Dentistry Today — March 2016

Inside this issue

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

1. Page 6

   The Golden Age of Material Choices It is interesting to think about the world we live in today versus just a relatively short time ago, when there were notably fewer choices in every aspect of our lives. For example, if you wanted a car in the 1960s, with a typical American income, you chose from just a major US car manufacturers. If you wanted to go to a grocery store to shop for some canned food for dinner, there was usually one aisle committed to a limited number of products. If you wanted the latest in phones (as there were…

2. Page 8

   Splints and Occlusion Get No Respect B e of good cheer! You thought there was a casual relationship between occlusion and headaches and pain? There is! When I was out of dental school for 7 years, I thought I knew just about everything I needed to know to be a good dentist. However, there were some questions that I could not answer. I, like most recent dental graduates, had a real disdain for occlusion. The subject, to a sophomore dental student, was beyond boring. Besides, at the time, I had no clue as to the importance of centric occlusion (CO)…

3. Page 10

   VIEWPOINT continued from page 8 and correctly. Then, if the condyle disc assembly is not healthy, proper adjustment can be done. This may lead to further unnecessary treatments such as root canal therapy or even extraction of a tooth. We must pay attention to the health and condition of the TM joints (as they relate to the occlusion) before, during, and after treatment. We have the potential to impact the stomatognathic system negatively or positively with every restoration, extraction, and tooth movement. Yes, humans are very adaptable; however, the system is not as forgiving/regulating as many would have us believe.…

4. Page 12

   This month on Technique of the Week Subperiosteal Anesthesia Technique Jose-Luis Ruiz, DDS The inferior alveolar nerve block (IANB) is a popular anesthesia technique for most restorative and surgical procedures in the mandible; however, IANB can be technique-sensitive, painful, and slow, and it has considerable postoperative discomfort. In this video, Dr. Jose-Luis Ruiz showcases an excellent alternative that he has been using and teaching for 15 years for every procedure in the mandible. Subperiosteal mandibular anesthesia is easy, fast, safe, almost painless, and is accompanied by only minor postoperative pain. Watch as Dr. Ruiz shares the step-by-step process in this…

5. Page 14

   FOCUS ON: Caries Arrest Rella Christensen, RDH, PhD, discusses what it takes to stop a developing carious lesion. Q: Can progression of a carious lesion be stopped clinically without cutting the tooth? A: Yes, if the following critical factors are in place: (1) patient dedication to sustained maintenance of a low sugar diet, excellent oral hygiene, and management of saliva flow rate (ie, nondiease-related factors in low saliva flow rate can be medication side effects and/or inadequate fluid intake); and (2) patient access to all developing lesions to allow daily clearance by the patient of biofilm accumulation in these critical…

6. Page 16

   From the December 2015 Issue RESIN CEMENT BISCO Dental Products The goal of eCEMENT is to strengthen and simplify the placement of lithium disilicate restorations. The eCEMENT resin cemente-tion system offers a light-cured and dual-cured resin cement, ensuring that these restorations will have exceptional long-term retention of singleor multiple-unit restorations. It provides shade stability and is radiopaque. This all-in-one kit provides all the materials necessary for successful cementation of lithium disilicate restorations. For more information, call (800) 247-3368 or visit bisco.com. FREEinfo, HANDPIECES Osseo Scientific The INTEGRITY ENDO Handpieces are specifically designed to offer a perfect alternative to handheld and…

7. Page 18

   Steri-Shield Suitable for all curing composites, Steri-Shield's competitively priced, portable LED curing light features 3 easy-to-program curing modes with independent time setting selections from 5- to 40-second increments. Its enhanced optical condenser light guide emits a blue-light wavelength between 420 and 480 nm with 1,200 to 2,000 mW/cm² light intensity (according to selected mode), and its lithium-ion battery provides up to eighty 30-second cure cycles between charges. For additional information, call (800) 699-7220. FREEinfo, DENTAL BATH WITH CLEANING BRUSH Archtek The Dental Bath can be used to store and clean dental appliances such as mouthguards, retainers, whitening trays, bruxing guards,…

8. Page 19

   DIGITAL IMPRESSION SYSTEM 3Shape 3Shape TRIOS, a powder-free, next-generation intraoral digital impression system, enables dentists to rapidly capture the complete intraoral situation and send the 3-D model directly to the lab. The system clinically validates the impression and includes flexible tools allowing dentists to edit their scans. Labs and dentists can communicate about the case using 3D design visualizations, annotations, and messages. For additional information, call tollfree (908) 867-0144. FREEinfo, CARBIDE BUR Microcopy The 557° carbide bur, reinforced for strength with a new blended neck design, is a true workhorse with durability that dwarfs the competition's. It's been precision engineered…

9. Page 20

   Lasers Expand the Procedural Scope for General Dentists Edward Kusek, DDS To say there is a lot of negativity about dental lasers, especially hard tissue lasers, would be a massive understatement. The application of lasers in hard tissue has created a lot of confusion, skepticism, and skepticism on the part of would-be users. Having used lasers since 2004, I can tell you that evaluating laser technology is easier than you think. The criteria for selecting a laser should be the same as any other technology you consider. Just ask yourself how it will grow your practice. The 3 ways to…

10. Page 22

    CLINICAL REVIEWS THE DENTAL ADVISOR TheraCal LC +++++ (three-year review) BISCO Dental Products | (800) 247-3368 | bisco.com Consultants' Comments • "TheraCal LC reduces sensitivity in my patients with deep caries." • "I continue to be pleased with TheraCal LC's ease of placement and success rate." Purpose The purpose of this clinical study was to determine the clinical performance of TheraCal LC at 3 years. Initial Placement One hundred sixty-five restorations were evaluated at placement. Areas noted were type of tooth, level of caries risk, type and quality of pulp capping materials used, and patient sensitivity before placement. The types…

11. Page 24

    "I Haven't Got Time for the Pain" Paul Feuerstein, DMD With patients downplaying fractured tooth treatment, your final statement usually is this: "Don't call me in the middle of your sister's wedding and tell me that the almond you bit into broke your tooth in half." Figure 3a. Direct view using ACTEON'S SoproCare unit. Figure 3b. Fluorescence view using SoproCare. Figure 1. Transillumination with AdDent's Microlux unit. Figure 2. View using DEXIS's CarVu unit. We as dentists have often heard this from a patient: "I have a tooth that hurts some times on the left side." The patient—let's call him…

12. Page 26

    Rotary Files Now Feature Greater Flexibility for More Predictable Performance [IMAGE: Eight rotary files with colored bands displayed in a row] TULSA, Okla–Featuring the same efficiency, tapered shapes, and predictable performance that clinicians know and love, ProTaper Universal Rotary Files, DENTSPLY Tulsa Dental Specialties' ProTaper Gold Rotary Files have been developed with proprietary advanced metallurgy to deliver greater flexibility for predictable ProTaper performance that's more brilliant than ever. They provide greater resistance to cyclic fatigue and are offered with a shorter 11 mm handle. For more information, call DENTSPLY Tulsa Dental Specialties toll-free at (800) 662-1202 or visit tulsamdentalspecialties.com. FREEinfo,…

13. Page 28

    Spotlight Device Combines Two Most Vital Components of Successful Endodontic Treatment— Irrigation and Ultrasonic Activation RACINE, Wis–With Vista Dental Products' patented, new UltraFlo, providing a constant, consistent flow of endodontic solutions has never been easier. A cordless, compact, battery-operated piezo ultrasonic (40 kHz) device, it combines the 2 most vital components of successful endodontic treatment—irrigation and ultrasonic activation. It features a quick-connect 20-mL reservoir that is easily filled with the medication of one's choice. Irrigating solutions are more effective with the introduction of ultrasonics, creating acoustic streaming and cavitation, known to significantly improve canal cleanliness. For more information, call Vista…

14. Page 30

    Spotlight Improved Removable Attachment System Offers New Benefits to Clinicians ESCONDIDO, Calif.-ZEST Anchors announces the evolution of implant retained, tissue-supported overdenture solutions with the introduction of its next-generation LOCATOR R-Tx Removable Attachment System. Building on 15 years of clinical experience with the award-winning LOCATOR, it is a better, simpler, stronger system that relies on the same restorative techniques as its predecessor. With the LOCATOR R-Tx system, clinicians will quickly realize practical benefits such as the following: (1) a new-to-dentistry DuraTec titanium carbon nitride coating that is aesthetic, harder, and more wear-resistant; (2) an industry-standard 293-in 1.6-appm fit drive mechanism requiring…

15. Page 31

    Uveneer: Simplifying Artistic Direct Composite Veneering Robert A. Lowe, DDS The Uveneer System (Ultradent Products) is a complete kit that provides dentists with preformed facial surfaces on maxillary and labial incisors, canines, and premolars. It has been designed to make it easier and faster for dentists to create direct composite veneers with predictable shape and symmetry. Uveneer templates come in 2 sizes to better fit the facial profiles of most teeth. The size of the templates is made to match ideal 86% width-to-length ratios and to correspond to smile design proportion ("golden proportion") meso-distal width of 1.0-mm central incisor to…

16. Page 32

    Spotlight Multipurpose Appliance Ideal for Solving a Variety of Clinical Challenges COCONUT GROVE, Fla.—Novo Smile, powered by First Fit Technologies, is a multipurpose appliance that is ideal for solving a variety of clinical challenges and can be used long term or as a transition to more extensive cosmetic and restorative procedures. Among its applications are using it (1) as an aesthetic provisional for implant restorations, (2) as a vehicle for raising vertical dimension, (3) as cosmetic removable partial dentures, and (4) as a long-term smile enhancement excellent solution for implant and prosthetic cases. In fact, research has shown that 40%…

17. Page 34

    Spotlight Self-Etch/Self-Adhesive Resin Cement Is First to Offer a Color Cleanup Indicator ORANGE, Calif.-Kerr introduces Maxcem Elite Chroma, the first self-etch/self-adhesive resin cement offering a Color Cleanup Indicator, making it the smartest cement available on the market today. Maxcem Elite Chroma begins with a pink color that fades at the gel state, indicating the optimal time to clean up excess cement. The pink color will disappear after both selfand tack-cure, allowing for maximal flexibility. Radiopaque for easy visibility, Maxcem Elite Chroma offers One-Peel cleanup; an automix delivery system; easy, no-refrigeration storage; and compatibility with all indirect restorations. Featuring best-in-class adhesion…

18. Page 36

    Spotlight Packaging Maximizes Effectiveness of Both Quality Control and Infection Control Procedures INDIAN LAND, SC-VOCO introduces next level of quality control with the introduction of its new ISO pak packaging. For use with all of VOCO's composite—Grandio, GrandioSO, and x tra fil—and VOCO's new Admira Fusion nano ORMOCER, the ISO pak is an airtight, individu ally sealed foil that includes the following information printed on each note—product name, expiration date, shade, cure time, storage indication, and lot number. The ISO pak will maximize a practice's infection control efforts, saving it time and money by making the disinfection of unit-dose capsules…

19. Page 38

    Take-Home Whitening Gel Yields Professional Results at a Lower Concentration, Enhancing Patient Safety and Comfort SOUTH JORDAN, Utah– Ultradent Products' Opalescence Go 6% hydrogen peroxide whitening gel yields professional results at a lower concentration than existing products, giving patients with sensitivity a safe, comfortable, and convenient take-home whitening option. The 6% hydrogen peroxide gel has a wear time of 60 to 90 minutes and is available in delicious mint or melon flavors. As with all Opalescence Go products, the 6% concentration features the UltraFit tray, which adapts comfortably to the teeth in a matter of minutes to give patients a…

20. Page 40

    NEWS/TRENDS Industry News DenMat Adds Renowned Master Ceramist to Its Team DenMat announced recently that it has added master ceramist Brad Jones to its team. In addition to his 36 years of experience creating world-class restorations for some of the world's top esthetic clinicians, Dr. Jones also is one of the few ceramists in the world who has achieved a Fellowship in the American Academy of Cosmetic Dentistry. DenMat will be introducing a number of new lab products and services to the dental community throughout 2016. The first of these will be its new Additive-Reductive Removal process for Lumineers, the…

21. Page 42

    STATE BY STATE PREVALENCE OF PERIODONTAL DISEASE EXAMINED In a recent study published in the Journal of Dental Research, the Centers for Disease Control and Prevention (CDC) estimate that at 52.79% and 51.10% respectively, New Mexico and Hawaii have the United States' highest prevalence of periodontal disease. The study, entitled "Predictive prevalence of periodontitis at state and local levels across the United States using a novel small-area estimation method. Estimated multilevel analyses were applied among adults aged 30 to 79 at state, county, district, and census tract levels. Other areas with an estimated high prevalence of periodontal disease were found…

22. Page 46

    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. BulkEZ Danville Materials Practitioners have been wrestling with the shortcomings of composite restorative materials for more than 3 decades. Material shrinkage, marginal voids, depth of cure issues, layering, and clinical sensitivity (read: operator mistakes) have all contributed to less than ideal restorations and shorter than desired longevity. A number of adjunctive techniques (thin layering, bulk placement, and sonic vibration, among others) have been suggested throughout the years to improve the clinical outcome, but their efficacy…

23. Page 48

    The Role of Fluoride-Releasing Materials and Caries Control A study performed on the Cochrane Database of Systematic Reviews and on Medline via PubMed had the objectives of: (i) describing caries lesions development and the role of fluoride in controlling disease progression; (ii) evaluating whether the use of fluoride-releasing pit and fissure sealants, bonding orthodontic agents, and restorative materials, in comparison to a nonifluoride-releasing material, reduces caries incidence in children or adults; and (iii) discussing how the anticaries properties of these materials have been evaluated in vitro and in situ. The study found that caries, a biofilm sugar-dependent disease and as…

24. Page 50

    Top 25 Implant Products .I.R.S.T. Designed for single tooth or multitooth replacements, the 2.5-mm-diameter one-piece mini-dental implant features a blossom thread design at the apical portion and microthreads at the abutment end for ease of bone cutting. This implant can be used in areas where conventional implants can't be placed. It also gives the patient another option. Not everyone can afford conventional implants. The increased abutment head design aids in single-tooth replacements. Regarding ease of use and insertion, the simplicity of the one-piece mini-dental implant system, combined with its strength and immediate stability, is superb. The implant is easy to…

25. Page 52

    Top 25 Implant Products ATOR Retentive Attachment System represents the next generation of the world's leading overdenture attachment system. It combines improved design, system simplicity, and a new coating that is aesthetic, harder, and more wear-resistant while relying on the same restorative techniques as the award-winning LOCATOR. For more information, call (800) 262-2310 or visit zestanchors.com. FREEinfo, OCO Biomedical The 3.0 incorporates the patented Sonic Dual Stabilization technology as OCO Biomedical's full-size implant line. The patented Dual Noise Adapter in combined with the Embedded Tapered Platform results in Dual Stabilization, making unmatched primary stability possible. Micro Cortic-O Threads engage the…

26. Page 54

    Top 25 Implant Products S implants provide long-term hardand soft-tissue stability based on an overall design referred to as the TissueCare Concept. The progressive thread design allows for excellent primary stability, while the subcrestal implant placement protocol helps to provide an aesthetic emergence profile and supports bone on the implant shoulder for long-lasting aesthetics. For added flexibility and simplicity, the connection is the same for all abutments, regardless of implant diameter, and both indexed and nonindexed prosthetic options are available. For more information, call (800) 531-3481 or visit dentsplyimplants.com. FREEinfo, Ritter Dental Ritter implants have everything you need, offering attractive…

27. Page 56

    Top 25 Implant Products provides a safe, easy way to protect an abutment screw head. Precut 2-in x 0.5-in Teflon tape, it allows for easy insertion prior to the final or temporary restoration, and it compresses easily, allowing ample space for the restoration. It's offered in peel-off form on a card containing 20 pieces of tape, saving time and the mess of cutting tape off a roll, hassling with cotton pellets, or dealing with wax or gutta-percha. For more information, call (800) 365-2839 or visit implantape.com. FREEinfo, Aseptico The AEU-7000E-70V provides the ultimate return on investment. A unique handpiece calibration…

28. Page 58

    Top 25 Implant Products actical, cost-effective 3-in-one implant tool that eliminates any guesswork among the surgeon, restoring doctor, technician, and patient, the Delineator is a radiographic guide, surgical stent, provisional restoration, and implant locator. See for yourself by prescribing the Delineator as the first step of your next implant case. For more information, call (800) 433-9833 or visit keatingdentalarts.com. FREEinfo, HIOSSEN Coming soon, the ETIII SA you know and trust is improving. A new bio surface treatment improves BIC by 30% compared to the original ETIII SA. ETIII BIO SA is still manufactured with pure titanium metal and equipped with…

29. Page 60

    Top 25 Implant Products Glidewell Laboratories Inclusive Mini Implants allow for the immediate loading and long-term stabilization of dentures in the presence of primary stability and appropriate occlusal loading. Small-diameter implants are traditionally prescribed for patients who cannot receive conventional-diameter implants due to medical, anatomical, or financial reasons. They can accommodate new or existing dentures, which are anchored to the heads of the mini implants via a simple and effective oring retention system, providing fully edentulous patients new levels of comfort, dental function, and confidence. Inclusive Mini Implants are part of the Inclusive Mini Implant System, an all-in-one implant solution…

30. Page 61

    ACCEPTING NEW DENTISTS. FREE STARTER KIT 866-905-1111 Global Dental Solutions, LLC® Full service dental laboratory Brad Hal Having grown up in their parents' laboratory, the Abramson brothers provide the highest level of expertise, with two generations of experience. Personal attention is guaranteed. Your #1 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 preprinted labels or local courier. Additionally, our co-founders, Hal and Brad, are in the laboratory 5 days a week. CROWN…

31. Page 62

    Top 25 Implant Products y versatile clinical situations at less than half the cost of some others with Legacy2 implants. Available in 3.2, 3.7, 4.2, 4.7, 5.2, 5.7, and 7.0 mm diameters with 6 lengths and 2 surface options (SBM and HA), the implant offers an incredible selection. Each Legacy2 implant is packaged with a cover screw, extender, and a carrier that can be used as an implant-head transfer and a titanium temporary abutment for maximum value. Legacy2 features a profession-standard internal hex connection and a tapered body with buttress threads, plus 3 self-tapping grooves. The body shape facilitates soft…

32. Page 63

    IMPLADENT LTD advancing the science of implantology Contact 800-526-9343 or Shop Online at www.impladenltd.com OSTEOGEN PLUG ONE STEP BONE GRAFTING SOLUTION FOR SOCKET PRESERVATION AND RIDGE MAINTENANCE OsteoGen Non-Ceramic Bone Graft For Ridge Maintenance Type I Bovine Achilles Tendon Collagen As A Carrier At only $50 per piece, the OsteoGen Bone Grafting Plug is the easiest and most affordable way to deliver bone graft for socket preservation and ridge maintenance without the need for a membrane MIS Implants Technologies The self-tapping Seven implants are specially designed for implantation in a wide range of bone types and bone augmentation procedures. Their…

33. Page 66

    Implant Overdentures Michael Tischler, DDS While I still believe overdentures are a valid option for a patient for full-arch tooth replacement, I now treatment plan overdentures either as a transitional option toward a zirconia implant bridge or as a final option for patients who just can't afford anything else. This month's Implants Today topic is implant overdentures. Overdentures are one of a few different and important prosthetic options to replace a patient's entire arch of teeth. Why would a clinician choose this removable option for their patient over other fixed implant prosthetic alternatives? The answer to this question could be…

34. Page 67

    IMPLANTS TODAY 67 treatment planning with a patient. There are advantages and disadvantages with each prosthetic option. While I still believe overdentures are a valid option for a patient for full-arch tooth replacement, I now treatment plan overdentures either as a transitional option toward a zirconia implant bridge or as a final option for patients who just can't afford anything else. As with every prosthetic option in implant dentistry, treatment planning is the most important starting point. Treatment planning is about explaining the available options to a patient while considering the individual's lifestyle, age, economic situation, health, career, and more.…

35. Page 68

    dentalCEtoday.com Go online to earn credit for reading this CE article. IMPLANTS A Sequential Approach to Implant-Supported Overdentures Timothy Kosinski, DDS INTRODUCTION Conventional maxillary complete dentures have been created for patients for years. Function may be an acceptable alternative to no teeth at all, but comfort may be compromised with acrylic relines on the full palate. Taste is inhibited. Throughout time, resorption of bone results in instability, and this requires relining on the existing prosthesis or creation of a new appliance. Modern osseointegrated dental implants have been around more than 30 years now, providing an increased quality of life and…

36. Page 70

    Figure 3. Preoperative CT scan (Vatch America) illustrates nonrestorable teeth, but adequate bone height and width to accept immediate implants. A Sequential Approach to... continued from page 68 implant may be splinted, thus improving the stability of the implants. If there is adequate interoclusal space (a minimum of 100 mm pararch), LOCATOR or GPS attachments can be positioned onto the bar (Glidewell Laboratories) to provide outstanding stability. It is critical that all bars attaching implants fit passively. Any stress placed on the implants can result in bone resorption. Maxillary spacing of implants needs to respect the arch form; that is,…

37. Page 71

    IMPLANTS 71 aspect of the tooth. Then, tension was created by using a rotational force with the wrist. The bumper of the Physics Forces with a green silicone covering positioned high up in the vestibule and only acts as a fulcrum for the instrument (Figure 4). As tension is created on the palatal root surface, physiologic enzymatic breaks down the periodontal ligaments, allowing the tooth to disengage down and out of the socket (Figure 5), maintaining the facial bone and leaving a socket with all walls intact. This is ideal for immediate placement of an implant in the socket site.…

38. Page 72

    Maximizing Stability and Prosthetic Durability INTRODUCTION When treatment planning a fixed full arch implant restoration, selecting a prosthesis that addresses the long-term needs of the patient is paramount. It is also imperative to utilize dental implants that can be optimally positioned to support the restoration while establishing a maximal amount of primary stability. For clinicians seeking a durable prosthesis, full arch implant restorations can now be milled from 600-monolithic zirconia. To establish the foundation needed for such a restoration, tapered implants with a pronounced thread design and flexibility in implant positioning as well as high initial stability, smoothing the path…

39. Page 74

    Figure 5. Preoperative panoramic radiograph and CBCT scan indicated sufficient bone quantity for the freehand placement of 6 implants along the span of each arch. Note, however, the bony defect in the area of teeth No. 8 and No. 9, which would require immediate loading in the left posterior region of the mandible. Figure 6. Maxillary and mandibular arches following atraumatic extraction of the patient's terminal dentition. (Note preservation of bone.) Figure 7. (a) Hahn Tapered Implant. (b) Following creation of the osteotomies, the implants were threaded into place. Figure 8. The deep, sharp threads of the implants helped achieve…

40. Page 76

    Maximizing Stability and Prosthetic... continued from page 74 the palatal and lingual aspects, while simplifying the positioning needed to avoid vital anatomical structures. Following implant placement, a restorative protocol would be followed that is remarkably similar to that of the screw retained hybrid denture. One key difference is the use of a provisional appliance that ensures the proposed final restoration is 100% accurate prior to milling the monolithic zirconia implant prosthesis. This extra step, along with the accuracy of the CAD design process, results in an extremely well fitting final prosthesis that addresses the precise aesthetic and functional needs of…

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