Dentistry Today — March 2015

Inside this issue

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

1. Page 10

   Closing the Gap in Risk Management While talking with my fellow dental school classmates, I always tend to get the feeling that none of us feel well trained in "real world" risk management issues. As a University of Southern California (USC) graduate right out of dental school, I felt comfortable diagnosing and treating a wide variety of procedures within the scope of my practice. My graduating dental class also had the pleasure of going through a newly implemented curriculum for behavioral dentistry, which has helped me tremendously in communicating with my patients from a wide variety of different backgrounds and…

2. Page 12

   Below is a Letter to the Editor that Dentistry Today received regarding the article "Focus On: Dental Insurance" by Tom Limoli jr, BSCJ, which ran in January 2015 on page 16. Dear Editor: I felt that I needed to comment on Mr. Limoli's article concerning dental insurance (on page 16 of the January 2015 issue of Dentistry Today). Make no mistake about it, Mr. Limoli knows vastly more than I do concerning dental insurance. But I do know a fair amount concerning the issue of medical insurance claims by dentists. After 14 years of practicing general dentistry, in 1985 I…

3. Page 16

   Utilizing the i-CAT System to Treatment-Plan Obstructive Sleep Apnea Juan-Carlos Quintero, DDS, MS Breathing is a function of life often taken for granted. We all breathe all day, every day, and as a function of the craniofacial anatomy, the airway has become a focus for my orthodontic practice. A hazardous medical condition that involves a restricted airway is Obstructive Sleep Apnea (OSA). This disease causes people to stop breathing at certain intervals during sleep, but the dangers do not stop there. People with OSA have the potential risk of developing cardiovascular disease, renal disease, diabetes, depression, and other illnesses for…

4. Page 18

   FOCUS ON: Emergencies Larry J. Sangrik, DDS, spotlights the not-so-rare medical emergency of the dental patient and how the entire staff can prepare for such an event. Q: What constitutes a medical emergency? A: An emergency is occurring any time the dentist's attention must be diverted from the planned treatment to address the patient's immediate physiological or psychological condition. Not all emergencies require emergency medical services (EMS) or a hospital visit. In fact, with timely intervention, the dental team can successfully address many situations within the office. Q: Are medical emergencies during dental treatment rare events? A: No. Some experts…

5. Page 20

   Shofu Dental PRG Barrier Coat effectively treats dental hypersensitivity by providing immediate and long-lasting relief. A light-cured bioactive varnish with an extended protection time of up to 6 months, it incorporates Shofu Dental's proprietary GIOMER technology, "Surface Pre-Reacted Glass," for high fluoride release and recharge, acid neutralization, and anti-plaque benefits. For more information, visit shofu.com or call (800) 827-4638. FREEinfo, ADHESIVE CEMENT Ivoclar Vivadent Variolink Esthetic, a dualand light-cure only resin adhesive cement, simplifies esthetic cementation. Indicated for the permanent adhesive cementation of demanding glass-ceramic and composite restorations, it demonstrates exceptional aesthetics, and its prosthetic shade matching of the restoration…

6. Page 21

   UNIT-DOSE TAKE-HOME TEMPORARY CEMENT Centrix Keep Your Temporary Secure! NoMIX single-component, moisture-activated temporary cement, designed for short-term cementation of any temporary, is now available in a new, unit-dose take-home application. Each unit contains a 0.5g dose of cement in a small tube for precise placement. Patients will appreciate its ease of use when applying it at home in case of an emergency. Packaged in a convenient display box, the 50-pack of take-home applicators fits right on your countertop. Also available is a 24-pack of take-home tubes with 6 x 1 mL prefilled syringes for in-office use. For more information, call…

7. Page 22

   From the December 2014 Issue WHITENING SYSTEM DenMat Your patients will smile more after discovering the new LumiSmile White In-Office and Take-Home Whitening Systems. Their proprietary formulations offer premium, professional-strength whitening without the premium price. Whiten your patients' teeth in 5 or less with a single visit with LumiSmile White's 25% hydrogen peroxide In-Office system, which delivers the effective, safe, and fast whitening your patients want, with or without the light. For additional information, call toll-free at (800) 40DENMAT (433-6628) or visit the website denmat.com. FREEinfo, INTRAORAL/EXTRAORAL CAMERA Denterprise QuickCam DUO, the world's first dental imaging instrument with 2 cameras,…

8. Page 24

   Efficient and Predictable Side-by-Side Posterior Restorations FIGURE 1. Preoperative view of teeth Nos. 4 and 5 showing caries on the mesial and distal of No. 4 and the distal of No. 5. FIGURE 2. View of the slot preparations. FIGURE 3. After placing the matrix bands and wedges, the preparations were selectively etched using 35% phosphoric acid. FIGURE 4. A universal adhesive bonding agent (Adper Universal) was scrubbed to the preparations using a VivaPen. FIGURE 5. The Tetric EvoCeram Bulk Fill composite was added to the preparations. Restorations were then light cured for 10 seconds. FIGURE 6. The restorations were…

9. Page 25

   Without Ivocerin it would just be another composite! tributes to the best bond strengths to enamel while preventing dential sensitivity due to over-etching. The etchant was rinsed away for 10 seconds, then the preparation surfaces were air dried to remove excess liquid. A bonding agent (Adhese Universal) was then expressed from a VivaVen, applied to the dentin and enamel, and scrubbed in for 20 seconds on both preparations (Figure 4). The adhesive was air dried for 10 seconds, then light cured for 10 seconds. Shade IVA of Tetric EvoCe ram Bulk Fill composite was placed to fill each of the…

10. Page 26

    CLINICAL REVIEWS THE DENTAL ADVISOR HYDRIM L110w G4 ++++½ SciCan | (800) 572-1211 | scican.com Consultants' Comments • "Instruments are clean and dry before sterilization." • "I used the 5-minute rinse cycle to clean soiled instruments immediately after use; later, I ran a full cycle." • "Control panel is easy to operate." • "I had to reconsider sequencing of my sterilization process." Description The HYDRIM L110w G4 is a large-capacity, stainless steel instrument washer that can be freestanding or mounted under a counter. The G4 series features a Web connection and interface that allow for data storage and remote access…

11. Page 28

    Paul Feuerstein, DMD, offers readers insight into dentistry's latest technologies, based on his clinical experience. In the Beginning A Look at the Genesis of CT Scanning During the mid 1990s, I became aware of a new company that developed a CT scanning unit for dentistry called the NewTom 9000. It was quite a large device; a patient had to lie on a small table, and his or her head was placed in large, donut-shaped device, open, and tunneled like an MRI. The images were amazing. Structures like TMJ, nerve canals, impactions, and more were visible not only in slices like…

12. Page 30

    Spotlight Two-Step Intraoral Composite Polishing System Provides Consistent and Reliable Results SAVANNAH, Ga—Introduced by Brasseler USA, the DiaComp Feather Lite 2-Step Polishing System provides consistent and reliable results for the polishing of the widest variety of composite materials. Its diamond-infused polishers are extremely versatile and work well on all types of classic restorative composite materials as well as new hybrid composites. The polishers' unique finger design and flexible spirals create an aesthetically pleasing, enamel-like finish while respecting existing surface differ-entiation. In addition, they deliver a quick, high-shine luster on every surface, including hard-to-reach locations such as the occlusion region, leaving…

13. Page 32

    Spotlight World's First Two-Step Guided Surgery System Introduced ALBUQUERQUE, NM-OCO Biomedical's Two-Step Guided Surgery System, the world's first 2-step guided surgery system, delivers unprecedented precision, predictability, and performance. Included among its features are the following: (1) innovative instrumentation specifically designed by dentists for dentists to increase placement accuracy, enhance predictability in treatment, and provide precise placement for implants with diameters of 3.25, 4, and 5 mm; and (2) a proven 2-drill protocol that significantly decreases surgical time and increases accuracy. The system's custom-designed kit includes one key per implant diameter; instrumentation is color-coded for quick reference; and all components are…

14. Page 34

    Matrix Ring Designed to Achieve Consistently Tight, Reliable Contacts Spotlight Device Accurately Detects Carious Lesions Without the Use of Ionizing Radiation HATFIELD, Pa.— Offered by DEXIS, the compact CariVu portable caries detection device uses patented transillumination technology to support the identification of occlusal, interproximal, and recurrent carious lesions and cracks without the use of ionizing radiation; CariVu in both and tablets it in safe, near-infrared light. CariVu's transillumination technology makes the enamel appear transparent, while porous lesions trap and absorb the light. This allows the clinician to see through the tooth, exposing its structure and the actual structure of any…

15. Page 36

    Impression Taking of Implants With a Snap Coping in Conjunction With a Triple Tray Neal B. Gittleman, DMD The use of dual-arch or triple-tray impression techniques for the partial dentition has been widely discussed in literature. Obviously, the dual-arch technique must offer advantages over other impression techniques currently in use today for dentists to so readily use them. Registering both the upper and lower arch in conjunction with a bite saves the dentist significant time and money. Three steps are reduced to one, and less impression material is used, resulting in a more comfortable experience for patients. Of course, when…

16. Page 38

    38 . 1 INNOVATIONS Spotlight Highly Filled Sealant, the First Offered in a Clear Shade, Offers Easy Diagnostics and Excellent Wear Resistance INDIAN LAND, SC—Offered by VOCO, Control Seal is the first highly filled sealant that comes in a clear shade, allowing for easy diagnostics and excellent wear resistance in one product. And due to VOCO's advanced nanotechnology, it achieves a very high filler degree at 55% by weight but still possesses the excellent flow characteristics of a superior sealant. Control Seal's nanofillers enable its shade to remain clear, allowing for the use of diagnostic methods based on laser fluorescence,…

17. Page 40

    Material Provides for Faster, More Efficient Placement of Direct Composite Restorations AMHERST, NY—Ivoclar Vivadent's Tetric EvoCeram Bulk Fill represents a significant advancement in the field of resin based filling materials. With its unique formulation, it provides for faster, more efficient placement of direct composite restorations while sustaining long-term clinical performance. Users will discover the 3 new technologies found only in Tetric EvoCeram Bulk Fill: (1) ivocerin, a new light initiator that provides a deeper and more efficient depth of cure and shorter curing time while enabling the material to be cured in 4-mm increments in just 10 seconds; (2) stress…

18. Page 43

    Systems Offer Premium Whitening Without the Premium Price LOMPOC, Calif.-Your patients will smile more when they discover DenMat's LumiSmile White In-Office and Take-Home Whitening Systems. Their proprietary formulations offer premium, professional-strength whitening without the premium price. Whiten your patients' teeth in a single visit with LumiSmile White's 25% hydrogen peroxide In-Office system, which delivers the effective, safe, and fast whitening your patients want, with or without the light. Patients can touch up their in-office procedures with LumiSmile White Take-Home or use it as their standard at home whitening system. Take-Home kits are available in 16%, 22%, and 32% carbamide peroxide…

19. Page 44

    Gel Helps Prevent Caries and Gingivitis and Treats Sensitivity PLYMOUTH MEETING, Pa–Enamelon Preventive Treatment Gel offers a safe, effective alternative for patient homecare when compared to 5,500-ppm toothpastes and remineralizing pastes. Containing over 5ppm, it is safe for daily use by patients of all ages to help prevent caries, gingivitis, and treat sensitivity. Its nonabrasize formula of stannous fluoride, calcium, and phosphate delivers significantly more fluoride uptake and helps to promote remineralization and inhibit demineralization. Enamelon also contains Dramamine and splantaines to boost salivary flow; it does not contain sodium laurel sulfate, gluten, or dyes. For more information, call Premier…

20. Page 45

    New Prophy Angle/Cup Cleans and Polishes Teeth Without Paste CHICAGO--Sunstar Americas' new Butler Prophylency Prophy Angle with BufferBoom Contouring Cup has polishing and stain-removing agents incorporated right into the cup, resulting in a more efficient cleaning and polishing process because no prophy paste is required. Utilizing the angle/cup, dental professionals will experience better visibility and virtually no splatter during the prophylaxis process because there is no prophy paste in the mouth. Two versions of angle/cup are available: (1) Clean & Polish, which has additional polishing and stain-removing agents incorporated into the cup for more effective stain removal; and (2) Polish,…

21. Page 46

    Planmeca's ProMax S3: Redefining Routine Diagnostics With Extraoral Bite-Wings, Lower Radiation Levels, and Superior Upgradeability ProMax S3 extraoral bite-wing. ProMax S3 standard adult pan, from same patient as bite-wing. What if dentists could capture interproximal caries and more extraoral bite-wings? With Planmeca's ProMax S3, bite-wings are quicker, easier, and more diagnostic than ever. Advanced developments by Planmeca have made it possible for dentists to use the ProMax S3's Anatomically Accurate Extraoral Bite-wing Program for periodontal patients, children, elderly patients, patients with special needs, patients who gag, and patients in pain. This program, possible only with patented Selectively Compliant Articulated Robotic…

22. Page 48

    NEWS/TRENDS Industry News Shofu Dental Announces Managerial Change [Two portrait photographs side by side] Brian Melonakos Randy Bailey Shofu Dental announced recently that Brian Melonakos has retired president. His successor will be Randy Bailey, currently vice president of sales. Since joining Shofu in 2004, Mr. Melonakos has led the company to significant growth in both and South America, including more than doubling sales and sales force size and developing a continuing education program that rivals those of major industry players. He will now act as executive advisor to the company. The Nash Institute Announces Richmond Dental Sponsorship The Nash Institute,…

23. Page 49

    "WANT TO FLOOD YOUR DENTAL OFFICE WITH NEW HISPANIC PATIENTS AND DOUBLE TO TRIPLE YOUR MONTHLY INCOME, WITHOUT HAVING TO DO A SINGLE THING??????" — Advertising Supplement — Antonio Otero D.D.S. Marketing Director of Hispanic Dental Network In private practice for over 30 years. His 6 clinics have been able to collect millions of dollars yearly thanks to his Spanish 1/2 hour Radio & TV If you're in a Hispanic Community or at least in driving distance of one, we are 100% sure we can Double to Triple your new patients right now! Having aired over 4,000 Hispanic Radio and…

24. Page 50

    US Environmental Protection Agency Issues New Radiation Usage Guidelines The US Environmental Protection Agency (EPA) this past January issued new guidelines on radiation usage during diagnostic and interventional x-ray procedures that recommend federal facilities use diagnostic and interventional x-ray equipment to keep patient radiation doses "as low as reasonably achievable without compromising the quality of patient care." The guidelines, developed by medical and radiation protection professionals from the EPA, the US Department of Health and Human Services, the Department of Vet erans Affairs, the Department of Defense, the Occupational Safety and Health Administration, and the Commonwealth of Pennsylvania, were initially…

25. Page 54

    MEETINGS/SEMINARS built up over metal and resin frameworks and its indications for veneering of full and partial crowns, bridges, inlays and onlays. The viewer has access to unlimited viewing and program notes. One hour of CE credit is available. For more information, call William Edgerton at (800) 888-3820 or visit the website at uiartofamerica.com/courses. Implant Symposium The 11th annual Mega-Gen International Symposium will take place from May 1 to May 2 in New York City. It will focus on faster, easier and patient-focused implant dentistry, providing insight into implants who will provide valuable insight on a variety of procedures. Speakers…

26. Page 56

    In First Impressions, Georac Freedman, DDS, gives readers a brief summary of products that have recently been introduced to dentistry, based on his clinical experience. Aquasil Ultra Cordless DENTSPLY Caulk The impression is the foundation of the indirect restoration. Any mistakes at the intaglio stage will be magnified during the try in and cementation phases. A major problem can be corrected prior to delivery, albeit at a high chairside cost; a major defect requires the entire restorative procedure to be redone from scratch. Clinical predictability and accuracy are paramount. The effective delivery of the impression wash material into the prepared…

27. Page 58

    Maxcem Elite Kerr Dentists are called upon to use cements in a variety of clinical situations. In the past, each separate cementation indication had its specific product, each with a highly specialized protocol, multiple components, multiple steps, and a host of contraindications. There has been an industry-wide evolution toward more universal and easier-to-use cements. The new and improved Maxcem Elite is not only new and improved Maxcem Elite is not only new and improved but incorporates the best of the latest technology in resin cements. Kerr is a self etch, self-adhesive resin cement that exhibits enhanced bond strengths and is…

28. Page 60

    New Antibiotic Shows Promise Against Drug-Resistant Microbes New research reports the discovery of a new class of antibiotics that can kill a wide range of dangerous, drug-resistant bacteria, and was published in the January issue of Nature. Laboratory experiments indicated that bacteria did not develop resistance to the new drug, called teixobactin, and may need several decades to do so because of the drug's special mode of action. It was reported that teixobactin is a promising therapeutic candidate; it is effective against drug-resistant pathogens in a number of animal models of infection. Studying 10,000 strains of bacteria that live in…

29. Page 62

    The Ultimate Bonding Experience An interview with Dr. Damon Adams, editor-in-chief of Dentistry Today, and 2 opinion leaders in restorative dentistry—Paul C. Belvedere, DDS, and Douglas L. Lambert, DDS—on the present and future state of direct composites and adhesive dentistry. Both of you have a very unique relationship that I believe our readers would like to know about. Would you care to elaborate? Dr. Belvedere: Our relationship goes back to when I first met Doug, as a new patient in my practice, when his family moved to Minnesota in 1970. During the next few years, discussions about post-high school plans…

30. Page 64

    Figures 1 to 3b. The patient presented with the desire to improve her smile with a past history of direct composite bonding of peg laterals, including endodontic treatment of the maxillary right lateral incisor. Her restorative choices were reviewed, with the patient choosing the most minimally invasive option: this polished direct composite to close the diastema between teeth Nos. 8 and 9 (partial coverage) and midfacial coverage veneers on teeth Nos. 7 and 10. The Ultimate Bonding Experience continued from page 62 Bowen's Resin and a glass powder filler. I placed my first composites in patients in 1964, sparking my…

31. Page 66

    Posterior composites are fun to do and should not be a daunting task! Figures 5 to 7. Completed direct nanohybrid composite resin restorations (Empress Direct [Ivoclar Vivadent]). The Ultimate Bonding Experience continued from page 64 dentin/enamel adhesives from penetrating beyond the prepared surfaces and causing one of the reasons for postoperative sensitivity. These matrices were then produced for the profession, called Contact Molar Bands (Ivoclar Vivadent). At the same time, as I continued working with Dr. Freidman at Demetron, concentrating light guides of 4 and 8 mm were made available. Using a 4 mm light guide, and a curing lights…

32. Page 67

    INTERVIEW and refining your finishing and polishing techniques to minimize the time needed to complete the tasks. Efficiency is the key since the only thing we have to sell is our time. If we can achieve an excellent result in fewer steps and in less time, we can take care of more patients. Dr. Belvedere: Proper understanding of the manipulation of our composite materials, the longevity of our composite temporaries, and the ability to reinforce them with structural fibers gives us the opportunity to expand their uses, such as creating fiber-reinforced posts and direct composite fiber-reinforced bonded tooth replacements. The…

33. Page 68

    Test 183 dentalCEtoday.com Regenerative Endodontics: Clinical Review and Case Reports This article describes regenerative endodontic procedures as a viable treatment option to biologically replace damaged, diseased, or missing structures such as dentin, root structures, and cells of the pulp-dentin complex in immature necrotic permanent teeth without performing conventional endodontic therapy. This article also includes an addendum to the informed consent prior to treatment as well as various materials and methods in order to provide successful treatment. Rico Short, DMD, graduated from Morris Brown College in 1993 as a biochemist with a B.S degree. He attended the Medical College of Georgia…

34. Page 69

    What are the Key Components of Regenerative Endodontics? In order for the regenerative endodontic technique to be effective, the following 3 key components are needed: 1. Stem cells 2. Scaffolds 3. Growth factors. Stem cells are undifferentiated cells that continuously divide. There are 2 main types embryonic and postnatal (adult). An adult stem cell can divide and create another identical cell, but the capacity for differentiation into other cell types is limited. There are several types of adult stem cells that have been isolated from teeth: (1) dental pulp stem cells, (2) stem cells from human deciduous teeth, (3) periodontal…

35. Page 70

    Implant-Retained Dentures in One Visit INTRODUCTION The Larell One Step Denture has created a new and innovative design process for making complete dentures in one visit, in about an hour. This, the third in a series of articles for Dentistry Today, demonstrates the use of this novel one-step denture technique in conjunction with dental implants. The first article1 illustrated the use of Larell One Step Denture in complete dentures for the edentulous month. The second article2 described their use for immediate denture cases. The Larell system completely eliminates the need for a commercial laboratory, allowing the clinician to fabricate and…

36. Page 72

    Implant-Retained Dentures in One... continued from page 70 order to allow room so that it seats passively without occlusal interference over the implant with housing, it is ready to be completed. This usually requires picking up the housings one by one directly in the mouth, or, all at once by mixing some acrylic or using the various products extruded in a gun cartridge that bond to methyl methacrylate (such as Secure [3M ESPE], or a mixed base and catalyst like the chairside product Reline [GC America]). This can be a trying process and leaves room for error, especially if the…

37. Page 73

    Dental implants, when indicated, have become the standard of care for the restoration of missing teeth. The use of dental implants with overdentures offers much improved retention and stability. Immediate-load implants are often used in combination with dentures. Their simplified armamentum and ease of placement have made them a viable and popular choice for general practitioners when treating denture patients. The ability to fabricate quality dentures in a single office visit, along with placement of immediate load SDIs placed at the same time, has become a popular restorative technique with benefits for the patient and the doctor. The patient has…

38. Page 74

    74 . 1 FIFTH ANNUAL READERS' CHOICE Top 25 Implant Products Dentistry Today's Fifth Annual Readers' Choice Top 25 Implant Products, selected on the basis of lead generation, represent some of the profession's most innovative implant products. The products appear in no particular order. Michael Tischler, DDS The 2015 Readers' Choice Top 25 Implant Products represent companies that Dentistry Today readers have shown the most interest in. Implant dentistry is truly an area that involves many different companies and aspects of dentistry to succeed. It appears that new technology has made a big impact in implant dentistry and the care…

39. Page 76

    76 . 1 READERS' CHOICE Top 25 Implant Products Dentium USA The SuperLine and Implantium dental implant systems are trustworthy and reliable, proven by more than 10 years of long-term clinical data. All implant diameters for SuperLine and Implantium share the same internal hex. The biological connection contained within the implant creates an even distribution load to the fixture, helping to minimize micromvement and marginal bone loss. Furthermore, the conical hex connection between the implant and abutment interface helps ensure greater hermetic sealing and provides an improved tactile sense. Both implants encompass the S.L.A. (sandblasted with large grit and acid…

40. Page 78

    Top 25 Implant Products . 1 Tischler Dental The Prettau Zirconia Implant Bridge is a screw-retained implant bridge that transforms implant prosthetics. Its all-inclusive pricing is less than most hybrid bridges, bar overdentures, or PFM screw-retained bridges, and there is a 5-year warranty against chipping or breakage, underscoring the confidence in the Prettau zirconia. With custom shades, custom shapes, no chipping, no staining, no acrylic, and less prosthetic space needed than a hybrid bridge, the Prettau Zirconia Bridge offers all the benefits over the alternative choices, with lower pricing. The Prettau all-inclusive laboratory fee includes a provisional denture or laboratory-processed…

And 31 more pages — read the whole issue.