Dentistry Today — MARCH 2014

Inside this issue

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1. Page 8

   Electronic Health Records: Who's Running the Asylum? There is no question that dentistry is on the cusp of an electronic health records (EHR) revolution. In addition to all the patient care, operational, and financial benefits a practice can obtain from adopting EHR, various mandates and incentive programs are calling us to the line and desire to get up to speed quickly. Just as physicians have evolved and experienced EHR adoption during the past 10 years, dentists who previously were looking for reasons why they should embrace EHR are now clamoring for the answers on how to do it. And others,…

2. Page 10

   VIEWPOINT continued from page 8 It can be a bit of work, but if you choose to take control and follow a proven process of evaluating and selecting EHR systems, which includes a needs analysis, scrutiny of proposals, practice-oriented demonstrations, and thoughtful feature comparison, you can save time, resources, and ultimately choose the right solution for your needs. There are tools that can help you along the way, such as this EHR evaluation and selection checklist (dentalsoftwareadvisor/dentalcontracts-checklist) that I put together. TAKE CHARGE OF YOUR ELECTRONIC HEALTH RECORDS CONTRACT After having structured and negotiated EHR contracts for more than a…

3. Page 12

   VIEWPOINT continued from page 10 panties. So, potentially a practice could purchase an EHR with the belief that they would be able to obtain incentive monies, yet there were no remedies laid out for the practice if the vendor fell short. The point is that vendor attorneys have a duty to develop and structure one-sided contracts with favor toward the vendor (if I were working for a vendor, I would do this as well); and, if the practice doesn't do its due diligence and take care of itself, the practice can suffer the consequences of these vendor contracts. So again,…

4. Page 13

   INTERVIEW DR. GENINHO THOMÉ, Neodent 1 Neodent is new to the United States. What should dentists Today readers know about your company? We started Neodent more than 20 years ago in 1993 as JGC Indústria e Comércio de Materiais Dentários S/A. Neodent was the first Brazilian company in the implant sector to receive certification from the Ministry of Health, and we started to manufacture dental implants and related instruments with just one production employee. Over time, we moved to our own premises in Curitiba in 1998, where the headquarters and a state-of-the-art manufacturing facility are located. As a periodontist, I…

5. Page 16

   FOCUS ON: Tooth Preparation Disinfection Rella Christensen, PhD, reviews how clinical microbiology identified 5% glutaraldehyde/35% HEMA is an excellent tooth preparation disinfectant. Q: Why disinfect a tooth preparation? A: Many of the same organisms cultured from within carious lesions remain in the finished prep. During removal of the infected dentin, clinicians inadvertently spread organisms and drive them into surrounding uninfected dentin, where they can remain viable. Clinicians have reported for years the presence of caries later found under their carefully placed restorations—on the pulpal floor. Although they attribute post-treatment caries on axial walls and margins to leakage, gross caries on…

6. Page 17

   KaVo Kerr Group 1 How did KaVo Kerr Group get started, and what was the goal at the time? KaVo Kerr Group really originated back in 2004, when our parent company, Danaher, acquired KaVo through Dentalez, followed shortly by DEXIS, Pelton & Crane, and Sybron, which brought Kerr and Ormco and then many others followed as time evolved. We were fortunate to then be able to assemble such an outstanding portfolio of brands during the past 10 years. The formal name KaVo Kerr Group was articulated just recently and will define our global dental business and portfolio of brands. 2…

7. Page 22

   From the December 2013 Issue INSTRUMENT WASHER SciCan HYDRIM C61w G4 uses fresh water and cleaning solution for every cycle to ensure superior washing results, and its unique combination of safety, efficiency, and instrument protection simplify reprocessing and maximize your return on investment. It has a capacity of 6 full-size cassettes, the largest of its kind, allowing offices to turn over 120 instruments in 35 minutes from start to dry. For more information, call (800) 572-1211 or visit the Web site scicanusa.com. FREEinfo, DIGITAL RADIOGRAPHY SENSOR Carestream Dental The RVG 6500 system features the latest innovations in digital radiography while…

8. Page 24

   SciCan The newest addition to the STAT/M family of autoclaves, the STAT/M G4 series boasts a contemporary new look and technology that provides a direct channel of communication through the Internet to increase productivity and limit downtime. Still powered by SciCan's signature steam technology, it provides sterilization at speeds faster than conventional chambered autoclaves. For more information, visit scicanusa.com. FREEinfo, SMALLER MIXING TIPS Exacta Dental Direct EXACTA Dental Direct will begin packaging smaller mixing tips with its dental materials to help eliminate material waste. The tips will eliminate up to 30% of the wasted material compared to the larger tips.…

9. Page 26

   CLINICAL REVIEWS THE DENTAL ADVISOR DUO-LINK UNIVERSAL ++++1/2 BISCO Dental Products | bisco.com Consultants' Comments • "I can use this to cement all of my indirect restorations." • "The system makes removal of excess cement easy." • "Dual cure ensures complete setting." • "Limited shades." Description DUO-LINK UNIVERSAL, a dual-cured resin-lusting cement compatible with many adhesive systems, can be used to cement restorations of all substrates. It is radiopaque and intended for use with a bonding agent. Evaluated by 13 consultants in 260 uses, it received a 93% clinical rating. Clinical Observations Instructions/Packaging DUO-LINK UNIVERSAL is packaged in automix syringes.…

10. Page 28

    Spotlight Entry-Level Model to Automatic Mixing Offers Affordability, Control, and Impression-Taking Convenience ST. PAUL, Minn.–Building upon the trusted Pentamix family name, 3M ESPE's new Pentamix Lite Automatic Mixing Unit offers dentists an entry-level model into the world of automatic mixing. An affordable, portable mixer, it works with all 3M ESPE impression materials and is built with convenience in mind. From high-viscosity putty to medium-bodied materials, the Pentamix Lite consistently delivers a homogeneous, reproducible mixing quality for vivid-free impressions. It works with all 3M ESPE impression materials, including Imprint a VPS Impression Material, the profession's fastest setting impression material, and Impregum…

11. Page 30

    Spotlight New Cordless Obturation System Introduced Uniquely Designed by Dentists, Sensor Offers Versatility and Ease of Use COPPELL, Tex Offered by AxisSybronEndo, the cordless elementsfree obturation system combines a breakthrough down-pack heat source with a world-class back-fill extruder. The down-pack device provides instant dense heating of the heat plugger with precisely controlled temperature and timing, making it perfect for single-motion down-pack obturation. Utilizing single-use gutta-percha needle cartridges, the comfort grip back-fill device features a motorized extruder system for precise temperature and speed control for a 3-dimensional fill when back-filling canals. Visit the elementsfreeendo.com Web site to download AxisSybronEndo's Q&A with…

12. Page 32

    Spotlight Implant Designed Exclusively for Overdentures ESCONDIDO, Calif.—Offered by ZEST Anchors, the LOCATOR Overdenture Implant System (LODI) features (1) intuitive surgical instrumentation designed with safety in mind, (2) narrow-diameter implants, (3) LOCATOR, the world's leading overdenture attachment, and (4) a male processing pack. Combined, these elements offer a less invasive, predictable, and durable implant-retained overdenture for patients requiring an effective, cost-conscious technique for securing their dentures. The LODI System incorporates a unique 2-piece coronal design not found with o-ball mini implants, a critical feature optimizing patient satisfaction by providing flexibility for simple attachment interchangeability and replacement should wear occur with…

13. Page 33

    LOCATOR OVERDENTURE IMPLANT SYSTEM "The new LODI System offers us a good alternative to o-ball attachments when the use of a narrow implant is desired. I also like the LODI Surgical Kit. It has fifty snap-on Drill Stops and a Torque Wrench that tops out at 70Ncm, which assists in determining the level of primary stability." Steven H. Pratt, DDS, FAGD, FAAID "I have placed more than 50 LOCATOR Overdenture Implants and this system is exactly what I have been looking for. It is easy to use with graduating drill diameters and multiple length drill stops, as well as paralleling…

14. Page 34

    Spotlight Temporary C&B Material Offers Strength and Aesthetics at a Practical Price LOMPOC, Calif.–DenMat's Perfectempo temporary C&B material has been created for clinicians who want to produce beautiful, natural-looking temporaries that are strong, durable, and available at a practical price. Its 1:0.7 automix, BPA-free formulation features high compressive and flexural strength, greater flexibility without brittleness, a minimal oxygen-inhibited layer for optimal handling, and an accelerated set time of 4.5 minutes. Additionally, its unique uniform level structure and small filler particle size result in a glossy surface requiring minimal to no polishing to achieve natural tooth luster. Perfectempo is available in…

15. Page 36

    Spotlight System Can Detect Caries Without the Need for X-Rays TORONTO-Quantum Dental Technologies' Canary System detects and monitors caries without the need for x-rays. It uses energy conversion technology, a combination of photothermal radiometry and luminescence, to identify and measure changes in the tooth's crystal structure, not bacterial porphyrins. The system's handheld laser emits a low-power pulsating light that collects unique signatures of luminescence and heat released from the tooth. The laser's light interacts differently with healthy crystal structure than with decayed tooth structure, providing the dentist with a tool to identify and monitor caries as deep as 5 mm…

16. Page 40

    Desensitizer Provides Immediate, Long-Lasting Relief NEW YORK CITY–When applied to dentin and/or enamel surface, Kuraray's TEETHMATE DESENSITIZER creates hydroxyapatite, the human body's strongest material, which seals dental tubules and cracks in the enamel. Indicated to prevent dentin and sensitivity challenges such as cervical sensitivity (exposed dentin) and scaling/root planing, the desensitizer is highly biocompatible and free of gum irritants such as glutaraldehyde. Results are immediate and long lasting, and there is no interference with adhesives. For more information, call Kuraray at (800) 879-1676 or visit kuraraydental.com. FREEinfo, How can LESS be MORE? APPLIQUATOR Fiber Free Bonding, that's how! Precise dosing…

17. Page 42

    World's Fastest Cosmetic Simulation Software Gets Faster LARGO, Fla-With the introduction of SNAP Cosmetic Simulation Software v. 3, SNAP software reduces the time, effort, and training required to produce realistic cosmetic trial simulation photos. In most cases, patients take their simulation photos home to spouse, family, and friends, significantly increasing case acceptance and cosmetic revenue. The update is free to current owners of SNAP Cosmetic Simulation Software and is included with all new purchases of the product. For more information, call Snap Dental at (866) 987-7627. FREEinfo, Ribbond bondable reinforcement ribbon #1 Fiber Reinforcement • Unsurpassed fracture toughness • Superior…

18. Page 45

    Root Canal Treatment Paste Offered BURNABY, BC-DiaDent's Diapaste, a calcium hydroxide root canal, temporary root filling, root canal filling for primary teeth, disinfection after pulp extirpation treatment, vital pulpotomy, and temporary pulp capping. Premixed, it is packaged in a convenient syringe, which eliminates mixing and provides an ideal vehicle for application to the root apex. It may be used in conjunction with gutta percha and regular canal sealers. For additional information, contact DiaDent at (877) 342-3368 or visit the Web site diadent.com. FREEinfo, Award-Winning Bulk-Fill Composite's Popularity and Dependability Cited ORANGE, Calif.-Since its launch in June 2011, Kerr's SonicFill Bulk-Fill…

19. Page 46

    NEWS/TRENDS Industry News 3M ESPE Announces New President and GM 3M ESPE Dental announced recently the appointment of James Inglebrand as its new president and general manager, responsible for 3M ESPE's strategic direction and overall operations. Mr. Inglebrand has a 30-year career at 3M, with much of it in healthcare, including dental, which will allow him to quickly transition into his new role. Mr. Inglebrand's previous positions with 3M include roles as president and general manager of 3M Drug Delivery Systems, global business director for 3M ESPE Dental, and marketing director for the 3M Infection Prevention Division. Carestream Dental Earns…

20. Page 48

    Registration Now Open for OSAP's Annual Symposium The Organization for Safety, Asepsis, and Prevention (OSAP) announced recently that registration is now open for its 30th Anniversary Symposium, to be held June 5-10, 8 at the Hyatt Sequoia in Minneapolis. Addressing issues of concern to dental professionals responsible for infection control and patient and provider safety, the symposium, dubbed "Moving Forward to a Safer Tomorrow in Dentistry," is tailored to risk managers, group practice infection control coordinators, educators, consultants, compliance officers, researchers, policymakers, and representatives companies that sell infection control products. OSAP was considered in the era of wet fingered dentistry.…

21. Page 50

    NEWS/TRENDS New Treatment Shows Promise for Chronic Pain Sufferers and Prescription Opioid Misuse A new treatment developed by University of Utah researchers Eric Garland has shown to decrease the pain and prescription opioid use among chronic pain patients, an affliction affecting nearly one-third of US citizens. Results of a study by Mr. Garland, published online in the Journal of Consulting and Clinical Psychology, revealed that this treatment led to a 63% reduction in opioid misuse, compared to a 32% reduction among participants in a conventional support group. Additionally, participants in the treatment group experienced a 22% reduction in pain at…

22. Page 51

    NEWS/TRENDS Evidence-Based Dentistry Faculty Award Established The ADA and the American Association for Dental Research (AADR) announced recently the establishment of the Evidence-Based Dentistry (EBD) Faculty Award to recognize a dental school faculty member who has made significant contributions to implement and advance EBD. Applicants must be ADA or AADR members and full or part-time faculty members at a US dental school, and they must have completed an EBD related project within the past 2 years. One application per dental school will be accepted. The award winner will receive a $1,000 award at the AADR's Fall Focus Symposium, which will…

23. Page 52

    MEETINGS/SEMINARS Star of the South The Greater Houston Dental Society presents the Star of the South Dental Meeting, taking place March 27 to March 30 at the George R. Brown Convention Center in Houston. Speakers include Drs. Douglas Lambert, Linda Niessen, William Nudera, Raymond Bertolotti, Jeffrey Okeson, Jose Luis Ruiz, and more. Continuing education (CE) credits are available. For more information, visit the Web site starofthesouth.org. Extractions and Bone Grafting, Levels I and II The University of Detroit Mercy School of Dentistry and Golden Dental Solutions are offering atraumatic extraction and socket preservation courses with live patients. Level I will…

24. Page 54

    Cells That Break Down Collagen National Institute of Dental and Craniofacial Research (NIDCR) researchers collaborated with an international team of scientists to isolate collagen protein within living tissues and determine whether cells degrade it, and they were surprised to find that the most important cell type in animals (mice) was different from the most common cell type identified in previous laboratory (in vitro) studies. Although many types of cells can make collagen-degrading enzymes, Thomas Bugge, PhD, chief of the Proteases and Tissue Remodeling Section of NIDCR's Oral and Pharyngeal Cancer Branch, and his colleagues reported in the Journal of Cell…

25. 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. ScanX Swift Digital Imaging System Air Techniques Radiography has expanded the dentist's investigative capacity in many ways: it is possible to confirm health and to detect disease in areas previously invisible to intraoral examination. Since digital dental radiography was first introduced in the late 1980s, it has provided many clinical advantages: virtually immediate clinical results, diagnostic accuracy, decreased patient radiation, convenient data storage and communication, and decreased consumable costs and environmental waste. Most digital sensors…

26. Page 60

    58 . 1 READERS' CHOICE Top 25 Aesthetic/Restorative Products BISCO Dental Products DUO-LINK UNIVERSAL is perfect for reliable, high-strength cementation with easy cleanup. Its extremely high, consistent degree of conversion in both self-cured and light-cured resins is required by today's stronger restorations. In addition, it has low film thickness to assist in effective seating and offers diagnostic radiopacity for that perfect margin. Unique to DUO-LINK UNIVERSAL is its 2 aesthetic shades, Universal and Milky White. Universal can be used for most restorations, while Milky White can be used to mask darker tooth preparations. DUO-LINK UNIVERSAL has been maximized to reduce…

27. Page 62

    60 . 1 READERS' CHOICE Top 25 Aesthetic/Restorative Products MicroDental Laboratories ZEUS full-contour zirconia crowns, bridges, and implant restorations are a strong treatment option for clinical situations that require an exceptional balance of strength, aesthetics, and value. Made of high-performance zirconia, ZEUS Restorations offer aesthetic advantages over full-metal restorations. Featuring excellent fit and biocompatibility, these restorations offer economical and durability advantages over PFM restorations. Available in 3 different configurations, ZEUS Restorations offer dentists more treatment options. The restorations provide dentists with an economical choice for single-unit posterior restorations. Classic ZEUS Restorations offer a balance of aesthetics and strength, making them…

28. Page 64

    62 . 1 READERS' CHOICE Top 25 Aesthetic/Restorative Products Kerr NX3 XTR combines the versatility of NX3 Nexus third-generation universal dental cement with the adhesion superiority of OptiBond XTR self-etch dental bonding agent. The result: an entirely new standard in effortless excess cement removal, lasting aesthetics, high adhesion, and minimal postoperative sensitivity. You can experience easy cleanup today by purchasing a kit. For more information, call (800) KERR-123 or visit kerrdental.com. FREEinfo, 3M ESPE Scotchbond Universal Adhesive is a single-bottle adhesive that provides uncompromising performance and bond strength, whether used for direct or indirect restorations. Its simple application process helps…

29. Page 66

    64 . 1 READERS' CHOICE Top 25 Aesthetic/Restorative Products Shofu Dental BEAUTIFIL Flow Plus is now available in 4 new shades: B1, B2, C2, and D2 in both Zero Flow and Low Flow. The next step in the evolution of restorative materials, BEAUTIFIL Flow combines the effortless delivery and adaptation of a flowable with the physical properties and functionality that rival leading packable hybrids. Approved for all indications (Class I to V), it is a radiopaque base, liner, and final restorative. Stay-put handling allows stacking and sculptability. Toothlike light diffusion and chameleon properties provide intuitive and highly aesthetic outcomes in…

30. Page 68

    66 . 1 READERS' CHOICE Top 25 Aesthetic/Restorative Products GC America GC FujiCEM, a next-generation resin-modified glass ionomer luting cement powered by F2 Flex Fuse Technology, incorporates new high-elastic crosslinking monomers with a modified filler-surface treatment to increase strength properties all around. Indicated for a broad array of indirect restorations, including all types of metal, resin, aluminaand zirconia-based inlays, onlays, crowns, and bridges, GC FujiCEM 2 delivers superior bond strength while allowing you to do more restorations in less time. To many patients, you're only as good as the quality of your restorations. With F2 Flex Fuse Technology, GC FujiCEM…

31. Page 69

    Improve gingival esthetics with your implant cases The patient presented with a fractured root on tooth #9. The patient wore a flipper, which served as a transitional appliance throughout the healing phase. Following four months of integration, the soft tissue had healed nicely, exhibiting optimal margins and gingival contours. The crown on tooth #8 was removed. Removal of the custom healing abutment revealed anatomically correct contours for a seamless transition between the implant and the restoration. The final gingival contours, established during the healing phase, conformed well to the emergence profile of the final custom abutment and crown. Clinical dentistry…

32. Page 70

    Top 25 Aesthetic/Restorative Products . 1 Tokuyama Dental America SOFRELINER TOUGH is an addition-cured silicone material for relining dentures on patients who require relief on upper or lower, partial, or full dentures. It has excellent tear strength, adhesion to the denture, stain resistance, and maintains its comfort for up to 2 years. Available in 2 formulas, soft and medium, SOFRELINER TOUGH is an ideal option for soft denture relines. SOFRELINER TOUGH S (soft) provides up to 18 months of relief of irritation and is intended for cases when pain relief is the primary concern, like for first-time denture users, after…

33. Page 71

    . 1 Kuraray Dental PANAVIA SA CEMENT has been designed to combine bond strength and simplicity into one dual-cured self-adhesive product. With the addition of Kuraray's original MDP there is no need for a bonding agent when using this cement. The simplicity this feature stands out during the clean-up process because the cement is incredibly easy to remove all the margins, negating the 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…

34. Page 72

    70 . 1 READERS' CHOICE Top 25 Aesthetic/Restorative Products DMG America Constic is a light-cured, self-etching, self-adhesive, radiopaque, flowable restorative composite. It can be used in procedures ranging from restorations and underfillings to pit and fissure sealing. It offers enamel bonding, and filling in a single step, so it helps reduce errors and save time. It has a very low elastic modulus, making it an excellent shock absorber under composites. When compared to other self-adhesive flowable composites, Constic provides one of the strongest bonds to tooth structure. The proprietary formulation reduces postoperative sensitivities, and the unique, cone-shaped brushes make accessing…

35. Page 73

    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, pulpotomies, perforations, and internal/external resorptions. In addition to treating damaged dentin, Biodentine is a viable and predictable alternative to root canal therapy in teeth with caries exposures and that lack pulpitis symptoms. Its versatility enables Biodentine to be incorporated into endodontic, pediatric, and general practices. Studies are available upon request. Biodentine comes in an operatory 5-pack and an economical 15-pack. For more information, call (800) 872-8305…

36. Page 74

    Body Dysmorphic Disorder and Cosmetic Dentistry Diagnostic, Management, and Ethical Issues Willie J. Winfree, DDS, MPA Leo E. Rouse, DDS Ronald S. Brown, DDS, MS The objective of this article is to discuss the diagnosis of body dysmorphic disorder (BDD) (which is also known as dysmorphophobia) and how this disorder relates to clinical dentistry. It is a relatively common condition, although an under-recognized psychiatric disorder that has been described for more than 100 years and reported around the world.¹ It often presents to nonpsychiatric physicians and to dentists, and particularly to clinicians with cosmetic practices. Although the presenting symptoms may…

37. Page 75

    of celebrities and become preoccupied with certain aspects of physical appearance, such as the look of their teeth. Herren et al³ reported that BDD patients seeking dental care demonstrated particular behaviors which included: (1) distress over minor flaws, such as tooth color, alignment, size, and/or shape; (2) difficulty in functioning because of an obsession with a minor flaw; (3) attempting to cover up a flaw; (4) excessive behavior regarding a flaw; (5) belief that others are treating them differently because of the perceived flaw; (6) unjustified dissatisfaction with other dental treatment; and (7) excessive request for unnecessary dental procedures. It…

38. Page 76

    AESTHETICS implications. Patients with this disorder are preoccupied with an imagined problem in the appearance of one or more body parts, which leads to clinically significant stress, impairment, and dysfunction. Cosmetic correction of perceived physical deficits is rarely an effective treatment. Therefore, related clinical cosmetic therapy may result in patient mismanagement with the potential to result in patient disability, depression, and suicide.24,25 Patients with BDD tend to demand overtreatment related to the imperfections, which they may perceive to be ruining their lives. Cosmetic dentistry serves as a potential need of these individuals and allows dentists to enable these BDD patients…

39. Page 77

    Test 171 Expiration date of this CE article is March 1, 2017. To submit Continuing Education (CE) answers, use the answer sheet below. Or, use our easy online option at dentalcetoday.com. This article is available for 2 hours of CE credit. The following 10 questions were derived from the article "Body Dysmorphic Disorder and Cosmetic Dentistry" by Willie J. Winfree, DDS, MPA, et al on pages 72 to 74. Learning Objectives: After reading this article, the individual will learn: (1) the definition and diagnosis of body dysmorphic disorder (BDD), and (2) clinical and ethical considerations related to BDD. 1. Body…

40. Page 78

    Predictable Tooth Replacement in the Aesthetic Zone INTRODUCTION Although perfection is never attainable, excellence is always expected. As dentists, we are faced with complicated situations involving both diagnostic and treatment complexities. We attempt to simplify our procedures so we do not overlook details that sacrifice predictability, longevity, or aesthetics. At the Kois Center we are taught, "intellectualize simplification," and we systemize protocols for all procedures. Through the American Academy of Cosmetic Dentistry (AACD), we are presented established accreditation examination criteria to evaluate the parameters for aesthetic excellence, giving us a checklist for optimal outcomes. The journey through the AACD examination…

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