Dentistry Today — March2012

Inside this issue

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1. Page 3

   Fantastic prices. Incredible customer service. Dentistry's best rewards. No donuts. We imagine it must be pretty nice when your dealer rep brings donuts and coffee for your staff. But are they grazing over all of their hidden costs as well? At Darby Dental, the price of donuts, coffee and other company cars may never comes out of your pocket. Direct, immediate access to your dedicated Darby Personal Account Manager means you are only just a phone call away from the dental products your practice uses every day. The only thing we pass along to you is savings, in the form…

2. Page 14

   Putting Our Readers First It is my editorial and professional mission, as the editor-in-chief of Dentistry Today, to provide our readers with informative, usable, and interesting content. For example, we owe it to receive frequent kudos on the sidebars by Tom Limoli Jr, who shares his candid expertise on issues related to insurance coding and billing. These practical tidbits, given in the typical direct and witty "Limoli style," are carefully crafted to relate directly to the main author's case report. As an editorial team, we hope that the timely content of these sidebars will help our doctors (and teams) by…

3. Page 17

   FOCUS ON: Minimally Invasive Dentistry Howard S. Glazer, DDS, discusses the latest trends for 2012. Q: How has dentistry changed since you were in dental school? A: I graduated in 1975 and then completed a general practice residency in 1976. In the last 36 years, dentistry has changed dramatically. This is even truer in the last 5 years alone. Dentistry at the end of the 20th century was still in a reparative mode; we were taught more about repairing decay. The emphasis was on reparative procedures that very often involved removing a lot of tooth structure and then replacing large…

4. Page 18

   Do Dentists Practice Medicine? Now that I have been in dentistry for more than 30 years, I believe that I have a historical perspective on this question. When I was in dental school, there was very little discussion or education about the overall wellness of our patients, and cosmetic dentistry was literally its infancy. The primary purpose of a dentist was to concentrate pretty much solely on teeth and, of course, the patient's periodontal health. Yes, we realized that teeth were connected to the rest of the body, but there really was not much involvement between professionals in dentistry and…

5. Page 20

   VIEWPOINT continued from page 18 ing, porcelain veneers, and surgical crown lengthening to fix a gummy smile is this technically within the scope of dentistry by the above definition? Probably not, but it certainly is not medicine either. It is the definition of dentistry in the year 2012. TEMPOROMANDIBULAR JOINT SYNDROME/ OROFACIAL PAIN Is this medicine or dentistry? Should dentists be limited only to treating these conditions associated with occlusal equilibration, orthodontics, and full-mouth reconstruction? Of course the answer is no, because teeth are connected to the jaws, which are connected to the muscles in the entire head and neck…

6. Page 22

   Dentistry Today.com Providing you with news and information from the industry leader in clinical content. Visit Our Site Today! Technique of the Week Digital Impressions Sponsored by iTero Taking a digital impression with iTero for Invisalign treatment offers clinicians 7 times fewer fit issues as compared to traditional vinyl polysiloxane (VPS) impressions. Invisalign ClinCheck cases using iTero scans typically are posted in 2 to 4 days, compared to 7 or more days for cases using VPS impressions. The Invisalign scanning protocol for the iTero intraoral scanner is a simple technique that involves a rocking and twisting motion of the scanner…

7. Page 24

   From the December 2011 Issue IMPLANT PICKUP SYSTEM VOCO America Quick Up is a complete implant pickup system that virtually eliminates the risk of interloching and cuts procedure time in half. Designed specifically for bonding attachments such as bar retainers, implant locator, and telescopic attachments, as well as other attachments in acrylic-based dentures, it can also be used for reaching secondary elements in a denture such as bar retainers. For more information, call (888) 658-2584 or visit vocoamerica.com. FREEinfo, CROWN/BRIDGE MATERIAL DENTSPLY Caulk Integrity Multi-Cure Temporary Crown and Bridge Material is a durable 10:1 bis-acrylic material with improved flexural strength.…

8. Page 26

   NEW PRODUCTS PHOSPHOR PLATE TOWELETTES Flow Dental Clean Ups, individually wrapped towelettes, help clean, protect, and prolong the life of phosphor plates. They remove fingerprints, dirt, smudges, and artifacts. Just open a package, wipe down the plates, and discard; simple, neat, and easy. To order a box or to obtain a free sample, contact your local distributor or visit the Web site flowdental.com. FREEinfo, MIRROR ATTACHMENTS AdDent AdDent introduces a 5-pack of mirror attachments for its Microlite Diagnostic System. The illuminated attachments easily slide into the Microlite Transilluminator and are very useful to help clinicians see hard-to-reach places. They feature…

9. Page 28

   To assist practitioners in their selection of essential dental products, Dentistry Today presents items reviewed by THE DENTAL ADVISOR'S staff editors and consultants. Established in 1984, THE DENTAL ADVISOR, based in Ann Arbor, Mich, has provided dental professionals worldwide with objective, accurate information using in vivo and in vitro results on the performance of materials and equipment based on clinical and laboratory research. For more information, visit dentaladvisor.com or call (800) 347-1330. MX2 Micro-Series +++++ Bien-Air USA | (800) 433-BIEN | bienair.com Consultants' Comments • "Easy to use within the month." • "I liked the ease of attaching the handpiece."…

10. Page 30

    Spotlight Curing Light Combines New, Lightweight Design With Acclaimed Power and Efficiency AMHERST, NY- The newest edition to Ivoclar Vivadent's bluephase family of curing lights, the bluephase style combines a new, slim, lightweight design with all the features, power, and efficiency that have made bluephase THE DENTAL ADVISOR'S top-rated LED curing light for the past 3 years (2009 to 2011). Ergonomic, high-powered, and cordless, the bluephase style reduces the strain exerted on the hand and arm while curing, and a newly designed light probe allows for convenient access in hard-to-reach posterior areas. In addition, bluephase style's inductive charging system makes…

11. Page 32

    Companies Collaborate to Realize Benefits of Cloud-Based Communications System SEATTLE, Wash. and FORT LAUDERDALE, Fla.-Sesame Communications, a leader in cloud based patient communication systems, and Dental Resource Systems, the pioneer of TruDenta technology and education for diagnosing and treating force-related dental conditions, announce a collaboration to provide all TruDenta member dental practices with the Sesame 24/7 patient connection system. Sesame helps dentists attract patients where they are most likely to be found today—online. On average, TruDenta practices using Sesame to market their services experience a calls a month, with 13 specifically identified as new patients. TruDenta, a rapidly growing patient…

12. Page 34

    Spotlight Treatment for Minor Tooth Crowding and Spacing Introduced SAN JOSE, Calif.–Align Technology introduces Invisalign Express 5, a cost-effective treatment option for very minor tooth crowding and spacing or orthodontic relapse treatments requiring 5 or fewer stages of Invisalign aligners. A shorter duration option to Invisalign Express 10, aligns treatment option for minor crowding, spacing, or pre-restorative treatments requiring 10 or fewer stages of aligners, it will help doctors treat more patients who could benefit from minor tooth movements but are reluctant to invest in treatment due to cost. Invisalign Express 5 offers the same high-quality features that doctors expect…

13. Page 35

    Utilizing Microburst Technology, Device Simplifies Interproximal Cleaning STAMFORD, Conn.–Phillips Sonicare has expanded its power toothbrush product line to include the Philips Sonicare AirFloss, an easier way to clean interproximally. Dental professionals often struggle to get patients to floss regularly. The AirFloss, with its breakthrough microburst technology, has been designed to address this problem by increasing ease of use while maximizing interproximal plaque removal and ultimately helping to improve gum health. During Philips' consumer testing, 86% of patients found AirFloss easier to use than string floss, and it has been proven to remove up to 99% more plaque in between teeth…

14. Page 36

    NEW TECHNOLOGY G-Files: Rotary Ni-Ti Instruments for Glide Path Enlargement Basic Clinical Aspects Regardless of the endodontic instrumentation system being used, initial exploration of the canal system has historically been accomplished by using stainless steel precurved hand instruments (files or reamers). Along with careful examination of radiographs and/or CBCT scans, this initial phase identifies possible difficulties and obstructions within the canal system that the clinician may encounter in preparation for use of rotary Ni-Ti instruments that will further shape the canal. Initial penetration and glide path development in the canal is usually accomplished by using a sequence of narrow diameter…

15. Page 38

    Spotlight New Single-Bottle Universal Adhesive Offers Speed and Convenience for Consistent and Reliable Results SCHAUMBURG, Ill—BISCO's new ALL-BOND UNIVERSAL, an adhesive for total, self, and selective etch techniques, offers single-bottle priming and bonding for direct and indirect indications as well as for desensitizing a tooth and indirect repair. It also can be used as a protective varnish for glass ionomer fillings. It bonds to all surfaces, including enamel, dentin, metal, zirconia, alumina, porcelain (silica-based), lithium disilicate, and composite, and it has been designed to work with light-cured, self-cured, and dual-cured composite materials without an additional activator. Offering speed and convenience…

16. Page 40

    New Viscosities Added to Line of Impression Materials HUNTINGTON BEACH, Calif–In addition to light body, Kettenbach's Identium in 1:1 cartridges is now available in medium and heavy viscosities, in both regular and fast set. Identium, which is a vinyl siloxanether impression material, represents an entirely new chemistry developed for the one-step impression technique. Offering excellent resilience, it provides an accurate impression in the narrowest of spaces, even in a moist sulcus, and with the lowest achievable contact angle. It also provides an optimal base for the identical transfer of a clinical case onto the working model because of its extreme…

17. Page 42

    Spotlight Device Provides Ultrabright Intraoral Illumination NEW MILFORD, Conn.—CLINICIAN'S CHOICE's LUMIPROP has been designed to provide 6 hours of continuous, ultrabright intraoral illumination, and its built-in mouth prop offers optimal patient comfort, relieving stress and fatigue, especially during long procedures. Simply snap on the appropriate sized mouth prop (small, medium, or large), insert LUMIPROP into the patient's mouth, and with the press of a button, the oral cavity is completely illuminated. LUMIPROP is also versatile, having the capacity to illuminate buccal areas by simply removing the mouth prop, inserting the hook buccally, and gently retracting the cheek. It is ideal…

18. Page 43

    New Implant Temporary Cement's Ease of Use and Reliability Cited SANTA YNEZ, Calif.-PREAT Corp introduces Implantlink, the first temporary cement specifically designed for easy and reliable cementation of crowns and bridges on implants. It is urethane methacrylate-based, with no fillers and low viscosity to provide a very thin (8 µm) layer for accuracy and marginal integrity. Eugenol-free and antibacterial, it works on all material combinations, and dual cure allows for immediate light curing and easy removal of excess cement. For a DVD or information regarding a free trial offer, call PREAT Corp at (800) 233-7732 or visit preat.com. FREEinfo, X-Ray…

19. Page 44

    Spotlight File/Obturation System Expected to Set New Standards in Root Canal Shaping Procedures TULSA, Okla.-DENTSPLY Tulsa Dental Specialties' WaveOne, a reciprocating file and obturation system expected to set new standards in root canal shaping procedures, is an M-Wire NiTi file powered by the e3 Torque Control Motor with reciprocating motion—a rotation technique that reduces file breakage while requiring only one instrument per root canal in most cases. Shown to decrease total shaping time by up to 40% compared to traditional rotary techniques in continuing motion, WaveOne is developed for single use, removing the risk of cross-contamination and dramatically reducing the…

20. Page 45

    Temporary Crown and Bridge Hood Reduces Ambient Nitrous Oxide in Operatory Material's Strength and Fast Cure-Time Range Cited PHOENIX, Ariz.-Used for the delivery of nitrous oxide, Accutron's ClearView Single Use Nasal Hood features a double hood design with a clear outer hood and a brightly colored and lightly scented inner hood. This hood-in-hood design draws more excess gas into the vacuum system than a single hood, reducing ambient nitrous oxide in the operatory. Offering visual assurance to the clinician, condensation collects in the clear outer hood when a patient breathes is comfortable against the patient's face. Its bright colors and…

21. Page 46

    Bridges Offer Superior Aesthetics and Long-Term Health Protection for Abutment Teeth SAN DIEGO–Captek Nano Bridges offer superior aesthetics and long-term health protection for the abutment teeth compared to traditional PFM, allium dissilicate, and zirconia restorations. Two recent studies comparing Captek Nano and zirconia bridges showed that cycle fatigue did not have a significant effect on Captek Nano frameworks, and researchers did not observe any statistical difference in strength between Captek Nano bridges and zirconia bridges. Most Captek-certified labs offer Captek flat fee pricing without a gold surcharge. For more information, including a list of dedicated Captek-certified labs, call Captek by…

22. Page 48

    Predictable Bulk-Filled Posterior Restorations: Tetric EvoCeram Bulk Fill Composite Eduardo Mahn, DDS Direct posterior composite restorations are routine in daily practice, but they are often viewed as being tedious and time-consuming when compared to amalgam restorations due to the additional steps required with bonding and layering. Although direct composites offer the advantages of being esthetic and metal-free option, if the recommended layering technique for traditional composites isn't followed, polymerization shrinkage can result in marginal leakage, postoperative sensitivity, secondary caries and perhaps ultimately failure. Bulk fill composites have been developed to provide clinicians with greater efficiency when placing posterior restorations. By…

23. Page 50

    NEWS/TRENDS Industry News BIOLASE Signs Sales/Marketing Partnership With Seattle Study Club Irvine, Calif.-based BIOLASE Technology, a leading dental laser manufacturer and distributor, announced recently that it has signed a strategic sales and marketing partnership with the Kirkland, Wash-based Seattle Study Club (SSC), a worldwide organization of dentists recognized as one of the professions most advanced continuing education groups. Under the terms of the partnership, BIOLASE will have access to the SSCs more than 350 study clubs and 8,000 members worldwide to discuss with them the best use of BIOLASE products and services. Activities involved will include the demonstration of BIOLASE's…

24. Page 52

    The Manhattan Tobacco Cessation Program's Toolkit Now Being Offered to Dental Practices Nationwide Administrators of the Manhattan Tobacco Cessation Program (MTCP) at the New York University School of Medicine (NYUSM) announced recently that Trending Global Use and Dependence: A Toolkit for Dental Practices is now being offered to the greater dental community nationwide. During the past 3 years, NYU College of Dentistry's teaching clinics' use of the toolkit has resulted in favorable smoking cessation outcomes. In one clinic alone, the smoking rate went down from 21% to 12% from 2008 to 2011. In addition, the assist rate, which is the…

25. Page 54

    New Research on Dentin Protein Recent research on dentin sialophosphoprotein (DSPP) is an example of how artificial the distinction is between medicine and dentistry. This protein was first identified in the late 1990s as regulating the mineralization, or hardening, of collagen fibers in dentin. Subsequent work has led to 2 fascinating lines of research. DSPP may have originated back in the mists of time ...protein is produced in the salivary glands, cartilage, liver, kidney, and brain. from a gene duplication in reptiles. And, preliminary work shows DSPP evolved not only to help make dentin, but is expressed and likely has…

26. Page 55

    Evaluation of Rotary Instrumentation Techniques in Primary Molars An article comparing the clean­ing effectiveness of manual, hy­brid, and rotary endodontic in­strumentation techniques in primary molar teeth was pub­lished recently in the Inter­national Endodontic Journal. This study involved 45 primary mo­lars. After endodontic access, the teeth were immersed in a medium containing Enterococcus faecalis and divided into 3 groups according to the root canal instrumentation tech­nique: group 1 was manual, group 2 was hybrid, and group 3 was nickel-titanium rotary files. For microbiological evaluation, comparisons before and after instrumentation were performed using the paired Student's t test. One way analy­sis of…

27. Page 56

    In First Impressions, George Freedman, DDS, gives readers a brief summary of products that have recently been introduced to dentistry, based on his clinical experience. Canon T3i Camera CliniPix One of the major hassles of taking intraoral photographs has been the electronic flash paraphernalia. The large battery housing was mounted in the shoe on the top of the camera body, effectively blocking direct visibility of the flashor the dentist. The dentist was forced to peek over or around the camera to see teeth. Digital objective screens have made this somewhat easier. The cord between the battery housing and the ring…

28. Page 58

    It's 80-20 With Biofilm Update on Oral Rinses Do you apply the "80-20 rule" at work? The 80-20 rule, or Pareto principle, is the idea that a relatively small percentage of any cause (20%) creates most of the subsequent effects (80%). In a business context, this means that 80% of a company's business stems from 20% of its customers. In dentistry, teeth make up only 20% of the surface area of the mouth, with the other 80% including interproximal spaces, the dorsum of the tongue and cheeks, and below the gumline; all reservoirs and niches for biofilm.1 There is a…

29. Page 60

    It's 80-20 With Biofilm... continued from page 58 Using the terms "biofilm" and "plaque" interchangeably can confuse our understanding. Because of the work of Costerton, we know that biofilm is a complex community and it has a tremendous ability for self-preservation.¹ Yet biofilm is not inherently bad. Biofilms are common in nature, yet damage can occur. Biofilm moving from a healthy to disease-inducing state can be prevented by routine home care. It is the routine disruption that keeps the biofilm in a healthy state. With this understanding of the 80-20 of biofilm, let's look again at the 80-20 of common…

30. Page 62

    It's 80-20 With Biofim... continued from page 60 There is a new ingredient on the US market that shows great promise: Delmopinol hydrochloride a 2% in G-UM PerioShield (Sunstar Americas) is a proprietary key ingredient that creates a less-adhesive environment for bacteria and biofilm. This prevents bacteria from sticking to the teeth, forming an invisible protective shield over the teeth and gingiva that caries cannot penetrate, essentially reducing biofilm buildup. The product breaks down the biofilm and bacteria, making them easier to remove, while coating the teeth and gums to prevent additional biofilm buildup. In other words, delmopinol does not…

31. Page 63

    fied as drugs. An FDA Class II medical device is defined as "a limited device that does not affect the structure or any function of the body of man or other animals, and which does not achieve any of its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes."18 This approval clearly shows the difference in the mechanism of action. Now we have the science for our EBD process: next is professional experience. Evidence-Based Dentistry,…

32. Page 64

    Product Focus SCALERS Obtura Spartan The Piezo-electric MTS ultrasonic unit is the premier multitask system with a handpiece and ultrasonic tips tailored for general and specialty procedures. Clinicians will appreciate the precision and accuracy they receive from the ergonomically designed handpiece, powered by microprocessor-controlled circuitry. It also delivers an easy-to-use, quick-disconnect, fully autoclavable handpiece, and the simple power-touch water control for wet or dry use. Users will find that this versatile, comprehensive system was designed to meet both clinicians' expectations and Obtura Spartan Endodontics' standards. For more information, call (800) 344-1321. FREEinfo, Parkell The Integra magnetostrictive scaling system takes scaling…

33. Page 66

    Product Focus SCALERS Premier Dental Products Big Easy Ultrasic scalers and curettes are surprisingly light, comfortably balanced instruments. The soft medical-grade silicone grips on a large-diameter, while the advanced technology polymer handles provide passive feedback so the practitioner uses less pressure. The weight of the instrument is up to 30% less than other hygiene instruments. The polymer handles can endure extensive autoclaving for long working life. With surgical 440A stainless steel tips, these instruments will maintain their precision cutting edge satisfaction guaranteed. For more information, visit premusa.com. FREEinfo, DBI America The Swift is a portable, self-contained, piezo ultrasonic scaler requiring…

34. Page 68

    Product Focus SCALERS DENTSPLY Professional Only Cavitron systems deliver new Tap-On Technology—the next big step in ultrasonic scaling. Nearly one-third of dental probs-signals cite musculoskeletal disorders as the reason for early retirement. Tap-On Technology improves efficiency and is designed to reduce hygienist leg strain. A single tap activates or deacti-vates scaling or air polishing, allowing you to rest your foot dur-ing the procedure. New prophy mode auto cycles alternate between air polish and rinse without a need to touch the pedal. For more information, call (800) 989-8826. FREEinfo, MTI Dental The economy air scaler offers excellent power for periodontal and…

35. Page 70

    Product Focus SCALERS Henry Schein Acclean Pro ultrasonic scalers are compact and lightweight and provide the handler superior handling. Available in 25- and 30-kHz frequency formats, the Acclean Pro ultrasonic scaler's features include: (1) 30,000 scaling strokes per second; (2) a solid state power unit; (3) innovative water-cooled circuitry for greater stability; and (4) the ability to not lose power at maximum pressure. For more information, call (800) 372-4346 or visit henryschein.com. FREEinfo, Deldent USA The Jetsonic 2000M is an advanced combination scaling and polishing device. Its unique sensor technology recognizes and activates the selected handpiece (scaling or polishing). The…

36. Page 71

    Vista Dental Products The clinician-friendly Piezo Pilot is a new breed of ultrasonic scalers, offering unprecedented power in a quiet, compact, and light-weight design. The Pilot's top-of-the-line performance and wide power range make it ideal for perio/hygiene applications. It comes with a set of 4 hygiene tips. Co-Pilot features a 700mL fluid capacity with dual reservoirs and offers expandable functionality with variable irrigation flow settings. It can operate without operatory air/water connections and includes 6 hygiene tips. Both units come in 6 colors with matching autoclavable handpiece sleeves. For more information, call (877) 418-4782 or visit vista-dental.com. FREEinfo, Bien-Air Dental…

37. Page 74

    The Modified Grassline Technique: A Case Report Grassline threads were used for the noninvasive intermittent movement of malposed teeth from the 1940s to the 1980s.1 Derived from the tamie plant, grassline is a heavily twisted fiber that shrinks when exposed to fluids. Unfortunately, grassline is no longer commercially available. Recently, Lohmiller2 demonstrated a modified version of the technique whereby heavily twisted 100% cotton crochet thread of varying sizes and composite "holds," which function similarly to orthodontic brackets, can be used as a suitable substitute. Once thought to be a contraindication to orthodontic therapy, periodontal disease is no longer a barrier…

38. Page 76

    The Modified Grassline Technique... continued from page 74 revealed clinical plaque and calculus, as well as 2 to 3 mm pocketing of anterior teeth with bleeding upon probing. Radiographs revealed 40% to 60% bone loss of mandibular anterior teeth with a widened periodontal ligament interproximally (tunneling) (Figure 4). The patient was made fully aware that realignment of the mandibular anterior teeth without subsequent treatment of the maxillary teeth would result in an increased overjet. The patient was unwilling to undergo comprehensive orthodontic treatment which would involve possible extraoral anchorage and bialtered bicuspid extraction. In addition, the patient was made aware…

39. Page 78

    Orange-Yellow Tongue and Palate: A Case Report Stephen A. Harden, DDS Aamir Sheikh, DDS, MA Ronald S. Brown, DDS, MS A number of drug therapies have a previously reported association with drug-induced pigmentation of the oral mucosa. These drugs include antimalarials such as quiaqcrine, chloroquine, hydroxychloroquine, quinidine, doxycycline, tetracycline, minocycline, chlorpromazine, oral contraceptives, clofazimine, ketoconazole, amiodarone, bismuth, doxorubicin, bleomycin, cyclophosphamide, and 5-fluorouracil. Quinine antimalarial drugs are associated with blue-gray or blue-black coloring which is usually located only within the palate. The reason for the palatal location of the discoloration is currently not understood. Minocycline is known to cause pigmentation of…

40. Page 80

    Orange-Yellow Tongue and Palate... continued from page 78 ing such over-the-counter medications and supplements as fish oil, aspirin (81 mg), and calcium. She sometimes used such sleep aids as zalepton and zolpidem. The patient reported a previous drug allergy reaction to ciprofloxacin, but noted no other known drug allergies. Clinically, palpation for lymphadenopathy was negative. The parotid and submandibular salivary glands demonstrated limited function. The filiform papillae of the dorsal tongue and the midline portion of the soft palate had an orange-yellow line (Figure 1). The remaining oral tissues appeared to be within normal limits. The skin color and the…

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