Dentistry Today — March 2017

Inside this issue

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

1. Page 10

   Prophy or Perio Patient What's Your Why? NEW! FROM GREAT LAKES Not too long ago, I was in a client's dental office for a day of observation and coaching. As the dental team's consultant and coach, part of my assignment that day was to help them create partnerships with their patients. The team was role playing how they would create a partnership with the patient and how to show the patient what was happening in their mouth. It was the goal of the clinicians to help their patients "own" their disease." The purpose was to help more patients accept, schedule,…

2. Page 12

   VIEWPOINT continued from page 10 THE BIG PICTURE It is important that everyone on the dental team has answers to the following questions that are in line with the office's philosophy of patient care. • Why am I a dental professional? • What is my goal for patients? • What is our office patient care philosophy? • How do our treatment recommendations affect the patient's overall health? Understanding the answers to the above questions is helpful in treating your patients at the highest level of care. The answers provide valid reasons why you will tell patients the truth about what…

3. Page 14

   This month on The Wednesday Watch New Format Is a Success The Wednesday Watch, Dentistry Today's weekly video newscast, is newly formatted and getting rave reviews. We've modernized our look and added more stories that are shorter in length so you can get more news in less time. You can still depend on our Dental News Network (DNN) to bring the latest news about research studies, clinical topics, product releases, offbeat dental news, and more. If you're not on the email list for DNN, sign up by sending an email to Ali Cook at acook@ . Chicago Midwinter Meeting Video…

4. Page 16

   FOCUS ON: Lasers for Disinfection Cliford J. Ruddle, DDS, examines laser-activated irrigation in endodontic treatment. Q: How important is disinfection to predictably successful endodontic treatment? A: Like extraction, the biological goals of predictably successful endo treatment should be directed toward removing all the pulp, bacteria when present, and related irritants from the root canal system. To accomplish these goals, any given canal is shaped to provide an effective reservoir of reagent that, upon activation, can be exchanged into all aspects of the root canal system. Yet, the dimensions of the final preparation have ignited a debate between those who advocate…

5. Page 18

   From the December 2016 Issue WHITENING SYSTEM KöR Whitening The KöR Max Whitening System is a versatile and effective whitening system that combines at-home whitening with a single in-office whitening visit. KöR offers cost-effective solutions from phenomenal home whitening for average patients, to astonishing treatment of tetracycline cases—and everything between. And KöR is the first company to refrigerate its full line of whitening products from manufacturing until being delivered cold to dental offices. For more information, call (866) 763-7753 or visit the website korwhitening.com. FREEinfo, IMPRESSION MATERIAL Ultradent Products The new Thermo Clone VPS Impression Material represents exciting new advancements…

6. Page 20

   AdDent The new, high-intensity MicroLux 2 Transilluminator features an easy-to-use push button that controls its dual-intensity operation and provides for better visualization. Powered by 2 AAA batteries, the unit has a voltage regulator to ensure constant light output, comes with either a 2- or 3-mm light guide, and accepts all existing Microlux autoclavable attachments. Accessory attachments include a 5-pack of mirrors, a 0.75-mm proximal tip, a 0.75-mm perio tip, and a 1.0-mm endo tip. For more information, call (855) 211-3413. FREEinfo, SURGICAL HIGH-SPEED HANDPIECE Medidenta The only 90° surgical high-speed handpiece on the market, the 20W Air-Free 90S creates a…

7. Page 22

   Matchmaker, Matchmaker Paul Feuerstein, DMD Shade matching of teeth is an art form more than an exact science. We all sit there for a long time placing shade tabs next to a tooth and mumbling "too yellow/too dark/too light!" many times. And if there is a laboratory nearby, a patient may be sent off to let the technician figure it out. Some labs actually come to the office). Variations in color are affected by office lighting such as fluorescent, LED, incandescent, natural light, and more. Also, wall colors and even lipstick colors enter into the shade match game. One simple…

8. Page 23

   Restorative Digital Dentistry, Part 3 Integration of Technology Into the Clinical Practice Gary Kaye, DDS This is the final article in a 3-part series. Part 1 was published in the October 2016 issue and part 2 was published in the January 2017 issue of Dentistry Today. These articles can be found archived online at . Aligning your lab relationships in the changing digital dentistry world. In this last piece of the series, I will look more carefully at pitfalls and success factors from my own personal experience in Kaye Dentistry, as well as in NYCDD consulting and training. INTRODUCTION Recap…

9. Page 24

   Design of PMMA and Restoration Try-in It is now routine in our practice to collaborate with our dental lab technicians during the design and modification phases of the restorations. We are able to view a digital (virtual) wax-up and to provide vital input before the restoration is fabricated. In many cases, the lab team will fabricate the restoration in a polymethyl methacrylate (PMMA) material, giving us the ability to try in an exact replica of the final restoration and allowing for simple and convenient modifications. We usually have the patient wear the PMMA restoration for a few days or even…

10. Page 26

    Digital Design and Fabrication of Full-Arch Zirconia Hybrid Bridge Steps 1a and 1b. Digital design of maxillary teeth (3Shape design system). Steps 2a and 2b. Milled zirconia (KATANA [Kuraray Noritake/Henry Schein]) maxillary prosthesis. Step 3. Finished bridge attached to metal frame. Step 4. Final restoration, retracted view. Step 5. Final restoration extraoral full-smile photo. Restorative Digital Dentistry, Part 3... continued from page 24 and economics • Muted patient reactions • Slow transition to same day dentistry • Team members with low levels of IT experience and knowledge • Difficulties training uninterested fellow dentists and assistants • Cost and hassle of…

11. Page 28

    Spotlight Time-Saving High-Power Turbine Positively Impacts Practice Efficiency and Profitability IRVINE, Calif.–Hailed as the dental industry's most powerful turbine, Bien-Air's Tornado is destined to positively impact the efficiency and profitability of dental practices globally. Thanks to a series of proprietary technologies, it delivers an industry-best power output of 30W, helping to alleviate dentists' No. 1 concern, lack of time, while pushing them the level of quality and reliability they have come to expect from Bien-Air. Operating at an unparalleled 55 dB sound level, the Tornado skillfully combines performance with user and patient comfort, and it premieres such features as a…

12. Page 32

    Spotlight Latest Addition to Best-Selling All-Tissue Laser Line Cited for Its Ease of Use and Versatility IRVINE, Calif–Now FDA cleared for commercial distribution in the United States, BIOLASE's Waterlase Express all-tissue laser system is the latest addition to the company's best-selling Waterlase line of Er,Cr:YSGG all-tissue lasers and represents the fifth generation of the world's most widely used all-tissue dental laser wavelength. Waterlase Express's simple user controls and learning tools have been designed to help dentists new to all-tissue lasers integrate powerful Waterlase technology into their practices. Among its key support features are the following: HD quality clinical animations guiding…

13. Page 33

    Dentsply Sirona's Aquasil Ultra+ Smart Wetting Impression Material Focuses on Key Clinical Benefits Jason H. Goodchild, DMD Dentsply Sirona's recently introduced Aquasil Ultra+ Smart Wetting Impression Material (Figure 1), an upgrade in the well established Aquasil line of polyvinyl siloxane impression materials, has been specially designed to help clinicians in several ways. First, impression materials used intraorally need to work in the presence of moisture (i.e. be hydrophilic), not just when cured but most importantly when uncured. To provide hydrophilicity where it's needed most, in the mouth, Aquasil Ultra features a market-leading low contact angle as tested on uncured samples…

14. Page 34

    CLINICAL REVIEWS THE DENTAL ADVISOR Sani-Soak Ultra ++++1/2 Enzyme Industries | (888) 236-9963 | enzyineindustries.com Consultants' Comments • "It did not break down in ultrasonic cleaner like the other solutions do." • "Effective while being nontoxic; instruments come out shiny." • "Cleaned the instruments that were staining to rust." • "Opinions were split on the scent." Description Sani-Soak Ultra is an anticorrosive enzymatic cleaner that can be used as an ultrasonic cleaner and/or an evacuation system cleaner. Nontoxic and safe to use on burs and instruments, it is available in a one-quart bottle or in a 6-ounce bottle of 0.5-oz…

15. Page 36

    Spotlight New Nano-Enhanced Universal Restorative Material Introduced NEW MILFORD, Conn.-CLINICIAN'S CHOICE Dental Products this month introduces EVANESCE Nano-Enhanced Universal Restorative Material to its line of clinically proven products. Ideal for both simple, single-shade cases or more complex cases utilizing a layering technique, it is designed to perfectly match natural tooth structure. Formulated with a proprietary process to optimize the refractive index of its unique nanopigments and fillers, EVANESCE offers clinician's exceptional polishability and aesthetics, with margins that simply disappear. And requiring fewer layers of composite, it exhibits excellent handling properties, allowing clinicians to sculpt the most detailed anatomy without slumping.…

16. Page 38

    Spotlight Award-Winning Reline Material Offers Exceptional Comfort and Durability ENCINITAS, Calif–Tokuyama's award-winning Sofreliner Tough, a self-cured, soft silicone-based reline material, offers exceptional comfort and durability. It is indicated for patients who require long-term relining on temporary, partial, or full dentures as well as those who need relief for irritated tissues after surgery, teeth extraction, or implant procedures. Sofreliner Tough provides superb stain, odor, and tear resistance as well as better adhesion and suction. It offers long-lasting comfort for up to 2 years, all in a simple, one-appointment procedure. With an automixing cartridge system, smaller tips for up to 40% less…

17. Page 39

    Full-Contour Zirconia Yields Strong, Natural-Looking Restorations ST. PAUL, Minn.–With the introduction of 3M Lava Esthetic Fluorescent Full-Contour Zirconia, clinicians and labs can now offer their patients strong, natural-looking restorations. It features unique, built-in color technology delivering an excellent shade match, and it is the first cubic zirconia to offer inherent, tooth-like fluorescence for all shades as well as a true color match with VITA Classic shades. Lava Esthetic zirconia delivers optimized translucency for aesthetic, full-contour crowns and 3-unit bridges at a strength of 800 MPa—higher than that of glass ceramics and other leading cubic zirconia—and a 2016 study has shown…

18. Page 40

    Spotlight Plug Offers One-Step Bone-Grafting Solution for Socket Preservation; No Membrane Required HOLLIS, NY–Implant Ltd's OsteoGen Bone Grafting Plug offers the easiest and most affordable way to deliver bone graft for socket preservation. Since all of its bone graft particulates are contained by the collagen plug, simply place the plug into your extraction sites and suture over it; no membrane is required. After thorough debridement, deliver the plug dry, and let it soak up the patient's blood. Condense it to the level of the soft tissue, and suture over top to keep in place. Bone grafting for socket preservation has…

19. Page 41

    Sensor Provides Top-Tier Imaging Without the Top-Tier Price LOS ANGELES—XDR Radiology's Anatomic Sensor, offered as the No. 1 and, provides top-tier imaging without the top-tier price. The sensor maximizes mesial imaging area to help you capture challenging canine pre-molar contacts, and in synergy with XDR Software, its top-tier contrast and spatial resolution mean you'll see both the subtlest of lesions and the tip of your No. 6 file. The sensor's rounded and beveled corners broaden the contact zone for increased patient comfort, matching the mouth's contours, and its distinctive white face eases intraoral visibility. A sleek button on its hermetically…

20. Page 43

    Kit Helps Patients Achieve Fresh Breath and Better Overall Oral Health STAMFORD, Conn. The Philips Sonicare Breath care kit allows patients to analyze their breath in just 30 seconds, display real-time breath quality via the free Philips Sonicare app, and track the presence and impact of odor-causing bacteria. Featuring cutting-edge sensor technology and the latest Bluetooth wireless technology, the kit helps patients achieve fresh, healthy breath and better overall oral care. Included in the kit are a breath analyzer (shown); Philips Sonicare TongueCare+, a specifically designed tongue brush head; and Philips Sonicare BreathRx Antibacterial tongue spray, which kills and removes…

21. Page 44

    Top Innovative Products, Part 2 This section is a continuation of Dentistry Today's First Annual Top Innovative Products, which was in the February issue. All products are selected based on lead generation and appeared in our Innovations section throughout the past year. Komet USA Cutting Instrument Ideal for Materials That Clog Similarly Constructed Instruments Featuring a bright white head constructed of durable, high-performance ceramic, the large-diameter 923 LGS0.HK060 cutter is ideally suited for work on materials that tend to clog similarly constructed, nonceramic instruments. It is the instrument of choice for use on soft-denture reliners, artificial gingiva, positioners, and athletic…

22. Page 45

    Top Innovative Products, Part 2 Crown Delta Benefits of Award-Winning Try-In Adhesive Liner Cited Stabiliner is a translucent try-in adhesive liner for temporary stabilization of ceramic crowns and veneers. Use of Stabiliner during try-in facilitates a secure preview of restoration fit, eliminates repetitive on/off placement, and enables adjustments to restorations prior to final cementation. Awarded a 5+ rating by THE DENTAL ADVISOR and voted one of its 2015 Clinical Problem Solvers, Stabiliner, available for purchase through Zahn, Henry Schein, and Pearson Dental, also enhances the try-in experience for patients. For more information, call (914) 245-8910 or visit stabiliner.com. FREEinfo, Kaleidoscope…

23. Page 46

    Top Innovative Products, Part 2 Crescent Products Low-Profile Headrest Offered Designed to function with a double-articulating dental chair, the Low-Profile Headrest can be used to treat adults, children, and seniors. It comfortably supports the patient's head and neck while ergonomically positioning him or her to preserve the dentist's best working posture. Available in a variety of colors, it can also be used to treat petite adults and children in a dental chair with a flat headrest. For more information, visit crescentproducts.com. FREEinfo, JETPIK Power Floss System Combines Benefits of Oral Irrigation, Flossing, and Sonic Brushing JETPIK is the world's first…

24. Page 47

    Top Innovative Products, Part 2 Unitox FDA-Approved Botox Syringe Introduced The Unitox syringe, created by Sid Solomon, DDS, facilitates the simple, precise, and accurate drawing and injecting of botulinum toxins such as Botox and Xeomin. Current syringes on the market measure volume in cc (mL), while Botox is measured in units. This requires the dentist to make time-consuming mathematical conversions with every injection. The Unitox syringe eliminates the need for these often-confusing conversions, ensuring patient comfort and saving valuable chair time. Each 0.5-mL Unitox syringe is marked with bold 5-, 10-, 15-, and 20-unit hash marks based on the FDA-approved…

25. Page 48

    NEWS/TRENDS Industry News Convergent Dental Names New National VP of Sales Needham, Mass-based Convergent Dental announced recently that Colby A. Ledbetter has joined the company as national vice president of sales. In this role, she will drive all aspects of sales for Convergent Dental's flagship product, Solea, the first FDA-cleared CO2 9.3-μm dental laser for hard, soft, and osseous tissue procedures. Specifically, she will identify and implement all sales goals and strategies, manage the company's growing team, and maintain existing professional relations while listening new prospects to increase all company sales. Prior to joining Convergent Dental, Mrs. Ledbetter worked for…

26. Page 50

    NEWS/TRENDS Best and Worst continued from page 48 Rhode Island has the lowest percentage of population (27%) that didn't visit the dentist more frequently due to costs, 2 times lower than in Georgia, which has the highest at 74%. Massachusetts has the most dentists per 100,000 residents, 51.75, which is 3.4 times more than in Tennessee, which has the fewest at 15.39. Connecticut has the lowest percentage of students in grades 9 through 12 (11.6%) who drank regular soda at least once a day, 2.7 times lower than in Kentucky, which has the highest at 32.4%. Utah has the lowest…

27. Page 55

    Traus SUS10 Saeshin America Increasing the efficiency of the dental operatory with multitasking equipment is always beneficial. Technology that can be utilized in diverse clinical areas increases efficiency and productivity. Saeshin America's Traus SUS10 unit combines ultrasonic and rotary technologies specifically applied to dental implantology and pico surgery. The ultrasonic handpiece is noninvasive on soft tissue and active only on hard tissue, increasing safety and patient comfort during surgery. The optimized implant motor offers powerful and smooth zero to 70 Ncm torque for the drilling and insertion of dental implant fixtures combined with a 25,000lux LED in the handpiece for…

28. Page 56

    Implant Fixtures and Abutment Considerations Michael Tischler, DDS The angle and platform height at which an implant is surgically placed can be corrected through various implant manufacturers' components as well as by using custom abutments. Some implant companies have angle corrections built right into the implant fixture itself; however, these require more exacting placement positions. This month's Implants Today topic is implant fixtures and abutment considerations. The choice of how a final prosthetic solution attaches to the dental implant(s) involves various factors and is a fundamental concept in implant treatment. The 2 main considerations are about (1) the angulations or…

29. Page 58

    Technology Expands the Scope of the General Practice Daniel Drake, DDS INTRODUCTION Modern dental technology has played a considerable role in empowering general dentists to offer superior treatment to their patients through the use of guided implant surgeries in their practice. Detailed computer processing of cone beam scans translated to precise prefabrication of surgical guides has given the profession consistent and predictable implant surgical results without the potential guesswork of manual placement. Patients can feel comfortable knowing this protocol is less invasive, more efficient, and in many cases, results in less total treatment appointments. Let's face it, the more we…

30. Page 60

    Figure 2. Edentulous anterior photograph. Technology Expands the Scope... continued from page 58 Option 1—Forgo alternative dental treatment at this time and continue to use the metal based maxillary removable partial denture currently worn to replace Nos. 6 to 16. Replacing the teeth and clasps may be necessary to alleviate the instability of the partial. Option 2—Fabricate a new metal-based maxillary removable partial denture. Aesthetics could be improved with the right denture tooth shade selection and midline correction. Elimination of the rocking/lateral movement of the current partial could be achieved. Option 3—Fabricate a maxillary fixed partial denture (FPD) using teeth…

31. Page 61

    The lab team fabricated a verification jig to verify the correct positioning of the implants. the implants were torque tested to 35 Ncm. Osseointegration of all 4 implants was confirmed. Impression copings were placed on all 4 implants and an open-tray final impression was taken with a polyether impression material (Impregum [3M]).4 A lower impression and bite registration in centric occlusion (coincidental with her centric relation) was also taken to provide to the dental laboratory team. Jig Verification The lab team fabricated a verification jig to verify the correct positioning of the implants. The jig was finger tightened in the…

32. Page 62

    Top 25 Implant Products . 1 Glidewell Laboratories Named the official system of the Misch International Implant Institute, the Hahn Tapered Implant System is precisely engineered to meet the demands of modern implant dentistry. Designed by implant pioneer Dr. Jack Hahn, Hahn Implants allow for precise control during placement, efficient insertion, and excellent primary stability. With implant-specific drills and time-tested features enhanced by cutting-edge design, the Hahn Tapered Implant System enables clinicians to improve the quality of treatment while reducing the cost of care. For more information, call (888) 303-3975 or visit hahnimplant.com. FREEinfo, Ritter Dental The SB/LA Spiral Implant…

33. Page 64

    Top 25 Implant Products Impladent The OsteoGen Bone Grafting Plug offers one of the easiest and most affordable ways to deliver bone graft for socket preservation. Since all OsteoGen bone graft particulates are contained by the collagen plug, just place the plug into your extraction sites and suture over top—there is no membrane required. After a thorough debridement, deliver the plug dry and let it soak up the patient's blood. Condense it to the level of the soft tissue and suture over top to keep in place. Bone grafting for socket preservation has never been easier. For additional information, call…

34. Page 66

    Top 25 Implant Products Dentatus Designed to complement your current implant system, ANEW's narrow diameter is ideal for patients lacking time, money, or sufficient bone structure. ANEW is the only narrow-body implant with a screw-retained prosthetic system. The implants can be placed in interradicular spaces as narrow as 3.5 mm. ANEW is FDA-approved for long-term use and is backed up with more than 10 years of clinical research. ANEW placement procedure is quick and usually flapless. The prosthetic components are designed for immediately loaded chairside restorations. For more information, call (800) 323-3136 or visit the website dentatus.com. FREEinfo, HIOSSEN All…

35. Page 68

    Top 25 Implant Products . 1 Aceptico The product of 30 years of motor manufacturing experience, the 7000 Series Implant Motor is one of the most powerful and comprehensive implant motors on the market today. It features adjustable torque and can be used for implant, surgical, and endodontic applications. Aceptico's worldwide reputation for building strong, dependable dental equipment guarantees reliability and performance for years. Many other features set the 7000 Series Implant Motor apart from the rest. A dynamometer calibration system ensures that the motor's torque output is always accurate. Six programmable preset buttons allow for complete personalization, making it…

36. Page 70

    Top 25 Implant Products . 1 Z-Systems USA With more than a decade of clinical experience in Europe, Swiss-based Z-Systems is the world's leading solution for naturally white, metal-free zirconia implants. Its latest-generation implant, the Z5m(t) zirconia implant with an active thread design, offers excellent primary stability and osseointegration. It fits into today's oneand 2-piece implant systems with no prep capability and a greater than 98% implant survival rate (data on file), which is a profession-leading number. For more information, call (877) 874-9407, visit zsystems.com or email usa@zsystems.com. FREEinfo, DePlaque The Guide Right Surgical Guide System is an in-office, model-based…

37. Page 72

    Top 25 Implant Products BioHorizons The Tapered Internal family of dental implants provides excellent primary stability, maximal bone maintenance, and soft-tissue attachment for predictable results. All of these implants can be placed with the same instrument kit, giving you surgical convenience and flexibility to choose the ideal implants for each patient's needs. The Laser-Lok implant surface has been developed from more than 25 years of research and has been shown to establish a physical connective tissue attachment. It also achieves superior osseointegration, helping to preserve crestal bone. For more information, call (888) 246-8338. FREEinfo, integrated dental systems With its patented,…

38. Page 73

    Top 25 Implant Products J.L. Blosser Implantfix is an aesthetically pleasing, semipermanent luting cement with good elastic behavior for cementation of implant abutment-retained crowns and bridges. It has a good seal due to controlled minimal expansion. Most implant cements shrink, which will create a void, allowing bacteria to enter, possibly causing implantitis or other infections that lead to loss of bone supporting the implant. Implantfix will allow crowns or bridges to be removed for inspection of implants without instruments and then can be recemented for less stress on implants and fixtures—and the dentist as well. Implantfix is suitable for cementing…

39. Page 74

    IMPLANTS dentalCEtoday.com Go online to earn credit for reading this CE article. Considerations in Abutment Selection Jack Piermatti, DMD INTRODUCTION Dental implants have had a profound effect on prosthodontic treatment plans and have changed the way clinicians consider the mutilated dentition. Certainly, there has been a paradigm shift in the way we handle teeth that are periodontally compromised, grossly carious, or failing endodontically. Procedures such as periodontal flap surgery with osteotomy/osteoplasty, mandibular molar hemisections, and maxillary molar root resections are used much less frequently in favor of extraction and implant placement. In general, treated molars are not easy to maintain…

40. Page 75

    When considering the implant abutment, first and foremost, the component interface must be strong, secure, and resist screw loosening under function. Much has been written regarding screw-joint stability and maintenance of clamping force. When reviewing the current literature, it is reasonable to conclude that prevention of component misfit and applying adequate torque to retaining screws are the most predictable methods for keeping implant-abutment joints secure. These principles apply to all implants regardless of the nature of the abutment interface morphology.12 The importance of the implant abutment design for the cement-retained crown cannot be overemphasized. When abutments are designed poorly, it…

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