Dentistry Today — December 2017

Inside this issue

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

1. Page 5

   Load fast, finish fast The AnyRidge patented knife-thread design and XPEED S-L-A with nano calcium ion surface treatment deliver faster cell proliferation, immediate stability, and fast osseointegration. And our MegalSO 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,…

2. Page 10

   Celebrating the 20th Annual Leaders in CE For 20 years now, our December issue of Dentistry Today has directed the spotlight on some of the top leaders in continuing education and dental consulting. As I have mentioned in the past, our focus on Leaders in Continuing Education is just one of many ways that our editorial team takes its role in serving the profession as the clinician's magazine very seriously. Leaders must have a real passion for their work, along with a sincere desire to become one of the top professionals in their declared area or areas of expertise. They…

3. Page 12

   Professional Journeys Are Unique When I afford myself the time to look back and evaluate my decision to become a dentist, I could never have imagined the different and exciting avenues I have experienced throughout my career. I have always taken exceptional pride in my dental profession. While my clinical education has its mix of both art and science? We as clinicians have the exceptional responsibility to help patients with their appearance, function, and oral health, which, as a result, has positive effects on their overall health. As a student at the University of Pennsylvania School of Dental Medicine, I…

4. Page 14

   VIEWPOINT continued from page 10 More Changes, More Room for Growth Another shift in my career came when I sold Snap-On-Smile to DenMat (Lumineers) and signed a 2-year contract to lecture for the company around the world. Even though it was an exciting time, it was difficult to constantly be traveling and leaving my young family. So, instead, I decided to stay local, focusing on my private practice in New York City. With the help of great doctors and a wonderful team, I grew into a phenomenal multimillion-dollar practice. While the knowledge gained in these experiences, I felt the confidence…

5. Page 16

   What's New on Online Featured Interview Dentists Offer Opinions on the GentleWave Procedure Sonendo's GentleWave Procedure provides cleaner root canals with greater patient comfort. The system offers an alternative to standard root canal treatment by combining broad-spectrum acoustic energy and advanced fluid dynamics to flush away debris from the entire root canal system. In a short video interview with Dentistry Today, various clinicians weigh in on the ways in which they have implemented the technology into their practices. Based on their experiences, the system has enhanced the way they can treat patients. Watch the video at . What's Your Why?…

6. Page 18

   FOCUS ON: Enhanced Endodontics Manor Haas, DDS, discusses how new instruments enhance endodontics. Q: Have endodontic outcomes really improved over the years? A: A quick glance at outcome studies may demonstrate how success rates of endodontic treatments have not improved significantly over the past couple of decades. However, this may be the wrong way to consider enhancements in endodontics. Q: Then, how should we view new endodontic instruments and techniques as they relate to enhancing endodontics? A: One should look at this differently than just from the success and failure perspective that studies present. We must keep in mind that…

7. Page 20

   From the September 2017 Issue DIODE LASER BIOLASE Epic Pro is the first premium diode laser providing innovations that will allow dental professionals to manage soft tissue in a way that no other diode laser has achieved. It features profession-first Smart Thermal Pulse technology, real-time Automatic Power Control, and preinstalled opti tips with Smart Tip Technology to provide unmatched cutting speed, consistency, safety, and precision. Epic Pro provides greater value to dental practices than traditional diode lasers. For more information, call (888) 676-6051 or visit biolase.com. FREEinfo, CERAMIC PRIMER Ivoclar Vivadent Monobond Etch & Prime is the first single-component ceramic…

8. Page 21

   NEW PRODUCTS RESTORATIVE MATERIAL Ivoclar Vivadent Four additional shades for IPS e.max ZirCAD LT blocks have been introduced, offering users even more flexibility. With these blocks, Ivoclar Vivadent offers preshaped monochromatic zirconium oxide blocks for chairside restorations in a single visit. As a result, IPS e.max ZirCAD for CEREC/inLab is now available in the LT shades BL, A1, A2, A3, B1, B2, C2, and D2. Also available is one bleach shade (BL) in block sizes C17 (crown) and B45 (3-unit bridge). For more information, call (800) 533-6825 or visit ivoclarvivadent.com. FREEinfo, INSTRUMENT SET ContacEZ PrepSure is a set of long-lasting,…

9. Page 22

   CLINICAL REVIEWS THE DENTAL ADVISOR Tetric EvoCeram Bulk Fill +++++ (97%) Ivoclar Vivadent | (800) 533-6825 | ivoClarvivadent.com Consultants' Comments • "An excellent composite." • "Good results without layering." • "This is my 'go to' product for posterior composites." • "Great aesthetics." • "Shade names are confusing." Description Tetric EvoCeram Bulk Fill is a nanohybrid composite for direct restorations in posterior teeth. This radiopaque composite contains patented polymerization blockers and high sensitivity filters for a depth of cure with extended working time. According to the company, patented shrinkage stress relievers that are integrated into the filler composition reduce polymerization shrinkage…

10. Page 24

    New World Man Paul Feuerstein, DMD The company Dr. Fischer built may seem like a small, niche brand, but Ultradent is far from small. The company is headquartered in South Jordan, Utah. I recently had a chance to review a new soft-tissue laser from Ultradent Products: the Gemini 810 + 980 diode soft-tissue laser. (More on that later.) It struck me that when I think of Ultradent Products, I don't think of high-tech equipment; the name conjures up a variety of restorative materials, little syringes with unique delivery tips, impression materials, Opalescence tooth whitening systems, and, of course, the technological…

11. Page 26

    Spotlight Implant System Combines Clinically Proven Features With Contemporary Innovation NEWPORT BEACH, Calif.–From Jack Hahn, DDS, creator of the world's most widely used tapered implant, the Hahn Tapered Implant System from Glidewell Laboratories combines clinically proven features with contemporary innovation. Hoping to expand patient access to implant therapy, Hahn partnered with Jim Glidewell to design a system that makes the treatment process simpler, safer, and more predictable than ever before. Hahn Tapered Implants allow for swift insertion, precise control during placement, and exceptional primary stability. From tight anterior spaces to molar extraction sockets to immediate temporization, Hahn Tapered Implants are…

12. Page 28

    Spotlight System Represents Breakthrough in Treating Edentulous Patients and Those With Failing Dentition YORBA LINDA, Calif.–Nobel Biocare's introduction of the Trefoil system represents a breakthrough in efficiency for treating edentulous patients and patients with failing dentition, enabling the fixed, definitive, full-arch restoration of the mandible in one day. These significant efficiency gains are the result of an optimized workflow and componentry, which enables reduced chair time in comparison with conventional treatments that require multiple restorations. The cost-effective Trefoil system features a premanufactured titanium bar. Passive fit is made possible by a groundbreaking fixation mechanism that compensates for deviations in implant…

13. Page 30

    Removing Amalgam: Intermediate-Speed Dentistry With Electric Handpieces Figure 1. Bien-Air Dental's CA 1:1 L and 1:5 L EVO.15 Contra-Angles are perfect for all high-speed and low-speed procedures. They cut vibration and noise in half while providing the additional benefit of constant speed. Figure 2. In a committed effort to promote patient safety, Bien-Air Dental is introducing CoolTouch+, the world's first and only heat-arresting system proven not to exceed human body temperature. Figure 3. Controlled with the user-friendly interface of an Apple iPod touch, Optima is the world's first electric motor system to harness the ease of use and performance of…

14. Page 32

    Spotlight Two Systems Combine To Effectively Obturate Challenging Cases TULSA, Okla.-Dentsply Sirona Endodontics has combined 2 proven systems to create a convenient, single-system solution with the introduction of its new GuttaCore for WaveOne Gold system. It brings together the benefits and predictability of WaveOne Gold canal shaping with a 3-D fill of GuttaCore. GuttaCore for WaveOne Gold obturators are sized and color coded to precisely match the WaveOne Gold reciprocating file system. GuttaCore for WaveOne Gold allows clinicians to effectively obturate challenging cases using the same technique with the ease of a single insertion. GuttaCore obturators matched to the WaveOne…

15. Page 34

    Spotlight Laser Provides Ability to Cut Any Tissue NEEDHAM, Mass.–Convergent Dental's Solea is the first and only laser that can cut any tissue by using a variable speed foot pedal, giving the user total control. Its revolutionary software is so easy to use that any dentist can become a laser dentist. This simple and seamless technology works for both soft tissue as well as bone and soft tissue, enabling dentists to reliably deliver anesthesia-free, blood-free, suture-free, and pain-free results. Simply turn it on, direct the beam at the desired tissue, and step on the variable-speed foot pedal. Dentists experience dramatic…

16. Page 36

    Matrix Band Produces Anatomically Correct Restorations Spotlight Bite Registration Material Eliminates Risk of Vertical Distortion When Articulated HUNTINGTON BEACH, Calif–Kettenbach LP introduces Futar Cut and Trim, which is a new bite registration that replaces Futar Scan and has several improvements. If you loved Futar Scan, you will love Futar Cut and Trim. Keeping the opinions and suggestions of the clinicians in mind, this new Futar meets many of your bite registration needs. Futar Cut and Trim is scannable and has a working time of 15 seconds with an intraoral setting time of 45 seconds. Nonsluming, this Futar brand will not…

17. Page 37

    INNOVATIONS 35 Strips Offer Consumers Better Option For Achieving Whiter Teeth LOS ANGELES—Oral Essentials has introduced its newest innovation: revolutionary Oral Essentials' salt-based whitening strips that offer consumers a better way to achieve whiter teeth, with visible results in as few as 30 minutes. Unlike whitening strips that cause sensitivity over time by using harsh chemicals like hydrogen peroxide or baking soda, these whitening strips utilize a patent-pending formulation of coconut oil, lemon peel oil, and sage oil to whiten teeth without sensitivity, combined with Dead Sea salt, which contains beneficial minerals (calcium, phosphate, and manganese). Ultra enamel-friendly, these strips…

18. Page 38

    NEWS/TRENDS Dr. Paul C. Belvedere 1930-2017 Douglas L. Lambert, DDS Dentistry lost a true icon when Paul C. Belvedere, DDS, passed away on November 1, 2017, surrounded by his family and loving wife, Gail, in Minneapolis. Known as the "Father of Posterisor Composites," Paul spent most of his career working with composite resins and sharing his vast knowledge with dentists throughout the world. Dr. Belvedere's professional accolades are voluminous. Before entering private practice, he served his country as a captain in the Air Force Dental Corps after graduating from the Loyola University (Chicago) College of Dental Surgery. He was a…

19. Page 39

    NEWS/TRENDS Sleep Apnea May Increase Alzheimer's Risk Obstructive sleep apnea (OSA) may put elderly people at a greater risk of developing Alzheimer's disease (AD), according to an international team of researchers. Biomarkers for amyloid beta (AB), the plaque building peptides associated with AD, increase over time in elderly adults with OSA in proportion to OSA severity. Thus, individuals with more apneas per hour had greater accumulation of brain amyloid over time. Sleep disturbances might contribute to amyloid deposits and accelerate cognitive decline. "Several studies have suggested that sleep disturbances might contribute to amyloid deposits and accelerate cognitive decline in those…

20. Page 40

    NEWS/TRENDS Industry News Gel Disinfects Teeth During Root Canals continued from page 36 "I have worked with Keith for years. He has deep general counsel expertise and brings significant experience in the areas of product development, business development, and mergers and acquisitions," said Tierer. "We are fortunate to have someone with Keith's expertise to guide us from a legal perspective as we position Dentsply Sirona for growth." Ultradent Products Named Company of the Year Ultradent Products was named the 2017 International Company of the Year at the Utah Global Forum Meeting, held in October at the Grand America Hotel in…

21. Page 41

    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. Estelite Bulk Fill Flow Tokuyama Dental America Direct posterior restorations are a large part of every clinical practice, and many products are available. The practitioner's material preference is based upon ease of placement, predictable polymerization at depth, and acceptable aesthetics. Increasingly, dentists are choosing flowable posterior restoratives because they are less technique sensitive. They also have been designed to polymerize more deeply, allowing fewer layering steps. Tokuyama's Estelite Bulk Fill Flow is an innovative low…

22. Page 42

    MEETINGS/SEMINARS Register for the Chicago Midwinter Meeting CHICAGO DENTAL SOCIETY™ MIDWINTER MEETING FEBRUARY 22-24, 2018 www.cds.org The Respected Leader in Scientific Dental Meetings™ The Chicago Dental Society (CDS) has opened registration for its 133rd Midwinter Meeting, which will be held in the Windy City from February 22 to February 24, 2018. The theme for this year's meeting is "A Dental Triad: Pride, Passion, Professionalism." Attendees can participate in more than 300 CE courses, including full day seminars on topics relating to esthetics, pharmacology, oral pathology, prosthodontics, clinical phonography, and more. Visit more than 600 exhibitors on the show floor and…

23. Page 44

    Using Squid Ink to Detect Gum Disease By combining squid ink with light and ultrasound, researchers at the University of California San Diego have developed a new dental imaging method to examine a patient's gums that is noninvasive, more comprehensive, and more accurate than periodontal probing. Procedures using the periodontal probe are invasive, uncomfortable, and sometimes painful for the patient. Measurements can also vary greatly between dentists, and the probe is only capable of measuring the pocket depth of one spot at a time. In a paper published in the Journal of Dental Research, researchers at UC San Diego introduced…

24. Page 46

    Bone Grafting for Implant Dentistry Michael Tischler, DDS The key to choosing the right grafting material in a clinical situation lies in understanding the properties of the graft material, from both a handling and a bone-growth perspective. The importance of grafting bone for implant dentistry cannot be overstated. The quality and quantity of bone around dental implants sets the stage for both the stability of an implant as well as the soft tissue architecture around an implant. The interrelationship between bone and soft tissue support is important as the long term success. There are many bone grafting materials available on…

25. Page 47

    Redefine possibilities Trefoil™ – the next full-arch revolution The new Trefoil system makes definitive teeth possible in just one day.* Discover groundbreaking engineering, created with the needs of the many in mind, that enables passive fit with a pre-manufactured bar and unique adjustable fixation mechanism. nobelbicocare.com/trefoil Nobel Biocare® FREEinfo, on card *Depending on clinician preference and close cooperation with the laboratory. GMT 53206. Disclaimer of liability: This product may not be used or marketed in all markets. Products may only be used in conjunction with the associated original products according to the instructions and recommendation of Nobel Biocare. The user…

26. Page 48

    The Status of Bone Grafting for Implant Dentistry In an interview conducted by Dr. Michael Tischler, Dentistry Today's implants editor, Lee H. Silverstein, DDS, MS, MBA discusses bone grafting in implant dentistry. Dr. Silverstein is a clinical professor that teaches and is a worldwide leader in providing hands-on surgical dental courses. What is your material of choice for sinus grafting? Dr. Silverstein: Bone grafting and/or bone augmentation is a surgical procedure that tries to replace and/or regenerate the missing or lost alveolar bone in a patient. This procedure utilizes material from the patient's own body, a synthetic/artificial substitute, or natural…

27. Page 50

    Figure 5: An acellular dermal matrix soft tissue graft being placed under a facial flap prior to placement of a dental implant to create a better soft tissue topography. Figure 6: Dental implants placed into an area grafted with a monocortical block graft. Figure 7: A fixated block graft being covered with PRP-soaked demineralized bone matrix (DBM) graft material. Figure 8: Tricalcium phosphate graft material being added to the facial of a dental implant. The Status of Bone Grafting... continued from page 46 ticulate graft material, which could be sharp, against the sinus membrane and wedged between the dental implant…

28. Page 51

    INTERVIEW 49 [Three surgical images showing dental graft procedures] Figure 12: A maxillary anterior grafted ridge 8 months post graft placement. Figure 13: Sockets grafted with a DBM material. Figure 14: A DBM graft material mixed with tricalcium phosphate particles to act as a radiographic marker. The gold standard when placing a monocortical bone graft is to use an autologous graft harvested from the mandibular symphysis and ramus regions. in the maxillary and mandibular anterior and posterior regions. These sites are treated with monocortical bone grafts to regenerate the lost and/or missing bone so a dental implant can be placed…

29. Page 52

    A Novel Approach to Grafting Around Implants Charles D. Schlesinger, DDS INTRODUCTION Today's clinicians who provide implant treatment to their patients are more than likely to experience situations that require the extraction of a tooth with concomitant implant placement. In sites where the size of the implant is equal to, or greater than, the residual root socket, it is a straightforward procedure that will not usually require grafting. However, since the shape of the socket will most rarely be the cylindrical shape of a dental implant, in most circumstances there will be a moderate-to-large gap between the implant and the…

30. Page 54

    A Novel Approach to Grafting... continued from page 50 The tooth was sectioned and the roots were extracted atraumatically to protect the interstitial bone. Further reflection after debridement revealed a 5.0-mm buccal defect adjacent to where the distal root was located (Figure 3). Careful osteotomy preparation allowed for the placement of a 7 x 10 Hahn Tapered Implant (Cisloe well laboratories). Excellent primary stability was attained with a seating torque value of 60 Ncm and an ISO of 71 (Figure 4). Due to the size of the defect, the decision to not immediately load was decided upon. The alveolous was…

31. Page 56

    A Novel Approach to Grafting... continued from page 52 point that it communicated with the Schneiderian membrane of the sinus (Figure 19). The new implant osteotomy was directed slightly away from the defect, making sure not to compromise the position with respect to restorative needs (Figures 20 and 21). Once the osteotomy was completed, a 4.3 x 8 Hahn Tapered Implant was placed (Figure 22) with a final seating torque value of 50 N/cm. An Ossteell unit was used to verify stability with an ISQ of 65 BL and 67 MD (Figure 23). Profuse bleeding was established by a perforation…

32. Page 57

    Rotary vs Reciprocation: "How Do I Choose?" John West, DDS, MSD INTRODUCTION As a practicing endodontist and a clinical endodontic educator for more than 30 years, the most frequent question I am asked about technique is: "Is it predictable?" While every dentist wants his or her endodontic treatment to be easier, more efficient, simpler, and profitable, in the end, it is predictability that trumps all considerations. As dentists, we are built that way and that's how we think. We have to do it right. We are a self-selected culture that yearns to be better and to be our best. Endodontic…

33. Page 58

    The Moment Before "The Moment" Every dentist that has ever mechanically shaped a radicular preparation knows and can emotionally recall the feeling of the moment before "The Moment" (Figure 1). What is that moment? Following an unfettered canal access by first removing all of the coronal dentin triangles with a PTG S5 shaping file (Dentsply Sirona Endodontics), for example, and following a confirmed reproducible Glidepath, the moment that referring to the very seconds before you ultimately reach length without breaking the file."TM In the moment before the Moment, the fear of fracture can take away the joy of endodontics, and…

34. Page 59

    ENDODONTICS 57 length of the radicular preparation using a multipass technique (Figure 2). Motion Rotary: Shapers are first gently followed into the existing unrestricted orifice, then will drawn in a paint brushing motion, and then followed deeper into the preparation. The mental chant is "Brush and Follow (deeper), Brush and Follow, Brush and Follow" to length. The Shaper file is only removed if the file bogs down with dentin shavings. If this were the situation, it is usually because the file's blades are loaded with dentin carvings and/or remaining pulp. Remove the file and irrigate with sodium hypochlorite or EDTA.…

35. Page 61

    The Power of Imaging and Imagery Barry F. McArdle, DMD The old saying that a picture is worth a thousand words is particularly true in dentistry. About 70% of people are visual learners,¹ with dentists being even more so.² When dentists communicate with patients or peers, visual imagery is key to their success. Diagnosis, treatment planning, patient education, interdisciplinary collaboration, and practice promotion require effective imaging. You could say that what you see is what you get. Not getting the shortchanges you in terms of treatment outcomes, case acceptance, and practice production. Digital Radiography Dentists understand that imaging is fundamental…

36. Page 62

    Figure 4. A conventional panoramic view of this patient's mesially tipped and fully impacted third molars. Surprisingly indicated that each tooth was partially contained within the man-dibular canal. Figure 5. CBCT revealed the exact location of these structures showing (in red upper left) that the mandibular canal was actually buccal to impacted tooth No. 17. Figure 6. A similar scenario was noted with tooth No. 32 on CBCT scan. Figure 7. CBCT in this case revealed radicular crazing at No. 19 (left arrows) and 2 canals in close proximity at the distal root of endodontically treated tooth No. 30 (right…

37. Page 64

    Figure 11. CBCT and impression scanning provide a unified virtual model upon which the correct contours and position of the implant crowns (both provisional and definitive) can be first designed. Figure 12. Next, the angulation path of the abutment was calculated. Figure 13. Lastly, the position of the implant, based on the crown/abutment combination already formulated, was virtually identified. Having the entire face frame aesthetic cases humanizes this treatment, letting your patients see that their smiles are very important to their overall appearance. Figure 14. A white lesion on the glossal border of this patient's tongue was much more easily…

38. Page 65

    RESTORATIVE 63 photographer. Therefore, I decided to take this portraiture myself (Figure 21) by simply adding time to the regular scheduled visits. This type of photo portraiture requires training and equipment. As previously mentioned, courses in the Clinical Aesthetic Series can provide the training, and the photography dealers listed previously can supply the additional gear. These portrait photographs can promote your practice and increase treatment acceptance, especially online. In a June 2017 survey by Dental Practice Marketing and Management, 84% of all dental offices in the United States have a website. If you do not have a website for your…

39. Page 66

    Anesthesia Systems Anutra Medical The Anutra Local Anesthetic Delivery System is a revolutionary way to simplify 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 (268-8722) or visit anutramedical.com. FREEinfo, Septodont Discover what Septocaine can do for your patients and you. It is consistently the No.…

40. Page 68

    Direct Composite Diastema Closure Anatomic Matrix and Placement Technique Robert A. Lawe, DDS Anterior Tooth Anatomy and Matrix Options Freehand sculpting of anterior tooth anatomy using direct composite is challenging for even the most artistic clinician. The more surface area that is lost, along with anatomic landmarks, the more difficult it is to recreate the subtleties of anterior tooth form. Rebuilding the anterior interproximal surface presents its own inherent challenges as well. The emergence profiles, which are concave below the gingival crest and convex in the gingival embrasure as the interproximal profile extends incisally toward the contact area, are extremely…

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