Dentistry Today — March 2022

Inside this issue

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

1. Page 6

   Around the World I am thrilled to feature our own Implants Today editor, Dr. Timothy F. Kosinski, on the cover this month. Tim has been one of my greatest helpers as I pushed through my first year in this role. His expertise in this area and his network of terrific clinicians have helped make this magazine a wonderful reference to all. Being in the trenches himself, Tim has contributed an article demonstrating the use of many digital technologies but also addressing a frequently overlooked area—gingival architecture and attached gingival issues related to implants and restorations. The rest of the clinical…

2. Page 8

   Pediatric Airway in a Dental Setting Have you ever wondered if you slept well the previous night? You might have thought the drawn you had was misplaced or related to the prior day's events. For a child, sleeping may not have been given a second thought. The physical traits and behavior of a young child can tell many stories in a roundabout way and give insight to what really is going on. The growth and development of a child and his or her ability to thrive can be hindered by poor sleep quality and deficient release of important hormones. There…

3. Page 10

   VIEWPOINT continued from page 8 or she is fast asleep. Finding a team of knowledgeable and open healthcare providers is the first step in ensuring proper treatment for a child who may have sleep-related breathing and airway concerns. Just like any opportunity to expand the upper and lower jaws is there, and it is the most opportune time to make room for expansion of all the teeth and space for the tongue. Oral habits such as tongue thrusting and thumb or fin-ger sucking can affect a child's bite his sleep quality was poor. In fact, the test ranked his sleep…

4. Page 12

   Pharmacology Paul Feuerstein, DMD, editor-in-chief of Dentistry Today, talks with 2 practicing oral surgeons, Jay Reznick, DMD, MD, and John Roberson, DMD, about pharmacology and a new webcast they have introduced to the profession. Q: Please take a moment to introduce yourselves. Dr. Reznick: John Roberson and I are the PharmaDocs. We came up with the concept of bringing pertinent information on pharmacology to dentists who are in the trenches seeing patients every day. These patients are on an increasing number of medications, many of which the doctor might not be familiar with but have an impact on how to…

5. Page 13

   New! Every shade. One choice. omnicHROMA Flow One-Shade Flowable Composite OMNICHROMA Flow is the world's first one-shade flowable composite to esthetically match every color of tooth from A1 to D4 with a single shade of composite. Tokuyama Dental's Smart Chromatic Technology, first implemented through the universal composite OMNICHROMA, has changed the way thousands of dentists practice restorative dentistry forever. Now, the same one-shade benefits are made available in a flowable consistency capable of addressing a wider range of restorative needs, saving clinicians even more time and money. Outstanding Features • Unprecedented shade matching • High polishability • High stain resistance…

6. Page 14

   Q&A: The Return of 'Guiding Leaders' Glidewell CEO Stephanie Goddard Resumes Her Landmark Business Leadership Program Aimed at Empowering Women Dentists Stephanie Goddard Bobbie Norton Leila Fejzagic Figure 1. Celebrating their hard work and progress, the 2019-2020 Guiding Leaders mingled with Glidewell executives on a sunset cruise. Figure 2. The 2019-2020 Guiding Leaders graduating class. Q: Why should a dentist look to join Guiding Leaders? A: On the surface, she'll earn 70 CE credits. In doing so, she'll also gain invaluable insight, guidance, and practical advice on how to be a successful business leader. Each participant is assigned an executive…

7. Page 15

   Q: Other groups supporting women in dentistry have emerged in recent years. Why continue with Guiding Leaders? A: It's seldom safe to assume a need is being fully tended by others. Statistics show that women comprise more than 50% of graduating dentists. And while they've been taking positive strides in terms of overall representation in the dental industry, COVID-19 reports suggest that more women dentists left the workforce than men, so the pandemic has hampered that progress. We're thrilled that there are other initiatives to help elevate women in dentistry because there can never be too many. But we also…

8. Page 16

   Preowned Intraoral Scanners Offer Comparable Performance to New Units SAN JOSE, Calif.–The path to practice digital transformation is now more affordable with Align Technology's iTero Element Certified Preowned intraoral scanners. Offering comparable performance to a new unit in the same model, these scanners offer an affordable pathway to practice digitization with the award winning iTero Element platform and restorative work flows. Keep patients engaged with the oral health with powerful chairside tools and visualization. Work more efficiently and confidently with labs thanks to the MyiTero portal, making Hero scans available quickly. It also allows one to choose his or her…

9. Page 18

   Electric Toothbrush for Children Provides Superior Plaque Reduction WALNUT, Calif.–BURST has teamed up with global sensation CoCommelon to release a one-of-a-kind electric children's toothbrush. Made with help from the company's community of more than 30,000 ambassador dental professionals, this brainy brush boasts 31,000 sonic vibrations per minute; 2 modes; a built-in timer; soft-tapered bristles; and vibrant, officially licensed CoCommelon designs. These features do more than make toothbrush time fun and exciting for kids aged 2 and older—they also help provide 26 times better plaque reduction than a manual toothbrush (data on file). And thanks to exclusive CoCommelon video content, replacement…

10. Page 19

    Handpiece Sports Durable Titanium Body HOFFMAN ESTATES, ILL–The T-Max Z series is NSK Dental's premium line of contra angles. The Z series has a small head and thin neck compared to other brands on the market, improving operators' functional visibility. The handpieces have a durable titanium body with ceramic bearings, and with NSK, infection protection comes standard. The DualDefense system offers a clean head system that prevents cross contamination of the airlines and anti-retraction valves in the high-speed handpieces and electric micromotor to prevent cross contamination of the waterlines. The Ti-Max Z Series of titanium electric attachments is available in…

11. Page 20

    Lasers Provide Extensive In-Office Support and Training ALBUQUERQUE—Utilizing the latest micro-pulsed technology, an advanced articulating arm delivery system, and the latest RF technology, DEKA CO. lasers from Diamond Dental Supply represent the latest advancements in laser technology. DEKA Dental Lasers has a range of lasers available and is now offering a new fractional handpiece for applications in sleep medicine as well as facial aesthetics. DEKA is part of ELEn., which is the only company in the world to manufacture medical and industrial lasers. ELEn. is also the only 600 laser manufacturer that produces its laser systems as well as its…

12. Page 22

    DirectaDentalGroup DIRECTA topdental ORSING parkell physics forceps RØNVIG TrollDental Sendoline CONTACTEZ DIRECTA FOCUS Directa AB, a dental manufacturing company founded in 1916, highly renown and one of the fastest growing dental companies in the Nordic region. Directa's Headquarters is located in Sweden with manufacturing and distribution facilities in multiple countries, with more than 200 employees representing well know brands worldwide. Flagship products The Luxator product line offers a safe and precise solution for successful extractions. The fine tapered blade compresses the alveolar, cuts the membrane, and gently eases the tooth from its socket reducing damage to surrounding tissue, keeping a…

13. Page 24

    Overcoming Clinical Challenges to Implant Placement in the Resorbed Ridge With Short Implants Raul Mena, DMD Gregori M. Kurtzman, DDS Implant initial stability is a key to success, especially with short implants that will have less height in contact with the surrounding bone. Stability of the implant during the initial healing is critical to success, even when the implant will not be immediately loaded. Several factors contribute to that initial stability, including the osteotomy site preparation (osteotomy-site-signification) and the implant design that is selected. Thread design plays a factor in not only initial stability but also in functional loading. Deeper…

14. Page 25

    FIGURE 4. Avoidance of maxillary sinus augmentation by utilizing the available bone present for implant placement with the Short implant achieves good primary stability with the threaded fins. FIGURE 5. Placement of Short-T implants in the posterior mandible is offered with minimal available height superior to the inferior alveolar nerve. than issues discussed in the posterior maxilla. Repositioning of the IAN is a complex procedure with potential complications that can include permanent or transitory paresthesia. Utilization of a short implant, such as the Short-T (Quantum Implants), when a minimum of 6 mm of available crestal height is present, allows a…

15. Page 26

    Flowable Composite Eliminates Need for Technique-Sensitive Bonding Procedures In Children SAN MARCOS, Calif.–A pediatric self adhesive flowable composite, Shofu Dental's Beautiful Kids SA has eliminated the need for technique-sensitive bonding procedures for pediatric patients. Simplify pediatric procedures with Beautiful Kids SA, a BPA-free, self-adhesive, nanohybrid flowable restorative with bioactive Giomer Technology. It delivers high bond strength for reliable adhesion, precision placement with superior handling, and light transmission and diffusion properties that blend well with primary or permanent dentition for picture-perfect restorations. The lack of a bonding agent allows total integration of the healthy benefits, including an antibacterial effect, acid neutralization,…

16. Page 28

    Desensitizer Provides Immediate Closure of Open Dentinal Tubules IRVINE, Calif.-KöR Complete Desensitizer is a unique oxalate desensitizer that strongly fuses to hydroxyapatite molecules of highly mineralized enamel (98% mineral) and peritubular dentin (92% to 93% mineral) to provide immediate closure of open dentinal tubules. Unlike oxalate desensitizing products that simply "clog up" the open orifices of dentinal tubules, KöR Complete reacts with, and fuses to, the hydroxyapatite molecule in tooth structure via a chelation reaction. This forms a durable compound of calcium oxalate mineral crystals fused to peritubular hydroxyapatite 7 to 12 µm deep within dentinal tubules. In addition to…

17. Page 29

    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…

18. Page 30

    Varnish Delivers Targeted, Sustained Release of Calcium and Fluoride SCHAUMBURG, Ill–BISCO Dental Products' FluoroCal is a fluorideand calcium-releasing varnish that is indicated for application to enamel and dentin for the treatment of hypersensitive teeth. It delivers a targeted and sustained release of calcium and fluoride for more than 24 hours and provides immediate relief of sensitivity by penetrating and sealing dentin tubules. When tested, FluoroCal showed significantly higher fluoride uptake than other leading fluoride varnishes (data on file). Additionally, it contains Tri-Calcium Phosphate (TCP), which studies have shown may help strengthen enamel and build more acid-resistant minerals when combined with…

19. Page 32

    Industry News North American Dental Group Names Todd Nickerson CDO North American Dental Group (NADG) has welcomed Todd Nickerson into the role of chief development officer (CDO). Nickerson will play a key role in attracting new partners to NADG and executing the company's growth strategy. "NADG is in the early stages of executing an exciting and ambitious growth plan," said CEO Jonathan Walker. "Todd will be instrumental in helping us attract new partners that fit within our partnership approach to group dentistry. That approach is founded on the strength of the relationships we have with our doctor partners. Todd's efforts…

20. Page 34

    Chewing... continued from page 32 it especially difficult to conduct a study of this scale and magnitude. The cluster randomized trial enrolled participants from 8 health centers in Malawi and was approved by the Malawi Ministry of Health. Participants enrolled voluntarily and consented to participation before they became pregnant or within 3 weeks of becoming pregnant. All the participating health centers provided healthcare messages promoting oral health care and preterm birth prevention and care, while half of them were randomized to also provide xylitol chewing gum to enrolled research participants. In the 4 health centers that served as the control…

21. Page 36

    Positive Developments to Elevate Your Implant Practice Dental implants are certainly an acceptable mode of therapy in the restoration of the edentulous space. This follows the gambit from single-tooth replacement to multiple units to supporting conventional removable appliances to, finally, full-arch reconstruction. As materials, surgical protocols, instruments, and our diagnostic abilities have elevated to a high level, dental implants are in the realm of the general practitioner. There is so much more to understand about this procedure than just drilling a hole in the hard tissue. Understanding vital anatomy is, of course, paramount. The emergence profile ensures that restorations look…

22. Page 37

    Ceramic Dental Implants Where Aesthetics Matter A Healthy, Natural-Looking, and Long-Lasting Fixed Solution for Edentulism INTRODUCTION Ceramic implants are one of the relatively newer and most exciting developments in oral implantology. These implants have been used in Europe since the early 2000s and subsequent to FDA approval in 2011, in the United States. The first ceramic material that was used in the past for dental implants was aluminum oxide. This material showed good osseointegration, but it did not have adequate mechanical properties for long-term loading. More recently, a new generation of ceramic materials, such as zirconia (ZrO2), was introduced. Zirconia…

23. Page 38

    Figure 3. Soft-tissue contours and healing 4 months after the surgery. Figure 4. A closed-tray impression coping is used to take the final impression for the restoration. Figure 5. A customized zirconia abutment with the laboratory screw is shown. Figure 6. The final restoration is delivered, showing good pink and white aesthetics and a natural fit. Figure 7. The final periapical radiograph of the implant and the restoration. Figure 8. A preoperative photograph of the proposed implant site No. 13, showing adequate hard and soft-tissue volume. Figure 9. A periapical radiograph of the 4.1 × 10 mm Straumann Pure Ceramic…

24. Page 40

    Ceramic Dental Implants.... continued from page 28 tion, adjacent structures, and soft-tissue emergence profile. The final screw retained restoration (Figure 12) was produced and delivered using standard protocols. The seating of the restoration was confirmed by a bite-wing radiograph (Figure 13). The patient's new implant restoration blended in well with her existing teeth, gums, and oral harmony (Figure 14). DISCUSSION Ceramic implants are gaining popularity worldwide as an excellent option for tooth replacement. As the demand for metal-free solutions increases, more research is being done in the field of zirconia implant materials, surface characteristics, and implant designs. Many studies have…

25. Page 41

    Guided Implant Surgery and Attached Gingiva INTRODUCTION Guided surgical procedures allow the practitioner to diagnose and treatment plan implant positioning. Being able to visualize the final process prior to any surgical intervention is an art that is accelerated with virtual design. CBCT and software analysis provides a 3D image of the edentulous space that requires a dental implant. Digital positioning helps minimize the fear of damaging vital anatomy, such as the mandibular or mental nerves, and aids in proper angulation in the available hard tissue to maximize the emergence profile and smile design of the final prosthesis. Taking a tooth-down…

26. Page 42

    IMPLANTS FIGURE 1. (a) An edentulous mandibular right quadrant, evaluated for potential dental implant placement. (b) An evaluation of the interocclusal space and attached gingiva. FIGURE 3. A stable surgical guide is both toothand hard-tissue-supported. and eliminate the removable appliance he or she had been wearing for years. Epithelial attachment should also be considered here, as there must be an adequate band of attached gingiva on the facial aspect of any dental implant. As teeth are lost and bone shrinkage occurs, the mucosal tissue often migrates to the facial aspect of the edentulous ridge.21 This concept will be reintroduced shortly.…

27. Page 43

    IMPLANTS 43 our CBCT analysis and planning software. The Hahn Tapered Implant System has an aggressive thread design and a 1-mm machined collar. A cover screw was hand tightened into the implant, and the tissue was sutured with Vicryl PGA (Newport Biologics) (Figure 6). You can see that the incision line was lingual, but the implant was placed in the available bone. Following 3 months of integration, the edentulous ridge was healed and ready for the next steps. The implant needed to be exposed to remove the cover screw to thread in an impression coping. Using the surgical guide, an…

28. Page 44

    Figure 8. An impression coping was seated, and a digital radiograph was made to ensure complete seating. Figure 9. Due to the lack of attached gingiva on the facial aspect of the implant, a new reflection was made, and a 5-mm tall healing abutment was torqued to 25 Ncm. Figure 10. A suturing technique was used to reposition the band of attached gingiva from the crestal-lingual area to the facial aspect of the healing abutment. Figure 11. A new band of attached gingiva on the facial aspect of the implant was established in a 3-week period. Figure 12. The final…

29. Page 46

    DENTISTRY TODAY 12TH ANNUAL Top 25 Implant Products Dentistry Today's Readers' Choice Top 25 Implant Products, selected on the basis of lead generation, represent some of the profession's most innovative implant products. The products appear in no particular order. Glidewell Dr. Jack Hahn, renowned implantologist and designer of the original tapered implant, created the Hahn Tapered Implant System, which combines clinically proven features and contemporary innovation to meet the demands of modern implant dentistry. With a design based on Dr. Hahn's 45 years of clinical experience, this implant showed a 99.2% survival rate and less than 0.2 mm of mean…

30. Page 48

    Top 25 Implant Products Dentis Implants Dentis SQ is one of the company's newest and most advanced implant systems, featuring the SQ Mini. The narrow design allows for less interference with adjacent teeth and is excellent for anterior placement. Its dual-thread, tapered design produces high initial stability. The SLA surface ensures strong and fast osseointegration that increases the long term success of the implant. Healthy soft tissue is also vital for implant success. The platform switching design improves the soft-tissue connection and aesthetic appearance. For more information, call (323) 677-4363 or visit dentisusa.com. FREEinfo, TruAbutment The Angulated Screw Channel (ASC)…

31. Page 50

    Top 25 Implant Products IMPLADENT LTD OsteoGen -Non-Ceramic Bioactive Crystal Bone Graft -Type I Bovine Achilles Tendon Collagen The OsteoGen Bone Grafting Plug combines OsteoGen Bioactive Resorbable Calcium Apatite crystals with bovine Achilles tendon collagen for one-step socket preservation without the need of a membrane. The bioactive calcium phosphate crystals and clusters combine with collagen to create a hydrophilic structure that mimics physiologic bone. To preserve socket, entirely remove infected periodontal ligament, flush out, and repeat. Make holes or partially remove lamina dura due to the alveolar process, where available; paper plug, apply, deliver dry into socket, and let it…

32. Page 52

    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 esthetic. Bicon's 360° universal abutment positioning provides for the revolutionary cementless and screwless Integrated Abutment Crown, consistently offering a nonmetallic esthetic gingival margin. For more information, call (800) 882-1266. FREEinfo, Shatkin F.I.R.S.T. The Mono Bendable Implant is a…

33. Page 54

    Top 25 Implant Products Sterngold Sterngold is one of the leaders in the mini implant market thanks to the MOR Implant System. Its popularity stems from its simplicity, versatility, and high potential to deliver patient satisfaction. MOR provides small-diameter implants—ranging from 2.1 to 3.0 mm—designed to help clinicians provide an affordable alternative for the places where smaller implants make the most sense: overdentures, single-arch, or crown and bridge fixation in tight spaces. The MOR Mini Dental Implant is equivalent to 3M's MDI, allowing the same drills and instrumentation to be used. Free CE courses are always available to all interested.…

34. Page 56

    Top 25 Implant Products OCO Biomedical The Engage bone level implant system product line leverages a 1-mm, machine-finished collar, which brings the junction of the implant and abutment above the crest of bone. This prevents bone loss and improves soft-tissue preservation. The implant's proprietary auger tip, mini-cortico threads, and unique thread pattern lock directly into the bone, providing instant fixation. It features a platform-switching design on the 5.0- and 6.0-mm Engage Plus implants that aids in maintaining biologic width. For more information, call (800) 228-0477 or visit ocobiomedical.com. FREEinfo, Ritter Implants The Ritter SB/LA Spiral Implant System combines German state-of-the-art…

35. Page 58

    Minimally Invasive Cosmetic Dentistry Creating Aesthetics for the Young Cosmetic Dental Patient in the Social Media Era INTRODUCTION Younger patients are seeking cosmetic dentistry now more than ever. With the popularity of social media platforms such as TikTok, Instagram, and YouTube, many younger adults want a beautiful and dynamic smile to elevate their facial beauty, drive more attention to their posts, and increase their number of followers and subscribers. During this time of instant gratification, younger patients want cosmetic dental procedures to be done quickly. Thus, minimally invasive composite resin veneers have become popular during this post-COVID-19 surge. CASE REPORT…

36. Page 60

    Minimally Invasive Cosmetic... continued from page 58 air for 5 to 10 seconds. The adhesive was light cured for 10 to 15 seconds on both the facial and lingual sides (Figure 4). Next, a very thin film layer of nanohybrid composite resin (G-zenial ACHORD A1 [GC America]) was placed along the lingual and incisal aspects of the PVS matrix of both central incisors (Figure 5). The PVS matrix was then placed on the teeth, so the composite resin material intimately adhered to the lingual aspect of both central incisors. After light curing the composite resin, the matrix was removed, which…

37. Page 61

    AESTHETICS goals is important to be successful with cosmetic dental treatment (Fig. ure 14). Being able to deliver a one-appointment cosmetic restorative treatment is not only gratifying for the patient but also a good achievement for the clinician. References 1. Spoor H. The use of direct composite in the conservative esthetic correction of the altered passive eruption. Pract Periodontics Aesthet Dent. 1998;8:1161-8; quiz 70. 2. Kugel G. Materials continue to expand dentistry's esthetic. Compend Contin Educ Dent. 2000;21(2):97-104; quiz 106. 3. Fahl N Jr. A polychronic composite layering approach for solving a complex Class IV/direct veneer/diastema combination: Part II. Pract…

38. Page 62

    Congenital Growth Defect and Missing Teeth A Conservative Aesthetic Rehabilitation in an Adolescent INTRODUCTION Pediatric odontogenic tumors are rare but can lead to developmental consequences resulting in issues regarding aesthetics and functionality of a patient's dentition.¹ A majority of these tumors are benign if diagnosed early. A collaboration between multiple specialties is often necessary to acquire an optimal outcome.¹ The most aggressive benign lesions and malignant tumors require major surgery with imminent of delayed reconstruction.² In addition, the adaptation of procedures to accommodate a patient's medical and social needs is necessary to maintain patient satisfaction and adherence. Although benign, if…

39. Page 64

    Congenital Growth Defect and.... continued from page 62 radiographs and preliminary TRIOS (3Shape) scans were taken prior to treatment.2 One of the advances of this technology that uses intraoral scans and digital models, in this particular case, is a promising alternative to conventional impressions in regard to patient acceptance and efficiency.3 Consultations with an oral surgeon, an orthodontist, and a prosthodontist were obtained. Following caregiver approval, orthodontic treatment was started in order to create the necessary spacing to re-create the patient's midline. ...the patient's dentition was restored conservatively.... One year later, a new TRIOS scan was obtained for a diagnostic…

40. Page 66

    Management of Compound Fractured Coronal Tooth Structure Reattaching Fractured Segments INTRODUCTION Approximately 92% of accidental traumatic injuries commonly affect the anterior region involving the maxillary central incisors (CIs), followed by the lateral incisors (LIs) with coronal fractures due to falls, sport injuries, and vehicle accidents that have been documented in the literature.¹ Cast or prefabricated posts with cores, pin-retained restorations, and partial or full coverage crowns have been the only treatment choices in the past era of dentistry. Yet their drawback is compromised sound tooth structure that may limit the long term prognosis of that tooth and the aesthetics with…

And 2 more pages — read the whole issue.