Dentistry Today — March 2013

Inside this issue

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

1. Page 6

   North American Dentists: Stand Tall! For anyone who has had the opportunity to travel the world, one can begin to see the contrast in the dental care that exists. If you travel with your dental observation radar on, you will likely come to the conclusion that the people of North America must generally have access to some very good dental care. And, while we could argue that there are always exceptions, overall, the level of dental care delivered is reflected in the smiles to be seen. The United States and Canada are not the only countries with dental professionals delivering…

2. Page 8

   The Brave New World of Digital Dentistry CONFRONTING A MORAL AND PROFESSIONAL DILEMMA The dental profession is facing a moral and professional dilemma regarding prosthetic dentistry. If dental crowns and bridges (C&Bs) are to be considered the equivalent of medical devices, at least in terms of possible federal taxation, should we not have standards by which these devices can be judged? In light of this new consideration, isn't it time for the profession to take a hard look at these restorations, their materials, and their making? In recent years, our profession has been chided to base our clinical decisions on…

3. Page 10

   VIEWPOINT continued from page 8 Increasingly, the "dental industrial complex" has become the sole source of that information, yet all too frequently purveyor knowledge of data on materials and their production has taken a backseat to marketing. As a result, evidence based dentistry is becoming more and more elusive. In our opinion, a precision crown is brewing. The margins of C&Bs are increasingly creeping subgingivally to mask with compromised medical devices, or to salvage aging dentitions, or boost youthful smiles, while an understanding of these materials is diminishing. How is the practicing dentist to determine the efficacy, safety, and useful…

4. Page 12

   Global Dental Solutions, LLC A full service dental laboratory dedicated to your success since 2001. Our consistently low remake rate and competitive pricing make us the laboratory capable of handling all of your needs. We offer free round-trip shipping via FedEx preprmted labels or local courier. Additionally, our owners, Hal and Brad, are on site 5 days a week. Just a sampling of our products: ALL-ON-4 SCREW RETAINED DENTURE All inclusive $2480 *plus abutments CROWN & BRIDGE CEREC CADENT iTero Authorized laboratory REMOVABLES Vuplast CERTIFIED LABORATORY tcs IMPLANTS Round-house implant supported bridges with gingival shaded porcelain Atlantis custom milled abutments…

5. Page 14

   Benco Dental Initiates The Lucy Hobbs Project to Unite and Empower Women of Dentistry Acknowledging and Honoring the Legacy of Lucy Hobbs, DDS At age 26, Lucy Hobbs wanted a career change. She had been teaching for 10 years and felt a strong desire to pursue her passion—dentistry. However, this was 1859, and female dentists didn't exist. Hobbs was refused admission to dental school because of her gender. Undeterred, she convinced a professor from the Ohio College of Dental Surgery to create a private program of study. In 3 short years, Hobbs opened her own practice, professionally recognized, and allowed…

6. Page 16

   From the December 2012 Issue ORAL EXAM SYSTEM DentLight The DOE SE System is a simplified version of the award-winning DOE oral exam instrument for oral cancer screening. It uses patent-pending collimated LED beam technology and a custom high-contrast fluorescence viewer for direct detection of oral lesions without the need for rinsing the mouth. For more information, call (800) 763-6901 or visit the Web site dentlight.com. FREEinfo, CARBIDE BURS Brasseler USA SabreCut carbides cut faster, generate less vibration (chatter), and leave a smoother finish than the leading aggressive-cutting carbides. With sharp, deeply ground transverse blades at the tip, these carbides…

7. Page 18

   Assured Dental Lab Zenostar is a 100%, full-milled pure zirconia crown with no porcelain overlay—no porcelain fractures! Less than half the price of a gold crown, it is an aesthetic alternative to gold restoration and PFM. Among its benefits are its 1,200 MPa flexural strength, conventional chamfer prep and cementation, and excellent marginal fit. For more information, call (877) 283-5351 or visit assureddentallab.com. FREEinfo, MAGNIFIER Vision USA The Task-Vision Clamp-On Flex Arm Magnifier With High-Power Insert offers excellent optics and features a 5m 2x lens and a 4x lens insert for extraclose inspection. The lens can be turned vertically and…

8. Page 20

   Dentistry Today.com Providing you with news and information from the industry leader in clinical content. Visit Our Site Today! 2013 GIVEAWAY ipad Enter to win a FREE Apple iPad with Retina display Educate yourself and your patients View your appointments and reports Add diagnoses to your patients' records Improve your patients' experience Display x-rays, videos, and procedures For more information and to enter, visit ipad All entries must be received by 11:59PM (EST) May 31, 2013. Technique of the Week Adjusting Occlusion After Restoration Jose Luis Ruiz, DDS, of Burbank, Calif., demonstrates one of the most important techniques in dentistry:…

9. Page 22

   FOCUS ON: Monolithic Crowns Rella Christensen, PhD, discusses clinical performance of the new monolithic crowns. Q: What is a monolithic crown? A: Crowns that are uniformly one material are referred to as "monolithic." Today, these types of crowns are taking over in the United States. Monolithic crowns are not new to dentistry. All ceramic porcelain jacket crowns have been around a long time, and all-metal crowns date to early beginnings of dentistry. However, for more than 50 years, the multilayered PFM has been the predominant technology used for crowns, providing strong substructures and veneered ceramics with various colors and translucencies.…

10. Page 24

    Luxatemp Ultra ++++1/2 DMG America | (800) 662-6383 | dmg-america.com Consultants' Comments • "Nice aesthetics and shade selection." • "Great material." • "Luxatemp Ultra polishes to a high lustre." • "Very pretty quickly compared to other products." • "Easy to place and remove." • "Fractures if removed too soon." Description Luxatemp Ultra advances the Luxatemp provisional material line, providing enhanced strength. It is a self-cured composite for the fabrication of temporary crowns and bridges, inlays, onlays, and veneers, and it is also indicated for the fabrication of ultra-tem temporaries. A 2-component material, it is based on multifunctional methacrylates and automatically…

11. Page 26

    Spotlight Leading Endodontic Rotary File System Refined to Improve Performance TULSA, Okla.-PROTAPER NEXT, DENTSPLY Tulsa Dental Specialties' newest innovation and an expansion of one of the world's leading endodontic file systems, utilizes the same variable taper design found in the original ProTaper, but it has been refined to improve performance. It features (1) the patented M Wire Ni-Ti alloy for increased flexibility and resistance to cyclic fatigue, (2) a rectangular cross-section for greater strength, and (3) unique Asymmetric Rotary Motion. It uses the same trusted rotary action as the original ProTaper; what's different is how the files work down the…

12. Page 28

    First-Ever iPad App for Dental Practices Facilitates Patient Monitoring MIAMI, Fla.–DENSIO is the first iPad app for dental practices that allows dentists to keep patient records for most dental specialties. Starting from a basic medical exam, they can then work on dental and periodontal charts, orthodontics, and TMJ, followed by diagnosis and the development of a treatment plan. After a simple installation process that does not require any cables and major hardware, dentists will be able to access all records (x-rays, photos, etc.) and follow patients' progress. For more information, call DENSIO at (286) 279-6966 or visit densio.com. FREEinfo, All-Steel…

13. Page 29

    Give us 10 minutes, and we'll save you up to 50% (800) 474-7665 www.exactadental.com/10min FREEinfo, on card Scaler's Range of Power Lauded RACINE, Wis—Offered by state-of-the-art circuitry give power to do both endodontics Vista Dental Products, the the user the widest range of and implants. piezo Pilot offers unpreceamplitude settings for high- The Pilot is available in 6 dented power in a quiet, comend performance. colors with matching autopact, lightweight design, and The Pilot has a greater clavable handpiece sleeves its innovative features and power range than average. Its and includes a set of 4 ultralow range is great for…

14. Page 30

    System Provides One-of-a-Kind Approach to Wireless X-Ray Imaging CHARLOTTE, NC–Offered by MyRay, X-pod is a wireless digital system that allows users to capture diagnostic quality x-rays and review them on the integrated hand-held touchscreen. It comes with multifunctional capability, image-enhancing tools, and tooth-association charts to give dentists maximum flexibility on the go, and a high-capacity lithium polymer battery allows recharge-free usage all day long. With chamfered edges and rounded corners, X-pod's 3-layer, 25 line pairs/mm sensor is designed for maximum patient comfort. It features a thin thermetic plate to improve image definition and protect the silicon receptor from direct x-ray…

15. Page 31

    Curing Light Defines Performance Without Compromise CUYAHOGA FALLS, Ohio- Defining performance without compromise, the Coltene S.P.E.C. 3 Curing Light effectively reduces chair time due to its rapid and deep polymerization of various light-cured materials. Its sealed aluminum body ensures quick and easy disinfection between patients, and its powerful lithium polymer battery offers enough storage capacity to perform more than 300 ten-second cures between charges. Additionally, the S.P.E.C 3 features multiple curing modes for maximum functionality in any clinical situation. Visit specs.led.com for more information or contact your authorized Coltene dental supply distributor. FREEinfo, Imaging System Can Be Tailored to Meet…

16. Page 32

    Simplifying the Placement of Large Composite Restorations Ivoclar Vivadent's Tetric EvoCeram Bulk Fill Solution With Ivocerin Traditionally, the process of placing composite restorations has been extremely challenging. The standard placement method has been the techniqueand time-sensitive process of 2 mm incremental layering and curing of composite to ensure complete polymerization and adequate marginal integrity. Groundbreaking advancements in direct resin material and photopolymerization sciences have enabled dentists to easily and predictably place highly aesthetic and durable composite restorations while simultaneously reducing chair time. A product originating from this innovation is Tetric EvoCeram Bulk Fill (Ivoclar Vivadent), a nanohybrid composite material exclusively…

17. Page 34

    Spotlight New Lithium Silicate Ceramic Crowns Exhibit Ideal Combination of Aesthetics and Strength NEWPORT BEACH, Calif.–Glidewell Laboratories introduces Obsidian lithium silicate ceramic, a glass ceramic material indicated for the fabrication of monolithic restorations, including individual crowns, 3-unit anterior bridges, veneers, inlays, and onlays. Unlike layered ceramic or PFM restorations, Obsidian ceramic restorations are resistant to chipping due to their monolithic composition and average flexural strength of 373 MPa, and they exhibit an ideal combination of aesthetics and strength, with translucency that mirrors the vitality of natural teeth. Obsidian ceramic restorations exceed the ISO strength requirements for cemented all-ceramic restorations and…

18. Page 36

    Spotlight New Smile Makeover Treatment Hailed As a More Affordable Cosmetic Option SANTA MARIA, Calif.–New from Denmat, the Duo:PCH Porcelain Composite Hybrid System combines the convenience of a composite buildup with the finishing beauty and longevity of porcelain. As a more affordable cosmetic option, it is a comprehensive treatment solution that gives clinicians everything they need to complete multiple smile makeovers without involving a lab or lengthy temporaries. Not every patient seeking a perfect smile can afford a custom veneer makeover, but Duo:PCH now makes it possible to create affordable, beautiful, long-lasting restorations. Here's how it works: First, Duo:PCH prefabricated…

19. Page 38

    Feature-Laden Full-Quadrant Model Added to Line of Impression Trays NEW MILFORD, Conn.–An addition to its top-rated QUAD TRAY family of metal dust arch impression trays, CLINICIAN'S CHOICE QUADRANT XL incorporates all the benefits of the original QUAD TRAY theme–inflexible aluminum construction; a wide, customizable arch; and a thin distal bar–with 2 additional benefits: (1) a full quadrant design to assist the dental lab in providing ideal occlusion by recording cuspid rise and (2) more lateral support for the impression material, increasing rigidity and reducing impression lag. Other unique features to the QUAD TRAY XL include slots on the lingual walls…

20. Page 40

    Precious Metal Refining Company Expands Online Presence PITTSBURGH–Atlantic Precious Metal Refining, serving dental professionals worldwide, recently unveiled its redesigned Web site and announced its official launch into social media via YouTube, Twitter, and Facebook. The Web site has been updated with a fresh look and includes intuitive navigation links and improved functionality. Added features include (1) tips on efficient scrap recovery and collection, (2) information to help dental professionals fully maximize their return on dental scrap materials, (3) photos and videos of the actual refining process, and (4) step by step instructions for properly collecting and shipping valuable precious metal…

21. Page 44

    Spotlight Microhybrid Composite Now Highly Radiopaque, Allowing for East Identification on Radiographs SCHAUMBURG, Ill.-BISCO Dental Products' legendary ELITFLO LV light-cured, low-viscosity microhybrid composite has been reformulated and is now highly radiopaque, allowing for easy identification on radiographs. ELITEFLO LV's flow characteristics make it ideal for use as a dentin liner, for lining undercuts, pit and fissure sealants, preventive resin restorations, and its easy handling and low-viscosity flow allow for effortless adaptation to dentition. Additionally, it exhibits self-leveling properties, facilitating excellent adaptation to the preparation walls, avoiding air entrapment, and its microhybrid formula provides outstanding strength and high polish and gloss…

22. Page 45

    Oral Exam System's Efficacy and Ease of Use Cited PLANO, Tex.-Offered by Dent-light, the DOE SE System, a simplified version of the award-winning [?]06 oral exam instrument for oral cancer screening, uses patent-pending optimi-LED LED beam technology and a custom high-contrast fluores-cence viewer for direct detection of oral lesions without the need of rinsing the mouth. The system's small, solid-metal, high-power cordless wand enables both extra and intra-oral access for early detection of both traditional and HIV virus associated oral cancer. Offered with custom-fit barrier sleeves for easy disinfection, the instrument allows dental professionals to perform easy, effective, and efficient…

23. Page 46

    NEWS/TRENDS Industry News Carestream Dental Announces Managerial Appointment Atlanta-based Carestream Dental, Carestream Health's worldwide dental division, announced recently the appointment of Marc Gordon to the position of general manager, Carestream Dental LLC, the US segment of the business. In this role, he will report to Rich Hirschland, global president of Carestream Dental and oversee the design and execution of the company's imaging and software growth strategies across the United States. Since 2009, Mr. Gordon has served as Carestream Dental's finance director, where he led projects that accelerated revenue growth and strengthened the company's competitive position. Prior to joining Carestream Dental,…

24. Page 48

    NEWS/TRENDS Dr. Sherwin R. Shinn to receive 2013 ADA Humanitarian Award Dr. Sherwin Shinn and his family. Pictured are (front, back): Shaleena, Yashmeen, Tomar, and Jim Nasser, and his wife, the rod Faria while volunteering in Uganda. On the last day of a 6-week mountain-climbing vacation in Nepal, Dr. Sherwin R. Shinn, DDS, was 11,500 feet above sea level when he realized his life's mission was to devote his life to providing dental care and education to the less fortunate in his community and the world. And now, 30 years later, Dr. Shinn, a staff dentist at Lindquist Dental Clinic…

25. Page 52

    Protection From Radiation Side Effects A recent article published in the journal Cell Stem Cell describes research by scientists at the National Institute of Dental and Craniofacial Research (NIDCR) and their colleagues at the National Institutes of Health regarding a protein called mammalian target of rapamycin (mTOR). The scientists had helped to build the case that mTOR is frequently elevated in epithelial, or skin, cells extracted from head and neck squamous cell carcinomas (HNSCC). This discovery aided an intriguing therapeutic possibility. Since almost 80% of patients with HNSCC will receive radiation therapy, what if the tumor cells were protected with…

26. Page 53

    Electric Brain Stimulation Releases Powerful Painkiller A current clinical study used electricity on certain regions in the brain of a patient with chronic, severe facial pain to release an opiate-like substance that's considered one of the body's most powerful painkillers. The findings of this group expand on previous work done by researchers at the University of Michigan, Harvard University, and the City University of New York. In the previous study, researchers delivered electricity through sensors on the skull of chronic migraining patients, and found a decrease in the intensity and pain of their headache attacks; however, the researchers then could…

27. Page 54

    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. Massad Edentulous Low Temp Impression Tray Nobilium The most difficult part of creating dentures is to get an accurate initial impression. If the denture impression does not capture all the soft-tissue details along with the underlying hard-tissue framework, the denture cannot possibly fit well. For every detail that is not accurately recorded, the practitioner will spend tremendous amounts of chairside time adjusting and repairing the error. The Massad Low Temp Edentulous Impression Tray is designed…

28. Page 55

    Embrace Varnish Pulpdent The key to maintaining a healthy and stable oral condition is often dependent on the environmental input of the dental team. The most important parameters are the protection of the mineralized state of hard tissues and the bioavailability of suitable ions in the oral fluids, particularly in the immediate vicinity of the teeth. The dentist and hygienist must ensure that patients, in spite of their diet and oral care practices, are protected as much as possible from the acid damage that is the most common source of hardand soft-tissue breakdowns. Pulpdent's Embrace Varnish is a 5% sodium…

29. Page 56

    Top 25 Aesthetic/Restorative Products Dentistry Today's first annual Readers' Choice Top 25 Aesthetic/Restorative Products, selected on the basis of lead generation, represent some of the profession's most innovative aesthetic and restorative products. The products appear in no particular order. Argen Captek Nano crowns and bridges offer aesthetic and health advantages where all other metal or metal-free options fall short. Captek Nano is ideal for restorations over dark tooth structure, endodontically treated teeth, implants, patients with periodontal or caries risk, and any time where margin placement is intrasulcular. The warm yellow collar of the metal protects against darkness at the margin,…

30. Page 58

    Top 25 Aesthetic/Restorative Products VOCO America Structur 3 is a strong, nanofilled, quick-setting temporary crown and bridge material with "Wipe & Go" technology. It's the material of choice for the quick fabrication of strong and aesthetic provisional crowns and bridges (short-term and long-term), inlays, onlays, veneers, and temporary posts. With Structur 3, VOCO is using its advanced nanotechnology to create strength and aesthetics. One of the biggest advantages is the "Wipe & Go" effect. Structur 3 has a very smooth surface with a minimal oxygen inhibition layer and no longer needs to be polished. All it takes for the clinician…

31. Page 60

    Top 25 Aesthetic/Restorative Products . 1 DMG America New PermaCem 2.0 provides an exceptional self-adhesive bond to zirconium. This universal, dual-cure composite luting cement can be used for the permanent cementation of crowns, bridges, inlays, onlays, and root posts without the need for separate enamel and dentin bonding. By incorporating a recently developed adhesive monomer formula, PermaCem 2.0 offers an exceptional bond across all substrates. Plus, as a single-step cement, it provides the added benefit of not requiring an etching step, which saves time and reduces post-op sensitivity. It also features a lower water sorption rate for greater reliability and…

32. Page 62

    Top 25 Aesthetic/Restorative Products MicroDental Laboratories ZEUS Full Contour Zirconia Restoratives are a strong alternative to PFM and full-metal restorations. These restoratives offer aesthetic advantages over full metals and are more resilient to fracture or delamination than PFMs. They are highly biocompatible and are not affected by fluctuations in alloy prices. ZEUS Restoratives are available in 3 tiers of products. For more information, call (800) 229-0936. FREEinfo, BISCO Dental Products DUO-LINK UNIVERSAL is perfect for reliable, high-strength cementation with easy cleanup. It's extremely high, consistent degree of conversion in both self-cured and light-cured modes is required by today's stronger restorations.…

33. Page 64

    Top 25 Aesthetic/Restorative Products . 1 Ivoclar Vivadent Tetric EvoCeram Bulk Fill is a faster posterior composite without compromise. It represents a significant advancement in the field of resin-based filling materials. Its unique formulation provides for faster, more efficient placement of direct composite restorations while sustaining long-term clinical performance. You can discover the 3 new patented technologies found only in Tetric EvoCeram Bulk Fill, including (1) Ivoceran, which is a new light initiator that provides a deeper and more efficient depth of cure and shorter curing time while enabling Tetric EvoCeram Bulk Fill to be cured in 4 mm increments…

34. Page 66

    Top 25 Aesthetic/Restorative Products . 1 Parkell EPIC-TMPT creates a resilient restoration that actually flexes with the tooth to absorb and dissipate occlusal pressure without causing marginal discrepancies. Conventional Class V restorations are stiff and may cause stress at the margins, which can result in leakage, sensitivity, staining, and discoloring. Made with a reactive organic filler (built on the TMPT molecule), EPIC-TMPT is more resilient than traditional microfills, and the bonded filler is tough and durable with superb wear resistance. EPIC-TMPT polishes beautifully. After a light polishing, margins simply disappear. For more information, call (800) 243-7446 or visit parkell.com. FREEinfo,…

35. Page 67

    Kuraray America Panavia SA Cement has been designed to combine bond strength and simplicity into one dual-cure, self-adhesive product. With the addition of Kuraray's proprietary MDP there is no need for a bonding agent when using this cement. The simplicity feature stands out during the cleanup process. The cement is also incredibly easy to remove at the margins, leaving no room for damage to the gum tissue or the restoration itself. The cement, in syringe format, is available in either automix or hand mix to fit the needs of each patient and practice. For more information, call (800) 879-1676 or…

36. Page 68

    The matrix of choice for almost all situations! FENDERMATER Design by Dentists The fastest sectional matrix for perfect class II restorations Pre-curved, easy to insert sectional matrix and wedge in one piece. Available in two sizes for perfect contact and tight cervical sealing. Designed by Dentists for quick, safe and predictable composite restorations. N E W FENDERMATER Fix Design by Dentists The matrix of choice for wide cavities when used with FenderMate Fix. Excellent results with minimal finishing! Place FenderMate Fix into the space between the wedge and the matrix. Light cure to seal and shape. Proceed with the restoration.…

37. Page 69

    Septodont Biodentine is an all-in-one dentin replacement material that is bioactive and biocompatible and can be used in both the crown and root wherever dentin is damaged. Indications include restoring deep cavities, pulp capping, perforations, and internal/external resporptions. In addition to treating damaged dentin, Biodentine provides a number of clinical benefits, including remineralization, preservation of pulp, and prevention of clinical failures. Studies have shown that Biodentine induces odontoblasts, enabling mechanical properties equivalent to human dentin. (The studies are available upon request.) Biodentine is now available in an operatory 5-pack size. For more information, call (800) 872-8305 or visit septodontusa.com. FREEinfo,…

38. Page 70

    Managing the Buccal Gap and Plate of Bone Immediate Dental Implant Placement When a dental implant is placed into a fresh extraction socket, the space between the implant periphery and surrounding bone is called the gap or jumping distance.1 The gap consists of 2 dimensions: horizontal defect width and vertical defect height (Figure 1). The term jumping distance refers to the ability of bone to bridge the horizontal gap and fill the void. A gap can occur on any aspect of an immediately placed implant: buccal, lingual, or proximally. The main objective of immediate implant placement is to provide an…

39. Page 72

    Managing the Buccal Gap... continued from page 70 1.25 mm were treated with and without barriers and the implants were submerged. The defects healed with bone and BIC against sublasted, largegrit, acid etched surfaced implants was similar to the control sites where an implant was placed into a healed ridge. They concluded that a defect one mm may heal with a high degree of osseointegration. It was noted that previous assessments employed machined surfaced implants, whereas the latter study used rough surfaced implants. In an earlier study, Borselli et al8 demonstrated that created defects ranging from 1.25 to 2.35 mm…

40. Page 73

    IMPLANTS and there was no difference between test and control sites. Subsequently, Botticelli et al¹⁶ assessed 21 sites in 18 humans with respect to gap healing around rough surface dental implants that were not submerged. The flaps were placed next to the abutment portion of the implant exposed to the mouth. No bone or barriers were employed. Eight of 9 defects initially > 3 mm in width, were completely filled with bone. The vertical bone crest resorption amounted to 0.3 (buccal), 0.6 (lingual/palatal), 0.2 (mesial), 0.5 (distal), and 56% of the horizontal width. No biopsies were done. There were 2…

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