2-D mode. The 3-D mode is supported by SIMPLANT implant planning software and the combination from Materialise and Owandy Radiology's expertise makes the i-Max Touch a 3-D must-have for your practice. For…

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    NEWS/TRENDS Industry News Holden and Anders Take on New Roles at Ivoclar Vivadent Ivoclar Vivadent is making a pair of changes to its North American executive team to better align itself with dentistry's ever-evolving market dynamics, according to the company. Chris Holden will assume the role of executive vice president/chief administrative officer, while Sarah Anders will serve as executive vice president/chief sales officer. [Photo of Chris Holden and Sarah Anders] Chris Holden will serve as executive vice president/chief administrative officer and Sarah Anders will serve as executive vice president/chief sales officer at Ivoclar Vivadent. "The addition of the management and…

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    NEWS/TRENDS Sleep Apnea... continued from page 28 the amount of sleep nor objective sleepiness improved." UIC has licensed intellectual property related to the experimental drug treatment used in the study to Respirex Rx. Sleep apnea affects about 22 million Americans, with 80% of moderate and severe obstructive sleep apnea cases going undiagnosed. Researchers have attempted to identify drugs to treat sleep apnea for nearly 35 years to no avail, Carley said. "By providing a path toward the first viable obstructive sleep apnea drug, our studies could have a major impact on clinical practice," Carley said. "However, expanded and pivotal clinical…

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    NEWS/TRENDS ADA Launches National Online Advertising Campaign You may be seeing more new and returning patients, if the ADA's latest efforts succeed. The organization is launching a new $18 million, 3 year campaign to encourage adults to visit a dentist. The initiative is set to reach 19.6 million prospective patients and connect them with ADA members. The online ads will mix search advertising, sponsored Facebook posts, and animated display ads. Those who click on the advertisements will be sent to the ADA's Find-a- The initiative is set to reach 19.6 million prospective patients and connect them with ADA members. Dentist…

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    MEETINGS/SEMINARS Will Smith, Imagine Dragons at Dentsply Sirona World DENTSPLY SIRONA SWORLD2017 THE ULTIMATE DENTAL MEETING Billed as "the ultimate dental meeting," Dentsply Sirona World 2017—hosted, naturally, by Dentsply Sirona—will offer entertainment, exhibits, and most importantly, educational value. This year's celebrated event is highlighted by a special ADA with actor and recording artist Will Smith. In addition, the Grammy Award-winning band Imagine Dragons will play a private concert at the event. Other celebrities appearing at the meeting include comedian Jeff Dunham, providing evening entertainment, and Beachbody super trainer Jel Freeman, who will lead a morning workout. The meeting closes with…

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    MEETINGS/SEMINARS seminar at the 2017 Southwest Dental Congress (SWDC) (held from September 15 to September 16 in Dallas). The seminar, titled "The Business of Dentistry 101," will cover the ins and outs of running a successful practice. The agenda includes such topics as setting up a dental practice, tax strategies, dental equipment contracts, corporate dentistry, and legal issues for dental practice owners. Tickets are $25; registered SWDC attendees are free. For more information, contact Dr. Jackie Stanfield at (817) 403-1337 or via email at jackiedds@aol.com. The Racing Dentist As both a dentist and a professional race car driver, Dr. Todd…

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    Dental Implant Systems George Freedman, DDS Most North American dentists offer implant services to their patients. There has been a tendency by general practitioners (GPs) to refer the surgical phase though it is not technically difficult to periodontists, oral surgeons, and implant-trained general practitioners. The increasing prevalence of CBCT imaging, reliable implant positioning software, and mechanically integrated surgical stents have made the routine implant placement procedure more accessible and attractive to GPs. Internationally, most implants are surgically placed by GPs. In the past, the GP was responsible for the restorative portion of implant therapy, as well as the long term…

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    DENTAL IMPLANT SYSTEMS continued from page 34 screw retained, removable, or cement retained. The retention is determined by the intended function. Copings Impression copings transfer the exact positioning of the implant in the mouth to a stone model. For the open tray (direct method), the copings are unscrewed from the implant and removed with the impression tray. With the closed tray (indirect method), the copings are removed after the tray and then repositioned in the impression. Abutment Design The abutment design facilitates the restorative procedure. Hexed abutments engage the antirotation mechanism. Nonhexed abutments use various physics principles to prevent inadvertent…

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    DENTAL IMPLANT SYSTEMS continued from page 36 zone. For more information, call (888) 678-0001 or visit biosseon.com. FREEinfo, Implant Direct The Legacy System offers surgical and prosthetic compatibility with Zimmer Dental's Tapered Screw Vent Implant with considerable versatility and design advantages. With 7 diameter options and 6 length options, Legacy offers the greatest range of choice. In addition, Legacy implants feature Implant Direct's patented microthreads for increased stability and double-lead threads for faster insertion. The implants differ in thread design, self-tapping features, packaging, and available options. For more information, call toll-free at (888) 649-6425 or visit implantdirect.com. FREEinfo, integrated dental…

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    Proprietary Simulation Labs Live Interactive Webcasts Surgical Cadaveric Labs On-Demand CE Programs Progressive Minds Meet Here Powered By Knowledge Transcend traditional learning with Zimmer Biomet Dental's new continuing education portfolio, designed to fit varying learning styles and lifestyles of the modern clinician and lab professional. Whether your interest is in emerging digital dentistry innovations or the latest techniques in restorative and implant dentistry with industry leading regenerative solutions, our commitment is to you and your patients. Your progress. Our promise." Join the movement that is defining the future of dental education. Together, let's do more. Call 1-800-342-5454 or visit zimmerbiometdental.com/education.…

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    DENTAL IMPLANT SYSTEMS continued from page 38 simple crown-and-bridge dentistry, and a superior cosmetic outcome. Perio-Seal incorporates conventional dentistry principles (ferrule crown attachment) to implant dentistry. For more information, call (888) 446-7126 or visit periosel.com. FREEinfo, PREAT Corp PREAT offers abutments and attachments for nearly every implant system on the market with tremendous customer service. Options include impression copings, analogs, fixed or removable, cement or screw retained, hafers bars, and even CAD/CAM printed bars to fit your patient's needs. Whether you need help with case design, abutment choices, or figuring out which attachment to use, a highly trained technical support…

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    continued from page 40 Recognized for unsurpassed precision and design, the company's products deliver predictable, aesthetic results without compromise. Most implant companies view the clinician as just a customer; being family-owned, Thommen views them as partners to ensure long success. For more information, call toll-free at (866) 583-9800 or send email to info.us@thommenmedical.com. FREEinfo, Tischler Dental The Prettau Zirconia Implant Bridge is a screw-retained implant bridge that transforms implant prosthetics. Its all-inclusive pricing is less than most hybrid bridges, bar overdentures, or PFM screw retained bridges, and there is a 5-year warranty against chipping or breakage, underscoring the confidence in…

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    Cone Beam CT for Implant Dentistry Michael Tischler, DDS When you look at the many safety and planning advantages a CBCT scan offers—combined with its accessibility either through purchased equipment, mobile units, or local scan centers—it only makes sense to have a CBCT scan involved when treatment planning an implant and/or a bone graft. This month's Implants Today topic is cone beam CT for implant dentistry. CBCT technology has infiltrated many aspects of dentistry and implant dentistry. It provides an invaluable source of data that allows clinicians a 3-D view of the jaws, with the ability to focus in on…

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    The Implant Practice Justin D. Moody, DDS The incorporation of dental implants into the general dentistry practice is certainly on the rise, as it should be. Many organizations have done surveys which have yielded results showing somewhere between 10% and 15% of dentists in the United States place and restore their own implants.¹ Many of those clinicians discovered that they should not be afraid to place them and that implants can be very successful, thus provoking thoughts of creating an implant-centered practice (Figure 1). WHERE DOES ONE BEGIN? Like anything we do in life, we must first learn, then do…

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    IMPLANTS planning the case using today's software has kept me energized and loving my job.5 Is CBCT the new standard of care? That is not for me to decide, but I will tell you that CBCT is the gold standard in my practice (Figure 4).5 No Dentures, Removable Partials, or Fixed Partial Bridge Dentures Confidence in your ability to deliver the very best in implant dentistry is the backbone for putting implants at the front of your practice. You must also believe in your heart and have the sincere conviction that tooth replacement with a dental implant is the best…

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    You must make the effort to talk to [patients] and to educate them about...the benefits of implants as an option to replace teeth. Patient Education and Marketing Patients only know what they have been told or what they have heard. You must make the effort to talk to each one of them and to educate them about their dental condition and the benefits of implants as an option to replace teeth.¹ Visual stimulation is the easiest and, perhaps, the most effective way to educate your patients. In our practices, we have modalities such as implant magazines, brochures, models, posters, and…

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    dentalCEtoday.com Go online to earn credit for reading this CE article. IMPLANTS Implant Restorations in the Aesthetic Zone Function, Biology, and Aesthetics Todd R. Schoenbaum, DDS INTRODUCTION Implant treatment in the aesthetic zone is complex and multifactorial. Successful and predictable treatment requires proficiency and collaboration of the surgeon, the dental technician, and the restorative/prosthodontic dentist. This team must address 3 key areas in planning and treatment: function, biology, and aesthetics (Table 1). Long term success will be achieved when the implant/abutment restoration is strong (function), retains bone and gingiva (biology), presents a natural result (aesthetics). Much of the challenge with…

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    Figure 2. Asymmetric treatments require strong lab work to complete successfully. In this clinical case, the following were used to replace a missing central incisor and adjacent teeth: (a) the lithium disilicate crown (IPS e.max [Ivoclar Vivadent]) for a natural tooth, (b) IPS e.max veneers, (c) and IPS e.max implant crown. (d) The custom zirconia abutment was designed with margins at 0.5 mm below the tissue and a titanium insert for strength. Table 1. Considerations for Implant Treatment of Partially Edentulous Sites in the Aesthetic Zone FUNCTIONAL: • Abutment failure • Crown failure • Loose/broken screws BIOLOGICAL: • Risk of…

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    IMPLANTS 53 Based upon this clinical literature, it is quite clear that cement cannot be adequately cleaned at the 1 mm subgingivally at abutments with margins deeper than 4 mm, especially in the interproximal areas, are highly susceptible to retained cement (Figure 5). This issue is particularly problematic with stock abutments or tissue-level implant designs. In sites with insufficient keratinized tissues (< 2.0 mm), the margins should be placed nearly even with the free gingival margin or above it. Proper margin placement is easily obtained with custommilled abutments (Figure 6). Concerns about soft-tissue recession and visibility of the abutment are…

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    IMPLANTS is generally true for the mid-facial soft tissue over an implant. Understanding this response is key to manipulating the soft tissues in the provisional stage and thereby minimizing the chance of gingival recession. The more challenging (and noticeable) area of soft-tissue issues is the papilla. Much of the great work in the science of peri-implant papilla has been done by Kan et al24 and Tarnow et al.38,51 And yet, our ability to predict ably and repeatedly replace and restore missing papilla next to implants remains limited. While pushing on the papilla may compress it (like a water balloon) to…

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    IMPLANTS 55 Figure 14. All abutments for cemented implant restoration must have clearly visible margins. Here the margins of the restorations were positioned at zero millimeters to ensure that cement removal would be predictably accomplished. Figure 15. The provisional restoration is a critical tool for treatment of implants in the aesthetic zone. (a) Here, one is being lubricated for use in immediate placement/immediate loading. (b) After ensuring proper stability of the implant, the provisional is lubricated. Special attention is given to designing an emergence area with an undercontoured profile and significant clearance in MIP and excursive movements. Figure 16. To…

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    Test 212 dentalCEtoday.com Immediate Loading of Short Dental Implants: A Case Report This article discusses the predictability of immediate loading of short implants, and presents a clinical case involving the restoration of a missing tooth with a single-unit short implant with immediate loading and a 9-year follow up. Eduardo Anitua, DDS, MD, PhD, earned a degree in medicine and surgery from the University of Salamanca (Salamanca, Spain), a PhD in medicine from the University of Valencia (Valencia, Spain), and a specialized degree in stomatology from the University of the Basque Country (Vitoria, Spain). He is the director of the Instituto…

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    CASE REPORT A 43-year old female patient attended the dental clinic complaining of pain in the posterior area of the upper left jaw. After careful clinical examination, the maxillary left first molar was diagnosed with a vertical root fracture and tooth extraction was recommended (Figure 1). The patient accepted the treatment plan. Atraumatic tooth extraction was performed, preserving the socket walls. The extraction socket was then treated with RTI Biotechnology Institute's Endorel (plasma-rich growth factors [PRGFs]). For that procedure, peripheral venous blood was extracted by venipuncture into 9 mL extraction tubes containing sodium citrate as an anticoagulant (BTI Biotechnology Institute).…

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    Figure 4. Regeneration of extraction socket using the PRGF-Endoret technique. After tooth extraction, the authors fill the post-extraction alveolus with the Endoret (PRGF) clot recently formed using F2. Then insert a well-retracted fibrin plug (formed using F1). Finally, suture the gingiva to maintain the Endoret (PRGF) inside the alveolus. Figure 5. Healing after 24 hours. Figure 6. Healing after 7 days. Figure 7. Healing after one month. Figure 8. Treatment plan post-healing period. Figure 9. Planification on CBCT before the insertion of implant. Figure 10. Implant with immediate loading prosthesis. The use of Endoret (PRGF) as a biomaterial for tissue…

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    TEST 212 Expiration date of this CE article is August 1, 2020 To submit Continuing Education (CE) answers, use the answer sheet below. Or use our easy online option at dentalcetoday.com. This article is available for 2 hours of CE credit. The following 10 questions were derived from "Immediate Loading of Short Dental Implants: A Case Report" by Eduardo Ahinjo DDS, MD, PhD, on pages 56 to 58. Learning Objectives: After reading this article, the individual will learn: (1) the use of plasma-rich growth factors (PRGF) for bone regeneration in an extraction socket, and (2) a technique for placement of…

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    Digital Impression Systems Benco Dental The OneVisit CAD/CAM solution provides same-day restorations. Affordable innovation has long been sought after in dentistry. With 3M's True Definition Scanner, used in conjunction with the IOS Glidewell TS50 mill, same-day restorations are no longer something of dreams. The system is within every dentist's reach through special offers and financing. The simplicity of the software eases its integration into each dental office. For more information, call (800) GO-BENCO (462-3620) or visit benco.com/technology-and-equipment/onevisit. FREEinfo, 3M The Mobile True Definition Scanner is the first intraoral scanner that operates solely on a tablet. The compact, ergonomic design gives…

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