Dentistry Today — March 2019

Inside this issue

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

1. Page 8

   Websites, SEO, and the Referral Practice As I walked the exhibit halls at the Greater New York Dental Meeting last November, I was struck by the growing number of companies offering dental social media/website services. With one or two exceptions, I found the booths staffed with sales reps from outside dentistry. I felt I was having a "shark Tank" moment as I listened to the sales pitches. Of and sure I heard the phrase "patient acquisition costs," but I came close.) Search engine optimization (SEO) services were presented as essential to raising a practice's Google ranking to increase new patient…

2. Page 10

   VIEWPOINT continued from page 8 relationships. Building a strong reputation builds practice stability and growth. In my article "How Dentists Are Judged by Patients," which I wrote for Dentistry Today in 2004, painless injection ranks No. 1 and money/costs ranks No. 2. A painless injection given to a new patient scared of dentistry because of a past episode does more to promote confidence and trust in that dental practice than a flyer offering discount dentistry to the community. Social media has become a wonderful tool to enable happy patients to spread the word about their dentists of choice. A unique…

3. Page 12

   Bio: Brooks Haney, DDS, is a general practitioner in Richardson, Texas, with more than 40 years of experience. He is a former adjunct professor in operative dentistry at the Baylor College of Dentistry and a current assistant clinical director for Six Month Smiles. Dr. Haney is also a Good Fellow of the Dallas County Dental Society, an I.D. Pankey alumnus, and a member of the ADA and the American Academy of Cosmetic Dentistry. Dr. Brooks Haney Short Story: After practicing dentistry for 30 years and enjoying the knowledge I gained from attending the I.D. Pankey Institute, as well as some…

4. Page 13

   FOCUS ON: Technology Choices for a New Practice Sabiha S. Bunek, DDS, talks about the decision-making process when purchasing new technology. Q: You recently built a brand-new office directly across from the University of Michigan football stadium. What were some of the decisions you made in regard to technology options? A: I chose Open Dental, an open source practice management software, for my new office because of very positive reviews it received from my colleagues. However, I had pushback from my team because no one had experience using it. It is also not sold by a dental supplier, so not…

5. Page 14

   NEW PRODUCTS ULTRASONIC CLEANING SYSTEM COLTENE The BioSonic UC150 features the latest in ultrasonic technology. Equipped with a multilingual, user-friendly touchscreen, it is a quiet, compact, 1.5-gal ultrasonic cleaner that can be placed on a countertop or recessed. It offers customizable settings, a degas function, optional heating, quick/easy draining, and an exclusive USB interface for easy downloading of cleaning data. Since 1988, BioSonic Ultrasonic Cleaning Systems have been trusted as the standard in ultrasonics. For more information, call (800) 221-3046 or visit coltene.com. FREEinfo, CAD/CAM ZIRCONIA BLOCK 3M Chairside Zirconia is a new CAD/CAM zirconia block optimized for the fast-sintering…

6. Page 16

   Spotlight New System Revolutionizes Digital Impression Technology CHARLOTTE, NC—Dentsply Sirona's Primescan makes digital impression taking easier than ever, faster than before, and more accurate than previously possible. With its completely new, patent-pending digital impression technology, it enables high-precision digital impressions to be taken of the entire jaw. These scans present numerous possibilities for users. Primescan was designed for various digital workflows, with the laboratory directly in the practice, with CEREC, or in cooperation with external partners. Validated interfaces noticeably simplify the process, offering dentists the flexibility they desire. Primescan's optical impression system has been decisively developed. The scan of the…

7. Page 18

   Spotlight Abutment Digital Solution Offers Customized Options IRVINE, Calif.–TruAbutment offers a variety of CAD/CAM implant prosthetic components and milling solutions. TruAbutment DS (Digital Solution) is distinguished by truly customized solutions, such as TiLoc and All-on-I for custom-angulated attachment abutments. The new I-Bar solution allows denture cases to be completed with just 3 patient visits. The TiLoc abutment is widely recognized in the industry because no other company can mill a titanium abutment like it. The Swiss-turning CNC machines produce these custom abutments requiring no manual polishing because they are milled with fewer than 5 µm of milling tolerances. TruAbutment scan…

8. Page 20

   Spotlight Chair Provides Premium Performance and Ultimate Comfort NEWBERG, Ore.—The A-dec soo dental chair was designed with an ultra-thin flexing back and headrest that allows one to work in a comfortable position—legs under the patient and elbows at your side, maintaining a healthy, natural posture. A radius delivery with left/right flexibility and a pivoting control places everything within reach. The 6° swivel lets one position patients where needed for better ergonomic access to the oral cavity. Patients can simply settle in and relax, too, because pressure mapping science properly supports and cushions their entire bodies. With each chair adjustment, the…

9. Page 21

   Handpiece Engineered for Durability and Consistency HOFFMAN ESTATES, ILL— NSK Dental features an ultra-premium line of air turbines, the Ti-Max Z handpiece line. The handpieces are engineered for maximal durability, consistent performance, smooth cutting, and optimal access to all areas of the mouth. The standard-head Ti-Max ZsooL delivers a profession-leading 26 W of power and operates between 330,000 and 400,000 rpm. A proprietary, specially shaped turbine makes these power outputs possible and enables fast cutting for reduced treatment time. There's also a smooth, consistent cutting feel for comfortable operation. The handpieces feature solid titanium bodies. The ergonomic shape and DURA-GRIP…

10. Page 22

    Obturation Device Boasts Precise Control for Great Tactile Feedback TULSA–Gutta Smart from Dentsply Sirona Endodontics is a cordless, low temperature obturation solution. When paired with the enhanced fit of Conform Fit master cones, it provides the efficiency expected in a complete solution. Available in master cones and Gutta Smart cartridges, Conform Fit gutta-percha formulation flows at a lower temperature, requiring less heat from the handpieces. A single charge provides all day power to complete a full day's work. For more information, call Dentsply Sirona Endodontics at (800) 662-1202 or visit dentsplysirona.com/gutta-smart. FREEinfo, AS BIOLOGICAL AS THE PULP TISSUE Special offer…

11. Page 23

    Two Cases Demonstrating OMNICHROMA— A Single-Shade Structurally Colored Universal Composite Edwin McDonald, DDS In the direct restoration of natural teeth, shade matching is a critical component to a successful outcome. To accomplish this, manufacturers historically have used color additive techniques to create materials with a variety of shades and translucencies. This requires a busy dental practice to inventory more materials, learn a subjective process of shade selection, and take the time to do it prior to beginning the procedure. To address this, Tokuyama Dental America has developed a revolutionary resin-based composite brand, OMNICHROMA, that is capable of matching all 16…

12. Page 24

    High-Tech, Single-Visit Restorative Solution Perry E. Jones, DDS INTRODUCTION Digital dentistry is transforming the way the profession views dental care. With the onset of CAD/CAM, in-office milling systems, and single-visit restorative systems, doctors and patients are changing their expectations when it comes to what it means to deliver and receive great dental treatment. The changes associated with the move to digital dentistry can be both a positive thing and, yet, have its challenges. For doctors, the move to digital technologies offers opportunities to revamp patient schedules and offer more treatment to more patients in less time while saving money on…

13. Page 26

    Figure 4. Preparation for a chairside BruxZir NOW (Glidewell Laboratories) fully sintered zirconia restoration requires only a 0.7-mm minimum reduction. A nonaggressive design philosophy for the margin was used. Centering of the restoration. This lateral view shows the occlusal and buccal reduction that was done. Figure 5. After completing the preparation, a digital impression (iTero Element Intraoral Scanner [Align Technology]) was taken. This process was streamlined, involving a simple scanning of the prepared teeth, a bite and taking just under one minute to accomplish. Figure 6. As part of the glidewell In-Office Solution (Glidewell Laboratories) workflow, the iTero Element scanner…

14. Page 27

    Figure 1.3. I had the option at this stage to submit my crown proposal to Glidewell Laboratories, either for help and confirmation of my design or for final milling. Again, as I was confident with my design choice, I chose to proceed with the workflow by processing the case for in-office milling. The design is shown on the monitor (left), and I submitted the file to the fastmill.io unit (Glidewell Laboratories) unit for milling through the software interface. Figure 1.4. BruZir NOW zirconia milling blocks, which are pre-shaped in cylindrical form, are fully sintered zirconia blocks for post-processing or even…

15. Page 28

    Spotlight Company Offers Two Innovative Attachment Systems CARLSBAD, Calif.–Zest Dental Solutions, the only manufacturer of LOCATOR attachments and a leader in full-arch implant solutions since 1977, offers 2 innovative attachment systems, including patient-removable and fixed options. The LOCATOR R-Tx Removable Attachment System is the fourth generation of award-winning patient removable attachments and relies on the same restorative techniques as its predecessor, LOCATOR. It combines progressive design features, enhanced benefits, and system simplicity for clinicians and patients alike. The LOCATOR F-Tx System is fixed for the patient but removable by the clinician. This system utilizes a unique, snap-fit connection that eliminates…

16. Page 29

    Gel Offers Antimicrobial Boost Where Gums Need It Most LANCASTER, NH - Dental Herb Company's PerioSpot is a new, powerful gum therapy gel designed to fight harmful bacteria and inflammation directly at the spot. Formulated with the same truly natural ingredients as Dental Herb Company's award-winning Tooth & Gums Tonic, this sticky gel can be placed directly on the affected site to provide an antimicrobial boost where the gums need it most. PerioSpot is perfect for stubborn inflammation sites or to enhance preventative care after dental procedures. It is indicated for in-office, post-procedure treatment and patient home care. For more…

17. Page 30

    Spotlight Partial Provides Outstanding Aesthetic Results LAKE CITY, Fla - Many patients who need a partial denture complain about the unsightly metal clasps on anterior teeth. Give patients the best of both worlds with a combination partial from Sunset Dental Lab. You will have the strength of a cast metal framework, and the patient will enjoy the virtually invisible clasping provided with the EverFlex nylon material for the saddles and clasps. Aside from the outstanding aesthetic results, patients will not experience any of the side effects of monomer-containing acrylic used in conventional partials that are a problem for patients with…

18. Page 31

    Root Canal Sealer Material Ensures Long-Lasting, Leak-Free Seal LANCASTER, Pa.—Hailed as a breakthrough in mineral-based root canal filling materials for permanent canal obturation, Septodont's BioRoot RCS (root canal sealer) incorporates an easy-to-use cold obturation technique that ensures a long-lasting, leak-free seal and high pH (>11). And because it is biocompatible and resin-free, it will not have any impact on human cells in case of overturbination. For more information, call Septodont at (800) 872-8305 or visit septodontusa.com. FREEinfo, Bioceramic Repair Cement Maintains All Indications LONDRINA, Paraná, Brazil—MTA Repair HP is a bioceramic repair cement that maintains all indications and chemical and…

19. Page 32

    Composite Produces Durable, Long-Lasting Restorations Capable of Retaining Gloss ALSIP, Ill.-GC America's G-aenial BULK Injectable is an injectable, high-strength nano-particle composite with ideal viscosity, handling, and adaptation characteristics that may be used as a one-step application for bulk-filling up to the occlusal surface (up to 4 mm) without the need for capping or veneering with another composite. The homogeneously dispersed nanoparticle formula provides high flexural strength and wear resistance for a durable and long-lasting restoration that retains its gloss for many years after placement. It is highly shapeable and easy to manipulate yet provides super adaptation to the cavity for…

20. Page 33

    Nanohybrid Composite Provides Extremely Low Water Sorption Properties THE VILLAGES, Fla.—With DMP Dental's NANOCERAM-BRIGHT's adaptive, chameleon-like technology, one can easily and confidently create long-lasting, natural-looking restorations that patients won't stop smiling about. For more than 30 years, DMP has developed an innovative manufacturing process that integrates a unique blend of microand nanofillers into the resin matrix, creating an easy-to-sculpt nanohybrid composite for Class I to IV restorations. Adaptive Chameleon-like technology achieves excellent color matching, high polishability, and lifelike translucency, allowing the restoration to blend into the natural tooth structure and surrounding area. NANOCERAM BRIGHT outperforms the competition with extremely low…

21. Page 34

    Trays Deliver and Hold Medication Deep Into Periodontal Pockets ST. LOUIS—Harness the power of oxygen with Perio Protect's prescription Perio Tray delivery of 1.7% hydrogen peroxide. The FDA-cleared Perio Tray has internal peripheral seals to deliver and hold medication deep in periodontal pockets. The trays are ideal for patients with generalized pocketing, struggling with maintenance and for cosmetic, restorative, and pediatric cases. Research shows Perio Tray delivery of 1.7% hydrogen peroxide and SRP achieves better results than SRP alone. Hygienists note reductions in inflammation and pocket depth scores, while also reporting more efficient appointments. Perio Trays are comfortable, convenient, and…

22. Page 35

    Recurrent Decay: What caused it and who pays for it? Robert Haraden, DDS What Caused it? The following is a case study of a 22-year old female with a seven month old MOL Composite restoration on tooth #3. As seen on Figure 1, there are dark stains around the cavosurface margins of the seven month old composite restoration indicating the filling is already failing. It is apparent that during the original procedure, the prep area was contaminated causing the bond strength of the composite to be significantly reduced. Case Study photos: Figure 1 - Seven-month-old failing filling. Figure 2 -…

23. Page 36

    Opens Oral Health Center for People With Disabilities The New York University (NYU) College of Dentistry has opened its Oral Health Center for People with Disabilities. The 8,000-square-foot facility provides comprehensive care for patients whose physical, cognitive, or developmental disabilities or medical conditions prevent them from receiving care in a conventional dental setting. "The NYU Dentistry Oral Health Center for People with Disabilities addresses a major public health challenge by providing comprehensive, compassionate dental care for people with a full range of disabilities who experience significant barriers to accessing care," said Charles N. Bertolami, DDS, DMedSc, the Herman Robert Fox…

24. Page 40

    Soft-Tissue Considerations The osseous tissue that a dental implant is placed into, and surrounded by, has obvious major importance relating to the health of a dental implant. For six months Implants Today section, Dr. Charles Schlesinger has written an excellent article on ridge preservation technique that outlines the science and material considerations to grow bone. In his article, Dr. Schlesinger spells out how osseous cells form and why various materials help out in that process. When I was trained by my mentor, the late Dr. Carl Misch, I remember realizing how important it was to understand the science behind how…

25. Page 42

    Ridge Preservation Technique There's More Than One Way to Fill the Hole! Charles D. Schlesinger, DDS INTRODUCTION Try as we may, ours or someone else's dentistry does not last forever. Throw in lack of dental care, periodontal disease, decay, or the occasional popcorn kernel, and you can end up with a tooth that needs to be extracted. Alveolar ridge preservation, or socket preservation, is the first step to successful implant placement if a patient does not want to have an implant placed immediately at the time of extraction. According to Christensen,¹ this simple procedure should be the standard of care,…

26. Page 44

    IMPLANTS CASE 1 Figure 1. Non-restorable tooth No. 30. Figure 2. The 557 LS Surgical Bur (Henry Schein). Figure 3. The tooth extracted atraumatically. Figure 4. Allograf t (Newport Biologics) particulate. Figure 5. Particulate in the extraction site. Figure 6. A disc of collagen plug (Alvelogro). Figure 7. The plug, containing graft material. Figure 8. The site, sutured with 3.0 silk. Figure 9. Radiographic evidence of the grafted site. Ridge Preservation Technique continued from page 42 or other beliefs. I have found that very few, if any, patients will decline the use of an alloplast. I will now introduce and…

27. Page 46

    IMPLANTS CASE 3 Figure 20. Non-restorable tooth No. 2. Figure 21. Intra-oral view of the second molar. Figure 22. Roots were removed individually. Figure 23. The extraction site. Figure 24. The OsteoGen plug segment, placed in the palatal root. Figure 25. A bifurcated plug for buccal grafting. Figure 26. The plug in place. Figure 27. The sutured site. Figure 28. The radiograph at time of placement. Figure 29. Radiographic evidence of healing. Ridge Preservation Technique continued from page 44 can provide. The cortical component provides structural support; a mineralized graft; and, ultimately, slower resorption of the graft. The cancellous bone…

28. Page 47

    Case 3: OsteoGen Plug A 54-year-old patient with an unremarkable medical history presented with a failing tooth No. 2. The tooth radiographically presented with large decay and a periapical radiolucency associated with the roots (Figures 20 and 21). The decision to extract the tooth in preparation for an implant at a later date was decided upon by the patient. Profound anesthesia was achieved with a PSA block and palatal soft tissue infiltrate using 2% lidocaine with 1:100,000 epinephrine (Cook Waite). After sectioning the tooth mesial-distally with a high-speed handpiece, the tooth roots were extracted individually (Figure 22). The resulting socket…

29. Page 48

    Resolving a Common Implant Complication Creating Attached Gingiva Timothy Kosinski, DDS INTRODUCTION Implant dentistry is at the forefront of treatments that our patients are considering. With the Internet, our patients easily search for solutions to their dental problems, including "missing teeth," "teeth hurt," or "I hate denture/removable partial." Inadvertently, what comes up in the Google search results is information about dental implant treatment and a list of dentists who provide this service. All the information may not be completely correct, but it is our job as dental professionals to accurately explain the options available and to discuss the benefits and…

30. Page 50

    Resolving a Common Implant... continued from page 48 minimizing the available bone. When this occurs, the mucosal tissue will often follow, reducing or eliminating the normal keratinized tissue on the facial aspect of the edentulous ridge.3 As we proceed with our surgical procedures, I find it helpful to first infiltrate into the vestibule with my local anesthetic. The fluid will bubble up the mucosa, leaving the attached gingiva. This allows me to clearly visualize and determine the amount of keratinized tissue I have to work with on the implant site. Dental implant treatment is a predictable and long-lasting solution to…

31. Page 52

    Resolving a Common Implant... continued from page 50 results in prostaglandin release and increased postoperative pain. This type of reflection will allow for easy replacement and repositioning of the keratinized tissue from the crestal portion of the edentulous site (Figures 4 to 6). A conventional implant site osteotomy was made for the chosen implant system (Hahn Tapered Implant System [Glidewell Laboratories]). A 3.2-mm-diameter pilot bur was used to establish mesial distal and facial-lingual angulation. The osteotomy was then widened using tapered burs corresponding to the diameter of the implant to be placed. In this case, for a 3.5-mm-diameter Hahn Tapered…

32. Page 53

    Dental implants are a viable alternative to conventional dental procedures and are in such great demand from our patients. The improved quality of life created by giving the patient back both form and function with permanent dentition, or even to better stabilize a removable appliance, is an important reason why dentists should train themselves well on the surgical and prosthetic techniques. Along with understanding the vital anatomy involved with the surgical approach, we must attempt to maximize the positioning of the implants in bone to best create emergence profiles and smile designs. There is much more to implant placement than…

33. Page 54

    NINTH ANNUAL READERS' CHOICE TOP 25 IMPLANT PRODUCTS Michael Tischler, DDS Implant dentistry is a multidisciplinary field, and this year's Readers' Choice Top 25 Implant Products exemplifies this fact. When a dental implant is placed in a patient's mouth, there are many supportive products that help make the physical placement of the dental implant happen, in addition to the various surgical, prosthetic, laboratory, diagnostic services, and more. The latest technology available, once again, is evident in every product that has made this list. This is the case with the technologies and designs of the many dental implant companies. As the…

34. Page 56

    Top 25 Implant Products Dentatus USA Dentatus implants signify a major shift in treating a greater range of patients; they are particularly appealing to those who previously declined implant treatment due to constraints of anatomy, finance, or cost. By using a smaller-diameter implant, dentists can provide more affordable, less invasive, and faster procedures. Only Dentatus offers a screw-retained, narrow-diameter implant system that is engineered to reduce incidence of peri-implantitis and preserve bone. Dentatus Implants are a great option for single-tooth, full-mouth reconstruction, as well as overdenture procedures. For more information, call (800) 323-3136 or visit dentatususa.com. FREEinfo, BioHorizons The Tapered…

35. Page 58

    Top 25 Implant Products Aseptico 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. Aseptico's worldwide reputation for building strong, dependable dental equipment speaks to 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 ideal to…

36. Page 60

    Top 25 Implant Products Impladent Ltd The OsteoGen Bone Grafting Plug is an easy and affordable solution for socket preservation. Place the plug into extraction sites and suture over top—no membrane is required. The combination of calcium phosphate and collagen creates a structure that mimics the organic and inorganic components of physiologic bone. After a thorough debridement, deliver the plug dry and let it soak up the patient's blood. Condense it slightly below the soft tissue and suture over top to keep it in place. There is no need to use a separate membrane to contain the graft. The OsteoGen…

37. Page 62

    Top 25 Implant Products Dentium Dentium is a premier, world-class manufacturer of high-quality dental implant systems, including SuperLine and Implantium. The implants are manufactured in the United States and are made from pure titanium and textured with S.L.A. (Sandblasted with Large grits and Acid-etched) surface treatment. They have tapered and platform-switched designs with an internal conical hex connection. Furthermore, these 2 implant systems have 1 connection size, allowing the sharing of abutments regardless of implant diameter and implant system. Dentium also manufactures a large selection of dental instruments, lab components, and biologics to complement the dental implant system. Dentium products…

38. Page 63

    Implant Products READERS' CHOICE Top 25 Norris Medical The Zygomatic implant is placed following the extramaxillary protocol, which is a modification of the traditional Branemark technique. The implant is anchored in the zygomatic bone, resulting in high torque. The implant prosthetic platform is being shifted bucally to a more appropriate position of the restoration. The design of the Zygomatic implant is an unthreaded body ending with an aggressive thread at the apical part of the implant. A special drill design allows the clinician to create a clean tunnel preparation with minimal risk of membrane damage. For more information, visit norrismedical.com.…

39. Page 64

    Test 231 dentalCEtoday.com Surface Glass-Infiltration of Monolithic Zirconia Optimizing the Adhesive Bond This article presents a case report in which surface glass-infiltration of the intaglio of monolithic zirconia restorations was used to increase adhesive bond strength. The resulting increased bond strength allows the use of zirconia for a wide range of conservative treatments where adhesion is required for retention. Richard Trushkowsky, DDS, has had a private practice in Staten Island, NY, since 1978 and is a clinical professor and the associate director for the Advanced Program for International Dentists in Esthetic Dentistry at New York University College of Dentistry. He…

40. Page 65

    Figure 1. The model of the preparations. Figure 2. The wax-up. Figure 3. A scan of the preparations. Figure 4. A scan of the mandibular model. Figure 5. The intaglio view of the framework. Figure 6. The occlusal view of the framework. Figure 7. A CAD/CAM milled full-contour 3 mol% yttria-stabilized tetragonal zirconia polycrysts (3Y-TZP) fixed dental prosthesis (FDP) was placed on 3Y-TZP beads (with the occlusal surface down) in a 3Y-TZP sintering tray. Figure 8. The application of aqueous-based powdered slurry on the cementation surface of the 2 abutments of the presinterred FDP (Figure 3). The mandibular model was…

And 16 more pages — read the whole issue.