Dentistry Today — January 2020

Inside this issue

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1. Page 6

   Change and New Opportunities in 2020 Happy New Year! We are proud to launch our 39th year in print! In this issue, along with another great lineup of clinical articles, we bring you our 27th Annual Equipment Buyers' Guide. This section serves as an excellent resource for clinicians who are just starting out in practice or those who may be interested making some visions or updates to their dental offices. We have an important announcement related to our popular Implants Today section of Dentistry Today. Dr. Timothy F. Kosinski is taking over this month as our new Implants Today editor.…

2. Page 7

   omniCHROMA One-Shade Universal Composite Why Are Thousands of Doctors Trusting OMNICHROMA? "OMNICHROMA is GROUNDBREAKING—a win-win for all offices. No need to stock 30 composite shades that expire and take up space. So economical and it works great!" -Dr. Peter Auster "OMNICHROMA has all the features you need from handling, strength, polishability, and, most importantly, it matches all the tooth shades. This is my go-to composite from the simplest to the complex... The result speaks for itself." • Dr. Allan Mohr Case image courtesy of Dr. Peter Auster, Pomona, NY Case image courtesy of Dr. Allan Mohr, Massapequa Park, NY REQUEST…

3. Page 8

   Controversies in Coding: Provisionals and Interims Each year, the ADA, in conjunction with representatives of the benefit industry, review and revise the Code of the Dental Procedure and Nomenclature as maintained within Current Dental Terminology. The upcoming version will be effective in January 2020, at which point the committees will again continually reconsider additions as well as modifications. It is unfortunate that many see a direct correlation between procedure coding and reimbursement. The mere existence of a code does not always justify its appropriate use as coding or reimbursement mechanism. Misguided are those who teach the mantra of "code for…

4. Page 10

   VIEWPOINT continued from page 8 If the more permanent appliance is not delivered in functional occlusion within that specified time period, benefits for the permanent crown can become unavailable until the plan's exclusionary period has elapsed. In other words, the provisional administratively becomes the final for the duration of the exclusionary period stated in the contract. Conversely, temporary crowns made on the date of the final impression and indirect fabrication are actually part of delivering the final prostheses and are not identifiable by procedure code. "Interims" Interims are not provisional, but they are, and can be, temporary—sort of. By far…

5. Page 12

   Mommy Dentists in Business Grace Yum, DDS, shares how to juggle being a working mom while running a business. Q: How do you do it all and fit everything in as a working mom? A: Many women ask me how I am able to juggle my schedule with 2 kids (ages 7 and 5), treat patients 3 days per week, and also manage 3 dental practices without any partners or family members to help. I have developed the practice of only focusing on duties that I want to do or can do. I have built a tribe of people around…

6. Page 13

   ADVERTISING SUPPLEMENT PRODUCT REVIEW New Technology for Occlusion Diagnostics Every dental professional has used articulating paper for a variety of procedures. The name Bausch is synonymous with this product and process as the company has been manufacturing and supplying products for teaching about occlusion for more than 60 years. Most dentists depend on the paper to adjust simple restorations, crowns, bridges, and a variety of dental restorations as well as to equilibrate the occlusion. However, there is an art and science to being able to read the blue and red markings beyond just grinding the spots until the patient reports…

7. Page 14

   TheraCal PT BISCO Dental Products | (800) 247-3368 | bisco.com TheraCal PT+++++ (96%) Overview • 39 clinical evaluators • 560 total uses • 96% clinical rating Evaluators' Comments • "Easy application with bendable metal cannula." • "Great consistency—it flows well while adapting to surfaces...even axial walls." • "I believe it is a superior product with good clinical results." • "I already called BISCO and ordered another syringe!" • "I needed to apply a lot of pressure to express from the tip." • "Good working time and hard set after light curing." • "Tip was a little wide." Primary Indication •…

8. Page 16

   Single-Visit Solution Provides Range of Indications WOBURN, Mass.—exocad America announces new enhancements to ChairsideCAD. The new release, 2.3 Matera, will have the widest range of indications for single visit dentistry and the broadest selection of integrated open architecture devices. The software is intuitive and easy to learn, so users reliably deliver aesthetically demanding restorations in single patient sessions. ChairsideCAD (and modules) are integrated using exocad's proven and robust software platform successfully in use for more than 10 years. With ChairsideCAD 2.3 Matera, exocad intuitively expands single visit capabilities. The new features are available with 2.3 Matera, including (1) Smile Creator…

9. Page 18

   Handpieces Ensure Greater Retention Force as Bur Rotates SANJOSE, Calif.–AG Neovo Dental's brand-new Revolution series high-speed, air-driven handpieces are engineered for maximal durability and a smooth, vibration-free carving experience for all restorative treatments. These handpieces engage the spring type chuck spindle mechanism that ensures greater retention force as the bur rotates. AG Neovo also has engineered one of a kind, dual impeller designed turbine that guarantees a smooth, stable, consistent, and powerful cutting procedure. Every handpiece comes with a proprietary coating that ensures a positive tactile grip when prepping oral processes. The Revolution series includes the most popular handpieces and…

10. Page 20

    Clear Aligners Display Ability To Be Used and Removed Easily SAN JOSE, Calif.—Many clear aligner systems use off-the-shelf plastics, but only Align Technology's Invisalign system uses SmartTrack material, which is a proprietary material designed for the sole purpose of moving teeth. Backed by decades of global research, patents, and successful cases, the SmartTrack difference includes (1) greater than 75% improvement in predictability of overall tooth movement compared to off-the-shelf, single-layer, 0.03-in materials; (2) being 4 times more durable than generic materials (data on file); and (3) providing a better fit and better comfort and being easier to use and remove…

11. Page 22

    Implant Engineered to Help Provide Lifelike Aesthetics Resin Cement Sets Faster and More Completely Than Other Self-Adhesive Cements IRVINE, Calif.—The ZERA-MEX XT Implant from Glidewell Dental is the newest addition to an extensive line of implant products and services. Engineered to help clinicians provide lifelike aesthetics for cases in the anterior or with thin-tissue biotypes, this state-of-the-art, 2-piece ceramic implant continues Glidewell's tradition of providing customers with the best in ceramic restorations and implants to maximize patient satisfaction in the ever-expanding field of dentistry. The ZERAMEX XT Implant includes an innovative, platform-switched internal connection that supports an expanded range of…

12. Page 24

    Partial Eliminates Side Effects Associated With Monomer-Containing Acrylic LAKE CITY, Fla.–Many patients who need a partial denture complain about the unsightly metal clasps on anterior teeth. Give patients the best of both worlds with a combination partial from Sunset Dental Lab. You will have the strength of a cast metal framework, and the patient will enjoy the virtually invisible clasping provided with the EverFlex nylon material for the saddles and clasps. Aside from the outstanding aesthetic results, patients will not experience any of the side effects of monomer containing acrylic used in conventional partials. For more information, call Sunset Dental…

13. Page 26

    Industry News Kosinski Joins Dentistry Today Staff as Implants Editor Dentistry Today would like to welcome Timothy F. Kosinski, DDS, to its staff as our Implants Editor. A Dentistry Today Leader in Continuing Education, he is an affiliated adjunct clinical professor at the University of Detroit Mercy School of Dentistry. He also leads Smile Creation of Bingham Farms, a private practice located in Michigan. Kosinski received his DDS degree from the University of Detroit Mercy School of Dentistry and his mastership in biochemistry from the Wayne State University School of Medicine. He is a Diplomat of the American Board of…

14. Page 28

    Cancer Detection... continued from page 26 developed to improve early detection and outcomes," said co-lead investigator Tony Yin Huang, PhD, of the Duke University Department of Mechanical Engineering and Materials Science. "Considering these factors, the successful detection of HPV from salivary exosomes isolated by our acoustofluidic platform offers distinct advantages, including early detection, risk assessment, and screening," said Huang, adding that this technique also may help physicians predict which patients will respond well to radiation therapy or achieve longer progression-free survival. Exosomes are tiny microvesicles originating within cells that are secreted into body fluids, and their numbers are elevated in…

15. Page 34

    27th Annual EQUIPMENT BUYERS' GUIDE 3-D PRINTERS Planmeca USA | The Creo C5 (630) 529-2300 | planmeca.com FREEinfo, VOCO America The SolFlex 170 3-D printer offers complete the highest quality splints, surgical guides, full-arch models, and more, printed in-house with unique innovations. Its patented Flex-Vat is designed to bend, significantly reducing peeling forces. The optional Sensor Monitored Production measures peeling forces to optimize print speeds, minimize print failures, and reduce print times by up to 40%. For more information, call (888) 658-2584 or visit vocoamerica.com. FREEinfo, VOCO America The SolFlex 350 3-D printer offers the same high-quality production as VOCO's…

16. Page 36

    36 27TH ANNUAL EQUIPMENT BUYERS' GUIDE Use New Personalized FREEinfo Card on pg. 1 [Image of Inoclar Vivadent Silamat S6 mixing device] [Image of dental tubing/equipment] [Image of CofferCor system with color display] and auto-off. The user is notified when an endodontic file reaches the apical foramen by the virtual apex function. For more information, call (800) 231-3046 or visit coffercore.com. FREEinfo, Inoclar Vivadent Silamat S6 is a modern universal mixing device for amalgam, glass-ionomer cements, and other predosed dental materials in capsules and injection capsules. Patented and time-tested Silamat technology features the special figure-8 mixing pattern. Its above-average rotation…

17. Page 37

    Use New Personalized FREEinfo Card on pg. 1 27th ANNUAL EQUIPMENT BUYERS' GUIDE 37 feedback; and (3) fully automatic, multifrequency measurements. Because of its compact design and small footprint, FIND easily fits on any counter or treatment tray. For more information, call (800) 552-5512 or visit ultradent.com. FREEinfo, both arches for hands-free whitening to achieve noticeably whiter teeth in 30 minutes or less. The Sapphire Plus allows for some of the best dentist-assisted whitening and is proven to whiten teeth up to 86% more than just whitening gel alone. For more information, call (800) 433-6628 or visit denmat.com. FREEinfo, BLEACHING…

18. Page 38

    38 27th ANNUAL EQUIPMENT BUYERS' GUIDE Use New Personalized FREEinfo Card on pg. 1 Dentsply Sirona Preventive | Captivate by Nupro Tooth Whitening System (844) 848-0137 FREEinfo, LumaLite | LumaCool Whitening System (619) 660-5410 | luma-lite.com FREEinfo, Vista Dental Products | Fluorescent (877) 814-1872 | vistadental.com FREEinfo, CABINETS A-dec Inspire offers swing-out shelves; rotating work surfaces; and a telescoping, gliding monitor mount that brings everything within reach. Integrated LED dental lights; the light color matches A-dec LED dental lights. Every detail, inside and out, is well-planned, placed, and tested to ensure productivity and longevity. For more information, visit a-dec-inspire.com. FREEinfo,…

19. Page 42

    27th ANNUAL EQUIPMENT BUYERS' GUIDE continued from page 40 SurgiTel | SurgiCam HD (800) 959-0153 | surgitel.com FREEinfo, Video Dental Concepts Quick-CamDO Alpha is the newest generation of the DUO model, which offers 2 cameras in one very sleek handpiece. The Alpha model includes a caries detection mode. The DUO Alpha allows one to take quick, full-face arch or quadrant shots, as well as single-tooth and macro still photos, from the same handpiece. For more information, call (800) 323-2690 or visit the website videodental.com. FREEinfo, XDR Radiology The HD1600 Intraoral Camera is a true plug-and-play camera with an ergonomic metal…

20. Page 44

    continued from page 42 Midmark | Elegance Chair (800) MIDMARK (643-6275) | midmark.com FREEinfo, Ritter Dental USA The exciting, new, German-engineered Vanguard Dental Unit combines the technology of electronics with the smooth movements of hydraulics. Ritter's latest and most advanced chair. It has a left/right version with all the quality and features that you have come to expect from Ritter. For more information, call (855) 807-8111 or visit ritterdentalusa.com. FREEinfo, Summit Dental Systems | 6700M Marathon Chair (800) 275-3368 | summitdental.com FREEinfo, CURING LIGHTS AMD LASERS | Monet (866) 999-2635 | amdlasers.com FREEinfo, B&L Biotech USA The small head of…

21. Page 45

    Use New Personalized FREEinfo Card on pg. 1 27th ANNUAL EQUIPMENT BUYERS' GUIDE 45 ond cure, and a 20-second cure. It has 2 selectable intensity settings and a lens that can be removed easily for effortless replacement. For more information, call (800) 243-7446 or visit parkell.com. FREEinfo, SDI (North America) | LED Radii Plus Light (800) 228-5166 FREEinfo, Spring Health Products The TC-3 LED curing light comes with a wider lens. composites. For more information, call (800) 699-7220 or visit steri-shield.com. FREEinfo, Ultradent Products The VALO Grand light uses a custom, multiwavelength light-emitting diode (LED) for VOCO America Celatlux 3…

22. Page 52

    52 27th ANNUAL EQUIPMENT BUYERS' GUIDE Use New Personalized FREEinfo Card on pg. 1 DentalEZ | StarDental Solara QT (866) DTE-INFO FREEinfo, Dentsply Sirona | T2 and T3 (800) 659-5977 | sironausa.com FREEinfo, Essential Dental Systems The Endo-Express Reciprocating Handpiece has revolutionized endodontics. Dentists can get excellent results quickly and easily by using engine-driven reciprocal strokes. Designed to be used with SaliSliders relieved reamers, the competitively priced Endo-Express creates an environment in which dentists can get clinically superior results without fear of breaking instruments. For more information, call (800) 22-FLEXI or visit edsdentalcom. FREEinfo, J. Morita USA | Air Torx…

23. Page 54

    54 27th ANNUAL EQUIPMENT BUYERS' GUIDE Use New Personalized FREEinfo Card on pg. 1 continued from page 52 Medidenta | BA Electric.eps (800) 221-0750 | medidenta.com FREEinfo, NSK Dental The NSK nano series of handpieces might be small, but the handpieces might to offer. They are more than 10% smaller than conventional models and are delicate and precise while in use. The smaller, slimmer, and lighter nature of the handpieces make them ideal for any clinician. The handpieces have a durable titanium body with ceramic bearings. For more information, call (888) 675-1675 or visit nsk-dental.us. FREEinfo, HANDPIECES (HIGH-SPEED) A-deciW&H These…

24. Page 56

    56 27th ANNUAL EQUIPMENT BUYERS' GUIDE Use New Personalized FREEinfo Card on pg. 1 BrandMax BrandMax Tri-Clean Ultrasonic Cleaners deliver the next generation of cleaning power. With the superior power, free heating elements, and free stainless steel baskets, these ultrasonic cleaners can produce sharper instruments, prolong instrument life, and improve infection prevention. All BrandMax Ultrasonic Cleaners include stainless steel construction, a 12- or 24-month warranty, and product support. For more information, call toll-free at (844) 874-2532 or visit brandmax.us. FREEinfo, COLTENE BioSonic UC300 has a large 3-gal tank capacity and unmatched flexibility with multiple basket/beaker arrangements. The ample space can…

25. Page 58

    58 27th ANNUAL EQUIPMENT BUYERS' GUIDE Use New Personalized FREEinfo Card on pg. 1 LOUPES (FRONT LENS-MOUNTED) DenMat The PeriOptix Flip-Up-style loupes allow the flexibility to flip the loupes out of the field of view and share with others in the practice. These loupes feature patented OptiClick and dual-pivot convergence technology that allows them to be easily adjusted and removes the annoyance of the loupes becoming misaligned. For more information, call (800) 433-6628 or visit denmat.com. FREEinfo, DentiLight The iZoom Flip-up is a lightweight, high-performance loupe. The custom, sports-style frame uses advanced TR90 thermostatic material that is incredibly durable, flexible,…

26. Page 59

    Use New Personalized FREEinfo Card on pg. 1 27th ANNUAL EQUIPMENT BUYERS' GUIDE 59 60 frames per second with one of the fastest image processing systems available. For more information, call (800) 898-2282 or visit seilermicro.com. FREEinfo, OBTURATION SYSTEMS B&L Biotech USA Beta Mini Cordless Obturation device is designed for warm gutta-percha techniques. It provides simplicity, durability, ease of use, and comfort in a cordless, compact injectable obturation gun. It is designed for an effortless squeeze of gutta-percha while being lightweight and ergonomic for all users. For more information, call (844) 265-2460 or visit bnlbio.com. FREEinfo, Brasseler USA | EndoPro270…

27. Page 60

    The CanalPro Syringe Station is a simple and convenient way to fill syringes with liquid solutions with no mess and no waste. It features a syringe-activated valve for quick, drip-free syringe filling and a level sensor that illuminates when the bottle is empty. Several units may be connected to create a convenient station for filling multiple solutions. For more information, call toll-free at (800) 221-3046 or visit coltene.com. FREEinfo, Medidenta | M-Endo Irrigator (800) 221-0750 | medidenta.com FREEinfo, Meta Biomed | EQS (267) 282-5893 | metabiomeramericas.com FREEinfo, Prophy Magic | Magic Tips (866) 544-MAGIC | prophymagic.com FREEinfo, Vista Dental Products…

28. Page 61

    Use New Personalized FREEinfo Card on pg. 1 27th ANNUAL EQUIPMENT BUYERS' GUIDE 61 patient's pain threshold. The result is an accurate reading that can be relied upon while keeping the patient comfortable. For more information, call (800) 243-7446 or visit parkell.com. FREEinfo, or ear. For more information, call (800) 763-6901 or visit dentlight.com. FREEinfo, Designs for Vision The LED DayLite Wireless Mini HDi clips onto your loupes and utilizes an exclusive, advanced photonic design to produce 40% more light over an even spot. Weighing only 1 oz., SHADE-MATCHING SYSTEMS Ardent The Fire-Lite 2 HiCRI uses 3-color light temperatures to…

29. Page 64

    Interdisciplinary Endodontics INTRODUCTION Endodontically treated teeth can be the weakest link in the aesthetic/restorative diagnosis and treatment plan. They can also be the missing link between success and failure of the interdisciplinary treatment plan. In this, the second decade of the 21st century, we are born out of the humblest biologic stance: When the cause of a disease is removed, the disease itself disappears. The former disease cannot produce continued pathology because, quite simply, it is gone.¹ And not only is the disease gone, but the results of the disease are no longer sustainable without the use. It is this…

30. Page 67

    ENDODONTICS ...endodontic techniques can be mastered by any dentist who wants to learn endodontic skills.... endodontic retreatment of tooth No. 8, and nonsurgical endodontic treatment of tooth No. 16. The bridge would be permanently cemented after evidence of sinus tract healing (Figure 1). Case 2 The patient had previously experienced multiple accidents to her maxillary anterior teeth and presented with a sinus tract in tooth No. 8. Biologic Considerations: Nonsurgical or surgical endodontic treatment more predictable given that a lateral PRF could not only be lateral but also toward the palatal, making it surgically inaccessible for preparation and obturation? The…

31. Page 68

    Wow! What an Honor! It is a tremendous honor for me that the publishers and editorial staff of Implants Today asked me to take the helm of Implants Today! My training in implant dentistry began in 1984 during my residency at Miami Valley Hospital in Dayton, Ohio. Therefore, I began placing our modern endosseous implants soon after their introduction to the profession. I did start out in my career with subperiosteal implants and blade implants though, but quickly evolved to using the IMZ system followed by becoming a key opinion leader with several of the prominent implant companies. I often…

32. Page 70

    Full-Arch Implant Surgical and Restorative Considerations Innovative Digital Workflow Using a Verification Jig With Teeth If a patient presents with a failing dentition, there are several different treatment options available when a fixed prosthetic result supported by dental implants is contemplated. This could include extraction and bone grafting, allowing the ridge to heal before implants are placed, or extractions and immediate implant placement with concurrent bone grafting to fill any voids in the remaining bony architecture. These 2 examples would usually leave the patient with a removable, complete denture during the healing phase prior to loading of the implants for…

33. Page 72

    Full-Arch Implant Surgical and... continued from page 70 were placed on each implant based upon the tissue height and to redirect the screw access hole correctly within the envelope of the restoration. Titanium sleeves were then attached to each implant, and the Carrier Guide was used to accurately position the transitional prosthesis that could be secured to the implant sleeves with dual cure composite material (Stellar DC [TAUB Products]) (Figure 6). The process was repeated for the mandibular arch. The post-op panoramic radiograph reveals an excellent surgical result for both arches after the placement of 13 implants (Figure 7). The…

34. Page 74

    Full-Arch Implant Surgical and... continued from page 72 tual tooth setup based on standard triangulation language (STL) digital files that mimic the simulation. During the planning phase, the implants were positioned based upon the merging of intraoral scans or digitized stone cases in combination with the transitional prosthesis design exported as an STL implant and tooth planning phase rendered a ideal set-upSTL file based on the simulated smile design and stored in the computer until the final restorative phase began. The new STL files of surgical/prosthetic/intraoral scans were merged with the original tooth setup. The new jIJG was then fabricated…

35. Page 75

    Three Great Choices for your Composite Restorations extraordiny and merged with the opposing arch and bite scans as previously described (Figure 19). The introduction of the soft tissue aids in the design of the prototype ijlG in establishing the material-to-ridge relationship of the final prosthetic tooth position, tissue contours, cantilevers, etc. The ijlG and resin try-in phase provide the clinician with essential information to deliver a more accurate and predictable final restoration. The sixth generation requires the previously described seating procedures. The information was again introduced into the CAD/CAM software (gShape) to complete the design of the final prosthesis, taking…

36. Page 76

    IMPLANTS soft-tissue maturation surrounding the multi-unit, screw-retaining abutments. Conventional analog prosthetic protocols have required intraoral impressions that capture the implant abutments within a stone master cast to be mounted on an articulator at the proper vertical and centric relation position. The dental laboratory technician was then tasked to create a wax-up with denture teeth to confirm the bite, lip support, phonetics, and aesthetics. From this analog protocol, a screw retained, definitive restoration was completed. It was not until digital workflow and advanced CAD/CAM software that allowed for digitization of the analog setup to create a virtual design and resultant STL…

37. Page 77

    Maxillary Osteotomy Implant Site Preparation A Less Traumatic and Safer Approach INTRODUCTION Bone quality plays a factor with initial implant stability in immediate or delayed approaches. Implant placement in the maxilla frequently requires some site manipulation to accommodate the implant. Bone width deficit can be due to resorption in the buccal-lingual direction related to either periodontal issues with a tooth or at time immediate placement is planned or following healing of a prior extraction site. Bone quality can be lower density is typical of the maxilla and is usually D3 or D4 in nature. Bone density on standard radiographs is…

38. Page 78

    Figure 3. (a) VGO handle and crossbar (b) with crossbar held magnetically (c) to allow rotational torque with the threaded tip in the handle's chuck. Figure 4. The offset, non-threaded VGO tips are available for posterior applications. Figure 5. A precision pilot tip (top) and an immediate implant placement marker tip (bottom) is utilized before site initiation to create a purchase point for the pilot drill. Implant placement in the maxilla frequently requires some site manipulation to accommodate the implant. bone found in the maxilla.4-5 The use of osteotomes to improve bone quality at implant sites has been reported over…

39. Page 79

    IMPLANTS 79 FIGURE 10. The No. 1 anterior VGO osteotome was utilized in the incisal space to expand the root geometry to accommodate implant placement. FIGURE 11. Site preparation continued with the No. 3 anterior VGO osteotome, engaging the No. 2 osteotome. FIGURE 12. Site preparation was completed with the No. 4 anterior VGO osteotome. FIGURE 13. The implant was placed into the osteotomy using a surgical handpiece, engaging the implant driver. non-threaded, and offset, with depth marks at 5, 8, 10, 13, and 16 mm (Figure 4). These are designed for posterior use when straight line access is not…

40. Page 80

    Figure 14. The implant was then placed into the lingual root space that had been enlarged using the internal VGO osteotomes to preserve bone and improve osseous density. Figure 15. The buccal root space was filled with graft material, which was then condensed into any voids from the extraction. Figure 16. As the site cannot be closed by primary closure, a piece of non-resorbable membrane was placed under minimally elevated flap margins to cover the implant and graft material. Figure 17. Sutures were placed to secure the membrane. eter of the generic pilot drill the surgeon has used. To attain…

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