Dentistry Today — June 2022

Inside this issue

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

1. Page 6

   Sweet Home Alabama It looks like the dental companies have come out of a forced hibernation and are introducing new products at a rapid pace. Keeping up with them is just another full-time job that I add to my otherwise busy schedule. Companies are combining forces, acquiring others, changing names, and reorganizing leaders and staff all in (hopefully) the interest of helping practitioners achieve higher levels of practice. As I read article submissions, talk to colleagues, and travel to meetings, I constantly eat about these new products and processes, so I understand what they are talking about. Emerging technologies—especially in…

2. Page 8

   Introverted Dentists: Can They Be Successful? Private practice is a challenge for everyone! That means for everyone in the practice, not just the dentist. So many times, dentists forget that the staff does. Without the staff support, no one would be productive. We cannot do it alone. For many dentists, this is very hard because we tend to be, as a group, self motivated and "used to working alone." The model has changed from the solo dentist, front desk person, and someone who mixes amalgam. We also need to remember that it is not just the MOD on tooth No.…

3. Page 10

   VIEWPOINT continued from page 8 beautiful in the world, but if the patient experience is not great, you will fail. It is the first impression when the phones answered, the cease of finding the office and parking, the greeting at the front desk, how the office smells and looks, staff friendliness, and all the things that happen before the patient leaves the building. It is not just beautiful dentistry. How many tasks does your front desk staff need to do that we as dentists do not see or even know about? What are they doing, and most importantly, what are…

4. Page 12

   Reputation Marketing Leonard F. Tau, DMD, talks about improving your practice's web presence, generating positive reviews, and how to handle negative reviews. Q: I have more reviews than other practices. Why am I not ranked as high on Google search results? A: Getting a high number of reviews for your practice is only one of 2 important parts of ranking high on Google search results. Beyond reviews, it's important to stay on top of how your practice appears in local citations. Local citations are links or references to your business on other websites, such as listing websites, including Yelp and…

5. Page 14

   DirectaDentalGroup DIRECTA topdental ORSING parkell physics forceps RØNVIG TrollDental Sendoline CONTACTEZ RØNVIG FOCUS Located in Daugaard Denmark, Rønvig was founded in 1981 by Mr. Jorn Rønvig and was acquired by DirectaDentalGroup in 2019. New to the USA market, Rønvig is known worldwide for its deep technical expertise and unique quality designs of dental products by skilled and experienced employees who take pride in making quality products that last. Calaject Flagship products Calaject - A computerized anesthesia delivery system helps deliver pain free injections. Designed with 3 delivery settings, the device controls the flow rate ensuring a smooth and gentle flow…

6. Page 16

   Device Measures Electrical Conductance of Enamel ROSLYN HEIGHTS, NY—The Ortek ECD caries detection device from Ortek Therapeutics instantly detects early cavitated occlusal lesions that often go undiagnosed by x-ray and visual methods. Unlike other systems, the patented ECD measures the electrical conductance of enamel and demonstrated 100% sensitivity and 93% specificity in a peer-reviewed, published clinical study. The extremely affordable ECD detects if a suspicious occlusal lesion has breached the dentin-enamel junction, progressed further into the dentin, or is confined to the enamel. The ECD immediately displays a quantitative digital caries score from 0 to 100, depending on the extent…

7. Page 18

   Software Enables Practices Pulp Vitality Tester Offers to Continue Growing Single-Button Control HUNTINGTON BEACH, Calif.- Asprodontal is an all-in-one, best-in-class cloud dental practice management software built around a modern and optimized digital workflow. It has all of the same features in other cloud software programs, plus the signature One Page Chart feature where all clinical information can be seen on a single screen. The software runs in any browser, on any computer, and includes scheduling, reporting, charting, practice analytics, appointment reminders, automated messaging/texts, backups, updates, support, and so much more. Software is the command center of one's practice, so it…

8. Page 20

   Imaging System's Capabilities Improve Experience for Practice and Patients SAN JOSE, Calif.-The iTero Element 5D Plus imaging system from Align Technology in cart configuration is a powerhouse of capabilities designed to improve the practice and patient experience with state-of-the-art computing power, elegant design, and ideal ergonomics. Enhanced, more detailed visualizations with wider viewing angles provide an unmatched patient experience. Powerful computing advancements enable a smoother and more intuitive scanning experience. The system is ergonomically designed to conform to how practices scan. The integrated intraoral camera eliminates the need for a second device while enhancing the patient experience and communication. Near…

9. Page 22

   Dynamic and Innovative Dental CAD/CAM Software Company DentalCAD productivity-boosting software from exocad features instant Anatomy Morphing, which adjusts the anatomy of the teeth in real time. exoplan provides powerful implant planning and surgical guide design to dental labs, dentists, implant specialists, and surgeons. ChairsideCAD is exocad's easy-to-use CAD software for single-visit dentistry. The chairside workflow is stream-lined, intuitive, and optimized for use in the practice. A leading dental CAD/CAM software provider, exocad, an Align Technology company, vigorously pushes the boundaries of digital dentistry. Headquartered in Darmstadt, Germany, exocad provides open and easy-to-use design software for dental practices and labs worldwide.…

10. Page 24

    Toothbrush Offers Twisted Tufts of Bristles and Longer Filaments CINCINNATI–Oral-B iO from Procter & Gamble comes with 2 brush heads that are only compatible with Oral-B iO. The Ultimate Clean brush head has twisted tufts of bristles and longer filaments for an outstanding clean, including in hard-to-reach areas. The Gentle Care brush head uses thousands of fine filaments for an extra gentle clean that patients will love. For more information, visit Procter & Gamble's website at dentalcare.com. FREEinfo, Resin Cement Boasts Excellent Color Stability NEW YORK–PANAVIA Veneer LC from Kuraray Noritake Dental is an advanced, light-cure resin cement with excellent…

11. Page 26

    Composite Simplifies Restorative Procedures ENCINITAS, Calif.–Tokuyama Dental America's OMNICHROMA FLOW, a one-shade flowable composite, follows in the footsteps of OMNICHROMA. OMNICHROMA FLOW is capable of matching any of the 16 VITA classical tooth shades with a single shade of composite. By eliminating the need to shade match or stock multiple shades of composites, OMNICHROMA FLOW simplifies restorative procedures and allows dentists to reduce their inventory, saving time and cost. OMNICHROMA FLOW is indicated for Class I through V restorations in anterior and posterior teeth. The following qualities make OMNICHROMA FLOW an excellent choice for dentists looking for great cavity adaptation…

12. Page 28

    Simplifying Endottic Irrigation Allen Ali Nasseh, DDS It's drilled into our heads that the cleaning component of the endodontic triad of cleaning, shaping, and obturation is the most important determinant of clinical success in root canal therapy. However, when we finally decide to focus on irrigation, we find that we either face a complicated irrigation protocol or need expensive, laser-based/sound-based devices. So, how can we simplify our irrigation protocol without expensive gadgets and complicated resolutions? Before we set out to simplify our irrigation protocol, it would be worthwhile to review the important components of effective irrigation. Physical Parameters and Limitations…

13. Page 30

    Industry News Academy Launches Prestigious Credentialing Program The Academy of Osseointegration (AO) has announced the launch of its new credentialing program to incentivize practitioners to reach the highest level of education, training, and competence in implant dentistry. This prestigious new Academy initiative offers AO Master Certificates and AO Diplomate Certificates to applicants who meet defined criteria. Applicants may prepare for surgical, restorative, or a combination of both surgical and restorative certificates. Applicants must complete a required minimum number of didactic training hours involving restorative and/or surgical components including hands-on training. In addition, applicants must provide case presentations and take an…

14. Page 31

    Double-Stranded RNA Causes Bone Loss During Gum Disease Researchers at the Tokyo University of Agriculture and Technology have reported findings on the causes of bone loss in periodontitis. They've discovered that double-stranded RNA (dsRNA) molecules have the ability to activate the immune system response that leads to the deterioration of bone. It's known that concentrations of bacterial plaque in the tooth pockets are the cause of periodontal disease. The main components of outer membranes of the bacteria that cause gum disease are lipopolysaccharides. Lipopolysaccharides have been implicated in causing gum inflammation by switching on toll-like receptors (TLR4) on immune cells…

15. Page 33

    Take Advantage of FastPass at Dentsply Sirona World What is your "why?" We learn in Simon Sinek's book Start With Why that knowing your "why" ultimately helps you achieve success. Whatever your "why" is focused on, when you attend Dentsply Sirona World on a FastPass, with Henry Schein, you'll be given heavily discounted admission to "The Ultimate Experience in Digital Dentistry," where you'll learn how digital dentistry will help support your "why," no matter what that may be. Dentsply Sirona World 2022, taking place from September 15 through September 17 in Las Vegas, promises to bring together like-minded dental professionals…

16. Page 36

    Are Biologic Medications Becoming the New Catch-22 in Implant Dentistry? INTRODUCTION In the early 2000s, the field of dentistry was shocked when published reports of severe complications and morbidity surfaced with patients on a newer therapeutic antiresorptive medication (bisphosphonates). Marx and Ruggiero et al were the first to report patients taking bisphosphonates for cancer treatment (IV) or osteoporosis (oral) becoming susceptible to bone necrosis lesions termed medication-related osteonecrosis of the jaw (MRONJ). Since that time, there has been significant debate and controversy with no general consensus on how bisphosphonate patients should be treated (eg, no treatment, no drug modification, drug…

17. Page 38

    Are Biologic Medications.... continued from page 36 medications will be developed in the future to treat even the most complex diseases." BIOLOGIC MEDICATIONS Biologic medications have been approved for a wide array of conditions and disease processes. Biologics are most commonly classified by their suffixes as to their origin: human ("mab"), humanized ("zumab"), or chimeric ("ximab"). Table 1 describes the most common biologics and their intended targeted conditions and diseases. Possible Side Effect Complications in Dentistry Although biologic drugs have far fewer side effects than conventional pharmaceuticals, they do specifically have potential adverse effects on normal bone physiology. There exist…

18. Page 40

    Immediate Implant Using a Socket Shield and a Final Titanium Abutment INTRODUCTION Losing a tooth can be traumatic for dental patients—affecting their ability to chew, digest, and speak, as well as their self-esteem.¹ Implant protocols have been redefined to satisfy patients' expanding expectations for comfort, aesthetics, and shorter treatment times.² All of these are excellent reasons to explore immediate implant placement procedures rather than delayed implant placement.³ Utilizing a final titanium abutment at the time of implant placement has also been shown to additionally compress treatment times. My introduction to the concept of using definitive abutments at the time of…

19. Page 42

    Figure 1. Initial radiograph with evidence of extreme resorption. Figure 2. Cutdown of clinical crown. Figure 3. Preparation of root to create a socket shield. Figure 4. Removal of the palatal segment and apex. Figure 5. The implant was coated with autologous serum. Figure 6. Ideal axial placement of the implant. Figure 7. OsteoGen IMPLANT LTD bone graft in the extraction site gap. Immediate Implant... continued from page 40 mm above the gingival margin (Figure 2). The pulpal canal was identified and used as the guide for the socket shield burs that were used sequentially to enlarge the root preparation…

20. Page 44

    Implant Systems Bicon Dental Implants The SHORT implant design comprises plateaus; sloping shoulders; and a bacterially sealed, 1.5° locking taper implant-to-abutment connection. With the plateau design, cortical-like bone forms around and between each plateau, which allows for the routine use of 5.0 mm short implants. The sloping shoulder provides the necessary room for bone to support interden­tal papillae. It's arguably aesthetic. Bicon's 360° universal abutment positioning provides for the revolutionary cementless and screwless Integrated Abutment Crown, consistently offering a nonmetallic, aesthetic gingival margin. For more information, call (800) 882-4266. FREEinfo, BioHorizons Tapered Pro implants deliver predictable results for immediate treatment.…

21. Page 46

    continued from page 44 Genicore Genicore is the exclusive distributor of TAG Dental Implants. TAG Dental has been manufacturing medical devices for more than 20 years for major corporations worldwide. With the experience gained from many years of success in the medical device industry, TAG has expanded its horizon to dental implants. It is currently manufacturing dental implants of a medical-grade quality, ensuring optimal clinical results worldwide. For more information, call (877) 291-5677 or visit genicore.com. FREEinfo, Glidewell If you're seeking to make implants a bigger part of your practice, the Hahn Tapered Implant System can help with a simplified…

22. Page 48

    continued from page 46 at the collar and becoming moderately rough and porous toward the implant apex. Tiultra features surface chemistry and topography that promotes early osseointegration and is designed to support long-term hardand soft-tissue stability. The surface chemistry and hydrophilicity of TiUltra is preserved with a protective layer. For more information, call (800) 322-5001. FREEinfo, OCO Biomedical The Engage Dental Implant System, with its patented Bull Nose Auger Tip, Mini Cortico-O Thread design, and high-performance surface treatment, was designed for high initial stability and optimal bone integration. The implant benefits from OCO Biomedical's 40 years of experience and offers…

23. Page 49

    IMPLANT SYSTEMS 49 Z-Systems USA With more than a decade of clinical experience, Swiss-based Z-Systems is one of the world's leading solutions for naturally white, high-performance zirconia dental implants. The market-leading Z5c zirconia 2-piece implant offers excellent osseointegration with its patented laser-modified surface, excellent soft-tissue response, no gray shine-through, and customizable technology. It achieves one of the profession-leading survival rates at greater than 98%. For more information, call (877) 874-9407, visit zsystems.com, or email usa@zsystems.com. FREEinfo, Zest Dental Solutions The LOCATOR Overdenture Implant is a permanent, 2-piece implant solution that incorporates the industry's gold standard LOCATOR Attachment System. These implant…

24. Page 52

    Guidelines for Cementing or Bonding Ceramic Restorations INTRODUCTION Ceramics have become the material of choice for indirect restorations, with one of the nation's largest laboratories reporting that 90% of their indirect restorations were fabricated from ceramic. Perhaps one of the more confusing aspects of using ceramic crowns is the decision of whether or not to bond the restoration, followed by the clinical steps involved in either conventionally cement or bond the ceramic restoration. For the purpose of this article, conventional cementation involves the use of a glass ionomer or resin modified glass ionomer (RMGI) cement, whereas bonding implies the use…

25. Page 53

    CHAIRSIDE WITH DR.K THE SECRET TO MORE EFFECTIVE WHITENING No two patients are exactly the same. So why use just one whitening protocol to treat them all? At KöR Whitening, we recognize that each patient presents a different whitening challenge and that's why we developed a full line of whitening systems to meet your patient's individual need. And KöR Whitening is the first whitening system in the world to maintain potency of its entire line of whitening gels by constant refrigeration from the instant of manufacture until being received cold-packed at your office. Dr. Rod Kurthy #1 Proper Product and…

26. Page 54

    Guidelines for Cementing or... continued from page 52 which means it will require slightly more restoration thickness. A recent study suggested a restoration thickness of 1.2 mm for 4 mol% or 3 mol% yttria-containing zirconia, whereas a 3 mol% yttria-containing zirconia has been recommended3 to be used between 0.6 mm and 1 mm. Bonding both translucent and traditional zirconia will improve its strength; however, it is less critical to bond any type of zirconia than it is to bond to lithium disilicate.4 Despite the advantages of resin cements, a limitation is that they must be used in cases in which…

27. Page 55

    RESTORATIVE 55 mixed paste/pastecement. There was no significant difference between the mixing/dispensing techniques for compressive strength or diametral tensile strength of the same cements. For another brand of RMGI cement, the compressive strength of powder/liquid automix cement was higher than the paste/paste automix, but there were no differences in the fracture toughness or diametral tensile strength.14 Another laboratory study determined that a powder/liquid version of an RMGI cement provided higher crown retention force than the same cement in a paste/paste form.15 These studies imply a slight improvement in properties with the powder/liquid versions of RMGI cements; however, paste/paste systems are…

28. Page 56

    RESTORATIVE is less affected by saliva contamination than that of resin cements, and the fluoride release of RMGI cements may help prevent recurrent caries. Powder/liquid and handmixed RMGI cements may provide slightly improved properties over paste/paste and automixed cements. Assuming ideal bonding conditions, RMGI cements may be less able to seal the margins of a crown than resin cements, and hygroscopic expansion of RMGI cements may be an issue with weaker glass-based ceramics. CONSIDERATIONS FOR BONDING WITH RESIN CEMENT Mechanisms of Bonding Bonding to any type of restorative material can be achieved by 2 basic mechanisms. First, surface roughening of…

29. Page 57

    RESTORATIVE 57 Table 2. Protocol for bonding glass-based and zirconia restorations if the laboratory has already performed surface roughening (etching or sandblasting) GLASS-CONTAINING CERAMICS (IE, FELDSPATHIC PORCELAIN AND LITHIUM DISILICATE) | ZIRCONIA Cleaning of crown | After try-in, clean with phosphoric acid or ceramic cleaner | After try-in, clean with ceramic cleaner Chemical treatment of crown | Apply silane primer | Apply 10-MDP primer Application of tooth primer | If instructions for use (IFU) recommend, apply tooth primer, and if IFU recommends, light cure tooth primer | Application of cement | Apply resin cement to internal surface of crown |…

30. Page 58

    Practical Application of Digital Technology for Complete Dentures INTRODUCTION Applying digital technologies in dental practices today can be confusing, especially for removable prosthodontics. Until recently, complete denture technologies and procedures had remained practically unchanged for better part of a century. The invention of the intraoral scanner, printable biocompatible resins, and the desktop 3D printer has essentially revolutionized complete denture techniques for the modern dentist. However, acquiring these technologies alone does not necessarily lead to better outcomes. Digital hardware and software must be utilized with sound principles practically and efficiently to benefit dentists in clinical practice meaningfully. The topic of digital…

31. Page 60

    Figure 1. Preoperative presentation. Figure 2. Reference denture impression. Figure 3. Data was captured and aligned digitally. patient and evaluated for aesthetics, occlusion, and phonetics (Figure 8). Photographs were retaken and analyzed by both the doctor and patient. Following the evaluation, the file was sent to a digital denture laboratory (The Denture Center, Windsor, Ont, Canada) for manufacturing and delivered to the patient in normal fashion. Final photographs were obtained at the one week postoperative visit (Figure 9). Practical Application of Digital... continued from page 58 did not move significantly between the photographs. If the patient's head moves between the…

32. Page 61

    RESTORATIVE 61 Figure 7. Prototype STL file. Figure 8. Prototype try-in. Figure 9. Final prosthesis. situation on how best to use or not use digital technology. The advent of advanced intraoral scanners has allowed dentists to capture edentulous data digitally for the first time. The advancement of milling and printing technologies over the past 20 or so years has allowed the dental technician freedom to manufacture dentures using various techniques, workflows and materials. The clinical case presented above utilized multiple techniques and This could be potentially upsetting to both doctor and patient when the intention is to finalize treatment during…

33. Page 65

    Noble Metal Refining Noble Metal Refining provides peace of mind that goes above and beyond when it comes to properly recycling dental metals. Noble is a fully licensed industrial refiner of gold, silver, palladium, and platinum, servicing many industries nationwide. Noble provides dental professionals and dental organizations with true Chain of Custody and a certificate of destruction, transferring metals directly from one's dental office or organization to Noble's refinery. For more information, call (888) 764-3105 or email info@noblemetalrefining.com. FREEinfo, Aurident For almost 50 years, Aurident has been providing efficient refining services, yielding a high rate of return at competitive processing…

34. Page 67

    nology) in centric relation. The STL file was exported to the laboratory, where digital wax up was completed using DentalCAD (exocad GmbH) (Figures 4 and 5). This digital wax up was first overlaid with the digital smile design to verify the wax-up with respect to the patient's face for facially driven treatment planning. The digital wax up was then overlaid with the preoperative STL file to create the dual-zone crown lengthening guide (Figure 6). The surgical guide contained 2 reference points: one for desired gingival margin position and another for desired osseous crest position set to 3 mm from the…

35. Page 68

    Figures 13 and 14. A photo of 8-week postoperative healing, during which soft-tissue modification was completed using the Er,Cr:YSGG laser. Figures 15 and 16. The one-year post op view with full smile (Figure 15), and a close-up view of the final prosthesis (Figure 16). The advent of digital technology has allowed for a novel approach to aesthetic crown lengthening. lengthening, mostly based on analog methods, including the use of a "proportion gauge" and clear matrix based on a diagnostic wax-up. The proportion gauge, while providing an efficient method of verifying the desired width-to-length ratio of 75 to 80% and an…

36. Page 72

    QUICK TECHNIQUE REALIZE THE FULL POTENTIAL OF YOUR INTRAORAL SCANNERS Digital records reduce patient visits and chair time for duplicate dentures Clinical Application of Intraoral Scanners – Fabrication and Application of Duplicate Dentures Intraoral scanners have proven to be clinically useful in digital guided implant surgery. Aside from digital guided surgery, intraoral scanners are also used for the fabrication of duplicate dentures via denture scanning. In various cases of actual clinical practice, patients may need to replace previously used complete dentures. When complete dentures are used as temporary prosthetics after implant placement, ways then can be normally used to obtain…