Dentistry Today — March 2023

Inside this issue

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1. Page 6

   New Day Yesterday I have spent most of my dental career watching the development of digital technology. In the past few years, 3D scanning, imaging, treatment planning, and implementation have arrived at a rapid pace. My expertise is in how the digital devices actually work individually and their specifications. Now we have to learn how to implement these in practical situations and use them to improve our outcomes. Dr. Diana Tadros is one of the new practitioners who has taken this to another level. She is also so committed to the technology that she has the equipment displayed up front…

2. Page 8

   Assumption Assumption can be one of the most dangerous words in the dictionary. It can even get you into trouble if you "assume" your next occlusal restoration will be like the last. Nevertheless, most of us do. In my early years, I learned the hard way. When I was 13, my parents took me to New York City and to a famous restaurant for steaks. It happened to be the best steak I had ever eaten, and from then on, I judged every steak by how good the one in New York was. It became my goal to go back…

3. Page 10

   VIEWPOINT continued from page 8 cattes the outcome to me. In being the third person to listen to the patient's desires, we have a good idea of what she or he expects. Another example was an elderly lady with an aging full denture containing many artifacts of gold. I assumed she wanted me to make her look younger and prettier. When I tried in the final denture she looked in the mirror and started crying. I was pleasantly surprised at her happiness, which was short lived. I said, "I'm so happy you like the final result." Her response was "Like?…

4. Page 12

   PRODUCT PROFILE RAYFace Takes Dental Industry by Storm RAYFace, the revolutionary 3D facial scanner from Ray, received a resounding reception at the recent Chicago Dental Society Midwinter Meeting. The device seamlessly integrates a patient's facial information with dental data to create a comprehensive treatment plan, revolutionizing the diagnostic process. With its innovative approach, RAYFace is poised to be a game-changer in the dental industry. Streamlined and Efficient: Acquire 3D Data in a Fraction of a Second Traditional 2D cameras and conversion apps struggle to produce accurate images due to inconsistencies caused by factors such as posture, angle, and sensor performance.…

5. Page 14

   The Future of Dental Meetings Nanette Tertel, DDS, chair of learning for SmileCon 2023, talks about new trends that are reigniting dental conferences after the COVID-19 pandemic. Q: What is the impact that the COVID-19 crisis had on our shows? A: It's been a rough few years for the dental industry all around! Not only did the pandemic alter our patient care, but it also changed how continuing education is delivered. While online courses existed prior to COVID-19, we all became much more comfortable with technology due to the inability to meet in person. The decision meeting planners had to…

6. Page 16

   Difficult Patients, Difficult Choices Raymond Kimsey, DMD Introduction My practice is open to patients with special needs, and I often receive referrals from other practitioners for challenging cases. As difficult as they may be, I find them especially rewarding. Case Report Naomi was 10 and suffered from acute dental phobia and rampant caries (Figure 1). She was so difficult to manage that she had not been able to receive treatment elsewhere. She was referred to me, which was not particularly convenient for her mother, who had to make the 40-mile drive to my office in Miami. My first challenge was…

7. Page 18

   Owandy Radiology Orthodontic Software Simulates Treatment Plans ROSLYN, NY–The AI-powered Ceph Analysis Orthodontic Software is available as an optional module to the I Max Ceph panoramic digital radiography unit. The orthodontic software is available in a standard or an advanced feature package. Both packages include an industry-proven artificial intelligence engine to automate orthodontic diagnosis and treatment planning for predictable results. The Ceph Analysis Orthodontic Software includes several features and benefits. It offers fully automatic cephalometric tracing. The AI-powered tracing feature automatically finds softand hard-tissue landmarks, planes, and silhouettes on lateral or PA radiographs within seconds. There is radiograph analysis and…

8. Page 19

   Designs for Vision Device Differentiates Between Active, Arrested Caries Lesions BOHEMIA, NY--The paradigm-shifting REVEAL system allows one to visualize mature biofilm in real time without the use of any pharmaceuticals, chemicals, or dye. The REVEAL headlight uses a narrow spectrum excitation light to stimulate the byproducts of the bacteria associated with caries, calculus, and peri-implantitis, causing them to emit endogenous fluorescence. The REVEAL eyewear filters out the excitation wavelengths to allow clear visualization of the fluorescence. REVEAL allows one to detect and manage peri-implantitis and confirm successful treatment. The system helps one identify and differentiate between active and arrested caries…

9. Page 20

   Hiossen Digital Imaging System Produces Clear Images ENGLEWOOD CLIFFS, NJ–T2 reconstructs 2D and 3D images by converting x-ray signals into digital signals to analyze the oral and maxillofacial region anatomically. T2's metal artifact reduction function reduces the noise caused by metal materials, resulting in clear images. Supporting multiple fields of view, including 5 x 5, 8 x 10, 10 x 9, 12 x 9, 15 x 9 (standard), and 15 x 15 (stitching), T2 is specifically designed for orthodontic treatment, tooth impaction required for implant placement, and sinus analysis to determine the arch morphology. With an 80-μm resolution and 6…

10. Page 22

    MouthWatch Teledentistry Solution Serves as Backbone of Key Virtual Clinical Workflows METUCHEN, NJ--The award-winning TeleDent was upgraded to improve patient care and profitability in the post-pandemic world. Thanks to its intuitive, mobile-friendly patient portal and streamlined workflows within dental teams, it is the smart choice when it comes to connecting with patients in the safe and convenient way they need—and that many now demand. New patient consultations, post-operative evaluations, home care instructions, specialist referrals, and emergency evaluations can all be conducted with the highest degree of simplicity, security, and safety. Unlike "teledentistry lite" solutions, TeleDent's professional-grade, enterprise-level technology can serve…

11. Page 23

    Complete Chairside 3D Printing Ecosystem SprintRay, established in 2014, is a technology company that builds endto-end 3D printing ecosystems for dental professionals. Because we control the design, manufacturing, and support of our products, SprintRay is uniquely positioned to provide full-stack additive manufacturing solutions that are cutting-edge and user-friendly. SprintRay was Born From the Dental Community For us, finding and solving problems is a way of life. Our design and engineering choices are not just informed by the dental community, they are created in service to the community. We build our products so that they solve problems today while being prepared…

12. Page 24

    Digital Radiography—Intraoral Sensors DentiMax The award-winning DentiMax Dream Sensor is an open sensor that works natively with almost all imaging software. It excels in every area, including image quality, patient comfort, durability, and hardware/software compatibility. The sensor produces phenomenally crystal-clear x-ray images that are among the best in the industry. Patient comfort is achieved with rounded, beveled corners as well as the thinnest CMOS design on the market (data on file). The sensor is built to last, with a Kevlar-reinforced, repairable cable. For more information, call (800) 704-8494 or visit dentimax.com. FREEinfo, Apixia | Phosphor Plate Scanners (626) 810-9201 |…

13. Page 26

    Why Dentists Choose KöR Whitening A KöR Kit for every case type. The KöR Complete Desensitizer instantly relieves sensitivity in exposed dentinal tubules to prevent and eliminate all types of sensitivity. Including whitening sensitivity, it is also approved for dispensing to patients for at-home use. The KöR Lab provides impeccably fitting and sealing KöR-Seal Whitening Trays with costs lower than most labs charge for ordinary whitening trays. KöR is Based on Science KöR's amazing effectiveness is not just about the whitening gels. It's a different, unique way to perform whitening, with whitening gels formulated with the detailed chemical and physical…

14. Page 28

    Print Resin Allows for Precise Fit to Teeth for Optimal Patient Comfort INDIAN LAND, SC-V Print splint comfort is a new biocompatible 3D printing resin for the production of clear, strong, thermoflexible therapeutic splints and night guards that are durable and aesthetic. V Print splint comfort thermo flexible resin allows for a precise fit to the teeth for optimal patient comfort. The high flexural strength and excellent wear resistance permits the fabrication of devices as thin as one mm. The easy-to-polish V Print splint comfort is clear, color-stable, and odorless. All V Print resins are sedimentation-free and, therefore, do not…

15. Page 30

    TruAbutment Software Allows Users to Design Full Custom Abutments IRVINE, Calif.–TRUST software was founded on TruAbutment's proprietary split file. It allows users to design from scans with TruScan Body and export capable STL files for crown and custom abutments at no cost. Users have the option to design a full custom abutment, custom healing abutments, and SCRP restorations with TruBase (coming soon). One of the biggest benefits to the ecosystem is that it is 100% cloud-based, eliminating the use of physical dongles. Users can also access the fully integrated TruSuite and download Dentrix, MiBuilder, and NiGuard for digital dentures, 3D…

16. Page 31

    Directa-A Division of DirectaDentalGroup Periotomes Minimize Amount of Force Needed During Extractions NEWTOWN, Conn.– Luxator periotomes are instruments designed specifically for extraction by luxation. A world-renowned, ergonomic handle minimizes fatigue and the amount of force needed during extractions. The Luxators preserve bone integrity and are dramatically less traumatic for the patient. Luxators have fine tapering blades that compress the alveolar bone, cut the membrane, and gently ease the tooth from its socket. For more information, call (800) 537-8765 or visit directusa.com. nsure Positive Control for Isthmus Troughing SANTA BARBARA, Calif.–Munce Discovery Burs are the world's first endodontic troughing burs and…

17. Page 32

    SprintRay Tokuyama Dental America Hybrid Ceramic Resin Offers Flowable Composite Simplifies Balanced Ratio of Opacity Restorative Procedures and Translucency LOS ANGELES–New material innova- ENCINITAS, Calif.– tions have made it possible to 3D OMNICHROMA print ceramic alongside, and Ceramic Crown is an example FLOW, a one-shade of that. It's a new hybrid ceramic flowable composite, resin approved for definitive full follows in the crowns, partial crowns, and veneers. footsteps of OMNI- This macramer, hybrid resin con- CHROMA FLOW is tains greater than 50% inorganic capable of matchceramic content and is radiopaque ing any of the 16 for clear visibility in radiographs.…

18. Page 33

    INNOVATIONS 33 SPOTLIGHT Curaprox Toothbrush Cleans Teeth With Maximum Precision MESA, Ariz—The Hydrosonic Pro Toothbrush offers savvy design with its innovative, 3-brush head technology, resulting in some of best oral health. CUREN filaments are gentle and effective for manual cleaning and strong and powerful in hydrodynamic cleaning. The extra-small head, with its innovative drop-like design, cleans each tooth with maximum precision and supports the hydrodynamic effect. Every area can be easily reached with CURACURVE ergonomics. Also, an extra pleasant rubberized back prevents unpleasant vibrations. The Hydrosonic boasts 7 intensity levels with up to 84,000 movements per minute. It also offers…

19. Page 36

    Industry News Software Training for Labs and Clinics Introduced by exocad A training session in progress. CAD/CAM software company exocad announced that licensees can book individual training sessions with exocad's technical help desk staff. Customers can select from a variety of training topics, including DentalCAD core basics, the latest software release featuring highlights, system closures, module licenses, and more. "We're delighted to provide basic and advanced courses to new users, as well as longtime customers who want to deepen their CAD design skills and familiarize themselves with the capabilities of exocad's DentalCAD software," said Michael Nohren, global head of application…

20. Page 38

    Periodontitis May Create Risk for Heart Trouble A team of researchers at Hiroshima University have found a connection between periodontitis and fibrosis—scarring to an appendage of the heart's left atrium that can lead to an atrial heartbeat called atrial fibrillation—in a sample of 76 patients with cardiac disease. The left atrial appendages were surgically removed from the patients, and the researchers analyzed the tissue to establish the correlation between severity of the atrial fibrosis and severity of gum disease. They found that the worse the periodontitis, the worse the fibrosis, suggesting that the inflammation of gums may intensify inflammation and…

21. Page 42

    The Digital Road to Aesthetic Success INTRODUCTION There are very few milestones in my career that changed my entire trajectory and method of practice. Designing my own cases in house digitally would have to be at the top of that list. I can think of numerous reasons why having a full in-house digital workflow will benefit a practitioner, his or her patients, and the lab-ceramist. This article will take you along my path. As patients present to our practice for cosmetic consults, they often have an idea of what they want their smiles to look like but cannot explain things…

22. Page 44

    The Digital Road to Aesthetic... continued from page 42 that will allow for a purely additive case. There was a discrepancy in this patient's gingival heights, so it was noted that aesthetic crown lengthening would help facilitate a better outcome in this case. The teeth were virtually crown-lengthened first, and anaesthetic crown lengthening guide would be designed and 3D printed to ensure the proper contours on the day of surgery (Figure 9). Once the wax-up teeth are set on the jaw scan, the next ideal step is to mount them on a virtual articulator. This ensures that the dynamic movements…

23. Page 46

    The Digital Road to Aesthetic... continued from page 44 porcelain veneers. This increases lab communication exponentially as well as the accuracy of the final ceramics in being replicate of the approved temporaries. The final ceramics were inserted (Figures 16 and 17) and approved by the patient—all while reducing turnaround time, increasing patient and lab communication, and reducing the cost to the patient. Figure 18. A magnified view of a patient's fracture as she presented at office. Figure 19. Patient's pre-op photo. Figure 20. An intraoral scan of the patient was captured and brought into exocad. Figure 21. Tooth No. 9…

24. Page 47

    AESTHETICS 47 then applied throughout the tooth surface. The initial lingua layer was placed on the PVS matrix to provide the framework for the composite and then placed on the tooth and bonded (Figure 26). The case was completed utilizing a layered composite method with IPS Empress Direct composites in shade B1 dentin and Bleach enamel (Ivoclar), along with white and low chroma stains (Cosmedent) (Figure 27). The restoration was polished, and she left extremely happy and stated that it looked like her original smile again. CONCLUSION I have found that the implications for digital are broad and hugely outweigh…

25. Page 48

    Ceramic Implants and Prostheses in Available Bone Timothy F. Kosinski, DDS Techniques, materials, and procedures have dramatically improved since First begun placing and restoring dental implants way back in 1985. The process was challenging and time-consuming. Endosseous implants became prominent in the early 1990s and proved to be a predictable means of restoration. The surgical armamentarium was expensive, and the procedure relied on the experience and knowledge of the surgeon. CBCT, as we know it today, was not available. Our best diagnostic tools were panoramic and lateral cephalometric radiographs. Being able to visualize vital anatomy and hard tissue discrepancies came…

26. Page 49

    Ceramic Implants and Dental Implant Rehabilitation, Part I Single-Tooth and Extended Edentulous Restorations BACKGROUND Titanium and titanium alloy implants have been the materials of choice in the manufacturing of dental implants for more than 5 decades. They have been thoroughly investigated and have proved great success thanks to improvements in macroscopic and nanoscopic surface improvements and design. Conversely, the popularity of metal alloy implants has come with increased reports ranging from poor aesthetics to immune reactions to these implants and their prosthetic components.1-3 Metal alloy orthopedic and dental implants are well documented to be able to induce hosts' responses to…

27. Page 50

    Figure 1. Periapical radiograph of the edentulous area showing a cantilever bridge from Nos. 12 to 13. Figure 2. Final periapical radiograph of a 2 × 10-mm Zeramex XT ceramic dental implant (Dentapoint AG) placed at site No. 12. Figure 3. Clinical photo showing the Ostell SmartPeg positioned over the implant to measure implant stability. Figure 4. Clinical photograph showing the healing abutment immediately after a minimally invasive implant placement. gingivae. A closed-tray impression coping (Figure 5) was used for the final impression; a bite registration and photographs were also captured to allow for the fabrication of the final prosthesis.…

28. Page 52

    IMPLANTS [THREE CLINICAL IMAGES showing dental implants and radiographs] FIGURE 14. Clinical photo of the provisional crowns. FIGURE 15. Periapical radiograph showing the implants in ideal position in bone and parallel to each other. FIGURE 16. Final clinical photograph of the restorations that harmoniously with surrounding tissues and dentition and healthy gingival tissues. implants, the ability to prepare the cervical section of the implant itself to improve prosthetic clinical outcomes. The advances in manufacturing techniques (injection molding, 3D printing, and hot isostatic pressing) have allowed for the creation of a wide variety of load-bearing bioceramics, including one-piece and 2-piece configurations,…

29. Page 53

    IMPLANTS by the patients, whom the authors regard as the secondary consumers of dental implants after the clinicians. After 2 decades of experience with ceramic implants between them, the authors have observed a faster and greater demand for ceramic implants from the public. However, in the last 3 years, thanks to continually increasing patient requests, improved macroscopic and microscopic designs, longer-term clinical reports, and greater availability of training opportunities in the United States, there has been a perceptible rise in interest from dentists in ceramic implants. References 1. Evard U, Wanquier D, Pierret D. Les allergies aux métaux dentaires. Un…

30. Page 54

    DENTISTRY TODAY 13TH ANNUAL Readers' Choice 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. TruAbutment The Angulated Screw Channel (ASC) solution allows users to retain the advantage of the natural emergence profile for improved blending of surface areas for the final prosthesis. The fully angulated custom abutment allows the user to offset the angulation of the screw channel up to 25°. The ASC abutment and the final crown may be designed at once…

31. Page 56

    Readers' Choice Top 25 Implant Products Dentatus Anew is the only narrow body implant with a screwretained prosthetic system. It is FDA approved for long term use, is validated for permanent use, and is supported by more than 20 years of clinical research. Its placement procedure is quick and often flapless. The prosthetic components are designed for immediately loaded chairside restorations. Components for custom, laboratory-fabricated restorations are also offered. For more information, call (800) 323-3136 or visit dentatus.com. FREEinfo, Nobel Biocare TiUltra is a novel implant that features an ultra-hydrophilic, anodized surface. It features a gradual change in topography along…

32. Page 58

    Readers' Choice Top 25 Implant Products Zimmer Biomet Dental The 3.1 mmD Extetic 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 Extetic implant-abutment connection, along with a Conical Abutment profile, is designed…

33. Page 60

    Readers' Choice Top 25 Implant Products Biotech Dental USA Reflect Implant Systems offer surgical and prosthetic compatibility with well-known brands but do so at a fraction of the cost—up to 80% less—while at the same time offering uncompromised quality and performance. Manufactured from the company's enhanced titanium alloy, Reflect Implants provide greater strength when compared to implants manufactured with conventional Grade 4 Titanium. Reflect offers compatible options with Nobel Biocare's NobelActive and NobelReplace, Zimmer Biomet's Tapered Screw Vent and Certain Implant System, and Dentsply Sirona's AstraTech OsseoSpeed TX. For more information, call (866) 277-5662 or visit biotechdentalusa.com. FREEinfo, KAT Implants…

34. Page 62

    Readers' Choice 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 5.0-mm short implants. The sloping shoulder provides the necessary room for bone to support interdental papillae. Implant Direct SMARTbase engaging CAD/CAM abutments provide dental practices and labs with more restorative options and are designed to improve aesthetics for screw-retained restorations. The abutments offer improved esthetics and greater accessibility by angulating the screw channel up to…

35. Page 63

    Readers' Choice Top 25 Implant Products Glidewell If you are among the growing number of dentists seeking to expand the implant services you offer patients, the Hahn Tapered Implant System can help your practice thrive through world-class education, every-day cost savings, and the strongest warranty in implant dentistry—from Hahn implants to BruXZir restorations. The Hahn implant is available at a fraction of the price of other premium implant systems. Plus, you get 20% off every time you restore your Hahn case at Glidewell. The design of the Hahn implant is based on Dr. Jack Hahn's more than 50 years of…

36. Page 64

    Prosthetic Reconstruction Using Available Bone INTRODUCTION Our modern endosseous dental implants osseointegrate into the available hard tissue and serve as a foundation for fixed and fixed detachable prostheses.1 Many advances in dental implant prosthetics are available, including full arch, implant-retained prostheses and implant-retained overdentures. Conventional dentures serve a viable function for many individuals. Today, quality of life issues and improved chewing function, as well as aesthetic concerns, are in the spotlight. Many ountry patients present to our practices with considering options that may improve their overall health and self-confidence. Dentures give some function and facial support, but the gagging reflex…

37. Page 65

    and solutions can be evaluated. To determine which type of prosthesis is possible for the individual situation, a treatment map is formulated. Maxillary and mandibular anatomic restrictions are evaluated. These include the maxillary sinuses in the posterior maxilla and the mandibular and mental nerves, as well as lingual cavacities in the lower arch. In this case, a screw retained zirconia bridge (BruxZir [Glidewell]) was planned for the maxillary arch, and a removable implant overdenture over a milled bar was planned for the mandible. Since angulation of the implants in the available bone compromises the emergence of the access holes to…

38. Page 66

    Figure 1. Preoperative panoramic and CBCT evaluation on minimal available mandibular and maxillary anterior hard tissue. Figure 2. Maxillary implants precisely positioned in available bone anterior to the maxillary sinuses. Figure 3. Following 4 months of integration, the maxillary implants were uncovered, and open-tray impression posts were used to fabricate the initial cast. Figure 4. Impression made of 3 Hahn mandibular implants (Glidewell) precisely positioned in the symphysis. Figure 5. Following uncovering, healing abutments were torqued to place the tissue reflection closed with Vicryl sutures. Figure 6. The technicians at Glidewell lab fabricated a cast and created passive fitting acrylic…

39. Page 67

    IMPLANTS 67 Figure 16. Due to the necessary surgical position of the mandibular implants, a milled bar was created to extend support posteriorly using 4 LOCATOR (Zest Dental Solutions) abutments. The CAD/CAM-milled LOCATOR bar was con-nected to the implants. The bar elevated the prosthetic connections, minimizing pressure on the bone and soft tissue in the area of the implants. precisely positioned in the symphy-sis. Following this uncovering of the implants, 3-mm-tall healing abut-ments were torqued to 25 Ncm, and the tissue resorption was closed using Vicryl sutures (REDSORB PRO 3-0 [Newport Biologics]) (Figure 5). The laboratory then created a stone…

40. Page 68

    Figure 19. The fixed maxillary composite implant-retained bridge was tried in, opposing the removable mandibular milled-bar overdenture. Esthetics and occlusion were verified. The patient was allowed to wear this transitional to evaluate satisfaction prior to final BruxZir (Glidewell) fabrication. Figure 20. The final zirconia (BruxZir) implant-retained bridge was threaded to place, and the occlusion was verified with the opposing mandibular overdenture. to final BruxZir fabrication (Figure 19). The final zirconia (BruxZir) implant retained bridge was threaded to place, and the occlusion was verified with the opposing mandibular overdenture (Figure 20). The access holes of the screw retained prosthesis were filled…

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