Dentistry Today — March 2020

Inside this issue

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1. Page 6

   The Value of Mentorship New and recent graduates in dentistry would likely be able to start off their careers in dentistry on a better foot if they had access to caring mentors. A small percentage of graduates choose to enter into a general practice residency (GPR) program to boost their knowledge, while others may join one of the armed forces to serve the country and to gain more chairside practice before going out on their own in private or group practices. The debt burden that accumulates during the prerequisite undergraduate education and in dental school is higher than ever before.…

2. Page 8

   Grow Your Practice by Focusing on Three Numbers Data is more important now than ever. Without data, you're simply having a conversation based on opinion, not fact. With a strong understanding of how metrics and data points influence practice growth, you will no longer make decisions based on gut feelings and learn exactly which levers to pull to reach your goals. Of course, there's a lot of different data that you can generate about your practice. You could manipulate it in a variety of ways to help you fit a particular narrative. However, if you really want to track the…

3. Page 10

   VIEWPOINT continued from page 8 office really show their influence. Gross collections percentage is the ratio of what the practice invoiced, sold, or produced after write offs and discounts. Even if your top line production increases, the effects of your insurance write-offs, the ability of your team to collect outstanding accounts, and your day of service payments are what create the challenges with this data point. Here is an example of how this affects your bottom line: let's say your gross collections percentage is 80% and your Gross Production is $100,000. In this example, you have write-offs or high accounts…

4. Page 12

   Icon Smooth Surface: Minimally Invasive Treatment With Maximal Results Figure 1. Preoperative image of dark staining in tooth Nos. 7 to 10. Figure 2. OtraGate lip retractor (voclar Vivadent) and dental dam used for surface lesion removal and icon-Etch application (DMG America). Figure 3. Significantly decreased lesion after use of icon-Etch and iconDry. Figure 4. Dental dam removal post icon technique. Figure 5. Final restorations after polishing. Peter Auster, DMD Resin infiltration is a revolutionary addition to the growing trend of minimally invasive dentistry. This conservative restorative technique is used to arrest incipient carious lesions early on and treat white…

5. Page 14

   Teledentistry for Private Practice Paul Labbe, DDS, explains how teledentistry helped him expand his pediatric group practice. Q: When did you first consider adopting teledentistry? What problems were you trying to solve? A: Our dental group started looking into teledentistry about 7 years ago. Early on in our community outreach efforts, we would have our booth set up at local community health fairs. Our goal at these events was to provide information about our practice, give oral hygiene kits (each containing a toothbrush, toothpaste, floss, and basic hygiene instructions), and educate attendees on their oral conditions with a complimentary oral…

6. Page 16

   Company Introduces 5 Year Warranty Program to Provide Optimal Protection MIDDLEBURY, Conn.–Owandy Radiology introduced its new 5-year warranty program during the Chicago Midwinter Meeting. In addition to the I-Max 3D, the Owandy 5-year warranty provides optimal protection to the following products: (1) Owandy I-Max digital pan unit; (2) Owandy digital sensors; (3) Owandy RX x-ray generator; (4) OsandyCR plate scanner system; and (5) Owandy-Cam and Owandy-Cam HD intraoral cameras. The 5-Year warranty covers Owandy parts and service. Repairs are performed by Owandy's network of local distributors. For more information, call Owandy Radiology at (203) 745-0575, visit owandy.com, or email sales@owandyus.com.…

7. Page 18

   Caries Detection Device Demonstrates High Level of Sensitivity ROSLYN HEIGHTS, NY-Ortek Therapeutics has introduced the Ortek-ECD, a revolutionary electronic caries detection device. The ECD was specifically designed to help diagnose suspicious caries lesions on occlusal surfaces of posterior teeth. The ECD demonstrated 100% sensitivity and 93% specificity in a clinical study, helping solve an everyday challenge that dental professionals face. By measuring the conductivity of enamel, the ECD can instantly and accurately detect if a suspicious caries lesion has breached the dentinal/enamel junction, advanced and progressed further into the dentin, or is confined to the enamel. Using the ECD is…

8. Page 20

   Mobile Operatory Works Without Connection to Air or Plumbing WOODINVILLE, Wash.—Brand new for 2020, Aseptico's AMC-15 Self-Contained Mobile Operatory can perform general dentistry and endodontic procedures—all with no connection to air or plumbing. Just fill the two 1-L water supply bottles and power with either 115 or 230 V and you're fully operational with 2 high-speed handpieces, one low-speed handpiece, high volume and low-volume suction, and an amalgam separator. Engineered to provide many years of reliable service, the AMC-15 is easily moved and sets up to make an extremely efficient instant operatory. Add the height-adjustable auxiliary arm with accessory tray…

9. Page 21

   In First Impressions, George Freedman, DIS, gives readers a brief summary of products that have recently been introduced to dentistry, based on his clinical experience. He can be reached at freedman@epdot.com. Electronic Caries Detector (ECD) Ortek Therapeutics It's easy to visually identify larger areas of decay, but the differentiate soft portions of tooth structure, and radiographically interpret the carious penetrations of enamel and dentin. Difficulties occur when the caries is very small or appears only small, as in the case of hidden decay. All too often, the dentist will opt to watch and wait, allowing the damage to worsen with…

10. Page 22

    Flowable Restorative Eliminates Need for Technique-Sensitive Bonding Procedure SAN MARCOS, Calif.—Shofu Dental's FIT SA is a new, comprehensive, and self-adhesive flowable restorative with bioactive Giomer technology inside. It has eliminated the need for the technique-sensitive bonding procedure. This revolutionary, nanohybrid, bioactive, and self-adhesive flowable composite is designed for use as a liner, including small Class I (IPR), Class II, and Class V options, as well as other non-load-bearing restorations. Its unique chemistry is BPA-free and provides a chemical bond, as well as resin tag infiltration. FIT SA offers superior strength and polishability. The unique filler structure combines the light transmission…

11. Page 23

    CHAIRSIDE WITH DR.K THE SECRET TO MORE EFFECTIVE WHITENING No two patients are exactly the same. So why use just one whitening protocol to treat them all? At KöR Whitening, we recognize that each patient presents a different whitening challenge and that's why we developed a full line of whitening systems to meet your patient's individual need. And KöR Whitening is the first whitening system in the world to maintain potency of its entire line of whitening gels by constant refrigeration from the instant of manufacture until being received cold-packed at your office. Dr. Rod Kurthy #1 Proper Product and…

12. Page 24

    Composite Contains Bioactive Fillers New Matrix Bands Provide Multitude of Advantages CHICAGO - Cosmedent's new FULL CONTACT sectional matrix bands have a multitude of advantages for the clinician: they are (1) ultrathin and easy to place; (2) precontoured for complete contact; and (3) resilient, holding their shape once placed. These new matrix bands can wedge from buccal and lingual sides, ensuring a complete gingival seal. They can also be used with any ring system or alone. FULL CONTACT sectional matrix bands are available in adult and pediatric sizes. For more information, call Cosmedent at (800) 621-6729 or visit cosmedent.com. FREEinfo,…

13. Page 25

    Ergonomic Syringe Designed for Enhanced Comfort, Easier Injection ST. PAUL, Minn.-Both of 3M's current flowable composite mate rials, Filtek Supreme Flowable Restorative and Filtek Bulk Fill Flowable Restorative, will now feature improved syringe design to simplify placement. The new tip reduces bubbles and waste by producing virtually no bubbles or material run-on during the dispensing process. It also allows for effortless access to the prep area with an easy-to-bend cannula that can be bent by hand without kinking. The new syringes also more ergonomic and user friendly, featuring a triangular finger grip and larger plunger, making it easy to hold…

14. Page 26

    Industry News Allen Joins Clinician's Choice as Chief Commercial Officer Clinician's Choice Dental Products has named Brian Allen its chief commercial officer. With more than 25 years of experience in the global dental industry, Allen has served in various sales and marketing leadership positions with global leaders and innovative manufacturers. "We are fortunate to have someone of Brian's talent step up to lead Clinician's Choice," said Peter Jordan, president and CEO. "I am honored and thrilled to join Peter Jordan and the Clinician's Choice team. The foundation of this dynamic brand has been so very well established as Peter and…

15. Page 27

    Grant to Fund Research into Bioprinting Face, Mouth, and Skull Tissues Bioprinted bone constructs loaded with stem cells for craniomaxillofacial reconstruction. Kerin Moncal, Ozbolat Lab, Penn State Seamlessly correcting defects in the face, mouth, and skull is highly challenging because it requires precise stacking of a variety of tissues, including bone, muscle, fat, and skin. Now, researchers at Penn State University are investigating methods to 3-D bioprint and grow the appropriate tissues for craniomaxillofacial reconstruction. A 5 year, $2.8 million grant from the National Institute of Dental and Craniofacial Research will allow a team of researchers to explore the use…

16. Page 30

    Conservative Treatment of a Non-Consonant Smile Arc INTRODUCTION One of the characteristics of an attractive smile is the relationship between the maxillary incisal edges and the lower lip, referred to as the smile arc. The ideal smile arc has the maxillary incisal edge curvature parallel to the curvature of the lower lip. In his book, The Science and Art of Porcelain Laminate Veneers, Dr. Calip Gürel states "In a pleasing smile, the incisal edges of the maxillary incisors follow a convex curvature, which is parallel to the lower lip and more pronounced and convex in females." When this visually pleasing,…

17. Page 31

    without anesthesia), then the crowns were cleaned with pumice, and then the restorations were tried in with water to evaluate the fit and color. After try-in, the internal surfaces of the lithium disilicate veneers (IPS e.max Press Ivoclar Vivadent) were cleaned using 35% phosphoric acid (Select HV Etch [BISCO Dental Products]). (Alternative products for this step include the universal cleaner Ivoclear [Ivoclar Vivadent] or ZirClean [BISCO Dental Products]). Next, the intaglio surfaces were treated with silane (Silane [Ultradent Products]) and set aside, organized by tooth number. A rubber dam was placed for isolation, and the previously prepared facial surfaces of…

18. Page 32

    Private Group Practice Develops Unique Mentorship Program Our editor-in-chief, Damon Adams, DDS, interviews Steven Barrett, DDS, a founding partner and the chief clinical officer at Greenberg Dental & Orthodontics, part of one of the largest privately owned group practices in the country with 9 2 offices in Florida, about his unique approach to doctor development for recent graduates as well as for doctors with many years of experience. With more than 30% of graduating students now choosing to start their career with a DSO—and many believe this will only increase—this is an important topic within our profession. Dr. Barrett, you…

19. Page 34

    Private Group Practice Develops... continued from page 32 speed faster not only helps them overcome the huge debt burden but, more importantly, also helps more patients experience the full potential of clinically excellent dentistry. This occurs not just from my own efforts but also in combination of working with other mentoring doctors and in house specialists. I must also add that today's dentists want answers quickly. It may be a chairside decision that needs to be addressed or a case planning discussion. In either situation, I truly believe that because we are a privately owned group that's owned and operated…

20. Page 36

    Figure 7. (Figure 7a) Pre-op view. (Figure 7b) BioTemps Provisionals (Glidewell). (Figures 7c and 7d) Final lithium disilicate restorations (IPS e.max [Ivoclar Vivadent]) on Teeth Nos. 7 to 10. Private Group Practice Develops... CONTINUED from page 34 only need based concerns but also elective dental concerns. The case presentation must be non-confrontational, caring, and compassionate. It must always take into account the patient's dental budget. This is something I learned a long time ago from one of my mentors, Dr. Paul Homoly, and it is still true today. We continually focus on being able to meet or exceed our patient's…

21. Page 38

    Private Group Practice Develops... continued from page 36 dentists complete the Vision First Mentoring Process, enabling us to develop regional mentoring doctors. These regional mentors share in the responsibilities and create a daily learning experience for young doctors. I refer to this as a "real life GPR." Many DSOs have training programs. So how do you measure that the training is translating into doctors becoming more confident and productive? Dr. Barrett: Great question. It is important to understand that we have quotas, but we do have expectations of our doctors. These expectations are based on 42 years of experience. Let…

22. Page 39

    INTERVIEW with you and your readers, and to have the opportunity to share my thoughts on doctor development. Speaking on behalf of my partners, we could not be more excited about the accelerated development curves we have witnessed and are even more committed than ever to improving the Vision First mentor program. As a privately owned, multi-specialty, general dentist practice, we have all the components of a "real life GPR" already in place within our model. This structure enables us to accelerate a young doctor's career, as well as add new levels of motivation for experienced doctors. It is important…

23. Page 42

    Same-Day Smile With Full-Mouth Guided Surgery INTRODUCTION With the introduction of guided surgery to implant dentistry, multiple benefits to both the planning and surgical aspects of the workflow have been realized. Predictable placement, faster patient recovery, and less chair time are some of the main advantages to utilizing the new technology. Switching to a top-to-bottom planning approach where aesthetic results are given more priority has opened the door for clinicians to take more control of the prosthetic aspect of their implant cases and to have CAD/CAM provisional crowns designed and delivered at the time of surgery. Whereas traditional implant procedures…

24. Page 44

    Same-Day Smile With Full-Mouth... continued from page 42 and implant placement procedures (Figure 9). The key-locking mechanisms on both sides provide extra stability during surgery and act as indicators that the guide is fitting on top of the base as digitally planned. For this case, it was determined that angled abutments would be required. To ensure perfect alignment with the planned hybrid denture, an abutment guide (Figure 10) was necessary. This guide was also designed to fit on top of the Snap In Bone Reduction Guide and had indented notches to help with accurately positioning the angled abutments (Figure 11).…

25. Page 45

    IMPLANTS maximal accuracy according to the digital plan. Implant Placement Control is a prerequisite of using the Guided Full Mouth Restorations protocol for one-day teeth. Once the pick-up procedure was completed, the Snap-In Bone Reduction Guide was removed, and healing caps were used to preserve the tissue margin after suturing. Now the temporary restoration was ready for Figure 13. All remaining teeth were extracted. Figure 14. Pin-positioning guide in place to mark the location of fixation pins as digitally planned. Figure 15. Mandibular mucosa reflected after extraction. Figure 16. Snap-In Bone Reduction Guide in place with all 4 fixation pins…

26. Page 46

    Simplifying the Decision Tree Choosing Graft and Membrane Options After Extractions INTRODUCTION Over the past 25 years, the market for biologics used in conjunction with bone grafting has exploded. Clinicians providing extractions for their patients are faced with a plethora of choices when deciding what they should use and when. This article's intent is to simplify the decision tree. The type of bone defect remaining after removing the tooth dictates the type of bone and membrane we should utilize for a given socket or bone defect. We will assume that in each of the clinical scenarios discussed, the clinician will…

27. Page 48

    Figure 3. Bone mill. Figure 5. A classic 5-wall socket graft, featuring mineralized bone graft, non-resorbable Cytoplast (not seen), and LPRF (leukocyteand platelet-rich fibrin). Figure 6. A titanium-reinforced membrane (Cytoplast Ti-Reinforced dPTFE Membrane BioHorizons) backed with 2 self-tapped screws. Simplifying the Decision Tree continued from page 46 should be secured with a non-resorbable suture that minimizes wicking. The sutures are typically removed in 2 weeks. CASE TYPE 2: THE 4-WALL SOCKET There are a number of clinical scenarios where a portion of the buccal wall is lost. This can be preceded by extraction by way of a buccal fistula secondary…

28. Page 49

    IMPLANTS 49 soft-tissue ingrowth in the socket. It is highly biocompatible and helps reduce the possibility of infection. The added titanium has a critical function in maintaining space to prevent the newly generated buccal plate from collapsing into the socket. It is necessary to stabilize this membrane with screws (Figures 6 and 7). Many clinicians report great success with a self-tapping (no drill required) system (Osteogenesis). Two screws are necessary, and it is critical that the clinician be aware of the underlying anatomy (ie, the roots of adjacent teeth) when planning the fixation. Ideally, this membrane should be covered by…

29. Page 50

    DENTISTRY TODAY 10TH ANNUAL READERS' CHOICE Top 25 Implant Products Dentistry Today's 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. TruAbutment The pioneering concept of the Angulated Screw Channel (ASC) TiBases has allowed users to deal with design challenges in the anterior region by providing a restoration that is aesthetic and convenient. The launch of ASC TiBases will further advance this concept by integrating it into the current custom abutment solutions. This allows the users to obtain the advantages of a…

30. Page 52

    Top 25 Implant Products Zimmer Biomet Dental The 3.1 mmD Eztetic Implant is a strong, aesthetic solution for narrow anterior sites. It is designed to offer improvements over similar commercially available implants, particularly in the areas of strength and primary stability. For the first time, 3 concepts have been combined to create a precise implant-abutment connection designed to reduce micromovement and microleakage. This unique connection comprises a conical interface, platform switch, and Double Friction-Fit technology designed to make strong narrow-diameter implants indicated for all anterior areas. The Eztetic implant-abutment connection, along with a Contour Abutment profile, is designed to provide…

31. Page 54

    Top 25 Implant Products Z-Systems USA With more than a decade of clinical experience, Swiss-based Z-Systems is one of the world's leading solutions for naturally white, high-performance zirconia dental implants. The market-leading Z5c zirconia 2-piece implant offers excellent osseointegration with its patented laser-modified surface, excellent soft-tissue response, no gray shine-through, and customizable technology. It achieves one of the profession-leading survival rates at higher than 98%. For more information, call (877) 874-9407, visit the website zsystems.com, or email usa@zsystems.com. FREEinfo, Sterngold The versatile MOR Mini Dental Implant can be used for denture connections or crown and bridge fixation. The implant line…

32. Page 55

    Top 25 Implant Products BioHorizons Tapered internal dental implants provide excellent primary stability, maximal bone maintenance, and soft-tissue attachment for optimal aesthetics. This implant achieves these benefits from its anatomically tapered dental implant body, aggressive buttress threads, and advanced Laser-Lok surface technology. The precision-engineered Laser-Lok collar has been shown to promote oblique connective tissue attachment, much like a natural tooth. The deep 1.5-mm internal hex connection with a lead-in tapered bevel creates a rigid connection and a stable biologic seal. Color-coded platforms and abutments increase safety and make restorative procedures fast and accurate. Offered in mounted and mount-free configurations, these…

33. Page 56

    Top 25 Implant Products PerioSeal The PerioSeal Implant System provides today's general dentist and specialists the simplest yet most advanced system marketed in the United States for addressing the issues of highest concern to patients and dentists. Its unique design incorporates safety features, lower costs, simple crown-and-bridge dentistry, and a superior cosmetic outcome. PerioSeal incorporates conventional dentistry principles (ferrule crown attachment) to implant dentistry. For more information, call (888) 446-7126 or visit perioseal.com. FREEinfo, integrated dental systems The Reflect Implant System is surgically and prosthetically compatible with leading implant brands from Nobel Biocare, Zimmer, Biomed, and Astra Tech. This allows…

34. Page 57

    Top 25 Implant Products Bicon Dental Implants The SHORT Implant design comprises plateaus; sloping shoulders; and a bacterially sealed, 1.5" locking taper implant-to-abutment connection. With the plateau design, cortical like bone forms around and between each plateau, which allows for the routine use of 5.0mm short implants. The sloping shoulder provides the necessary room for bone to support interdental papillae that is gingivally aesthetic. Bicon's 360° universal abutment positioning provides for the revolutionary cementless and screwless integrated Abutment Crown, consistently offering a nonmettalic aesthetic gingival margin. For more information, call (800) 882-4266. FREEinfo, Ritter Implants The Ritter SB/LA Spiral Implant…

35. Page 58

    Direct Resin Veneer Technique Using A Single-Shade Composite INTRODUCTION Direct composite veneers have gained an important role in clinical applications following the advent of recently developed materials and techniques in adhesive dentistry. A direct resin veneer can be a very conservative, functional, and long-lasting restoration. Some indications for direct resin veneers are discolorations of teeth, restorations, dental malformation or malpositions, diastemas, and cervical abrasion or erosion defects. A good example of this is on a patient with a peg lateral that needs to be stabilized during and immediately after orthodontic treatment. The composite material can be shaped and adapted to…

36. Page 60

    Direct Resin Veneer Technique continued from page 58 dent), followed by a fine rubber cup (pink FlexiCup). The final polish was achieved using FlexiBuff and Enamelite (Cosmedent). If any anatomic surface details (such as perikymata) are desired to match the adjacent teeth, this can be done by carefully tracing a diamond burr across the composite surface to create horizontal scratch lines, and then the entire restoration can be polished once again to a high shine.24 (Figures 12 to 18). The patient was very happy to have the discolored old filling replaced with a more natural and lighter colored restoration. The…

37. Page 61

    of the restoration with this direct technique.24 This requires a little skill and practice, but it is worth the effort to benefit the patient and allow the restorative dentist options for treatment and the satisfaction of creating a "work of art." A great way to test the option of a direct veneer is to do a mockup whereby the dentist places the composite material on the tooth (no etching or bonding agent) and then sculpts the composite material, light cures the material, and shows the result to the patient. Then the dentist can pop it off and restore the tooth…

38. Page 62

    Matrix Systems Directa Dental ProxyPal is a transparent, 3D contoured matrix for the front area. The pear-shaped progressive curvature creates incisal fillings with a correct anatomical shape and is especially designed for large proximal fillings and closure of frontal diastemas. To achieve a perfect filling, the matrix has been designed such that the curvature of the matrix escalates linearly along its total length. In one end, the curvature is vague, which is ideal for lower jaw incisors. In the other end, the matrix curvature is distinct, thus suitable. For more information, call (203) 491-2273, visit the website directadental.com, or send…

39. Page 63

    Three Great Choices for your Composite Restorations ProxyPal The pre-shaped progressive curvature aids to create incisor fillings with a correct anatomical shape A universal matrix for all anterior restorations. The innovative design of the ProxyPal matrix allows you to easily restore a broken down tooth to it's original anatomy. Reshaping and closing of a diastema is also very easy with ProxyPal. Samples Available While Supplies Last - Great Discounts FREEinfo, on card CoForm For temporary and permanent class IV composite restorations CoForm, matrix system, is a unique set of pre-formed transparent matrices, made of celluloid plastic that are specifically designed…

40. Page 64

    Retreatment vs Extraction and Implant Making Sound Clinical Treatment Decisions The Hippocratic Oath was written sometime between 500 and 300 BCE by Hippocrates. Its principles have survived to this day, and when dental students graduate, a dental version of the oath is often taken that reads something like this: "As a student of dentistry and as a dentist, I pledge to conduct myself with competence and integrity, with candor and compassion, and with personal commitment to the best interests of my patients. I shall care for my patients, as I would be cared for. The health and well being of…

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