Dentistry Today — June 2011

Inside this issue

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1. Page 8

   Continuing Education: For the Right Reasons Having just returned recently from presenting an all-day lecture for the Pennsylvania AGD, it was pleasantly reminded how wonderful it is to present for a group of doctors who are actively involved in making quality continuing education (CE) experiences and maintaining meaningful colleague relationships the focus of their professional development. At tending meetings for the right reasons (not just to meet some minimum state board requirement) really ought to be with others become ideals that are truly admirable within our dental community. Since the team at Dentistry Today shares the same ideals and high…

2. Page 10

   VIEWPOINT "Performance-Enhancing Oral Appliances": Fact or Fiction? Can an intraoral occlusion-altering appliance that also repositions the condyles truly enhance the physical ability of an individual, or is it a placebo effect? Further, can the placement of such a device be successfully positioned without the aid of extensive radiologic and/or neuromuscular evaluation? In my experience, I have observed that these things can be accomplished. Throughout history, the use of some form of mandibular repositioning device has been employed by those wishing to increase their ability to withstand certain physical stresses. Biting on a leather strap or an object of wood during…

3. Page 12

   continued from page 10 Every one of the appliances of that time, both upper and lower, were created and worn by myself at one time or another. Some were fixed appliances while others were removable, and all were worn with the expectation of relief. It was determined that the ideal lower-appliance would be the ideal solution, since total function could be expected. The accepted techniques at that time were utilized to determine the condylar position which was creating the pressure in the TMJ. First, centric relation (CR) and centric occlusion were determined using electromyography in 3 sessions (lasting for as…

4. Page 16

   From the March 2011 Issue NANO-OPTIMIZED COMPOSITE Ivoclar Vivadent Tetric EcoCeram is a clinically proven nano-optimized composite that features improvements, such as extended working time under ambient light, combined with finer curing times, new shades with enhanced shade-matching qualities, and improved handling properties. It reduces the application time necessary for completing direct composite restorations. For more information, call (800) 533-6825 in the United States and (800) 263-8182 in Canada. FREEinfo, IMPRESSION TRAY DENTSPLY Raintree Tuff Lock Disposable Impression Trays feature a unique mechanical locking system that eliminates the need for spray adhesives. High sides provide excellent margin and gingival detail.…

5. Page 18

   Polymerization on Demand: Ivoclar Vivadent's Tetric EvoCeram Jason Oliskp, DDS, AACAD A common cause of restorative failure when placing composite restorations, ambient light in the dental examination room initiates premature curing of composite materials during final contouring. Resulting in less predictable restorations, solutions have been limited to materials that effectively slow the polymerization process. However, these materials also increase curing time, making restorations more time consuming and costly. To solve the aforementioned issues, Tetric EvoCeram (Ivoclar Vivadent, Amherst, NY) universal nanohybrid composite has been developed to provide dentists with the ability to control curing in every situation. Featuring Polymerization on…

6. Page 20

   Impression Materials George Freedman, DDS The process of taking impressions is simply to transfer polyvinyl siloxane data from the patient's mouth to the stone model—as accurately as possible and as comfortably as possible. The greater the transfer accuracy, the better the crown or bridge will fit, and the less time needed for chairside adjustment. This is not a major clinical concern until the practitioner realizes that chairside time costs $6 to $8 per minute. As a major complicating factor, the mouth is a very wet environment. The laboratory bench, however, is a very dry environment. The impression material must be…

7. Page 22

   Ivoclar Vivadent Virtual impression materials combine the most desirable attributes of vinyl polysiloxane materials into one system. Available in fast and regular setting times, the system features 3 viscosities of wash material (x-light body, light body, and medium-body), 3 body viscosities of tray material (heavy body), putty, and a monophase material. The putty phase and heavy body materials are available in 50- and 380-ml cartridges. For more information, call (800) 533-8183 in Canada, or visit ivoclardental.com. FREEinfo, 3M ESPE Impregun Soft Polyether impression material provides polyether benefits and convenient vinyl polysiloxane dispensing style, allowing for use and multiple operations. Its…

8. Page 24

   Heraeus Kulzer Flexitime is the vinyl polysiloxane material that consistently provides precise detail for an accurate impression fit. It offers superior hydrophilicity on a polyether level for excellent performance in moist environments. Additionally, its exceptional roughness prevents tears and distortion upon removal. Even in the most adverse conditions, it offers reliable impressions. Also, fast-setting Flexitime Xtreme is perfectly suited to your more common single-unit impressions. For more information, call (877) 258-5937 or visit heraeus-flexitime.com. FREEinfo, Glidewell Direct The Capture Impression System is an ultrahydrophilic vinyl polysiloxane formulation. It is available in 7 viscosities and 3 oral set times for crown…

9. Page 25

   Discus Dental Precision is a premium vinyl polysiloxane impression material with amazing detail reproduction, making it the material for the most discerning clinicians. Its revolutionary formula displaces moisture better than other VPS materials, creating detailed margins in even the most challenging situations. You can make perfectly fitting crowns with one impression. Precision's flexible working time offers a completely set impression within 2 minutes and 45 seconds to 345. For more information, call (800) 423-9448. FREEinfo, Splash is the impression material for the clinician who demands reliability and value in a vinyl polysiloxane impression material. It features excellent flow properties, exceptional…

10. Page 26

    Spotlight Companies Combine Technologies to Transform Digital Dentistry SAN JOSE, Calif.-What happens when virtual modeling technology combines with advanced digital optics and wireless scanning? Digital transformation. Together, Align Technology and Cadent deliver compatibility between Invisalign and iTero intraoral scanning, enabling comprehensive restorative, implant, and orthodontic treatment. The only all-in-one intraoral scanning solution that can be used for all types of restorations, iTero also gives doctors flexibility and choice. An open architecture allows seamless integration with dental labs and other service providers. Scans are sent directly, saving time and eliminating the cost and effort of vinyl polysiloxane impressions. With powerful digital…

11. Page 27

    TAKE ANOTHER LOOK AT THE TREATMENT YOU CAN BARELY SEE Learn why it's the right time to grow your practice with Invisalign. 93% satisfaction with Invisalign investment! Expanding your practice has never been easier or more affordable with Invisalign. Its popularity continues to rise, and with such enthusiastic patients and ever better clinical results, why not see how Invisalign could grow your dental practice? It's time to take a closer look: • 1.4 million patients have already chosen Invisalign • 9 out of 10 patients would recommend it to their friends and family • 93% of Invisalign patients are satisfied…

12. Page 28

    Cart Allows Any Workspace to Become a Fully Functional Dental Operatory in a Matter of Seconds WOODINVILLE, Wash.-Aseptico's AMC-20 Self-Contained Mobile Dental Delivery Cart allows any workspace to become a fully functional dental operatory in a matter of seconds. Included among its features are the following: self-contained air, water, and vacuum systems that eliminate the need for on-site plumbing or utility room; automatic liquid waste purge and a handpiece flush system for improved infection control on an ample countertop work surface; large casters for easy mobility between operatories or within the facility; and movable holder arms that enable convenient positioning…

13. Page 30

    Digital Sensor Holder Designed to Ensure Placement Accuracy and Patient Comfort NEW MILFORD, Conn.-The key feature of TrollDental's TrollByte Kimera, its third-generation sensor holder, is the use of 2 different high-grade polymers, joined together in a single holder, that result in a one-piece holder with a stiff arm and a softer, adjustable claw. The stiff arm ensures accuracy of sensor placement in the patient's mouth, while the softer claw has very smooth edges for patient comfort. A TrollByte Kimera kit includes 3 different holders, a bite block for anterior PAs, and one aiming ring, which is color-coded to match the…

14. Page 33

    QUICK TECHNIQUE 3M ESPE's Impregum and Imprint 3 Intraoral Syringes Precise Wash Application With Less Material Waste Syringing wash material from a traditional hand cartridge can be frustrating and imprecise. The size of the cartridge makes it difficult to maneuver and can block the dentist's view of prep. Additionally, a significant amount of material is wasted with a traditional hand dispenser tip. To make it easier for dentists, 3M ESPE introduces Impregum and Imprint 3 Intraoral Syringes. These simplified, single-use syringes make it easier to access hard to reach areas of the mouth, letting dentists apply their preferred choice of…

15. Page 34

    Spotlight Versatile Bonding Agent Hailed as the "Complete Adhesive Tool Kit" SOUTH JORDAN, Utah- Hailed as the "complete adhesive tool kit," Ultradent's Peak Universal Bond, a light-cure resin system with chlorhexidine (0.2%) offers unmatched versatility, providing the ability to bond to dentin, enamel, porcelain, metal, composite, and zirconia. It's the only light-cure adhesive that contains chlorhexidine, which helps ensure long-term bond strengths. Peak Universal Bond is the ideal agent for indirect and direct bonding as well as post and core procedures, working equally well with selfand total-etch techniques. With such versatility, there's no need for multiple agents to complete either…

16. Page 36

    Universal Nanohybrid Composite Described as Being the Most Tooth-Like Composite Ever Developed BRIARCLIFF MANOR, NY-VOCO's GrandioSO, a substrate-optimized universal nanohybrid composite, offers a unique combination of superior handling, aesthetics, and physical properties that make it the most tooth-like composite ever developed. GrandioSO achieves a remarkably low shrinkage rate of 1.6% through its innovative nanotechnology. In composite materials, polymerization shrinkage occurs only in the resin matrix. Therefore, the greater the percentage of filler particles, the more shrinkage is reduced. The best that most universal restoratives can achieve is in the range of 77% to 86% filler particles. GrandioSO uses silicon dioxide…

17. Page 37

    Bite Registration Material's Accuracy Cited SAN RAMON, Calif.-Affordably priced, AlphaBite is a bite registration material made with the highest quality fillers and silicones. Highly stable and accurate, it has a working time 30 seconds and a total set time 90 seconds. It is offered in a sky blue color in 50-mL cartridges in 2-pack and 4-pack configurations. For more information, call Danville Engineering at (800) 827-7940 or visit danvillematrials.com. FREEinfo, Upper Root Tip Extraction System Introduced DETROIT-Golden Dental Solutions (formerly GOLDEN MISCH), inventors of the Physics Forceps, introduce the GMX 69 Upper Root Tip Extraction System, designed to atraumatically extract…

18. Page 38

    Color Pastes Designed to Recreate the Internal Effects and Characteristics of Natural Teeth SAN MARCOS, Calif.-Shofu Dental Corp's LITE ART Light Curing Coloring Pastes are designed to recreate the internal effects and characteristics of natural teeth. With a newly developed multifunctional monomer dispersion technology, LITE ART shows excellent surface-curing qualities. A LITE ART set includes one-mL syringes in 15 different colors, one 6-mL bottle of Clear Liquid, a Uni Brush No. 5 that includes one handle and 10 brushes, one color card, and both a 15-piece nozzle tip and nozzle cap set. LITE ART Color Paste shades are matched perfectly…

19. Page 40

    All-in-One Luting Cement Now Available in Syringe Version BENSENVILLE, ILL-SDI's seT PP, the syringe version of seT, SDI's radiopaque encapsulated, all-in-one luting cement, etches, bonds, and fills with just one component. Containing ionglass, it has been specifically designed to release a consistently high dose of fluoride over a prolonged period of time, and it minimizes postoperative sensitivity since it does not require separate etching and washing. seT PP is a dual-cure system. The material hardens in 5 minutes by itself or in just 20 seconds with the aid of a curing light. For more information, call SDI at (800) 228-5166…

20. Page 42

    Self-Adhesive Resin Cement Now Offered in Clicker Dispenser ST. PAUL, Minn–3M ESPE announces the launch of RelyX Unicem 2 Self-Adhesive Resin Cement in the popular Clicker Dispenser. Building upon the long-term success of its predecessor, RelyX Unicem Self-Adhesive Resin Cement, this next-generation system combines convenience and easier mixing with reliable clinical performance and enhanced bond strength. In addition, the cement offers well-balanced mechanical properties and long-lasting aesthetics. As with the original, the new formula offers virtually no postoperative sensitivity. The Clicker Dispenser was first made popular with the original RelyX Unicem cement. Its advantages include its consistent mixing ratio, its…

21. Page 43

    Combination Wedge/Guard Removes Risk of Damaging Adjacent Teeth and Papilla LOS ALAMITOS, Calif.-It takes concentration to cut an interproximal cavity, which can slow clinicians down. But with Trident's WedgeGuard, there's no need to slow down. premia, ensuring a cleaner, blood-free working area. Ideal for Class II and III cavities, veneers and crowns, and tunnel preps, WedgeGuard comes in 3 sizes: small (white), medium (pink), and large (purple). For more information, call Trident at (800) 811-3949 or visit wedgeguard.com. FREEinfo, Implant overdentures and milled titanium understructures with all-inclusive pricing! Locator CAD/CAM Milled Bar Overdenture NEW Starting at $2,995* complete even when…

22. Page 44

    QUICK TECHNIQUE BISCO'S ACE ALL-BOND TE: The Only Single-Step/Dual-Cure Adhesive in Dentistry Douglas J Brown, DDS, FAGD, senior manager, clinical affairs, BISCO; Ross Nash, DDS, FAGD, director of Dentistry of the Carolinas; Daniel Matérdomini, daVinci Studios, West Hills, Calif. Dual-handle adhesives (adhesives) have been rapidly evolving since the 1950s. It is now firmly regarded that the need for both total-etch, "etch-and-rinse" (fourth and fifth generations) and self-etch, "etch-and-dry" (sixth and seventh generations) are required for effective patient care. Enamel bonding is best accomplished with total-etch, whereas deep dentin sealing is effectively accomplished with self-etch technologies.1-3 The challenge to manufacturers has…

23. Page 46

    NEWS/TRENDS Industry News Morton Charleston, 1916-2011 Morton Charleston, chairman emeritus of Premier Dental, passed away this past April 4 at the age of 95. Mr. Charleston's gentle and fair management style earned him the respect of employees, suppliers, and competitors alike. Ever grateful for life, he exuded a warm positive glow toward all humanity. Mr. Charleston was active in 2 synagogues in Philadelphia and Florida, held leadership roles in many charitable campaigns, and contributed generously to dental education in the United States and Israel. He was everyone's kibitz statesman. Known affectionately as "Mr. M," Mr. Charleston became Premier's chairman emeritus…

24. Page 48

    Meetings/Seminars NEWS/TRENDS Implant Prosthetic Symposium Returns to Chicago in August ADA Joins Online Resource to Increase Public Knowledge About Dental Health The International Congress of Oral Implantologists (ICOI) welcomes dentists for its 14th Annual Implant Prosthetic Summer Symposium, scheduled for August 18 to August 20. This meeting promises to offer both educational enrichment through high caliber podium presentations, table clinics and poster sessions, preconference courses, and social opportunities. Dr. Scott Ganz, program chair, has arranged the scientific program to highlight the restorative aspects of implant dentistry, with a focus on expanding technologies that enhance our daily practice for the GP,…

25. Page 50

    Industry News continued from page 46 Coltène/Whaledent Announces Formation of Endodontic Business Unit Coltène/Whaledent, which has a long history of manufacturing and selling endodontic products under the Rooko, Hygenic, and Whaledent brands, announced recently that it will align the brands under new business unit—COLTÈNE ENDO. According to Coltène/Whaledent, this merger of brands will enable the Coltène/Whaledent team to focus on the endodontic field, thereby enhancing customer service and expediting innovation forces. EXACTA Dental Direct Working With Sulzer Mixpac to Combat Product Counterfeiting EXACTA Dental Direct has been a distributor of high-quality mixing tips manufactured by Sulzer Mixpac, in Switzerland for…

26. Page 52

    Significant Advance in Tissue Repair: Nanofiber Spheres Used to Grow Tissue For the first time, scientists have made star-shaped, biodegradable polymers that can self-assemble into hollow nanofiber spheres, and when the spheres are injected with cells into wounds, these spheres biodegrade, but the cells live on to form new tissue. Developing this nanofiber sphere as a cell carrier that simulates the natural growing environment of the cell is a very significant advance in tissue repair, says Peter Ma, PhD, M.A, professor at the University of Michigan (U-M) School of Dentistry and the lead author of a paper about the research…

27. Page 53

    Pharmaceutical Solutions Dental pain can make anyone edgy With Articadent® DENTAL, everyone can sit back and relax NEW EVERYDAY $36.99 MSRP LOW Price! 4% Articadent® DENTAL (articaine HCl 4% with epinephrine 1:100,000 injection) The confident choice for comfort Articadent® is indicated for local, infiltrative, or conductive anesthesia in both simple and complex dental procedures. Articadent® with epinephrine 1:100,000 is preferred during operative or surgical procedures when improved visualization of the surgical field is desirable. Reactions to Articadent® (pain and headache, for example, or convulsions or respiratory arrest following accidental intravascular injection) are characteristic of those associated with other amide-type local…

28. Page 54

    How People View Faces With a Cleft Lip and Palate The impact of physical attractiveness on social communication is a truth universally acknowledged. It is no surprise that individuals with a cleft lip and palate have experienced social isolation and poor self-esteem. Yet, how people really see faces affected by this anomaly has not been studied. Researchers are now seeking a more scientific evaluation of how people look at faces with a cleft lip and palate through the use of an eye-tracking camera. The Cleft Palate-Craniofacial Journal (March 2017) reports the findings of a study that analyzed eye movements while…

29. Page 55

    New Fiber-Reinforced Composite Material for Oral Implants New materials and new technologies offer opportunities to bring implant dentistry to more patients. Fiber-reinforced composite is a new material that promises advantages for use in oral and craniofacial applications as well as in orthopedics. Discovering how it responds to stress and strain can help gauge its usefulness. As part of a special issue of the Journal of Oral Implantology focusing on anticipated advances in oral surgery, a new study compares fiber-reinforced composite and titanium implants. Researchers analyzed how the 2 materials affect stress and strain on the implant and the bone tissue…

30. Page 56

    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. Xeno IV DENTSPLY Caulk Bonding agents must be effective, easy to use, predictable, and softand hard-tissue compatible. The practitioner, fortunately, has a tremendous variety of adhesives available and can thus select the product that is best suited to the patient's needs. The self-etching, single-component, seventh-generation adhesives are generally the least technique-sensitive, most effective in application, and virtually nonpostoperative sensitivity-free. However, most are entirely reliant on light-curing for polymerization. The recently introduced Xeno IV from DENTSPLY…

31. Page 58

    dentalCEtoday.com DENTAL Test 138 MATERIALS The Role of Modern Composites and Ceramics in Clinical Practice A key role modern composites and ceramics play in current clinical practice is the ability to restore teeth to their natural appearance or, in situations where the teeth show active appearance, to enhance it. Although debatable, this author arbitrarily breaks down these 2 types of dental services as aesthetic dentistry and cosmetic dentistry, where aesthetic dentistry is defined as needed dentistry that restores appearance as well as health and function, and cosmetic dentistry is defined as being entirely elective and is done strictly to improve…

32. Page 62

    The Role of Modern Composites... continued from page 60 gravity (Figure 5). Undoubtedly, the performance of these restorations over time is directly related to the decision of preparation, impressioning, fabrication, and adhesive placement, which in turn is related to the care and skill exercised by the technician and the dentist. More recently, in-office CAD/CAM technologies such as CEREC 3D (Sirona) and E4D (Technologies) have increased in popularity. These technologies allow these indirect restorations to be fabricated from ceramic or processed resin and placed in a single appointment. Nevertheless, many practicing clinicians feel that inlays and onlays, of whatever color, are…

33. Page 64

    The Role of Modern Composites... continued from page 62 reinforcement and to maintain the seal. It is also necessary to understand that some materials used for these restorations, such as indirect composite and low strength ceramics, require effective lamination to tooth structure in order to withstand posterior occlusal forces without fracturing. At this point in time, there are conflicting reports in the literature regarding adequacy and durability of the enamel bond when adhesive resin cements are used to place aesthetic inlays and onlays.18-19 As noted above, there is a long successful track record for these restorations when bonded with an…

34. Page 65

    At one time ceramic was considered the material in aesthetic materials. With today's NSCS, this is no longer true (Figures 7a to 7gb). In order for dentists to maximize anterior aesthetic results using these new systems, a basic understanding of opacity, translucency, hue, value, and chroma is necessary. In addition, many dentists might benefit by taking a mini-course on bonding to develop the skills to mimic tooth structure. These skills are easily learned with these new systems. Artistic ability is not necessary. Longevity may be the one drawback when comparing direct composite resin veneers to ceramic veneers. Although studies are…

35. Page 66

    DENTAL MATERIALS the years in order to maximize aesthetic outcomes and minimize preparation. Fortunately, since dental schools cannot possibly cover this topic in depth, postgraduate learning centers offering hands-on and event live patient treatment have been established in many countries. There are numerous meetings, lectures, articles, DVDs, online learning programs and texts available for dentists seeking to acquire the skills necessary to offer these services. The placement of anterior ceramic veneers is without question a great impact on patients. It demands more from clinicians than great effort and dedication to detail to achieve success. It also requires perhaps more than…

36. Page 68

    Test 138 Expiration date of this CE article is June 1, 2013. To submit Continuing Education answers, use the answer sheet on page 57. Circle the letter corresponding to the answer you believe is correct, detach the answer sheet from the magazine, and mail to Dentistry Today Department of Continuing Education. Or, use our easy online option at Web site dentaltoday.com. This article is available for 2 hours of CE credit. The following 16 questions were derived from the article The Role of Modern Composites and Ceramics in Clinical Practice by Ronald D. Jackson, DDS, on pages 58 through 67.…

37. Page 70

    No-Prep Veneers: The Myths Barry K. Frydberg, DDS Figure 1. Composite resin "cosmetic bonding," as it presented after the patient's braces were removed. Figure 2. The previous composite main bonding "esthetic" work was removed. Figure 3. Completed no-prep veneers (Lumineers [DenMat]). INTRODUCTION Myths are often attached to new practices (using new techniques and materials) that replace those that have become outfounded when cycles change and new technology and new materials become available that totally, not gradually, alter the landscape and, therefore, the best practice of the day. Often, new practices scare professionals and others who don't want to make changes.…

38. Page 71

    is much greater than those that are bonded to enamel. It is always optimal to bond veneers to enamel for both strength and long-term durability. Bonding porcelain to enamel creates a solid and secure bond, compared with bonding porcelain to dentin. This bond, when the techniques are done right, is even stronger than nature's bond of enamel to dentin. 2. Prepping is sometimes done to compensate for material deficiencies. Pure and simple: It is the porcelain that makes the difference. For example, in the case of Lumineers (DenMat) system and philosophy, the objective is to provide a safe and wear-,…

39. Page 72

    Bone Level Dental Implant Versus Gingival Crest Level Implant INTRODUCTION Can long lost alveolar bone regrow vertically around a dental implant body, after being loaded into function without the use of grafting materials? If this is possible, how does the mechanism work? After years of observing vertical bone growth around implants, the author believes this desirable outcome results from specific bone stimulating forces and a transgingivial implant neck design. This unique transgingivial implant neck design acts as a lattice, allowing lost bone to climb and regrow vertically along the implant surface. Radiographs in this brief article (Figures 1 to 6)…

40. Page 73

    crest), we avoid a potentially undesirable bone response. My experience shows that margins placed too close to bone will more likely result in bone loss around the implant instead of desirable bone growth. Platform switching is used with all bone level implants. This is done in order to place a biologically imperfect margin well away from the bone. In other words, the offending source is placed further away from the bone to minimize bone loss. After using many different dental implants over the years, my clinical experience suggests strongly that the shape of implants is very important. Generally, I find…

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