Dentistry Today — December 2019

Inside this issue

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

1. Page 12

   Leadership: An Awesome Responsibility This month we are showcasing professionals who are actively involved in helping others, each on their own unique path, to become the best that they can be. Please know that our 22nd Annual Leaders in Continuing Education directory is not intended to be an all-inclusive listing; there are many others worthy of appearing who are not on this short list of educators and consultants. Vince Lombardia, a Hall of Fame coach who never had a losing season and led the Green Bay Packers to a Superbowl in the 1960s said, "Leaders are made, they are not…

2. Page 16

   Dentist Anesthesiologists Receive Recognition I entered into my dental anesthesiology residency program with the full knowledge and understanding that I would not graduate as a "specialist" within dentistry. My rigorous, 3-year training program was spent in operating rooms, providing anesthesia for all types of surgical cases. At home, on the train, and in the library, I was pouring over pharmacology, physiology, and medical textbooks. I worked tirelessly to become the best anesthesia practitioner I could be so that one day I could safely provide anesthesia services for patients undergoing dental procedures. My co-residents and I worked side by side with…

3. Page 18

   What's New on CE Flash Winter Sale Buy 2, Get One Free For a limited time, dentakcetoday.com is offering a Flash Winter Sale on continuing education courses: Buy 2 courses, and get one free. To be eligible to receive the free course, you must select all 3 courses and proceed to checkout, and each course must have a value of $40.00. Then use the promo code Buy2Get1 at checkout. To take advantage and start earning CE credits now, visit dentakcetoday.com. This offer expires December 31, 2019. Greater New York Dental Meeting Video Blog Coverage The Dentistry Today film crew will…

4. Page 20

   Green Dentistry Lisa Knowles, DDS, shares how to create eco-ambiance in the dental office. Q: Why would anyone want to create eco-ambiance in a dental office? A: Let's discuss 2 main reasons. The first reason speaks to a number of people in the United States who are concerned about creating a sustainable planet. According to a report published in 2017 by the Yale Program on Climate Change Communication, the number of Americans "very worried about global warming" is at a record high. These kinds of beliefs are spurring people to alter their personal impacts on the environment. I fall into…

5. Page 22

   Minimally Invasive Dentistry: How it Applies to Endodontics — Why You Should Care How do you define the term 'minimally-invasive' as it applies to dentistry? Dr. Eric Herbranson: The term minimally-invasive, as it applies to dentistry, refers to a more conservative approach and a redesign of a given procedure to embrace the idea of conservation, which is part of the restorative-ly driven philosophy. Dr. Glen Doyon: Essentially, endodontics is a restorative driven discipline. Our job is to restore the tooth to form and function. Minimally invasive in dentistry is to remove the least amount of healthy tooth structure necessary to…

6. Page 24

   Heard It Through the Grapevine Paul Fuerstein, DMD There are many [podcasts] out there....Some are full of technical information, some are like Ted Talks, and others are just entertaining with some good dental information thrown in. One of the best (and sometimes worst) ways to learn about new technology and dental procedures is by scouring internet resources on your own website ( ) has a lot of information in both text and video formats. Some content comes directly from manufacturers, while the bulk is from clinicians. During the past year, I am in my practice. I sometimes sneak away before…

7. Page 26

   Spotlight App Enables Practices to Run Smoothly and Efficiently SAN JOSE, Calif.–Align Technology's Invisalign Photo Uploader app is designed to improve a practice's workflow and streamline the start of new Invisalign cases with the goal of saving one's practice time and money. The Invisalign Photo Uploader offers a simple and intuitive user interface to (1) quickly set up a patient record; (2) take photos with an easy-to-use, guided approach; (3) automatically load patient information and photos into the Invisalign Doctor Site; and (4) track case progress by taking photos at any treatment stage. This new digital technology can be implemented…

8. Page 28

   Spotlight Sensors Feature Multiple Technological Improvements Sterilizer Combines Efficiency With Optimal Drying Results CHARLOTTE, NC–With Schick AE, Dentsply Sirona is launching a new generation of intraoral sensors with multiple technological improvements and optimizations. The new Advanced Exposure technology combines market-leading image quality with advances in filtering enhancements and a broadened exposure spectrum, granting a solid base for safe diagnostics, even in lower x ray dose ranges. NEWBERG, Ore–The Lexa Sterilizer from Adec uses patented, steam-condensing vacuum technology to deliver bone-dry loads every time. Its universal rack design lets one load cassettes in the 11-in diameter chamber vertically or horizontally—or mix…

9. Page 30

   Spotlight Software Upgrade Provides Advanced Financial Capabilities MESA, Ariz.—DentiMax released version 2.0 of its practice management software. Available in cloud and server editions, this newest upgrade provides advanced financial capabilities, coupled with an easy-to-use clinical workflow. Dental offices expressed interest in software that streamlines the way money is collected from insurance companies and patients. After working closely with dental practices for 2 years, DentiMax has delivered software that does this exceptionally well. Now practices can spend more time attending to their patients and less time worrying about financials. For more information, call DentiMax at (800) 794-8494 or visit dentimax.com. FREEinfo,…

10. Page 31

    Dentapen: A Primer for Using the Next Generation CCLAD Robert M. Peskin, DDS Computer Controlled Local Anesthetic Delivery System (CCLAD) was first introduced for use in the dental profession in the late 1990s. When initially launched, they offered the promise of helping reduce the pain and anxiety usually associated with intraoral injections of local anesthesia. Over the past 20 years, they have provided dentistry with a deliberate and controlled administration of local anesthetic and, in doing so, it means to help reduce the potential discomfort many patients feared. Since their introduction, there have been a number of different systems developed…

11. Page 32

    Spotlight Abutment Provides Ability to Retrieve Restorations Without Cutting Them Off AMHERST, NY - Shatkin F.I.R.S.T.'s new Tru-Lok Abutments will revolutionize the way one cements crowns, bridges, and roundhouses on Shatkin F.I.R.S.T.'S O-Ball Mini Dental Implants. The patent pending Tru Lok Abutment allows the dentist the ability to retrieve these restorations without any damage to the O-Ball implant and without having to cut off the restoration. For more information, call Shatkin F.I.R.S.T. at (888) 4 SHATKIN (474-2854) or visit shatkinfirst.com. FREEinfo, System Designed to Fight Bacteria Buildup and Prevent Further Infection LOMPOC, Calif. - DenMat's Perio Restore is a non-invasive…

12. Page 34

    Spotlight Material Takes Impression to Next Level of Detail, Accuracy, and Simplicity Composite's Innovative Technology Utilizes Structural Color to Match Every Tooth Shade ENCINITAS, Calif.—OMNI-CHROMA from Tokuyama Dental America is the first universal composite that matches every patient's tooth shade from A1 to D4, with a single shade of composite. This new lutionary composite has been developed through the culmination of 35 years of research and development experience. Its innovative technology utilizes structural color to match every tooth shade. OMNI-CHROMA's 260-nm supranano spherical fillers are the precise shape and size necessary to generate red-to-yellow structural color as ambient light passes…

13. Page 35

    Class V (Cervical) Restorations That Just Blend Into the Tooth Using OMNICHROMA James H. Peyton, DDS A Class V, or "gumline" restoration is one of the most common restorations for a dentist to perform. This type of lesion is either due to trauma (abfraction or toothbrush abrasion), erosion (acid from gastric reflux), or tooth decay and sometimes there is a combination of causes. Many times, especially on anterior teeth, it would be nice to have a simple way to create an aesthetic match for the situation.1 History A 40-year-old male had decay at the gingival areas of teeth Nos. 18,…

14. Page 36

    Industry News GC Europe Earns EFQM Award The European Foundation for Quality Management (EFQM) has recognized GC Europe NV with its Global Excellence Award for 2019. This is the first time that a dental company has won the award, which is the highest recognition that any private, public, or nonprofit organization can receive, GC Europe NV says. EFQM recognized GC Europe for its culture of transparency. EFQM aims to create an environment where organizations can learn from each other to continuously improve their performance through the use of the EFQM Excellence Model. EFQM recognized GC Europe particularly for its strong…

15. Page 37

    Advertising Supplement DENTAPEN: The Next Generation CCLAD Historically, many patients have avoided visiting the dentist because of the fear and anxiety often times associated with the dental experience. While the sources of fear may include noise and vibration from dental handpieces, or the smells of drugs and/or materials utilized during treatment, one of the primary fear-provoking concerns patients have is the administration of the local anesthetic itself, which is often perceived as the primary source of concern more so than the procedural discomfort it is intended to eliminate. Robert M. Peskin, DDS Dental Anesthesiologist - Garden City, NY Dental local…

16. Page 38

    Industry News continued from page 34 professionals is taking advantage of and being empowered by our training offerings. In 2018, more than 432,000 dental professionals from 99 countries participated in the Dentsply Sirona clinical education program, which supports the implementation of innovative solutions and empowers dentists, technicians, and dental team members to improve dental care and oral health, Dentsply Sirona says. Key course topics include endodontics, implant dentistry, and restorative dentistry, according to the company. The program includes live lectures and product training as well as active learning and engagement methods, Dentsply Sirona says, including simulated patient demonstrations of procedures…

17. Page 41

    Anesthesia Systems Porter Instrument The Silhouette is a nitrous oxide nasal hood that does not obstruct access to the oral cavity. It is so lightweight, patients barely notice it. It delivers and scavenges nitrous oxide more efficiently than many other nasal hoods. It provides predictable results for the dentist and a pleasant experience for the patient. The Silhouette will revolutionize how nitrous oxide is used in the dental practice. For more information, call (215) 723-4000. FREEinfo, Septodont Discover what Septocaine can do for your patients and you. It is consistently the No. 1 branded anesthetic in the United States (data…

18. Page 42

    It's Been an Honor and a Privilege! For the past 3 years, as implant editor of Dentistry Today, I have had the honor and privilege to be a part of the editorial team in reviewing many articles and to work with wonderful and dedicated clinical authors. The Implants Today section has an incredible advisory board, consisting of some of the top implant dentists in the country; Dr. Damon Adams and I have worked with these board members (many of whom have contributed excellent content for publication over the years) and wish to thank them for their time and effort. The…

19. Page 44

    From a Removable Appliance to a Fixed Prosthesis That's Just What the Doctor Ordered! Timothy F. Kosinski, DDS Stephanie Tilley, DMD INTRODUCTION Dental implants have become a mainstream treatment modality for our patients. Many individuals with dental problems first investigate possible solutions by searching on the Internet. Searches often include "tooth aches," "missing teeth," "hate my partial," "hate my denture," "want permanent teeth," "ugly teeth," and "help my mouth!" The typical result of these searches is "dental implants." As our practical and continuing education (CE) opportunities have increased, the general dentist is now able to diagnose and treat edentulous situations…

20. Page 46

    From a Removable Appliance... continued from page 42 FIGURE 3. A precise surgical guide was fabricated by 3DNA using coDiagnostix software. FIGURE 4. Preoperative view of the edentulous space. FIGURE 5. The amount of vertical dimension of occlusion (VDO) was evaluated to ensure the final implant-related prosthesis. FIGURE 6. The nonrestorable, periodontally involved maxillary bicuspid tooth was extracted. This was facilitated by using the forces with an esthetic technique to maintain the facial anatomy and to facilitate the implant placement into the socket site. FIGURE 7. The edentulous ridge's attached gingiva was aggressively reflected to visualize the available hard-tissue contour.…

21. Page 47

    IMPLANTS 45 need to be realigned or replaced over time because of changes in the hard tissue, not because the plastic distorts it. With this resorption of bone comes a collapse of facial structures and lip support. Our modern implants are used for single-tooth replacements all the way up to full-arch reconstructions.13 It seems that permanent tooth placement is the gold standard to the public. Realistically, if we had an option, each of us would select a fixed result. There Proficiency is the result of knowing our limits and practice. are essential plans to maximize implant position to ensure aesthetics,…

22. Page 48

    Figure 17. After acceptance of the aesthetic smile design (BioZir Solid Zirconia [Glidewell Laboratories]) implant retained prosthesis was created and delivered to the dental office. Gingival shading allows for more "normal" contoured teeth. Figure 18. Occlusal view of the custom titanium abutments. Figure 19. The implant retained prosthesis was retained using a transitional cement (Improv Temporary Implant Cement [Salvin Dental Specialties]). Figure 20. The final smile design restored the patient's aesthetics and function. used to create the final osteotomy to accept the implants. We started with a smaller diameter bur and increased the osteotomy width to the predetermined depth (Figure…

23. Page 50

    Innovations in Extractions With Immediate Implant Placement Calvin Bessonet, DDS Steve Williams, DDS McLean Severson, DDS Brady Frank, DIS Recent Advances in Technique and Implant Engineering INTRODUCTION In the July 2019 issue of Dentistry Today, we explored how modern implant design and simplified drilling protocols are making implant dentistry easier for the clinician, with improved patient outcomes. We will now explore recent innovations in extraction and immediate placement clinical protocols, and how they relate to modern implant engineering and design. Research related to implant engineering has been complicated by an expanding US implant manufacturing facility. Research related to this clinical…

24. Page 52

    Figure 1a. Tooth No. 12 with deep distal caries necessitating gradient extraction techniques were used do the extraction, including rotational forces. Figure 1b. The implant was placed immediately after thoroughly converting the socket site (MorsToru [ft Biomedical]). Figure 2a. Tooth No. 14 with failing endodontic treatment requiring extraction. Figure 2b. The tooth was straumatically extracted, utilizing techniques discussed in this article. A lance drill was used to drill down the center of the septal area. Innovations in Extractions With... continued from page 48 some days, he did well over 100 extractions and more than 30 implant placements with one surgical…

25. Page 53

    IMPLANTS 51 the graft material, the implant may be placed in as few as 6 weeks or so, as opposed to months, making delayed placement seem all the more reasonable. Picking and choosing immediate placement cases based on a thorough inventory and reflection on the above variables ends up being the most prudent pathway. Taking time to reflect on these variables also helps prevent a lot of failures or less-than-desirable patient outcomes. For clinicians who have gone through the learning curve and educated themselves, however, there are many advantages to immediate placement or delayed placement. A 2016 article in the…

26. Page 54

    Simplified Implant Placement and Restoration for the GP Dr. Justin Chi, DDS, CDT INTRODUCTION An estimated 120 million people in the United States are missing at least one tooth.¹ Therefore, the need for general practitioners (GPs) who can perform standard implant procedures is growing, especially as awareness of and patient demand for implant treatment continues to grow. The high clinical success rates of implant treatment are well-documented in the scientific literature.²⁴ Single unit cases, in which a patient exhibits good general health with adequate bone in the area of implantation, are most common today and can be performed with confidence…

27. Page 56

    Figure 2. After making the initial mesial-distal incision, a full-thickness flap was reflected. Note the abundant amounts of bone axially, buccolingually, and mesial-distally. One of the reasons mandibular implant sites are ideal for distress new to implant surgery is the ease of access and visualization relative to sites located in the maxilla. Figure 3. The pilot drill was used to create the initial osteotomy, placing my ring finger on the patient's anterior teeth to establish fulcrum and stabilize drilling. Figure 4. A parallel pin was then placed in the initial osteotomy site, and a radiograph was taken to confirm proper…

28. Page 58

    Simplified Implant Placement and... continued from page 54 low, with all drills clearly marked and color-coded for ease of selection and use, according to the 3-mm x 10-mm implant Lifestyle for the case (Figure 5). With the implant on a driver, the speed of the handpiece was adjusted to a lower setting, and the device was held like a hand press. The implant was initially placed using the hand piece, followed by the use of a torque wrench to achieve the final seating (Figure 6). The aggressive threads of the implant helped achieve excellent primary stability, enabling the connection of…

29. Page 59

    Mandibular Overdentures With Enhanced Solitary Abutments Brian Jackson, DDS INTRODUCTION Oral reconstruction for the edentulous patient can be accomplished utilizing various treatment approaches. Conventional dentures, implant overdentures, fixed detachable restorations, and abutment ceramo-metal restorations are included among the alternatives.¹ Implant overdentures have demonstrated successful long-term outcomes while meeting patient expectations. Implant overdentures are recommended as the standard of care and treatment of choice for the mandibular edentulous patient.² Mandibular overdentures are soft tissue implant retained, depending on the number of implants employed. Support, stability, and retention are obtained via natural anatomy, retentive features of the prosthetic components, denture design, and…

30. Page 60

    PROSTHODONTICS mattress and an interrupted manner. A panoramic radiograph, postoperative instructions, and a soft reline of the mandibular denture completed the procedure (Figure 8). After 3 months, the healing collars were removed utilizing a 1.25 hex tool, and the gingival sulcus was measured with a periodontal probe (Figure 9). The appropriate abutments (LOCATOR R Tx Removable Attachment System [Zest Dental Solutions]) were selected and torqued (30 Ncm) into place (Figure 10). Next, 2 impression copings were placed (Figure 11). The existing denture was relieved in the area of the LOCATOR R Tx abutments and roughened in the area of the…

31. Page 62

    Mandibular Overdentures With... continued from page 58 insert coating material fabricated in Ti Carbon nitride demonstrates better wear resistance. The pink-colored anodization provides a better aesthetic appearance and prevents metal shine-through. A variety of retention inserts allows the management of prosthesis retention and customizes a patient's level of manual dexterity. The enhanced design minimizes complications and concerns about past abutments. The internal aspect of the LOCATOR legacy type has the potential to collect plaque and food debris, preventing seating of the male component. The new design contains a small internal aspect for the torque. hex aspect and lowers the potential…

32. Page 64

    Adjusting and monitoring occlusal trauma throughout the healing process CASE REPORTS Case 1 A 60-year-old female presented with peri-implantitis surrounding implants placed in the No. 8 and 9 central incisors 8 months previously. In addition, she had 2 draining fistulas on the buccal of each implant, as well as circumferential bone loss around the fixtures. Probing depths around tooth No. 8 measured 6, 6, 7 from MF and 6, 6, 6 from DL to ML probing depths on tooth No. 9 measured 6, 5, 6 and 6, 6, 6. Bleeding on probing and purulence were noted. The patient had thyroid…

33. Page 65

    over GTR as it does not necessitate a foreign membrane. With LAPIP, the blood clot is filled with regenerative cells and is sticky and stable, making it difficult to dislodge and creating a natural barrier. LAPIP provides biostimulation to the bone, and that biostimulation actively activates regenerative cells needed to regrow hard tissue that was previously lost to infection. Also, because no reflection of a vertically oriented flap is needed, the patient retains the integrity of the structure tissue, allowing for all other future treatment options, if needed. Moreover, the LAPIP protocol maintains soft tissue height, which sustains aesthetics and…

34. Page 66

    Insurgent RCT Concepts Treating Molars with Severely Curved DL Roots L. Stephen Buchanan, DDS The case in Figure 1 is a dramatic example of 3 massive changes that have occurred in the field of endodontics—rotary negotiation of virgin root canals; smaller shapes, fewer files and the irrigation reboot. Let's take a look at these changes. Rotary Negotiation of Virgin Root Canals Since the beginning of the rotary file revolution, it has been taken as gospel that handpiece-driven files are good for shaping, but only hand instruments are capable of successfully "scouting" through virgin root canals. This turns out not to…

35. Page 68

    Figure 2a. The 13-06 Traverse Rotary Negotiating File, with its tip having a 0.13 mm diameter, is smaller than nearly all small molar canal bends. It acts as a passing glide path file. In this CBCT image, the file easily went down the canal and then into the flute spaces and out of the canal. Figure 2b. Traverse Rotary Negotiating Files are the first rotary instruments designed to negotiate very curved canals without using any hand K-files beforehand. They are available in 13-06 and 15-06 sizes (21, 25, and 31 mm), with an associated 17 mm 25-06 Taper file shown.…

36. Page 69

    ENDODONTICS 67 irrigation and obturation. The corollary to this is the happy fact that young teeth have perfectly tapered canals, so the treatment plan in these cases is to push the pulp, irrigate for 40 minutes, and fill (Figure 5). The Irrigation Reboot The triad of conventional RCT has always been instrumentation, cleaning, and obturation. Advances in instrumentation and obturation procedures have been tremendous, while the development of better irrigation methods has trailed, relatively speaking. Why has this happened? 1. Sodium hypochlorite costs $5 per gallon and remains the all-time champion of RCT cleaning. After 100 years of using NaOCl…

37. Page 70

    Figure 7. A research block with proscutto captured in the replicated isthmus space between 2 primary canals. This significant challenge to the efficacy of irrigation methods showed that GentleWave multisonic irrigation is capable of digesting the lateral pulp tissue replica trapped in the replicated isthmus space in 7.5 minutes. Images (left to right) show the pulp replica in the research block at 0, 1, 3, 5, and 7.5 minutes. case, we couldn't open it up and drain the pressure if a flareup occurred. What we found was that our flareup rates went down, bringing the first golden age of single…

38. Page 80

    Intraoral Video Cameras MouthWatch The MouthWatch intraoral camera captures sharp, diagnostic quality images at an affordable price. Finally, dentists can equip every operator, document every case, and increase treatment plan acceptance. This intraoral camera is ergonomic, can be installed quickly, is easy to use, and integrates with just about all dental imaging software. Other features include single-button image capture and a fixed-focus lens that eliminates the hassle of manual focusing. In other words, everyone on the dental team can take consistent, quality images. For more information, call (877) 544-8130 or visit mouthwatch.com. FREEinfo, NDI DocPort 1o, intraoral camera, features a…

39. Page 81

    INTRAORAL VIDEO CAMERAS 79 call (800) 323-2690 or visit videodental.com. FREEinfo, DrQuickLook The DrQuickLook PDiA is a portable, 2-megapixel intraoral camera and tablet combination with preloaded, easy-to-use software that is integration-free. Save by name, then capture and review single images. In quad view, draw and save detailed intraoral or extraoral images with an S-megapixel back camera. You can transfer to any practice software or single computer with a thumb drive or over WiFi. Manage files with included clinical videos, and educate patients with optional patient education videos. It works right out of the box. For more information, call (888) 346-6153…

40. Page 86

    Zirconia for One-Day Aesthetic Treatment Dinesh Sinha, BDS, PhD, Senior Technical and Marketing Manager in the Dental Division of Kuraray America, interviews Mike Skramstad, DDS, faculty member in the CAD/CAM department of Spear Education and cerecdoctors.com. [PHOTO: Dinesh Sinha, BDS, PhD, Senior Technical and Marketing Manager, Dental Division, Kuraray America] [PHOTO: Mike Skramstad, DDS, faculty member in the CAD/CAM department of Spear Education and cerecdoctors.com] Figure 1. KATANA Zirconia Blocks (Kuraray Noritake). Figure 2. Design of a multilayer zirconia block. Q: What's your opinion on using zirconia for one-day treatment? A: The ability to manufacture same-day zirconia, first introduced in…