Dentistry Today — December 2015

Inside this issue

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1. Page 6

   Honoring Dentistry Today's Leaders in CE As we draw near to the close of yet another amazing year, the Dentistry Today team presents our 18th Annual Leaders in continuing education feature in print and at . There are so many talented clinicians and dental consultants that are worthy of this honor in North America, and I will continue to state each year that the list is by no means an all-inclusive one. A good number of our clinical authors, if they meet the qualifications and then approval from our CE selection board, appear on the cover or cover full out.…

2. Page 8

   Occlusion Fails The subject of occlusion has to be presented as a body of knowledge which is consistent with the norms of healthy physiology, good engineering, and common sense. But unfortunately, occlusion demonstrably fails to meet these norms, and this is causing problems. Freelance writer Jackie Syrop recently discussed these problems in an article for Inside Dentistry. After interviewing a group of dentists who work knowledgeably about the role of occlusion in dental practice, she concluded that "because frustration and confusion reign over this complicated subject, only a small percentage of dentists have significant knowledge to use occlusal guidelines in…

3. Page 10

   VIEWPOINT continued from page 8 But the majority of the dental profession was still committed to guiding patients into laterotru­sive movements without questioning the purpose this served, which confronted them with the subtle pathology of bruxism. The result was that the can­ines were distracted, teeth were wearing down, and the muscles of mastication were in tetany due to the accumulation of lactic acid. Faced with this damaging compressive power, Schuyler sought to minimize that force by distributing it to the buccal pids and molars, creating a group function. The group function philosophy created physiologic wear, which was viewed as a…

4. Page 14

   FOCUS ON: Endodontics L. Stephen Buchanan, DDS, talks about the exciting impact 3-D printing will have on endodontic education and hands-on training. Twenty-five years ago, I was chatting with a physician, Dr. Chuck Hull, at the University of California in Santa Barbara, and asked him about his area of interest. He said, "I invented a new technology called stereolithography. It uses a laser to trace and light-cure the cross sections of a CAD model onto a plate that progressively drops further into a bath of photocatalyzed polymer after each slice has been formed, until the plate comes back out of…

5. Page 16

   From the September 2015 Issue UNIT-DOSE BONDING MATERIAL BISCO Dental Products ALL-BOND UNIVERSAL is now offered in unit-dose packaging. Available in 50- and 100-count kits and not requiring refrigeration, the easy-to-handle, orange-colored unit-doses improve efficiency and reduce the potential of cross-contamination. ALL-BOND UNIVERSAL is indicated for direct and indirect restorations as well as desensitization/sealing of the tooth, intraoral repair, and as a protective varnish for glass ionomer fillings. For more information, call (800) 247-3368 or visit bisco.com. FREEinfo, SECTIONAL MATRIX RING/FORCEPS Polydentia MyClip is the world's first sectional matrix ring combined with forceps. Forget buying expensive forceps for every type…

6. Page 18

   Whole You Nexteeth Full Dentures utilize the latest in CAD/CAM technology and advanced materials to offer a precise fitting and longer palatal plate that provides enhanced comfort for wearers. In tests, Nexteeth had remarkably less deformation compared to a conventional denture base, achieved by its advanced high-strength polymer. This leads to less shrinkage, creating a better fit that helps to increase retention among patients. For more information, call (844) 548-3385. FREEinfo, HANDPIECE DENTSPLY Midwest With the Midwest Tradition Plus handpiece, DENTSPLY Midwest has taken a 30-year best-seller and made it even better. Smartly engineered and constructed, it simplifies each cutting…

7. Page 20

   "All I Want for Christmas..." Paul Feuerstein, DMD Companies today are promising "digital dentures." Two that are quite visible are Avadent (Global Dental Science) and Mitsui/Heraeus Kulzer, based on the DENTICA System, which is now used in Whole You's Nexteeth System. Digital impressions have been a popular topic of discussion during the past few years. The focus has gone from single crowns to multiple units to implants and beyond into complex cases. One area that has been lacking is fully dentiulous impressions. We still have many patients who have or need dentures and are not interested in more than just…

8. Page 22

   Spotlight Peri-Implantitis Protocol Upgrade Added to Dental Laser's Capabilities IRVINE, Calif. BIOLASE's WaterLase iPlus 2.0 dental laser has now been upgraded with the REPAIR implant protocol to assist clinicians in the effective management of peri-implantitis, a destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. As the number of dental implants placed globally increases, incidences of peri-implantitis are becoming a growing health issue. Estimates for the incidences vary from 10% and 43% of all dental implants placed. BIOLASE first introduced the REPAIR protocol for periodontitis in 2014, and it has now leveraged this significant clinical accomplishment to…

9. Page 23

   Hand Files and Burs Hailed for Their Shaping Efficiency and User Comfort SOUTH JORDAN, Utah— Ultradent Products' new line of Endo-Eze Endodontic Hand Files and Burs has been designed with shaping efficiency and superior instrumentation in mind as well as the comfortable transmission of the user's movements. The line's products offer the balanced flexibility and resilience of a full range of K-Files; the sharpness and cutting ability (with added flexibility) of NiTi K-Files; and the spiral design of fluted Hedstrom Files (H-Files). Also offered are Flex Files, which are made of stainless steel alloy with increased flex ability, and Finger…

10. Page 24

    Spotlight Blocks Enable Clinicians to Prep, Mill, and Cement Crowns in Just One Appointment NEWPORT BEACH, Calif.—Offered by Glidewell Laboratories, BruxZir NOW milling blocks produce restorations that can be designed and fabricated in-office, and they are available in 14 shades that correspond to the VITA Classical Shade System. Finished crowns exhibit flexural strengths of greater than 1,100 MPa, which negate the need for sintering, staining, or glazing. BruxZir NOW is compatible with the TS150 Chairside Milling Solution from IOS Technologies, which utilizes a powerful, air-driven, 150,000-rpm spindle in conjunction with a patent pending orbital milling strategy to promote excellent marginal…

11. Page 26

    Spotlight Ultrasonic Scaler, Now Available With LED Handpiece, Combines Power With Compact Design RACINE, Wis–Now available with an LED handpiece for enhanced visibility, Vista Dental Products' Piezo Pilot Ultrasonic Scaler offers a combination of unprecedented power and compact, lightweight design. And like the magnetostrictive technology of other scalers, which has a vibrating, figure-8 motion that produces a considerable amount of heat, the Piezo Pilot's piezoelectric technology operates in a linear push/pull motion, resulting in less patient sensitivity, less heat, and much less water usage. The Piezo Pilot is available in 6 colors with ergonomic, autoclavable handpiece sleeves and includes a…

12. Page 28

    CLINICAL REVIEWS THE DENTAL ADVISOR Ti-Max Z900L +++++ NSK | (888) 675-1675 | nskdental.us Consultants' Comments • "Great all around handpiece; very smooth and concentric." • "Seamless transition from my regular handpieces." • "Even water spray; slim neck, good visibility." Description The Ti-Max Z900L, an air-driven, high speed handpiece, delivers 26W of power and operates between 320000 and 400000 rpm. A proprietary, specially shaped turbine allows for this power output, enabling fast cutting as well as a smooth, consistent cutting feel. The handpiece features a solid titanium body with a DURAGRIP coating. A slim neck, 94' sight head, and a…

13. Page 30

    Finally, a Real Change in Dental Local Anesthesia Jack D. Griffin, Jr., DMD Numbing, freezing, pinching, burning, stinging, aching, and tingling—no matter what you call it, the thing many of our patients dislike most about visiting us are the injections associated with local anesthesia. Obviously, a high level of patient comfort while delivering dentistry is something we as conscientious practitioners try hard to maximize. Despite using topical, shaking, vibrating, wiggling, pressure, and numerous other things, the local anesthetic delivery system certainly could be improved. The Need for Change Dental materials have changed dramatically during the past few decades, but anesthetic…

14. Page 32

    Spotlight Wedge Fuses Two Materials Together to Produce Perfect Combination of Adaptability and Retention SPRING LAKE, Mich—Garrison Dental Solutions' new interproximal wedge, the 3D Fusion Ultra Adaptive Wedge, is the first to fuse 2 materials together to produce the perfect combination of adaptability and retention. The wedge, available in an assortment of kits, features a patent pending design that combines a Soft Face core mold with a firm inner core and advanced mechanical features to produce a wedge with improved adaptation to interproximal irregularities. Furthermore, while insertion and separation are significantly improved with the new design, soft retentive fins help…

15. Page 34

    Spotlight Handpiece is World's First to Feature Both Intraoral and Extraoral Cameras ORMOND BEACH, Fla.–Dentists today often face the following dilemma when taking patient photographs for case documentation: "Do I use a digital SLR camera with mirrors or do I use my intraoral camera (IOVC)?" QuickCam Duo, the world's first handpiece with 2 cameras, resolves this issue. Introduced recently by Video Dental Concepts, QuickCam DUO, in intraoral mode, offers the highest resolution images of any IOVC camera. In extraoral mode, its second camera renders brilliant photographs, due to its Liquid Lens Autofocus Technology. A dental imaging instrument capable of taking…

16. Page 35

    Single-Use, Matrix Band Offered MONTREAL The innovative Medicom Pro Matrix Band allows dentists to perfect the art of restoration while prioritizing patient safety. The band's sophisticated design simplifies procedures via easier placement and improved visibility. Single-use and preassembled, the band is easy to use and will save valuable time due to its adjustability. For more information, call Medicom at (800) 308-6580 or visit medicom.com. FREEinfo, Snap Coping Offered BIRMINGHAM, Ala–BioHorizons' one piece Snap Coping offers an accurate impression for single or multiple units by utilizing an easy-to-use, closed-tray pickup technique. It easily snaps into the prosthetic platform, and the color…

17. Page 36

    Cement's Easy Cleanup Facilitates Creation of Beautiful Restorations MILFORD, Del–DENTSPLY Caulk's Calibra Universal self-adhesive resin cement offers a wide tack cure window of up to 10 seconds and an extended 45 second gel phase, providing dentists with the ability to perform a thorough and effective cleanup and ensuring the creation of a beautiful restoration that will last. Conventional cements only allow light curing for one or 2 seconds before they harden to the point where a burr may be required to remove the excess. But Calibra Universal, with its tack-curing window of up to 10 seconds and extended gel phase…

18. Page 38

    Temporary Cement Combines Exceptional Aesthetics With Simple Application INDIAN LAND, SC-VOCO's Bifix Temp Temporary Cement combines exceptional aesthetics with simple application to provide its users with visually pleasing results. Its translucence and tooth like Universal shade ideally blends with highly aesthetic temporaries, does not shine through, and promotes the natural appearance of the temporary restoration. And thanks to Bifix Temp's low film thickness, temporaries can be cemented to fit perfectly, without adjustment. Bifix Temp is offered in an automix syringe with very short tips, making application precise and economical. For more information, call VOCO America at (888) 658-2584 or visit…

19. Page 39

    One-Piece Mini Dental Implant Hailed As an Affordable Treatment Option AMHERST, NY—Designed for single-tooth or multiple-tooth replacements, the 2.5-mm-diameter Shatkin F.I.R.S.T. One Piece Mini Dental Implant features (1) the BLOSSOM thread design at the apical portion and (2) a prenable, tapered abutment head. It can be used in areas where conventional implants cannot be placed, giving general dentists an affordable treatment option to offer their patients. For more information, call Shatkin F.I.R.S.T., LLC at (716) 839-2959 or visit shatkinfirst.com. FREEinfo, Easy-to-Use Bone Grafter Offered TOMS RIVER, NJ—Osseo Tip is an easy-to-use, effective tool that can be used to harvest bone…

20. Page 40

    NEWS/TRENDS Industry News Ivoclar Vivadent Promotes Chet C. Spivey to VP of Clinical Marketing Ivoclar Vivadent announced recently that Chet C. Spivey has been promoted to the position of vice president of clinical marketing. In addition to his responsibility of leading North American clinical product marketing, Mr. Spivey will focus on strategic growth and expansion of the company's clinical dental materials business in the United States and Canada. Mr. Spivey joined Vivadent in 1998 as clinical marketing manager and was promoted to senior marketing manager in 2002. Since 2007, he has served as director of marketing, clinical. For more information,…

21. Page 41

    NEWS/TRENDS Robert Gordon, DDS, Introduces PhenoEsthetics Robert Gordon, DDS, aka Dr. Lips, who wrote the first esthetic book and classification on lips in dentistry and medicine, introduces PhenoEsthetics, the first full facial, minimally invasive cosmetic diagnosis and treatment planning book to be published. It presents cutting-edge facial aesthetic procedures that result in higher case acceptance and valuable referrals and marketing. PhenoEsthetics allows dentists to represent the profession as trained aesthetic practitioners. It is built upon sound true fundamentals of facial aesthetics that include natural geometric forms, height of contour, and the perceptual diagnostic skill to identify and treat facial aesthetics.…

22. Page 44

    NEWS/TRENDS Become a Practice of Distinction With its Practice of Distinction Program, America's ToothFairy is providing dentists with a new way to expand and enhance their practices. With a contribution of less than $90 per month, dentists will receive valuable marketing, educational, and community engagement tools to raise awareness of their services and promote oral health in their communities. Among the program's resources available to participating dentists are (1) a Toothfairy for Community Education Kit, (2) a certificate for in-office display, and (3) recognition as a Practice of Distinction on the America's ToothFairy website. "I am proud to chair the…

23. Page 45

    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. PROFIN IPR Dentatus Removing interproximal enamel is easy, yet removing it in a controlled way without damaging the interdental papilla is another matter altogether. The traditional "stripping" techniques involved high speed burs and diamond finishing strips. The bur often removed far too much interproximal enamel far too rapidly and unevenly, despite the practitioner's best efforts. The finishing strips were hard to control and tended to slip in the gingival direction, damaging the tooth's emergence profile…

24. Page 46

    Test 182 dentalCEtoday.com A Contemporary Approach to Intraoral Optical Scanning and In-Office 3-D Printing This article examines the clinical applications of the latest intraoral optical scanning and in-office 3-dimensional printing technologies, and reviews the literature regarding the accuracy of these techniques for replicating the dentition and oral tissues compared to conventional impression techniques. Michael D. Scherer, DMD, MS, is an assistant clinical professor at Loma Linda University, a clinical instructor at University of Southern California, and maintains a practice limited to prosthodontics and implant dentistry in Irvine, Calif. He is a Fellow of the American College of Prosthodontists and has…

25. Page 47

    Figure 1. Chairside intraoral optical impression scanner: True Definition Scanner [3M ESPE]. Figure 2. The CBCT reconstruction with an odontoid superimposed over the virtual rendering of the patient's jawbone structure (Invivo [Anatomage]). Figure 3. The 3-D printed replicas of teeth and soft tissues allows for integration with dental implant surgical plans and creation of surgical guides (Anatomage Guide [Anatomage]). Figure 4. A patient presents with an interim restoration in tooth No. 20. technology rapidly become more affordable. In addition, it allows clinicians to delegate responsibilities for fabrication of traditional restorations to a technician in a similar manner to leverage existing…

26. Page 60

    Guided Implant Surgical Applications Michael Tischler, DDS These combined CBCT and prosthetic disciplines go one step further; when technology allows clinicians to have interactive communication through online modalities...the surgeon, the radiologist, and the prosthetic doctors can collaborate as a team, producing a plan implemented through surgical guides. This month's Implants Today is focused on dental implant surgical guides. A surgical guide for implant placement is a comprehensive blend of many technologies that translates to improved care for our patients. It was only in 1997 that Hounsfield and Cormack received the Nobel Prize for Physiology and Medicine for developing the diagnostic…

27. Page 62

    Guided Implant Surgical... continued from page 60 guide fits accurately over the existing teeth. Impressions for this can also be taken with one of the many optical scanners available, and a working model can then be made from the virtual scan. When teeth are stable and support a guide well, the guide can provide a very simple and accurate implant placement for one or multiple teeth. Utilizing the implant manufacturer's guide company's kit, implants can be placed through a guide using guide sleeves. The option also exists to utilize a guide for initial osteotomy preparation, and place the implants freehand,…

28. Page 64

    Full-Arch Zirconia Screw-Retained Bridges The Advantages of a Guided Surgical Approach dentalCEtoday.com Go online to earn credit for reading this CE article. INTRODUCTION Michael Tischler, DDS Claudia Fitch, DMD Art Mirelis, DDS When treatment planning full-arch reconstruction for a cross screw-retained implant bridge, implants can be placed either with a surgical guide or nonguided. While both guided and nonguided CBCT approaches can be successful, a guided approach offers certain advantages. These advantages include more precise alveoloplasty levels based on the prosthetic plan; more precise implant placement positions, especially with respect to the screw holes; and the availability to prefabricate a…

29. Page 66

    Full-Arch Zirconia Screw-Retained... continued from page 64 when a guide is being used after a complete arch of teeth are being extracted. The V2R system uses the pre-extracted teeth to reference guide pins that subsequently locate the alveoloplasty process and provide an implant placement guide. Other guide systems for full-arch implant placement rely on a CT-based virtual alveoloplasty that a surgical guide then sits on.¹ The virtual alveoloplasty sometimes must account for discrepancies when multiple teeth are extracted and the osseous anatomy changes due to traumatic extractions. If the alveoloplasty guide in a nonpin-based virtual alveoloplasty system doesn't fit and…

30. Page 67

    IMPLANTS patient can have a well referenced, milled nanoceramic provisional delivered at the chair on the same (or next) day using the GuidedSMILE V2R system (Figure 13). Tissue Closure Considerations The tissue closure technique for full-arch guided surgery is dependent upon the timing of the delivery of the screw-retained provisional if it is planned. If the screw retained provisional is being delivered the same day of the surgery, then the tissue is sutured around straight or angled multiunit abutments. By suturing around multiunit abutments, it allows time for the provisional to be finished chairside, without collapse of the soft tissue.…

31. Page 68

    Quality Aesthetics in the Digital Age of Crown and Bridge Robert A. Lowe, DDS FIGURE 1. The patient presented with old PFM restorations on teeth Nos. 30 and 31. Recurrent decay and labial ditraction necessitated replacement. FIGURE 2. After removal of the old restorations, deep excavated areas and recurrent decay can be seen. Areas that have been excavated close to the pulp necessitated conservative restoration restorations (ACTIVA Restorative [Pultaeon] prior to taking the master impression. FIGURE 3. The preparations after removal of decay, bioactive build-up placement (ACTIVA Restorative), and preparation refinement. INTRODUCTION The advent of digital technologies in dentistry is…

32. Page 69

    All ceramic crowns may be the material of choice; however, PFMs are a good restorative option for many indirect clinical situations. exhibits a high degree of transparency for beautiful, natural looking full-coverage restorations. The gingival color blends and transitions beautifully into a more translucent incisal or occlusal portion of the crown. Zirconia esthetic crowns absorb 100% of the shading liquid throughout the unit, ensuring that there are no white or opaque areas on the surface of the restoration. This material is also milled from CAD files, so the fit and accuracy of the restoration is precise and consistent. CASE REPORT…

33. Page 70

    RESTORATIVE FIGURE 4. An SLM Captek P (Argon) coping prior to the ablation of the Captek G layer. Note the minute capillary spaces in the coping into which the Captek G penetrates, reinforcing the coping with 97% gold inside and out. FIGURE 5. The same coping shown in Figure 4 after the Captek G layer was fired onto it in the porcelain furnace. FIGURE 6. The milled zirconia (ArgenZ Esthetic [Argenz]) crown and SLM Captek on the master model as the ceramic layers the porcelain on the SLM Captek coping. FIGURE 7. The finished restorations on the master model as…

34. Page 72

    Interdisciplinary Treatment Planning The Restorative Quarterback Elliot Mechanic, BSc, DDS The rapid evolution of dentistry during the past few decades has resulted in dramatic materials and procedures allowing dentists to provide results for their patients that can closely replicate nature. The standards of care have been improved in every dental discipline. Orthodontists routinely move teeth in adults with debilitated dentitions to enhance periodontal health and place teeth in predetermined positions to accept ultraconservative restoration. Dental implants are no longer simply inserted randomly but are preplanned to be in position to create the same emergence profile, contour, and function as natural…

35. Page 74

    Interdisciplinary Treatment Planning... continued from page 72 or mere restoration. However, in the 21st century, orthodontists are often treating adults who have benefited from preventive dentistry, and have serious restorative and/or periodontal needs. The objectives of orthodontic treatment may be totally different for the restorative patient as compared to a nonrestorative patient. For example, (1) the teeth may have to be moved by the orthodontist to place them in an ideal position to be restored and, sometimes, it may be beneficial to temporize these teeth before or during orthodontics to achieve a better vision and perspective of the final result;…

36. Page 76

    Figure 5. ANKYLOS (DENTSPLY Implants) implant placement using the surgical stent. Figure 6. ANKYLOS transfer copings. Figure 7. Verification using a panoramic radiograph of the ANKYLOS transfer copings. Figure 8. Bite registration using an acrylic baseplate and wax rim. Figure 9. Lab made provisional bridge (Telio Lab [Ivoclar Vivadent]), using ANKYLOS temporary abutments. Figure 10. The provisional bridge in place. Figure 11. Teeth Nos. 7 and 8 were prepared, and dentin and porcelain shades taken. Figure 12. Teeth Nos. 7 and 8 receive the provisional (Luxatemp Ultra [Dhas Anbro]). Figure 13. Parallel metal ANKYLOS abutments. Interdisciplinary Treatment Planning... continued from…

37. Page 77

    RESTORATIVE 77 Figure 14. The inguially placed Dentalus set screws attach the zirconia frame. Figure 15. An acrylic jig enables easy placement of the abutments in the patient's mouth. Figure 16. The zirconia frame (Prettau [Zirkonzahn]) with Dentalus set screws in place. Figure 17. The zirconia frame was layered with lithium disilicate (IPS e.max [hoclar Vivadent]). missing teeth, he was now interested in enhancing the look of his other front teeth. Teeth Nos. 7 and 8 were prepared, dentin and porcelain shades with shade photos taken (Figure 11), and then the teeth were provisionally sized (Luxatemp Ultra [DMG America]) (Figure…

38. Page 78

    ENDODONTICS 78 dentalCEtoday.com Go online to earn credit for reading this CE article. Tooth Resorption: The "Black Hole" of Dentistry Lisa Germain, DDS The video arcade game Pac-Man was developed in Japan in 1980 and released in the United States one year later. This iconic site of American pop culture has transcended generations, and fans still are entertained as Mr. Poggles up dots while avoiding his enemies Blinky, Pinky, Inky, and Clyde. When I played this game for the first time, my "dentrocentric" mind immediately associated the animated effects of Pac-Man with the process of resorption, giving me an uncanny…

39. Page 80

    Tooth Resorption: The "Black Hole"... continued from page 78 with vascular ingress into this area. He noted8 that if revascularization occurred, it would aid healing of the traumatized pulp that in turn would allow hard tooth structure to develop normally. In addition, associated color change in the coronal tooth structure from intra-enamel hemorrhage would likely be transient. If, however, the injury were to result in pulp necrosis, the tissues would lose their spontaneous vascular healing ability (Figure 5). At this point, the clinician would need to intervene with treatments intended to promote apexogenesis, including procedures to induce revascularization: even in…

40. Page 82

    Figure 11. Pressure resorption from orthodontics. Figure 12a. Post-ortho poor prognosis, post-op on No. 7. Figure 12b. Post-ortho poor prognosis on No. 11. Figure 13. Replacement resorption/ankyloisis, No. 8. Figures 14a and 14b. Internal resorption (a) pre-op and (b) post-op on No. 8. Figures 15a and 15b. Infectious resorption (a) pre-op and (b) post-op on No. 8. Figure 16a. Carious exposure on No. 30. Figure 16b. Invasive external cervical resorption (ICR) on No. 18. Figure 17. Untreatable versus treatable ICR. (Courtesy of Dr. Terry Pannkuk, Santa Barbara, Calif.) Tooth Resorption: The "Black Hole"... continued from page 80 recommended after trauma…

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