Dentistry Today — June 2016

Inside this issue

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

1. Page 8

   Practical Changes That Will Grow Your Practice Joe Blaes, DDS I have always been open to change—anything that allows me to work faster, better, and easier. I remember when I first used that amazing handpiece called the Borden Air Rotor. Wow, what a practice changer that was! At age 12, I collided with a parked car, flew over the handlebars of my bicycle, and hit the hood with both centrals, breaking the mesial borders of teeth Nos. 8 and 9. When my orthodontist saw this, he told me he wished I had broken my arm. Two weeks later, I had…

2. Page 10

   Dentures in the Digital Age In this issue of Dentistry Today, we are placing a focus on recent innovations and advances in technology that can bring positive changes to the dental practice for clinicians and patients alike. As an example, many clinicians still currently use denture fabrication techniques and delivery protocols that employ labor-intensive and time-consuming steps requiring 5 or more dental appointments. Some of the more "mature" (to be diplomatically sensitive) clinicians can likely recall all the procedures that they were taught many years ago in their respective dental schools to make and deliver full dentures. The memories of…

3. Page 12

   Competition: Are You Ready? Competition! It is here, and it's not going anywhere. In fact, it is only going to intensify in the coming years. The Great Recession, along with other game changers, has altered the business of dentistry permanently. Prior to the economic downturn, dentistry had a long-run with low levels of competition. The economic law of supply and demand worked in the profession's favor, with a small supply of dentists and a growing demand for dental care. Since 2008, the situation has reversed itself. There are more dentists treating a smaller pool of adult patients. The influx of…

4. Page 14

   VIEWPOINT continued from page 12 I recommend upping your enthusiasm by 20% to 25%. Patients prefer visiting a happy, positive dental practice. Remember, your patients would rather be doing almost anything else than going to the dentist. If you and your team aren't happy to see patients, why should they continue coming to your practice? No matter what's going on outside the practice, you've got to put on your game face when you walk into the office. No team wants to work for a distracted or negative dentist. I know some of you may be thinking, "This is silly. Over-the-top…

5. Page 18

   FOCUS ON: Endodontics Clifford J. Ruddle, DDS, examines why glide path management is the key to successful endodontics and gives a sneak peek into its future. Q: What is glide path management (GPM) and why is it critical for predictably successful endodontics? A: GPM may be thought of as an endodontic procedure that typically utilizes small-sized, stainless steel (SS) hand files to negotiate, catheterize, and ultimately "secure" the full length of any given canal. A glide path is verified, and any portion of the canal is termed secure, when a small steel hand file can slip, slide, and glide through…

6. Page 20

   Nacera US Nacera US offers Nacera Pearl and Nacera Multi Shade Zirconia for clinicians interested in a vital, more natural look with 1,400MPa strength and predictability. Nacera Multi Shade, in VTA A, B, C, and D, provides a natural transition from the 3 shade to the body shade, from gingival to occlusal/incisal, while Nacera Pearl introduces all 16 VTA shades. Also, both products have been specifically engineered for smoother milling to provide better margins. For more information, call (215) 345-5283. To find a Nacera lab, visit nacera.us. FREEinfo, CONTRA-ANGLE Bien-Air Equipped with patented COOLTOUCH+ heat-arresting technology, the EVO.15, hailed as…

7. Page 22

   From the February and March 2016 Issues CERAMIC-BASED UNIVERSAL RESTORATIVE VOCO Admira Fusion is the world's first all-ceramic-based direct universal restorative. Based on new revolutionary Nano-ORMOCER technology, it is a breakthrough in the category of direct restoratives, offering many advantages compared to composites. Some of the advantages include (1) up to 50% lower shrinkage and shrinkage stress, (2) improved aesthetics and handling, and (3) a new level of biocompatibility. For more information, call (888) 658-2584 or visit vococamerica.com. FREEinfo, DIODE LASER Ultradent Products The Gemini 810 and 980 Diode Laser offers dual-wave technology, combining the optimal absorption of the 810-nm…

8. Page 23

   TOOTH SHADE GUIDE LSK121 The Chairside Shade Guide provides dentists with the tools necessary for overcoming common pitfalls faced when matching adjacent patient teeth and communicating that information to laboratories. Based on more than a decade of research on approximately 1,500 natural teeth, the guide is a set of 5 individual trays of ceramic shade tabs that allows dentists to match and communicate tooth various characteristics. For more information, call (630) 955-1010 or visit chairslideshadesuide.com. FREEinfo, MATRIX SYSTEM Garrison The Composi-Tight 3D XR Sectional Matrix System features an ultraslender matrix ring designed for use with short or malpositoned teeth, including…

9. Page 24

   CLINICAL REVIEWS THE DENTAL ADVISOR Super-Snap X-Treme +++++ Shofu Dental | (800) 827-4638 | shofu.com Consultants' Comments • "Much more durable than original disks." • "Ideal for anterior restorations." • "Increased flexibility adapts to tooth contours." Description Super Snap X-Treme features an enhanced version of the green (fine) and red (superfine) polishing disks included in the original Super Snap polishing system. They are thicker and stiffer in order to increase durability and tactile feel, and the red disk has a new 3-D hemispherical grit coating designed to create space for ground debris and to discharge debris during polishing, resulting in…

10. Page 26

    Shine on Brightly Paul Feuerstein, DMD "The message here is don't take your curing light for granted; test it periodically for light output, and if it is being held together with duct tape, as one of your basic tools, do the right thing—spring for a new one." Every dentist owns one or more curing lights. We have new ones and old ones that we hate to throw out in case we need them for use or parts. The reasons we get new ones are that the newest models are smaller, maybe cordless, and use LEDs, either directly in a wand…

11. Page 28

    Spotlight Digital Dentures Require Fewer Appointments to Yield Exceptional Results SOUTH BEND, Ind.–Heraeus Kulzer's Pala Digital Denture System utilizes computer-aided design and 3-D printing to model and create dentures that laboratories can deliver to dental practices in one third the time of conventional systems. Moreover, the dentures provide exceptional aesthetics and a highly precise fit. The entire process requires just 3 appointments since dentists can capture the final impression, bite registration, vertical dimension, and centric relations in one appointment. The system's exceptional precision means minimal if any adjustment, and if a patient needs a duplicate denture, the denture's 3-D digital…

12. Page 30

    Finishing System Optimized for Use With High-Strength Ceramics SOUTH JORDAN, Utah--Because of the extreme hardness of newer ceramic materials, effectively adjusting and polishing ceramic restorations can be a major challenge. To address this challenge, Ultradent Products offers the IPS Universal Ceramic Finishing System, the only universal finishing system for high-strength ceramics. It features adjustors and polishers that work synergistically on porcelain, lithium disilicate, and zirconia. Each of the system's kits (Coarse and Intraglad) include everything a dentist needs to create a beautiful, high-gloss finish on all ceramic restorations while eliminating the need to purchase unnecessary or multiple components. For more…

13. Page 31

    Imaging Unit Offers the Latest in 2-D and 3-D Technologies ORMOND BEACH, Fla.— Owandy's i-Max Touch offers the latest in 2D and 3D panoramic technology. Its combination of intuitive and tactile technologies allows dentists to save precious time in their practices. Available in several upgradeable models, from a 2-D pan unit to a 3-in-1 pan/3D unit, Owandy offers a unit that fulfills the needs of most modern dental practices. With 14 programs, the panoramic unit facilitates any clinical exam. The cephalometric option adds 5 programs for acquiring x-rays of the skull and carpus. The 3-D option allows acquisition of 3-D…

14. Page 32

    Nasal Hood's Design Reduces Ambient Nitrous Oxide in Operatory PHOENIX, Ariz.-Used for the delivery of nitrous oxide, Accutron's ClearView Single-Use Nasal Hood, a DENTAL ADVISOR 2015 Top Product winner, features a double-hood design with a clear outer hood and a brightly colored and lightly scented inner hood. This hood in-hood design draws more excess gas into the vacuum system than a single hood, reducing ambient nitrous oxide in the operatory. Offering visual assurance to the clinician, condensation collects in the clear outer hood when a patient breathes through his or her nose, while the soft inner hood creates a desirable…

15. Page 33

    Attachment Hailed As a New Way to Perform Air Polishing MOUNT LAUREL, NJ-Hailed as a new way to perform air polishing, ACTEON's AIR N-GO easily attaches to a high-speed handpiece connection in any dental chair and has been complete supraand subgingival treatments, offering targeted action against biofilm in any area of the mouth. AIR-N-GO powders, customized to fit any clinical need, include the following: CLASSIC (=76 μm), which features fine grain and nonaggressive crystal geometry for increased patient comfort; PEARL (= 55 μm), gentle and safe to use on composites and other restorations; and PERIO designed to be simple to…

16. Page 34

    The Dental Decision Maker Reducing or Eliminating Failed Dentistry Every day in your dental practice, you tackle a variety of challenges that you diagnose and solve for your patients. Just think, for a few moments, about the patients you have seen this past week. Did you talk to them about periodontal disease, issues involving their temporomandibular joint (TMJ), broken teeth, root canals, crowns, bridges, dentures, and implants? Of course you did. These are the most common dental issues that come up in the office routinely. Is that list complete? What if I were to tell you that this list does…

17. Page 36

    Figure 2. The patient's face exhibited a square appearance due to very large and asymmetrical masseter muscles related to her TMJ disorder/orofacial pain. Figure 3. Bite-wing radiograph of the previously placed dental implant suggested osseous cupping of bone around the implant neck. Figure 4. Radiograph showing mesial bone loss; the implant was beginning to loosen. Figure 5. The home STATDDS Bruxism and Sleep Monitor provided objective data on bruxism and obstructive sleep apnea. The Dental Decision Maker... continued from page 34 The Dreaded Post-Treatment Phone Call Only 2 months after the crown was placed, it called her dentist's office to…

18. Page 37

    The BEI is the number of bruxism episodes a patient has per hour of sleep. A number higher than 2.5 suggests significant bruxism that should be addressed. A BEI higher than 5 is indicative of very destructive bruxism that can easily break and chip teeth and any dental restorations. If the AHI is higher than 5 the patient has obstructive sleep apnea (OSA), needing a medical diagnosis by a physician, and possibly an oral appliance and/or any prescribed care recommended by the physician. These numbers are very important in guiding our treatment decisions and, through post testing, will let us…

19. Page 38

    Convenient Cleanup With Calibra Universal for Easier Cementation Dentsply Sirona's New Self-Adhesive Resin Cement Features a Wide Tack-Cure Window and Extended Gel Phase for Easier Cleanup Jason H. Goodchild, DMD Self-adhesive resin (SAR) cements are designed to offer procedural and clinical advantages over the other cement categories. SAR cements ease use as they adhere to tooth structure (RMGI) cements but provides higher bond strengths, improved esthetics, and dual curing. Also, because SAR cement is resin-based, it can be used for cementation of both strongly ceramic (eg, lithium silicates), where GI and RMGI cements are usually not recommended. Compared to adhesive…

20. Page 40

    Spotlight New Biocompatible Sealer's Healing Properties and Ease of Use Cited TULSA, Okla.–A new addition to Dentsply Sirona Endodontics' ProRoot MTA family of endodontic advanced treatment options, ProRoot ES endodontic root canal sealer is an enhanced formula of its counterpart, ProRoot MTA root repair material. Now, the same healing properties that clinicians have come to know and trust from ProRoot MTA are available in a biocompatible sealer. ProRoot ES's unique formula provides a natural seal by sealing the root canal biologically. It is bio-inductive for cementum, thereby supporting tissue regeneration, and it is dimensionally stable and stimulates a hard tissue…

21. Page 42

    Spotlight Self-Adhesive Cement Facilitates Cleanup, Ensuring the Creation of Beautiful Restorations MILFORD, Del–Dentsply Sirona's Calibra Universal self-adhesive resin cement offers a wide tack cure window of up to seconds and an extended 45 second gel phase, providing dentists with the ability to perform a thorough and effective cleanup and ensuring the creation of a beautiful restoration that will last. Conventional resin cements only allow light-curing for one or 2 seconds before they harden to the point where a burr may be required to remove the excess. But Calibra Universal, with its tack-curing window of up to seconds and extended gel…

22. Page 44

    Spotlight Popular Core Build-Up Material Improved With Better Flowability, Strength, and Aesthetics ENGLEWOOD, NJ—Infused with zirconia, LuxaCore Z-Dual composite core build-up material offers exceptional physical properties that now include better flowability, strength, and aesthetics. With the most dentine-like capability in its category, clinicians get precise margin preparation with less ditching. The result: excellent fit, a long-lasting restoration, and the best possible care for the patient. It's no wonder why the LuxaCore brand is one of the most trusted names in core build-up materials. It is available in natural, blue, and high-viscosity shades. For more information, call DMG America at (800)…

23. Page 45

    INNOVATIONS 45 Enhanced Version of Popular Bulk-Fill Composite System Further Facilitates Posterior Restorations ORANGE, Calif-Since Kerr Corp.'s SonicFill bulk-fill composite first came to market, thousands of dentists have seen tedious, repetitive posterior restorations transformed into easy and reliable Single Fill placement, filling cavities up to 5 mm in depth in a single increment with a single material and no liner or capping layer. Now, with the availability of the SonicFill 2 Single-Fill Composite Systems, SonicFill's benefits have been expanded with enhanced polishability, durability, and extended working time. SonicFill 2 retains the same, patented sonic activation technology that made the original…

24. Page 46

    NEWS/TRENDS Industry News Dirk Jeffs Appointed President of Ultradent Products Ultradent Products announced recently that Eon E. Fischer, DDS, has appointed Dirk Jeffs as Ultradent's president, effective immediately. "Dirk Jeffs has a distinguished record of accomplishment as well as a clear commitment to the critically important role of cultivating and nurturing our core values," said Dr. Fischer. "As we plan for the future of Ultradent, it is critical that we leverage the forwardthinking attitude, wealth of experience, and positive demeanor of our newly named president." Mr. Jeffs joined Ultradent in 1996 as international sales manager. He then progressed to the…

25. Page 48

    NEWS/TRENDS Fighting Cavities... continued from page 46 acid, contributing to acidic conditions in the mouth that form cavities. The researchers found that A12 not only helps neutralize acid by metabolizing arginine in the month, but it also often kills S Mutans. "Also, if A12 doesn't kill S Mutans, it interferes with S Mutans." Study Highlights Dramatic Rise in Cost of Orally Administered Cancer Drugs According to a University of North Carolina (UNC) School of Pharmacy study, a cancer drug introduced in 2014 costs approximately 6 times the price of a cancer drug introduced in 2000, with the cost of many…

26. Page 49

    MEETINGS/SEMINARS Periodontology Meeting to Take Place in San Diego The American Academy of Periodontology (AAP) will hold its 102nd Annual Meeting from September 10 to September 13 at the San Diego Convention Center in California. This year's event is presented in collaboration with the Japanese Society of Periodontology and the Japanese Academy of Clinical Periodontology. Attendees can earn more than 26 continuing education (CE) credits from multidisciplinary courses if they want to use at all levels of dentistry, from student to seasoned specialist. Sessions include hands-on workshops and practical courses on diagnosis and treatment methods, the latest technologies, clinical applications,…

27. Page 51

    MEETINGS/SEMINARS how orthodontics compl-ements other specialties. Den-tists of various backgrounds are invited to attend upcom-ing classes in Orange County, Calif; San Jose, Calif; and New York City. Up to 12 CE credits are available. For more infor-mation, call (877) 223-2266 or visit mojannpostgrad.com. Digital Dentures AvaDent Digital Dental will present the First AvaDent Inter-national Symposium from Sep-tember 23 to September 24 at the Talking Stick Resort in Scotts-dale, Ariz. Renowned inter-national speakers—including educators, university experts from manufacturing companies, and dental office and laboratory professionals—will present their experiences and findings with digital den-tures. This program will also include a workshop wherein…

28. Page 52

    Research Says Gut Bacteria May Help Prevent Cancer A UCLA study published in the peer-reviewed journal PLOS ONE offers evidence that anti-inflammatory "health beneficial" gut bacteria can slow or stop the development of some types of cancer. Ultimately, doctors might be able to reduce a person's risk for cancer by analyzing the levels and types of intestinal bacteria in the body, and then prescribing probiotic or prebiotic supplements to bolster the amount of bacteria with anti-inflammatory properties, said Robert Schiessl, the study's senior author. Schiessl and colleagues isolated a bacterium called Lactobacillus johnsonii 456, which is the most abundant of…

29. Page 53

    Smoking Drastically Alters Oral Microbiome Smoking drastically alters the oral microbiome, the mix of roughly 600 bacterial species that live in people's mouths. This is the finding of a study led by New York University (NYU) Langone Medical Center and its Laura and Isaac Perlmutter Cancer Center, published online in the ISME (International Society for Microbial Ecology) Journal. The researchers say their analysis is the most comprehensive to date to examine the effects of smoking on the make-up and action of bacterial species in the human mouth based on pyrosequencing genetic testing. "Our study is the first to suggest that…

30. Page 54

    READERS' CHOICE TOP 25 FIRST IMPRESSIONS PRODUCTS Spectra Air Techniques Patients depend on their practitioner to diagnose and locate dental decay as early as possible. Dentists depend on their diagnostic tools to eliminate the guesswork. The Spectra carries detection aid utilizes fluorescence technology to reliably identify fissure and smooth surface caries, even when they are too small to be detected visually or radiographically. The Spectra shines a high-energy, violet-blue light onto the tooth surface to stimulate cariogenic bacteria metabolites (porphyrins). Viewed through the onboard optical filtration and seen on the monitor, decay appears red, yellow, or orange in contrast to…

31. Page 55

    PRESSIONS PRODUCTS TOP 25 EPIC 10 BIOLASE Many practices have at least one laser for convenience and at-hand efficiency. The portable EPIC 10 laser is indicated for soft tissue surgery, tooth whitening, and pain therapy and delivers 10W at peak power. Controlled through the intuitive touch-screen interface, there are 16 common procedure presets. Diode wavelengths cut soft tissues more cleanly and comfortably while the EPIC 10 tooth bleaching session takes only 20 minutes. The deep-tissue handpiece for the temporary relief of minor oral pain is controlled for spot size, thus avoiding inadvertent damage to surrounding tissues. The EPIC 10 delivers…

32. Page 56

    BulkEZ Danville Materials Restorative material shrinkage, marginal voids, depth of cure, layering, and clinical sensitivity have all contributed to imperfect restorations and decreased longevity. Chemistry and polymerization have limited adhesive techniques. BulkEZ is a practical, dual-cure restorative material specifically designed for direct restorations. Auto-mixed from twin barrels immediately prior to insertion, it offers an unlimited, curing-light independent, depth of cure without sonic vibration. Light curing simply hardens the air-inhibited surface layer. Self-curing encourages the restorative material to shrink toward the bonded cavity walls, eliminating void formation, open margins, recurrent decay, and sensitivity. Directed shrinkage minimizes microleakage (more patent interproximal margins)…

33. Page 58

    READERS' CHOICE TOP 25 FIRST IMPRESSIONS PRODUCTS iOCam DentLight Most dentists wear magnifying loupes and coaxial illumination devices. Action cameras have conditioned patients to expect video sequences of every aspect of life. New patients are always attracted to a "with-it" practice. The innovative iOCam is one of the smallest magnified dental videos at 2 g. Its high-definition (1280 x 720) extraoral video/image capture system offers live video streaming and recording. Distortion-free optical magnification and adjustable focal focus personalize the system. Compatible with the Nano headlight, the iOCam is upgradeable to convenient cordless operation. The iOCam fits all major loupe brands…

34. Page 60

    TOP 25 FIRST IMPRESSIONS PRODUCTS READERS' CHOICE SonicFill 2 Kerr Direct posterior composite restorations are today's standard of practice. Current techniques may leave internal gaps and voids, invisible until restoration failure. Layering is time and technique sensitive; imperceptible seams allow bacterial infiltration at inaccessible margins, resulting in white lines that mar aesthetics. SonicFill 2 is a single-fill composite system that makes posterior composite restorations less tedious and technique sensitive and thus less stressful. SonicFill 2's matching refractive index allows 5 mm in a single increment, reducing chairside operator time and enhancing efficiency and increased sensitivity ambient light offers 35% more…

35. Page 62

    SplashMax DenMat VPS impression materials were introduced 35 years ago. Easier and more convenient than the earlier polysulfides (rubber base), they were hydrophobic and their performance was compromised in the wet oral environment, particularly in the critical sulcus region continually bathed in crevicular fluid. The 1990s introduced hydrophilicity and cartridge mixing, fine-tuning dental impression taking. SplashMax has excellent dimensional accuracy with a 99% recovery after stretching and compression, preventing permanent deformation of the impression on mouth removal. Instant hydrophilicity offers consistently high-detail impressions in a moist environment, and high elasticity keeps the impression from tearing. SplashMax's thixotropic consistency and flow…

36. Page 63

    A new crown procedure CASE REPORT A 45 year-old female patient presented with a lower right 1st molar (#30) with a failing MOD with fractured mesio-lingual cusp. The patient was offered a large direct composite restoration, an OVC or a custom-made lab crown and selected the OVC for best value for money and the convenience of the single appointment. The OVC procedure is best considered in three stages: preparation, customization and finishing. Preparation A relatively flat-top simple preparation was completed quickly since no sub-gingival margin or cord-packing was required (Figure a). The occlusal clearance was checked using the blue thermoplastic…

37. Page 64

    READERS' CHOICE TOP25 FIRST IMPRESSIONS PRODUCTS STA System Milestone Scientific The fear of pain keeps half the population out of the dental office. Local anesthetic for overcoming the fear factor has been available for more than 70 years, but has created the discomfort of the injection process. The STA (Single Tooth Anesthesia) System selectively anesthetizes a single tooth for a limited amount of time by precisely administering an intraligamentary injection for general, periodontic, endodontic, periodontic, and cosmetic practices. Onset is one to 2 minutes and typically lasts one hour. At intrapulpar block, directing the entire quadrant, takes 10 to 15…

38. Page 66

    Stabiliner Crown Delta Try-in and adjustment are often frustrating, whether in the mouth or on the working die. Stabiliner is a highly innovative, try-in adhesive liner for the temporary stabilization of ceramic restorations, saving significant assessment and adjustment time prior to final cementation. It reduces repetitive on/off placement of crowns, veneers, or bridges during try-ins; adjustments are made right on the restorations while they are temporarily affixed. Patients can also assess restorations for fit and aesthetics before final cementation. Stabiliner is a translucent, adhesive, and modified silicone paste precisely mixed to the inside of the moistened restoration. During try-in, Stabiliner…

39. Page 67

    PRESSIONS PRODUCTS TOP 25 QuickSplint QuickSplint Oral pain is difficult to describe and diagnose. Its origin may be hard or soft tissue, single source, or multifactorial. QuickSplint offers an improved, custom-fit, interim anterior bite plane that takes minutes to fabricate. It assists in diagnosing, nosing, treating, protecting, and healing. It covers the anteriors, bicuspid to bicuspid, inhibiting destructive parafunctional forces. This allows pericanial muscles to relax during sleep (or while awake), protecting the teeth and restorations. QuickSplint comprises a hard plastic shell, enclosing a softer custom-made polyvinyl lining that conforms to the supporting teeth. It is an interim solution. Continued…

40. Page 68

    Dental Implants: Prosthetic Options Michael Tischler, DDS It must be kept in mind how surgical decisions directly affect prosthetic results. Examples of this are correct spacing of implants, achieving adequate alveoloplasty for prosthetic thickness, and providing the correct implant angulations; all of these surgical steps directly affect prosthetic success and choices. This month's Implants Today topic is "Dental Implants: Prosthetic Options." This is a very important topic and yet an important one that relates to all aspects of implant treatment. Although I will be focusing on the many choices of prosthetic options for dental implants, it must be kept in…

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