Dentistry Today — December 2016

Inside this issue

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

1. Page 6

   Hats Off to Our Leaders We are very proud to present our 19th Annual Leaders in Continuing Education in this edition of Dentistry Today. As we have mentioned previously, this listing is not intended to be an exhaustive listing of leaders in North America, but it certainly includes many of the top professionals involved in teaching and consulting within the profession. As a leading clinical and news source in dentistry, we strive to be the "clinician's magazine," so it is an excellent that we focus the spotlight on those who teach and mentor others in the field as a major…

2. Page 8

   Clean Out the Closet! Use the New Gingivitis Code Let's imagine that you have a patient who presents with inflamed and hemorrhagic gingiva, light to moderate subgingival calculus, and generalized pseudo-pocketing. For all the history of Current Dental Terminology® CDT coding, there has been no truly accurate codes for the treatment that this patient would need. There has been a gap; however, there is good news on the horizon: in 2017, this situation will change with the creation of a new CDT code. The tough question is: this: How will it work for your existing system? It could lead to…

3. Page 10

   VIEWPOINT continued from page 8 a mirror, she immediately observed that Dominic had active caries, bleed-line subgingival calculus, and his gingival tissues were red and swollen with bleeding upon touch. With the clock ticking in the practice schedule, should the hygienist move forward with the standard and generally expected routine that has produced a consistent production level? What's In Your Hygiene Closet? These are the challenges when new products, technologies, or in this case, a new code comes along. How does it fit? Once success occurs when we sign, step back a moment, and re-evaluate the entire system. It's like…

4. Page 12

   FOCUS ON: Digital Dental Marketing Roger P. Levin, DDS, explains how the Internet and digital media have altered the marketing landscape for dentists. Q: How has dental marketing changed in the recent years? A: Frankly, when I first went into practice in 1982, most dentists had little interest in marketing. There were more than enough patients to go around, so why spend money on advertising and other marketing activities? Gradually, dentists began to market their practices, and then the picture changed dramatically—and permanently—when the Great Recession hit. Along with other game changers that impacted the dental economy at the same…

5. Page 16

   Pick Up the Pieces Paul Feuerstein, DMD Why not spend $75,000 to $250,000 to get up to speed with new technology? The "experts" say this "modest" investment will provide a return far beyond the initial costs. But is it believable? As we strive to create new-age, high tech offices, the permutations of the equipment are getting more and more confusing. We are being pushed by the latest digital x-ray sensorsthe "new and improved" models, of course, implying that the ones we have been using the past two years are no good. And let's get rid of percussion material and get…

6. Page 18

   Spotlight New Workflow Improves Predictability and Gives Doctors More Confidence NEW YORK CITY–Carestream Dental introduces CS Solutions for Implants, a digital integrated implant solution designed to support more accurate diagnoses, improved treatment planning, and greater confidence when placing implants. First, doctors capture a digital impression taken with either the CS 3500 or CS 3600 intraoral scanner and a CBCT scan by either the CS 8100 3D Extraoral imaging system or CS 9300 system. The 2 scans are then automatically aligned in CS 3D Imaging software to create a virtual setup. Next, the new Prosthetic Driven Implant Planning module of CS…

7. Page 19

   Obturation Device's Ease of Use Cited FAIRFAX, Va.–Offered by B&L BIOTECH, the Superendo Beta Mini Cordless Obturation Device is designed for warm gutta-percha techniques backfilling a canal with warm vertical obturation or performing a complete fill (injecting from the apex up). Perfectly complementing B&L's Alpha heat source, it provides simplicity, durability, ease of use, and comfort in a cordless injectable obturation gun. For more information, call B&L BIOTECH at (844) 265-2460 or visit the website imhho.com. FREEinfo, Bone Grafter Offered TOMS RIVER, NJ–Osseo-Tip is an easy-to-use, effective tool that can be used to harvest bone without the need to employ…

8. Page 20

   Featuring Heat-Arresting Technology, Contra-Angle Hailed As the World's Safest IRVINE, Calif.—In response to public health authorities' growing concern about dental patient burns caused by electric handpieces, Bien-Air now offers the EVO.15, the safest contra-angle on the dental market today. In procedures utilizing electric handpieces, the briefest contact between the instrument's push button and the patient's inner cheek causes the instrument to overheat, resulting in possible burn injuries. The most severe incidents have caused third-degree burns, requiring reconstructive surgery, thereby likely subjecting the practitioner to lengthy legal actions. Equipped with Bien-Air's patented COOLTOUCH heat arresting technology, the EVO.15 is the only…

9. Page 22

   CLINICAL REVIEWS THE DENTAL ADVISOR EyeSpecial C-II Camera ++++1/2 Shofu Dental | (800) 827-4638 | shofu.com Consultants' Comments • "Easy to use with the different preset dental modes and shade comparisons." • "The WiFi compatibility is a great asset. With the Patient ID feature, photos can be labelled with patient ID numbers and sent wirelessly from the camera to a computer or iPad." • "I love how it has a sensor to let you know how close the camera should be to the patient in each setting to get an optimal picture." • "The photos have crisp, clear detail and…

10. Page 24

    QUICK TECHNIQUE BISCO's CORE-FLO DC LITE Continues the Evolution of Dental Science Joseph Kim, DDS INTRODUCTION Today's core build-up materials have been part of the continuing evolution of dental material science. One such material is BISCO's CORE-FLO DC LITE, a modern, dual-cure, composite core material possessing several clinically significant features that provide a predictable foundation for crown and bridge procedures. CORE-FLO DC LITE's lower viscosity provides self-leveling of the surface, allowing it to conform to undercuts, around pins, and into post preparation spaces while minimizing voids. Also, CORE-FLO DC LITE sets incredibly hard, allowing for tactile feedback during preparation, and…

11. Page 26

    Spotlight VPS Impression Material Signifies Exciting New Advancements in Prosthodontics and Restorative Dentistry SOUTH JORDAN, Utah–Ultradent Products' new Thermo Clone VPS Impression Material signifies exciting new advancements in prosthodontics and restorative dentistry. For the dental professional taking an impression while trying to minimize patient discomfort, bubblegum-scented Thermo Clone facilitates the task due to its consistent setting times and thermal set curing that activates when placed in the patient's mouth. ThermoClone is engineered to be reliable and consistent. Its extremely temperature sensitive nature allows for long working time, short setting time, and minimal time in the critical zone where distortions occur.…

12. Page 28

    Spotlight Featuring Adaptive Response Technology, Composite Facilitates Creation of Lifelike Restorations ORANGE, Calif.-Kerr's Harmonize Universal Composite begins with ART—Adaptive Response Technology, a nanoparticle filler network that helps you achieve lifelike restorations with more ease and simplicity than ever. With better blending capabilities and enhanced structural integrity, the ART of Harmonize provides your restorations with exceptional strength and unmatched aesthetics. With the ART filler system, Harmonize diffuses and reflects light in a similar way as human enamel, leading to an enhanced chameleon effect for better blending and improved aesthetics overall. Additionally, the particle size and structure is designed to offer superior…

13. Page 30

    Gloves' Ultrathin Construction Enhances User Comfort and Protection Spotlight Light Lets Clinicians Cure With Confidence BARRIE, Ontario—Putting you in control for the right cure every time, the SifiusMax Advanced Curing Light features a powerful, elegant, aluminum design that is built for durability and efficiency. Its 90° swivel head functionality and ultrasltim profile mean better ergonomics, easier access, and more precise placement; its optical dual-lens technology collimates the light beam for deep, even curing and its new generation battery and charging system provides up to 500 cures on a single charge. An easy-to-use, brilliant LED display and customizable menu offer multiple…

14. Page 31

    Small-Sized "Go Anywhere" Polishers Provide Exceptional Accessibility to Tooth Anatomy KENNESAW, Ga - Hailed as "go anywhere" polishers, Microcopy's new Minnow Polishers, perfectly suited for single patient use, provide just the right fit when accessing pits, fissures, and tooth anatomy that larger polishers just can't reach. Their small size provides an efficient and economical answer for finishing off all classes of restorations using today's nanocomposites, and they won't crumble and break off with use. Minnow's simple polishing system gives you a choice between one-step polishing for finishing off posterior restorations and 2-step polishing for bringing anteriors to a high luster…

15. Page 32

    NEWS/TRENDS Industry News Glidewell Laboratories Announces Managerial Promotion Glidewell Laboratories announced recently the promotion of Mike Cash, CDT, to vice president of sales and marketing. Mr. Cash began his career in dentistry in 1977 and joined Glidewell in 1993. During the next 2 decades, he served as director of customer relations and later as director of sales and marketing. His leadership and advertising knowledge have been instrumental in helping the company achieve extraordinary growth. For more information, call (800) 854-7256. Mike Cash, CDT Convergent Dental Partners With Patterson Dental Natick, Mass-based Convergent Dental, developer of Solea, the first and only…

16. Page 34

    NEWS/TRENDS In Memoriam Dr. Smigel had a favorite riddle: "If a tree falls in a forest and no one is around to hear it, does it make a sound?" Well, there are many thousands of dentists worldwide that heard the sound of his passing, and it was a giant roar! I knew Irwin professionally and personally. He continually encouraged dentists to fulfill their potential and was always willing to share his experience. After presenting ASDA programs at the Greater New York Meeting, we'd walk through the city sharing personal stories until we tired of walking. Those times I'll always cherish.…

17. Page 36

    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. All Ceramic Extra-Oral Kit Cosmedent Polishing ceramics is difficult at best; polishing zirconia and lithium disilicate makes the dentist's task even harder. Regardless of the challenges involved, it is the practitioner's clear responsibility to deliver a restoration with a natural tooth shine; a smoothness that will last long term in the less than ideal intraoral environment. Most existing polishing systems are indicated for specific ceramic material, and precious few actually work well with zirconia. There…

18. Page 37

    Fusion 5 Curing Light DentLight Curing lights are getting more powerful (and hence faster and more efficient) every year. It seems only a short time ago that a polymerizing output of 500 mW/cm² was considered a lofty goal; in the past 3 years, 1,500 mW/cm² has emerged as the new standard. Now DentLight, an award-winning designer and manufacturer of lighting products from Plano, Tex, recently introduced the new Fusion 5 LED Curing Light. This highly innovative curing light features a 4,000 mW/cm² laser sharp focused curing beam. The secret is in its upgraded optoelectronics, which delivers a more uniform and…

19. Page 48

    Guided Implant Surgical Applications Michael Tischler, DDS We would like to focus on the various CBCT-generated implant guides that are available and look at their advantages and disadvantages. A CBCT-based implant guide is a state-of-the-art concept that represents the highest aspects of implant technological advancements. This month's section revisits guided implant surgical applications, a topic that will appear in each December issue. We will focus on the various CBCT-generated implant guides that are available and look at their advantages and disadvantages. A CBCT-based implant guide is a state-of-the-art concept that represents the highest aspects of implant technological advancement. Of the…

20. Page 50

    IMPLANTS dentalCEtoday.com Go online to earn credit for reading this CE article. Dual CBCT Scanning Technique for Completely Edentulous Arches INTRODUCTION Two of the most popular and current trends related to dental implant treatment involve the use of minimally invasive surgery and the integration of computer-guided surgery. For these techniques to be successful, the preoperative radiographic evaluation of the proposed implant recipient sites is crucial in order to obtain an aesthetic, functional, and long-term implant prosthesis. With the use of CBCT coupled with stereolithographic surgical templates, the implant clinician has access to comprehensive technology that has been shown to improve…

21. Page 52

    Dual CBCT Scanning Technique for... continued from page 50 movement, functions ideally, and has proper aesthetics. Scan Prosthesis Markers To merge the 2 scans in a dual-scan technique, radiopaque markers are added to the existing removable prosthesis. Most importantly, the prosthesis and the radiopaque markers should consist of a material that will cause no scatter that could lead to inaccuracies in the scan. Materials commonly used in the past include gutta percha, titanium, or Cavit (3M), which all have a high opacity without causing scatter artifacts.7 For the dual scan technique, a new material is recommended: to use Suremark Clearmarkers…

22. Page 53

    The use of a dual-scan technique is a significant advancement over traditional methods for the fully edentulous patient. Merging of the Two Datasets Software programs (SimPlant [Dentsply Sirona Implants]) will allow the joining of the radiographic scanning guide and the patient's anatomy. The CBCT dataset files are merged by aligning the radiopaque markers so that the prosthesis will be visible over the available bony anatomy, thus allowing the clinician to accurately evaluate available bone, vital and anatomical structures, bone density, interocclusal distance, trajectory, and implant sites of the edentulous areas (Figure 6).16 End Result After proper merging of the datasets,…

23. Page 54

    Should General Practitioners Place Implants? INTRODUCTION My favorite reply, when asked why endodontists place implants, is: "Even orthodontists place implants now, and they don't even like to use sharp, pointy instruments!" At this stage of the dental implant revolution, there are clinicians in every specialty (except pediatric dentistry) who provide implant surgical services to their patients. It was the oft-quoted prosthodontist, Dr. Tom McCarty, who mentored me through my first 3 implant procedures. So, the answer to the question "Should general dentists place implants?" is absolutely! With that said, let's walk through the reasons that there has never been a…

24. Page 56

    Figure 2a. Heated extraction site. Figure 2b. Pilot drill (Golden Dental Solutions) with guide cannula to ensure centered osteotomy. Figure 2c. Osteotomy preformed with matri drill. Figure 2d. Post-placement radiograph of ideally positioned implant. Should General Practitioners Place... continued from page 54 fewer than 2 or 3 implants, this tool is excellent for neophytes. Nobel Biocare's model based drill guide system allows dentists to carefully secure an implant analog exactly where desired in a stone model of the patient's jaw, with a drill guide abutment that screws into the analog to hold a guide ring exactly 100 mm superior to…

25. Page 57

    NEW Midwest Stylus® Plus High-Speed Air-Driven Handpiece Midwest® E Plus Electric Handpiece Attachments NEW Low Speed 1:1 Low Speed 6:1 THE NEXT GENERATION AIR TURBINE PRECISION & CONTROL AT YOUR FINGERTIPS Power. New rotor design provides up to 30% more power than previous Stylus generations. Perform a broad range of procedures with the power and flexibility provided by the Midwest E Plus Electric Handpiece Attachments. They easily let you apply your skills to the fullest with confidence, accuracy, and efficiency. Control. Dynamic speed control in the head helps maintain cutting power while also protecting against excessive speeds that can cause…

26. Page 58

    Should General Practitioners Place... continued from page 56 (OsteoReady implant fixtures at $120) are coming down, setting prices at levels more in line with the general dentist's more modest implant placement fees. Because most dental insurance companies do not cover implant procedures, it is a free market for implant fees, and credit companies (such as CareCredit) can finance these proce Perhaps one of the most helpful tools for training dentists to place implants has come out of the 3-D printing realm. dures for patients with no interest payments for 2 years. Trainers Continuing education in implant surgery has never been…

27. Page 60

    Anesthesia Systems Anutra Medical The Anutra Local Anesthetic Delivery System is a revolutionary way to simply buffer local anesthetics. With buffering, practitioners can be more productive, efficient, and profitable while providing a more comfortable experience. Imagine anesthetizing your patient and going to work in just 2 minutes. One of the most innovative components of the system is the Anutra Feedback Aspiration Syringe. The extraordinary syringe allows for multiple doses in a single syringe. For more information, call (844) ANUTRA 1 or visit anuramedical.com. FREEinfo, Porter Instrument SILHOUETTE is a single-patient-use nasal mask and breathing circuit that will change your view…

28. Page 62

    ce dentalCEtoday.com Go online to earn credit for reading this CE article. ENDODONTICS Single Versus Multiple Endodontic File Use This is an article about doing the right thing for all the wrong reasons. It is also an article designed to move the reader into an action step that will positively change how he or she experiences the world of endodontics. John West, DDS, MSD The right thing refers to doing what is right for (1) the patient, (2) your office, (3) your staff, (4) your pocketbook, (5) your conscience, (6) your legal compliance, (7) your reputation, and (8) yourself. Let's…

29. Page 64

    Single Versus Multiple Endodontic... continued from page 63 manufacturer's directions for use are followed (something often violated)— is a very low risk. However, multiuse file systems are a risk that can be easily avoided, while at the same time, measurably improving confidence. When files are reused, the cyclic fatigue increases and the torsional resistance decreases.8-10 Multiuse file systems are a risk that can be easily avoided, while at the same time improving confidence. Peculiary Cost Considerations (Figure 4) The pecuniary cost of reusing files is very interesting. At first glance, and especially for "easier" root canal treatment treatments, it seems…

30. Page 66

    Figure 4. Ten steps while following our imaginary 4 ProTaper Gold (Dentsply Sirona) files through a cycle for reuse. (a) At conclusion of endodontic treatment, the dentist carefully evaluates that the files fit the visual criteria for reuse. (b) The dental assistant gathers the foursome, taking them to the sterilization area. (c) Four files are carefully wiped off with counterclockwise rotation through an unclogged 2x2 gauze. (d) Files are gently placed into heat with leftover scrapings depending if one, 2, or 3 reuses. Keeping the color code legend is critical here. Other tracking devices exist but marking files become quite…

31. Page 68

    68 . 1 BUYERS' GUIDE Intraoral Video Cameras George Freedman, DDS The dental profession's success during the past 30 years is due to the creation of new awareness through diligent chairside patient education. This awareness has developed an increased and more predictable demand for dental services, keeping dentists busier, and resulting in an increasingly dentate population. These clinical advances are now mainstream and well accepted, and even demanded by patients. Practitioners must continue to inform, educate, and continually raise awareness to maintain the profession's success. The single most important practice force during the past 2 decades has been appearance related…

32. Page 70

    continued from page 68 ACTEON North America SoproCARE gives the dental professional a visual tool to educate the patient on the importance of good dental hygiene and periodontal health. Utilizing fluorescence technology, SoproCARE illuminates dental tissue to reveal occlusal caries, plaque, tartar, and gingival inflammation. It can also be used as an intraoral camera to perform a complete and time-efficient oral examination. It is Windowsand Mac-compatible and functions in nearly all imaging software applications. SoproCARE is compatible with current and previous SOPRO docking stations. For more information, call (866) 850-6367. FREEinfo, Air Techniques CamX Elara's sturdy lightweight design fits comfortably…

33. Page 72

    INTRAORAL VIDEO CAMERAS continued from page 70 and significant treatment acceptance. For more information, call (888) 346-6153 or visit drquicklook.com. FREEinfo, Flight Dental Systems The Flight Whiscan Story 3 intraoral camera is one of the world's most advanced intraoral cameras. It features an HD camera, a CMOS lens for quick capturing, and one of the clearest HD images. The camera has a swivel head of 270° and a 3-position head tilt. For more information, call (866) 799-0517. FREEinfo, Gendex Dental Systems The GXC-300 intraoral camera is an exceptional tool for patient education, improved patient communication, and greater case acceptance. It…

34. Page 73

    INTRAORAL VIDEO CAMERAS 73 patient by taking intraoral and/or extraoral images. For more information, call (800) 331-0927 or visit sigmaditalxray.com. FREEinfo, SOTA Imaging The Claris i4D intraoral camera incorporates a proprietary high-end lens, hand-control focus, and compatibility with almost all dental imaging software programs. Features include (1) a Sony Super HAD color 0.25-in imager, (2) precision optics with a focal range of one mm to infinity for macro to full facial shots, (3) precise sliding focus, and (4) a silicon capture button for image stability. For more information, call (888) 266-7682 or visit sotaimaging.com. FREEinfo, SurgiTel The loupe-mounted SurgiCam follows…

35. Page 76

    Modern Posterior Composite Placement An Innovative Single-Increment Technique Edward Werner Schubert, DDS, MS Juliana Laroca de Grues, DDS, MS Yasmine Mendes Papa, DDS, MS, PhD Giovana Mongruel Gomes, DDS, PhD Osnara Maria Mongruel Gomes, DDS, PhD Joao Carlos Gomes, DDS, PhD INTRODUCTION With the increasing demand for aesthetic restorations and development of adhesive techniques, composite resins have become the material of choice for many clinicians, when indicated.¹ The placement of composite resin restorations using modern adhesive techniques allows for more natural aesthetics² and also the ability to place restorations that conserve more natural tooth structure as compared to other restorative…

36. Page 77

    The following steps were followed on both teeth: etching with 37% phosphoric acid (Condac 37 [FGM]) for 30 seconds on the enamel and 15 seconds on the dentin; washing with water for 30 seconds, followed by drying the enamel with the air syringe. A small cotton ball in the prepared cavity prevented dentin dehydration. Application of a 5th generation adhesive system (Ambar [FGM]) was done in 2 layers using a microapplicator (Cavi-brush [FGM]) (Figure 4). The adhesive was then light cured for 20 seconds using an LED curing light (Poly Wireless) (Figure 5). The composite resin (shade A2) was inserted…

37. Page 78

    Figure 2. Rubber dam was placed for optimal isolation of the operative site. Figure 3. Preparation and caries removal was completed in tooth No. 31, and a glass ionomer liner was placed into the preparation of tooth No. 30. Figure 4. Enamel and dentin acid conditioning, primers, and adhesive system application on tooth No. 31. Figure 5. Adhesive light-curing (tooth No. 31) (Poly Wireless [Kevo]). Figure 6. SonicFill (Kerri) device activation (tooth No. 31). Figure 7. Restoration sculpture (tooth No. 31). when used for the restoration of cavities in posterior teeth. This system demonstrates improved handling characteristics with excellent material…

38. Page 80

    Universal-Size Mouthguards An Affordable Alternative for the Young Athlete Theodore P. Croll, DDS In the last 7 decades, there has been much interest in preventing dental injuries that occur during participation in sports.¹¹ Teeth can be fractured and/or displaced by direct blunt force trauma or by a blow to the mandible that crunches the mandibular teeth traumatically against the maxillary teeth. Typical sports related dental injuries in children and teens are shown in Figure 1. The best type of tooth protection is a vacuum formed mouthguard, custom made on a stone model of the maxillary arch. Pressure-laminated mouthguards provide an…

39. Page 81

    slightly opened in order to accommodate shouting to a teammate or conversing on the field of play, as needed. CLOSING COMMENTS Custom fitted mouthguards are undoubtedly the optimal way to protect teeth from traumatic impact during sports activities. However, such mouthguards are not always available or affordable. ToothShields are adaptable to most children and teens, even to those wearing fixed orthodontic appliances, and can work as an acceptable alternative, when needed. References 1. Cathcart JT. Mouth protectors for contact sports. Dent Dig. 1951;57:346-348. 2. Marshall SW, Loomis DP. Mouth protectors for contact sports. J Am Dent Assoc. 1954:49:7-11. 3. Merchant…

40. Page 82

    Whitening Systems IN-OFFICE WHITENING SYSTEMS KöR Whitening The KöR Max Whitening System is a versatile and super effective whitening system that combines at home whitening with a single in office whitening visit. This option provides the best possible whitening result for the average patient. KöR offers cost effective solutions from phenomenal home whitening for average patients to astonishing treatment of tetracycline cases—and everything in between. And KöR is the first company to refrigerate its full line of whitening products from manufacturing until being delivered cold to dental offices. For more information, call (866) 763-7753 or visit korwhitening.com. FREEinfo, Zest Dental…

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