Dentistry Today — December 2014

Inside this issue

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

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   Attention Dentists Advertising Supplement Dr. Avi Weisfogel, DDS, Co-Founder of the Dental Sleep Masters Program discusses his humble beginnings, struggling to keep his practice afloat, living just to pay his creditors, spending thousands of dollars on various courses hoping to find the ULTIMATE ROI, accepting defeat and making a grand discovery. Find out more about his journey, how he came across the formula that transformed his life and his business. Now he is sharing with the entire Dentist World. The Dream When I first entered dentistry, I was full of hope and ideals. My practice was going to be the…

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   Your Future, your Way, your CHOICE! Sleep and Full mouth dentistry did it for me, but that does not mean that is what will do it for you. We have decided to bring every big ROI opportunity into one building, for one MASTERFUL event. Every-body who is anybody in the world of dentistry will be there. You choose your own path. Choose from the following: Sleep Dentistry Hear how one dentist continuously sees 300 plus Oral Appliance patients every month. Learn how you can get this in your town. Learn how to average $5000 of profit on all of these…

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   Leaders: In the Limelight It is with great pleasure that we present Dentistry Today's 17th annual Leaders in Continuing Education directory. While in no way intended to be an exhaustive or complete listing of active CE leaders in North America, we are proud to bring you a listing of many of the most authors, lecturers, business consultants who are contributing to quality educational activities within our profession. Some leaders are invited to send in an application for this honor by the publisher or a member of the editorial team, while others are referred for consideration to be included by a…

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   VIEWPOINT continued from page 12 idea that a heavy realization came over me: either my practice was going to control my life, or I was going to control my practice and I had 3 choices. On one side, there was the debt with the constant need to make money to pay the debts; bills and staff. There was a desire to make the practice exactly the way I envisioned it, while getting my way through dental school. There was the desire to show the patients that I was just as good as their previous dentist. On the other side, our…

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   DENTISTRY TODAY URGENT! It's about TIME! Renew your FREE Subscription Today! dentistry.com/subscribe Visit Our Site Today! Technique of the Week Subgingival Restorative Margins Jose-Luis Ruiz, DDS Jose-Luis Ruiz, DDS, shows how keeping restorative margins should not be left to luck, but to a supragingival protocol to avoid them. This video presents the "enamel margin preservation technique," a crucial way to avoid subgingival margins using adhesive dentistry with direct and indirect restorations. Subgingival restorative margins are extremely problematic when using bonded resins and can lead to contamination and failure. This video can be seen on . Greater New York 2014 Coverage…

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   FOCUS ON: Implant Bridges Michael Tischler, DDS, discusses the positive attributes of the full-arch, zirconia, CAD/CAM, screw-retained implant bridge option. Q: What are the clinical advantages of a zirconia screw-retained implant bridge? A: There are 6 options to replace a full arch of teeth supported by dental implants: an overdenture, a cement-retained PFM implant bridge, a cement-retained zirconia bridge, an acrylic screw-retained implant bridge, a screw-retained PFM bridge, and a zirconia screw-retained implant bridge. Only the screw-retained zirconia bridge option offers over all-retrievability, low susceptibility to chipping and staining, low plaque attraction, no casting distortion, and ideal aesthetics that includes…

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   From the September 2014 Issue ARTICULATION FILM Microcopy Featuring an innovative, easy-grip handle to simplify occlusal adjustments without the need for forceps, new Bite-Check articulation film is the ideal tool to accurately mark points of contact, minimizing the possibility of "too high" an occlusion, which can account for postoperative tooth sensitivity. And contrary to many thicker paper options on the market, its thin profile helps patients close their bite, eliminating mandibular reflexes that can skew the occlusion. For more information, call (800) 235-1863 or visit bitecheck.com. FREEinfo, AUTOMIX TIPS Sulzer Mixpac MIXPAC Automix Tips are designed to minimize material waste…

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   Colgate Colgate Total is one of the most extensively tested and researched toothpastes in the world. A 2013 independent systematic review by the Cochrane Oral Health Group affirmed the superiority of tri-closan/copolymer on several measures of plaque and gingivitis compared to regular toothpaste. It also concluded that there was no evidence of any harmful effects. The review included 30 studies of up to 3 years in duration from 1990 to 2012 involving 14,835 participants. For more information, visit colgateprofessional.com. FREEinfo, APEX LOCATOR Ultradent Products Endo-Eze FIND is an electronic device used for apex localization and working-length determination during root canal…

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   NEW PRODUCTS SNORING/SLEEP APNEA DEVICE Great Lakes Orthodontics The Soft Telescopic Sleep Herbst offers superior patient comfort and retention and allows some lateral and vertical movement without disengaging the appliance. Fabricated using low profile, reinforced EVA mate rial, it is proven effective for chronic snoring and mild to moderate obstructive sleep apnea. Additionally, all Herbst Sleep appliances fabricated by Great Lakes are approved for Medicare reimbursement. For more information, call (800) 828-7626 or visit greatlakesortho.com. FREEinfo, IMPLANT CEMENT Taub Products Zero-G BioImplant Cement is recommended for intermediate to long-term cementation of implant-retained restorations, and it can also be used for…

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    Spotlight Cordless Obturation System Ideal for Warm Vertical Obturation Technique ORANGE, Calif.—The elementsfree cordless obturation system, by AxisSybronEndo, combines a down-pack device with a 360° activation ring, instant heating, and digital temperature control. The back-fill unit features powered extrusion, a comfort design, and high-performance insulation. The system is ideal for the warm vertical obturation technique. For more information or to request an in-office demonstration, visit elementsfreeendo.com. FREEinfo, Kit Utilizes Heat to Optimize Performance of Composite Material RACINE, Wis.—Vista Dental Products' new line of Therma-Flo products are uniquely only needed to utilize heat for optimal performance of any preferred composite material.…

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    Spotlight Award-Winning Broadcast System Brings Constantly Updated Content to Reception Rooms and Operatories FORT COLLINS, Colo.–Winner of The Pride Institute's "Best of Class" Technology Award for 2014, Tellcast.TV blends entertainment, educational and external marketing, and patient education into a broadcast that runs on a Google TV, Smart TV, or computer networks. It lets dental practices outfit reception rooms and operatories with professional industry content that is constantly updated with short videos, news, weather, traffic alerts, social media, and interactive trivia. And unlike traditional television, users can interact with the broadcast through Tellcast.TV's mobile app, which allows them to customize video…

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    Cloud-Based Practice Management Software Helps Practices Operate More Efficiently ATLANTA–Carestream Dental's CS SoftDent Cloud practice management software has been designed to help even the busiest practices operate more efficiently. It offers a full suite of practice management software tools to increase productivity and streamline daily workflow. CS SoftDent Cloud's features enable practices to effectively manage their day-to-day business—including insurance benefits tracking, electronic patient charts, and detailed financial reports—at any time, from any location, and compliant storage. Utilizing CS SoftDent Cloud, practices will enjoy peace of mind because all applications, data, and patient information is stored under one virtual roof, giving…

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    How to Increase your Practice Income while you work less and feel more fulfilled By Dr. Ken Whelan Dr. Ken Whelan generated $9.2 million within 5 and-a-half years in one scratch practice in Southern California on a 3-day weekly schedule. He's launched multiple million-dollar practices and helped many other dentists do the same. Here are a few of the elements Dr. Whelan uses as part of his Winning Practice Strategy to build multi-million dollar practices. They may be useful to you as well. Become the go-to dentist in your area How do you position yourself so new patients flock to…

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    CLINICAL REVIEWS THE DENTAL ADVISOR Dentists and their teams face daily challenges with materials and equipment when treating patients. Most have identified "go-to" products that are helpful—products that can solve a clinical problem and save time, headaches, and costs. THE DENTAL ADVISOR reports on products such as these, products recommended by its editorial team, and each one is deemed an excellent choice for solving a particular clinical challenge, thereby earning the title of Clinical Problem Solver. To view THE DENTAL ADVISOR's complete 2014 Clinical Problem Solver list, visit dentaladvisor.com. SHOFU Super-Snap X-Treme CLINICAL PROBLEM: Too much time is required to…

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    INNOVATIONS . 1 Spotlight Systems Offer Premium Whitening Without the Premium Price LOMPOC, Calif.—Your patients will smile more after discovering DenMat's new LumiSmile White In-Office and Take-Home Whitening Systems. Their proprietary formulations offer premium, professional-strength whitening without the premium price. Whiten your patients' teeth in a single visit with LumiSmile White's 25% hydrogen peroxide In-Office system, which delivers the effective, safe, and fast whitening your patients want, with or without the light. Patients can brush up their in-office procedures with LumiSmile White Take-Home or use it as their standard at-home whitening system. Take-Home kits are available in 16%, 22%, or…

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    Kit Features Discs Ideal for Cutting and Polishing All-Ceramic Restorations TORRANCE, Calif.-Continental Dental Laboratories' Diamond Duck Zirconia and Emax Polishing Kit features uniquely formulated diamond discs designed to cut faster and last longer than other diamond instruments. They are ideal for cutting and polishing all ceramic restorations, especially zirconia and emax. Utilizing the discs, you can adjust and polish your restorations chairside. Get free Diamond Duck disc bars (a $52 value) when you send Continental Dental Laboratories any 3 unit Luxer Full Zirconia case. Use code duckya on your RX. (Certain limitations may apply or while supplies last.) For more…

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    Multi-Unit Abutments Added to Implant Line GROVER BEACH, Calif—PREAT Corp has expanded its implant Prosthetic Listing to include straight, 17°, and 30° multi-unit abutments compatible with Nobel Biocare Replace and Active systems, Straumann Bone Level, Biomet 3i, Certain, Astra, CAMIOG, Brânemarks, and Zimmer Screw systems. Available universal multi-unit components include analogs, temporary cylinders, guide pins, prosthetic screws, impression copings, castable abutments, and healing caps. All are manufactured to the stringent ISO13485:2012 quality standards and made in the United States. For more information, call PREAT Corp at (800) 232-7732 or visit the Web site preat.com. FREEinfo, [IMAGE: A dental syringe product…

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    Sharps Recovery Kits Provide Economical Alternative to Costly Land-Based Pickup Services MOUNTLAKE TERRACE, Wash—HealthFirst now offers a comprehensive line of sharps management kits, including specially packaged sharps containers with processing and prepaid shipping included. Smaller sharps containers, ideal for dental needles and ampules, are available in multipacks for use in each operatory, and larger DOT-rated containers are available to handle accumulated sharps waste in large quantities. All HealthFirst customers receive complimentary access to OnTrAQ, a proprietary, cloud-based portal that allows customers to track and document compliance with all aspects of their sharps management plan along with other compliance processes such…

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    Spotlight Articulation Film Hailed As the Ideal Tool to Accurately Mark Points of Contact KENNESAW, Ga.–Featuring an innovative easy-grip handle to simplify occlusal adjustments without the need for forceps, Bite Check articulation film from Microcopy is the ideal tool to accurately mark points of contact, minimizing the possibility of "too high" an occlusion, which can account for postoperative tooth sensitivity. And contrary to many thicker paper points on the market today, its thin profile helps patients close their bite completely, eliminating mandibular reflexes that can skew the occlusion. The result is a small, precise mark that makes adjustment easy to…

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    NEWS/TRENDS Industry News Carestream Dental Signs Integration Agreement With Sesame Communications Carestream Dental has signed an integration agreement with Sesame Communications, a leading provider of cloud-based dental practice services, to help practices accelerate new patient acquisition and build patient loyalty. Under the terms of the agreement, Carestream Dental will develop bidirectional integration for Sesame services in its CS PracticeWorks, CS SoftDent, CS OrthTrac, and CS WinDMS practice management software products. It will also provide technical assistance to Sesame Communications to integrate Sesame's existing practice management software with Carestream Dental's practice management software. For more information, call Carestream Dental at (800)…

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    Recognizes Members for Lifetime Achievements Dr. Irwin Smigel, founder of the ASDA, honored as being the "Father of Aesthetic Dentistry." Dr. Paul Belvedere (left), receiving an ASDA Lifetime Achievement Award from Dr. Doug Lambert for his development of practical techniques for placing direct composite restorations. Dr. Robert Weller, recipient of an ASDA Lifetime Achievement Award for his promotion and teaching of porcelain laminate veneer techniques. At its 38th Annual International Conference, the American Society for Dental Aesthetics (ASDA) recognized Drs. Irwin Smigel, Paul Belvedere, and Robert Weller for their lifelong contributions to aesthetic dentistry. Awards were presented to them on…

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    In First Impressions, Georac Freedman, DDS, gives readers a brief summary of products that have recently been introduced to dentistry, based on his clinical experience. Filtek Bulk Fill Posterior Restorative 3M ESPE Tooth colored materials are the standards of care for both anterior and posterior restorations. Bicuspid and molar treatments account for more than 79% of all direct restorations that dentists place. Clinically, there are a number of challenges in restoring teeth to their state of form and function prior to decay, including strength and resistance. One parameter that often escapes comparative attention is the actual clinical time that the…

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    Test 180 dentalCEtoday.com TMD Rediscovered: A New Paradigm, Part 2 This article builds upon the information presented in part one to present a diagnostic investigative clinical protocol for TMD. Part one of this 2-part article series predominantly dealt with temporomandibular disorder (TMD) as an infectious disease.1 A substantial effort was made to highlight the important relationships and changes inherent in the vascular biology of inflammation, which involved activation of the hemostatic system.2 While the activation of the coagulation system was clearly established in the previous article, the concept of thrombophilia as an independent cause in joint disease3,4 was somewhat marginalized.…

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    plasma extravasation in the rat TMJ.33 Musculotendinous stiffness and sensorimotor responses may have suboptimal protective roles with respect to joint stability during the ovulatory phase of the menstrual cycle, predisposing to injury.34-37 (Note: corticit reference 18 for more information on this topic.) The sexual dimorphism associated with TMD may be among the most difficult questions to answer in a straightforward fashion. As unique biological entities, each individual carries a distinct signature; no one answer can satisfactorily fulfill all the demands of this topic. SPLINT THERAPY Splint therapy poses a very thought-provoking question within the paradigm presented. The objective in answering…

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    The Art and Science of Implant Dentistry Minimally Invasive Considerations for the Aesthetic Zone Amir N. Esfandiari, DDS Implant dentistry is a constantly evolving combination of science and art, and recent advancements have allowed dentists to better satisfy their patients' demands for more predictable and conservative results, especially in the aesthetic zone. However, the placement and restoration of anterior implants continues to remain a challenge for the clinician. Careful attention must be given to extraction techniques and provisional restorations in order to ensure predictable results. One-stage or 2-stage implant placement are both acceptable techniques to replace anterior teeth that are…

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    IMPLANTS FIGURE 10. Long term provisional (BioTemps [Glidewell Dental Labs]) cemented. FIGURE 11. Soft tissues after 3 months of healing and remodeling. FIGURE 12. Temporary abutment/crown loaded to further develop the soft tissue. FIGURE 13. Final custom aesthetic abutments torqued to 35 Ncm. tures.5-10 Preservation of the hard tissue such as the interproximal alveolar bone, and the facial cortical plate over the roots of the maxillary teeth, which is thin and porous, is crucial to the success of the treatment in this region.10-13 This, in turn, will help keep the precious soft tissue available for contour and to ensure the…

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    RESTORATIVE dentalCEtoday.com Go online to earn credit for reading this CE article. Broadening the Spectrum of Use for Glass Ionomer Restorations INTRODUCTION The demand for economical direct tooth-colored restorations has never been greater. Patients want restorations that match the original appearance of the tooth and do not contain metals or chemicals they find objectionable. Well-placed composites are showing improved lifetimes. Challenges with composite restorations are often related to operator errors. Composite restorations are technique-sensitive, and attention to detail is paramount for success. Direct Composite Challenges Postoperative sensitivity remains a challenge with direct composite restorations.¹ Dentists using the total-etch approach to…

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    composite resins with significantly reduced postoperative sensitivity, fluoride release, better retention, and ease of use. In the meantime, improvements were made to the original GI formulations. Setting times were decreased and wear resistance was improved. The materials became more aesthetic than previous versions. Postoperative sensitivity due to water imbibition was reduced. Available and sustainable fluoride release was increased. Finally, ease of use was also improved. Today, GIs have a variety of forms including bases, liners, cements, sealants, and restorative materials. Advantages of Glass Ionomers There are 2 distinct materials within the GI family: GIs and RMGIs. This article will only…

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    wear more than composite resins, have a lower compressive and tensile strength, and do not have an initial bond strength to dentin as great as properly placed resin-bonded composites. Their restorations placed in dentin at an ideal depth. Their weakness may be more than compensated with an absence of setting-shrinkage stress, a similar coefficient of thermal expansion to tooth, fluoride release, and the ability to restore a tooth without inducing high internal stresses. Comparing more wear on the occlusal surface of GI restorative material to the loss of an entire cusp of a tooth due to polymerization shrinkage stress from…

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    RESTORATIVE moist surface. Next, the GI restorative material (EQUITA Fil) was quickly placed in one increment (Figure 16). The restoration was allowed to cure for 25 minutes. The retainers and bands were then removed, and preliminary shaping was performed on the occlusal and interproximal areas. Articulating paper was used to refine the occlusion. A metal band was placed around the tooth, the tooth dried, and a surface sealant (EQUITA Coat) was placed and light cured. The amalgam restoration on the adjacent tooth was removed and restored with a conventional composite restoration since no significant cracks were noticed (Figure 17). Case…

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    Effective and Simple Bone Grafting David Mangat, DMD CASE 1 Figure 1. Prepared osteotomy with defect. Figure 2. The implant placed into osteotomy. Figure 3. Puros cortical allograft and CollaTape membrane (Zimmer Dental) in place. Figure 4. Post-op radiograph of implant at No. 8 site (note old retained root tip). INTRODUCTION Guided bone regeneration has long been used for the clinical preservation of extraction sockets prior to implant placement, in internal and external sinus lifting, ridge augmentation, and for immediate implant stabilization. There are a variety of bone replacement graft types: autografts (from another site in the patient), allografts (from…

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    materials and membranes that work best for them. CASE REPORTS Case 1 Findings and Treatment—A 50-year-old male was referred by his general dentist for implant placement at the No. 6 site. The canine had been missing for so many years that an atrophic buccal bone defect had been created, requiring grafting at the time of implant placement. A 3.25 x 11.5 mm OSSEOITTE Tapered Certain implant (Biomet 3i) was placed into a prepared osteotomy (Figure 1) under local anesthetic using 3% lidocaine hydrochloride (HCl) (1:50,000 epinephrine). It was anticipated that the coronal third of the implant would be surrounded by…

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    IMPLANTS penicillin VK 500 mg (No. 28, 4 times a day for one week) and 0.12% chlorhexidine rinse (15 seconds, twice a day for 2 weeks). week) and 0.12% chlorhexidine rinse 0.12% (30 seconds, twice a day for 2 weeks). Case 5 Findings and Treatment—A 42-year-old male was referred by a general dentist after traumatic avulsion of tooth No. 9 in an on-the-job accident (Figure 15). The resulting socket (Figure 16) was filled with Puros cortical allograft (the size of the socket following extraction warranted placement of a Puros cortical allograft and CallaPlate membrane, in preparation for an internal sinus…

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    IMPLANTS CASE 1 Figure 6. Scratch mark over center of mandible. Figure 7. First mini implant (Mini-Dental Look, or MDL [Intra-Lock System International]) inserted. Figure 8. Second MDI inserted 10 mm from first MDL. Figure 9. Third MDI inserted in mandible. Figure 10. Four MDIs inserted over a 3-cm arc. Figure 11. Metal housing fixed into intaglio of mandibular denture. Maximizing Placement Accuracy... continued from page 70 midpoint of the mental foramen is usually 27 mm from the center of the mandible and that 60% of the time, there may be an anterior loop of the inferior alveolar nerve of…

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    IMPLANTS 73 CASE 2 Figure 12. Note central blue marking on ridge. Figure 13. Note dental floss over central marking. Figure 14. First implant seated to square hub. Figure 15. Two MDLs, 10.0 mm apart and parallel. Figure 16. Arrow points to ball top of MDL within o-ball recess of MIG. Figure 17. Arrow points to bone chips in spiral drill flutes. Figure 18. Periodontal probe within fourth MDL osteotomy; note height of subgingival pilot. Figure 19. Four MDLs shown in position with an 10.0 mm apart and parallel. Figure 20. Note the 4 ball-top indentations. Figure 21. Final seating…

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    ENDODONTICS dentalCEtoday.com Go online to earn credit for reading this CE article. Measuring for Success in Endodontic Therapy There is an old proverb in carpentry that cautions people to "measure twice, cut once." In endodontic therapy, the clinician has the opportunity to measure at 2 distinct stages before ultimately committing to the final radiographic appearance of their handy work. During the working length determination stage of treatment, the measurement of how far to clean a canal apically is calculated. Prior to obturation, another chance to measure again is presented before completing treatment, allowing the clinician to adjust any measurement errors.…

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    Figure 3. Use the appropriate file size to get the working length reading. If the canal is very wide like in both No. 9, then a larger initial file size should be used with the electronic apex locator. Figures 4a and 4b. Apex locator "fooled" by accessory canal. (a) Conefit radiograph, Cone is short. (b) Post-op radiograph. Accessory canal filled and corresponds to "short" working length produced by the apex locator. Figures 5a and 5b. Examples of (a) underextension, and (b) overextension. Figures 6a and 6b. Apicectomy was necessary to address the symptomatic tooth. (a) Pre-op radiograph. (b) Post-op radiograph.…

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    78 . 1 PRODUCT FOCUS Whitening Systems George Freedman, DDS In-office whitening has attained an enduring level of popularity within a large segment of the population. It is trendy, fashionable, and re-energized from time to time when notable celebrity shows up with particularly shockingly white teeth. It is hard to notice the white and super white smiles on television, in movies, in magazines, and on stage. For that matter, it is hard to escape bleached smiles in an office, gym, or supermarket. The ubiquitous youthful smiles and the overall public awareness of tooth whitening have propelled in-office tooth whitening into…

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    IN-OFFICE WHITENING SYSTEMS continued from page 78 K6R Whitening K6R is widely recognized as the world's most effective whitening system—with no need for lights or lasers. It offers cost-effective solutions, from phenomenal home whitening for average patients to astonishing treatment of tetracycline cases—and everything in between. K6R is the first company to refrigerate its full line of whitening products from manufacturing until being delivered cold to dental offices. And K6R comes with a 100% money back satisfaction guarantee. For more information, call toll-free at (866) 763-7733 or visit k6rdental.com. FREEinfo, CAO Group Precise White is a laser-assisted in-office whitening treatment,…

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    WHITENING SYSTEMS continued from page 80 der formula increases the effectiveness of the chemical whitening action of Perfection White when mixed with hydrogen peroxide. A one-hour chairtime treatment is all that is needed for your patient's whiter, brighter smile. Perfection White includes a gingival protectant gel that is to be used with a rubber dam. Light activation or refrigeration is not required. For more information, call (888) 670-6100 or visit premusa.com. FREEinfo, SDI (North America) Pola Office+ is the world's fastest in-office tooth whitening system, based on the total treatment time. The total treatment time will take fewer than 30…

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