Dentistry Today — May 2011

Inside this issue

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1. Page 11

   Ten Ways To Increase Practice Income and Efficiency With LightWalker® All Tissue Lasers LightWalker All Tissue Laser users enjoy substantial increases in practice income and efficiency performing these ten minimally invasive procedures, and so can you. We'll provide you with the world-class hands on training you need to be successful! 1: Anesthetic Free Cavity Prepstreat multiple quadrants in the same visit and save setup costs and time. Wow your patients for more referrals. 2: Gingivectomy for Class V Subgingival Cariesgain access without bleeding. 3: Crown Troughingno need to pack cord. Save time and get perfect impressions. 4: Closed Flap Osseous…

2. Page 14

   Careful Planning Pays This month, much of our editorial content is focused on topics related to aesthetics. One thread that weaves its way through our clinical articles is the need for thoughtful case planning. Achieving truly beautiful and natural aesthetics does not happen as a result of a series of random acts on the part of the clinician, even if done with the best of intentions. In addition to a solid knowledge of dental materials and techniques, the clinician must employ well developed observational, pretreatment planning, and teamwork skills. Every thought and subsequent action must be carefully designed to consistently…

3. Page 16

   Dentistry's Green Future WHAT IS GREEN DENTISTRY? I went into dentistry in order to participate in a healing profession. I hadn't been in practice long before I realized that, although all of the techniques I learned in school were invaluable, equally as valuable was a piece of advice from one of my mentors: "People do not care how much you know, until they know how much you care." When my wife and I created the first "green" dental office in the country in 2003, we created a healing environment that let our patients know we care as much about their…

4. Page 18

   continued from page 16 Let's look at 2 of the biggest sources of waste and pollution in the dental industry, areas where our profession has been slow to adopt change. Let's also think about why we should care about making some of the changes advocated in this article. CONVENTIONAL X-RAYS Twenty eight million liters of toxic x-ray fixer and 4.8 million lead foils are generated every year by dental offices in the United States alone. While dentists are responsible by law to handle disposal safely, chemical fixers and lead foils from x-ray process es have to go somewhere. Where are…

5. Page 20

   Dentistry Today.com Providing you with news and information from the industry leader in clinical content. Visit Our Site Today! Stay tuned for... LIVE ONLINE BLOG cda live-blog California Dental Association Meeting May 12 to 14, 2011 DENTISTRY TODAY Our blog will provide product descriptions and video demonstrations of products live from the exhibit floor. Photo courtesy of the California Dental Association. Interactive Coverage •Live video product demonstrations •Product releases •Announcements •Insight from clinicians on products •Interviews with manufacturers Blog Sponsored By Kerr Corporation Please visit the Kerr Booth # 1106/1206 At CDA Anaheim May 12 to 14, 2011 kerrdental.com Meetings…

6. Page 22

   From the February 2011 Issue DENTIN REPLACEMENT MATERIAL Septodont Hailed as "dentin in a capsule," Biodentine is a biocompatible, bioactive all-in-one dentin replacement material that can be used in both the crown and root widener dentin is damaged. Indications include restoring deep cavities, pulp capping, endodontics, perforations, and internal/external resorptions. It provides clinical benefits, including remineralization, among others. For more information, call (800) 872-8305 or visit septodontusa.com. FREEinfo, FLOWABLE COMPOSITE Shofu Dental BEAUTIFUL Flow Plus is an all-in-one flowable base, liner, and restorative approved for all classes. Mechanical properties rival leading composites. It has stackable handing that actually slows when…

7. Page 24

   NEW PRODUCTS REAMERS KOMET USA H269GK and H269QGK tungsten-carbide reamers are specially engineered for enlarging the pulp cavity effectively and efficiently. Recommended for use as a follow-up instrument to the diamond-coated 15802 endodontic access bur, the cross-cut H2690GK (shown) features staggered toothing on the lateral surface that works smoothly and effectively on enamel, with minimal vibration. For more information, call (888) 566-3887. FREEinfo, WHITENING PEN BrushOnSmile Manufactured in the United States, the BrushOnSmile teeth-whitening pen is used to whiten teeth on the go. It will whiten teeth and remove stains using the smallest amount of gel in the shortest amount…

8. Page 26

   CLINICAL REVIEWS THE DENTAL ADVISOR To assist practitioners in their selection of essential dental products, Dentistry Today presents items reviewed by THE DENTAL ADVISOR'S staff of 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. www.dentaladvisor.com THE DENTAL ADVISOR Editors' Choice THE DENTAL ADVISOR BeautiBond +++++ Vanish +++++ 1/2 Shofu Dental | (800) 827-4638 | www.shofu.com 3M…

9. Page 28

   Spotlight Broadband Curing Light Offers Unsurpassed Accessibility, Accuracy, and Efficiency SALT LAKE CITY - Offered by Ultradent Products, the VALO LED curing light offers unsurpassed accessibility, accuracy, and efficiency in a sleek body designed to deliver the right amount of power in the right place. Its optimized power output, broad spectrum custom LEDs, and precisely collimated beam provide consistent and uniform cures. By offering 3 curing options—standard power, high power, and a new plasma mode—VALO has the ability to cure all types of restorations with the touch of a button. With a 3-second time cycle and built-in 2-second safety delay,…

10. Page 30

    Integrated System Contributes to a Healthier, More Productive Practice NEWBERG, Ore–The A dec 300 system allows unprecedented integration of technology for its class and is well positioned to fit small spaces and conservative budgets. Learn More at: Townie Meeting, May 4-7 BOOTH #325 The Texas Meeting, May 5-8 BOOTH #771 CDA South, May 12-14 BOOTH #2129 [X-ray image of dental forceps] physics forceps Eliminate Extraction Frustration Forever 90-DAY UNCONDITIONAL MONEY BACK GUARANTEE Call Today for a Free Informational DVD www.physicsforceps.com 1.877.987.2284 FREE DVD OFFER CALL 877-987-2284 or on card [Image of dental chair in orange and white] It offers customers…

11. Page 32

    Wireless Intraoral Camera Upgrade Offered, With Trade-In Program Available ORMOND BEACH, Fla. The DiscoveryULTRA wireless intraoral Camera is an ideal upgrade for all existing RFIOV.c users. A kit includes a handpiece, charge et base, wireless receiver, and a macro lens for ultramagni­fied pathologies, and a trade in program is available to Einstein and DiscoveryCam customers. The ergonomic Discovery­ULTRA handpiece, powered by a user-replaceable lithium ion battery, features a Xenon CCD imager, ultralight LEDs, and an antifog, nonspherical lens, creating crisp, high quality images. Choose from 2 receivers, direct USB or universal, for your specific video needs, and digital inte­gration is…

12. Page 34

    Bien-Air Micro-Series A New Generation of Electric Handpieces Howard S. Glazer, DDS Dentistry has evolved from the archaic means of cutting and preparing teeth via a belt-driven, foot pedal-operated drill to a method of sophisticated instruments that allow the operator to perform better. Ben Franklin was right; electricity is a powerful tool. Electric motor handpieces are not necessarily new, but what is new is the size, power, and control afforded the operator with a new series of ultrasmall handpieces in combination with a compact LED micromotor from Bien Air. Until now, most electric motor handpieces were heavy, and they were…

13. Page 36

    Spotlight New Total-Etch System's Performance, Versatility, and Adhesion Cited SCHAUMBURG, Ill—BISCO's ACE ALL-BOND TE is a single drop universal dental adhesive dispensing system that lets you prime and bond in one application. Based on proven ALL-BOND 3 technology, it is an ethanol-based, dual cured, total etch system that combines uncompromising performance, universal versatility, and exceptional adhesion for all dental applications. ACE ALL-BOND TE effectively bonds to dentin and enamel, is compatible with light-, dual-and self-cured materials, and will completely set in the deepest of restorative areas where light access may be difficult. A low film thickness along with a high…

14. Page 37

    Introducing... Another innovation from Brasseler USA ET3000™ Oscillating Composite Manipulation Instrument* Despite tremendous advancements in resin and filler technology, even today's modern resins can be difficult and time-consuming to place and manipulate...until now. ET 3000™: A Powerful Ally for Every Procedure Involving Restorative Resins! The ET 3000 is the first device to effectively address both stickiness and lack of flow, two of the biggest challenges when working with composite resins. Utilizing a specific frequency and range of oscillating motion, the ET 3000: ✓ Eliminates the frustrating stickiness and "tug back" of composite resins. ✓ Increases composite resin flow (by approximately…

15. Page 40

    Intraoral Camera Docking Station Features Updated Modular Plug System and Mini-USB Port MOUNT LAUREL, NJ-ACTIEON North America's USB 2.0, its second generation, OEM-style intraoral camera docking station for the OEM dental chair market, features an updated modular plug system for connecting video cables and an updated Mini-USB port, all at a reduced price of ACTIEON's previous MU_USB 2.0 product. ACTIEON USB 2.0 docking station, adaptable to virtually all dental chairs, allows intraoral camera eras to be installed into a dental chair as integrated equipment. This new unit is USB only, removing memory boards and analog outputs and reducing the physical…

16. Page 42

    New Family Brand Debuts With Impression Material and Nanohybrid Universal Restorative ST. PAUL, Minn.—3M ESPE introduces the Paradigm brand, a new family brand that offers dental professionals competitively priced products with the standard features they rely on most. The brand debuts with the introduction of Paradigm VPS Impression Material and Paradigm Nano Hybrid Universal Restorative. Paradigm VPS Impression Material flows smoothly without dripping or slumping. Its hydrophilicity helps it produce void-free impressions with great detail. Additionally, its good tensile strength helps protect impressions from damage and distortion during removal from the mouth. With a range of viscosities and delivery options,…

17. Page 44

    Bonding Agent Embodies Power of a Total-Etch Adhesive and Simplified Protocol of a Self-Etch Technique ORANGE, Calif Kerr's OPTIBOND XTR, a self-etch, light cure universal adhesive system built on proven OptiBond technology, stands apart as the only bonding agent to embody both the power and durability of a total-etch adhesive and the simplified protocol of a self-etch technique. Universal compatibility enables its use for any type of restoration—direct or indirect. The unique chemistry of OptiBond XTR's enhanced self etch primer and optimized adhesive resin in this 3 bottle system brings unmatched strengths to uncut enamel and dentin. Kerr's ONDM monomer…

18. Page 46

    Gel Provides Easier and Faster Hemostasis With Precise Placement and Timesaving Cleanup LANCASTER, Pa.— Offered by Septodont, Racegel is a hemostatic material that controls bleeding and absorbs cervicular fluid prior to and during impression taking and crown placement. With its thermodynamic characteristics, it transforms into a gel upon contact with the gingiva (G+). Racegel contains 25% aluminum chloride, which is clinically proven for its astringent properties, and its bright orange color makes it easy to dispense, place, and rinse while causing no mechanical trauma to the gingiva. Packaged in a convenient delivery system, the Racegel kit contains three 1.4 g…

19. Page 48

    ATTENTION iTero USERS: Do you know you can have Cadent send Global Dental Solutions your modelwork for case fabrication? Since we're a partner lab, you can! Remakes are hazardous to your wealth! Looking for a better solution? Dental labs may be everywhere you look, but none can match the quality, service, life-like restorations, quick turn time, and on time delivery of GDS. Our consistently low remake rate and competitive pricing make GDS the laboratory capable of handling all of your needs. Let GDS be your number one solution. Valplast, Flexite, TCS partials $189 Lucitone FRS, FRS Clear partials $201 Captek…

20. Page 49

    Ceramic Block Line Expanded to Include Additional VITA Shades BREA, Calif VITA announces the expansion of the VITA BLOCS product line to include new VITA Shades. VITABLOCS TriLuxe and VITABLOCS Tri Luxe forte are now available in VITA Classical Shades, while VITABLOCS RealLife blocks are available in an expanded range of shades. Confirmed by clinical studies as the 'long-term gold standard' in successful clinical restorations, VITABLOCS are known for their outstanding material properties and exceptional bonding capabilities. The 3 shade intensive layers of the VITABLOCS Tri Luxe block permit the computer aided reproduction of natural color gradients for a more…

21. Page 50

    Captek: The #1 PFM Is Stronger, More Esthetic and Surprisingly Affordable The Captek technology for crowns and bridges received the most clinician votes for 2010 Best PFM in the online survey conducted by DentalTown®. Although Captek has received the Townie Choice® Award for the past eight years, there are several product improvements and noteworthy developments important for dentists and laboratories to know. Captek Nano is Stronger According to independent evaluations, the Captek Nano Series materials (Figure 1) have an optimal porcelain bond, increased elastic modulus (stiffness), and higher resistance to loading 2+. In addition to maintaining the beneficial esthetic and…

22. Page 52

    Two Hundred and Fifty Thousand CEREC Restorations Later, Pacific Dental Services Still Views CAD/CAM as the Future of Dentistry Since its inception in 1994, Pacific Dental Services (PDS) has been a promoter of modern dentistry and prides itself on its state-of-the-art offices and skilled affiliated clinicians that provide high levels of cost-effective patient care. As PDS continued to expand into a new decade, Steve Thorne, its president/founder, and the rest of his management team saw the potential of CAD/CAM as a technology that could take the company to the next level but understandably wanted to compare it to other systems…

23. Page 54

    NEWS/TRENDS Industry News Align Technology to Acquire Cadent for $190 Million San Jose, Calif-based Align Technology announced recently that it has signed an agreement to acquire privately held Cadent Holdings, a leading provider of 3-D digital scanning solutions for dentistry based in Carlsbad, Calif. Under the terms of the agreement, Align will pay approximately $190 million in exchange for all shares of Cadent. The acquisition strengthens Align's ability to drive adoption of Invisalign by integrating inpalab treatment more fully with mainstream tools and procedures in doctors' practices. Together, the companies will help accelerate the use of intraoral scanning in the…

24. Page 56

    NEWS/TRENDS Bone-Creating Protein Could Improve Dental Implant Success Healthy Gums May Lead to Healthy Lungs Using a bone creating protein to augment the maxillary sinus could improve dental implant success, according to Georgia Health Sciences University (GHSU) researchers. Dental implants won't work if the bone in which they are anchored is too thin, and bone thinning is a common cause a consequent following tooth loss. The current favored solution is to supplement the area with bone grafts to stabilize the implant base. But this technique is problematic "primarily because it involves additional surgeries to harvest the bone," said Dr. M.E.…

25. Page 60

    Computerized Tomography Scanning in Oral Surgery Recovery Computerized tomography (CT) has proven to be a useful tool in reconstruct dental implant surgery where a bone graft is required. It provides reliable information in diagnosis and treatment planning and has been used to determine the volume of bone for grafts. Now dentists are finding postsurgical uses for CT as well. An article in the Journal of Oral Implantology relates 2 case studies in which CT played an essential role. Both cases used CT scanning before and up to one year after the patients' oral surgery. With this technology, oral surgeons were…

26. Page 62

    Challenging Periodontitis With Innate Immunity A little more than 30 years ago, Dr. Anne C. R. Tanner and her colleagues at the Forsyth Institute isolated the oral bacterium now named Tannerella forsythia. Despite later being stitched on the cover of a Red Complex pathogens that typically trigger chronic periodontitis, T. forsythia flew mostly below the investigative radar in the 1980s and 1990s. It was too difficult to culture and not amenable to standard laboratory tricks. But 8 years ago, Dr. Tanner and a Forsyth league published a timely review and prediction, entitled, "Tannerella forsythia: A periodontal pathogen entering the genomic…

27. Page 63

    Researchers Connect Specific Protein to Head and Neck Cancers The discovery that a certain protein is overexpressed in patients with oral cancer may give new treatment hope to people suffering from the particularly aggressive, localized forms of head and neck cancer. The University of Michigan (U.M) School of Dentistry researchers found that when they inhibited the expression of the protein called Sirtuin 3 (SIRT3) in oral cancer cells in the lab, the cells did not proliferate and more of them died. Further, when they suppressed the protein in the cancer cells and combined that with radiation or chemotherapy treatment, the…

28. Page 64

    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. Crystal Tip Air Water Syringes Crystal Tip Air water syringes are used by every practitioner and every assistant numerous times every hour throughout the day. Most practitioners do not realize how essential these instruments are. (Try working without the air water syringe for one minute and see how difficult it is!) They are indispensable in keeping the operative area dry, visible, and clear of debris. In fact, most current dental chair setups offer separate syringes…

29. Page 67

    Unique Opportunity New Role for Hygienists in Modern Practices INTRODUCTION The evolution of technology has had a profound effect on dentistry. Advances in dental materials to progressive innovations in clinical techniques make dentistry more efficient, aesthetic, and even kinder to the patient. Dental hygienists can learn how to better add value to their contributions to the operation of the dental office once they realize the benefits and features of the newer dental materials. They can communicate more clearly how today's dentistry can look better, be stronger, and hopefully last longer than the dentistry of the past! It is to the…

30. Page 68

    DENTAL HYGIENE TODAY a greater role in supporting the practice and educating the patient. Dental hygienists have established interpersonal communication skills as well as clinical skills for preventive and therapeutic treatment modalities. The patient's confidence will be increased when the knowledge level of the dental office team is perceived as high, and if questions can be answered by not only the dentist, but by office and clinical team members as well. Not all team members feel confident in discussing treatment options. This is sometimes due to a lack of continuing education courses (ones dealing with appropriate topics), product knowledge, motivation…

31. Page 70

    A Unique Opportunity... continued from page 68 bonding the restoration into the tooth with a very thin layer of a luting resin. This virtually eliminates many of the short and long-term problems associated with polymerization shrinkage usually in relation to placing direct composite resin restorations (microleakage, stress on the dentin walls, etc). It should be noted that many manufacturers are working hard on reducing the shrinkage associated with direct composite resin materials (and have been successful in reducing it to as low as 4%) but to date, greater shrinkage still occurs when compared to the indirect composite technique. Composite resins…

32. Page 72

    Unique Opportunity... continued from page 70 Zirconia (Zirconium Oxide) Zirconia has evolved throughout the years and, with reported flexural strength of 900 MPa (depending on the manufacturer), it is the strongest biocompatible ceramic material avail able. Substructures or cores can be fabricated (CAD/CAM) out of zirconia (such as Lava [ESPE], IPS e.max CAD, VITA in Ceram Zirconia [Vident]), Cercon Zirconia [DENTSPLY Ceramco], and Procera AllZircon [Nobel Biocare], Kavo Everst [Kavo Dental], Zenostar [Wieland], or Katana [Noritake Dental], to name a few) and can have layering porcelains pressed or traditionally over it for The hygienist is a key cohesive team member…

33. Page 74

    Hygiene Update Antimicrobial Photodynamic Therapy for Periodontitis Investigating changes occurring in the subgingival microbiological composition of subjects with aggressive periodontitis who were treated with antimicrobial photodynamic therapy (aPDT) in a single episode, or scaling and root planing (SRP), was the study by Dr. Arthur Novaes, et al used a split mouth design on negatives; zero, anti-plus go days. Ten patients were randomly assigned to either aPDT using a laser source in conjunction with a photosensitizer, or SRP with hand instruments. Subgingival plaque samples were collected and using checkerboard DNA DNA hybridization determined counts of 40 subgingival species. The data were…

34. Page 76

    Product Focus ELECTRIC TOOTHBRUSHES Oral-B The ProfessionalCare SmartSeries 5000 with SmartGuide is Oral-B's most technologically advanced toothbrush for ultimate plaque removal. It provides 40,000 pulsations and 8,800 oscillations per minute, which helps remove up to 97% of plaque, thus preventing and reversing gingivitis. The wireless display acts like a dental professional in your bathroom. For more information, call (800) 566-7252 or visit dentalcare.com. FREEinfo, Sunstar Americas The Pulse Rotapower Toothbrush has (1) soft bristles that gently massage gums and clean teeth and (2) a rotary head with oscillating soft bristle action for effective cleaning. It is cordless (battery-operated) and requires…

35. Page 78

    Impressions: Going With the Flow Howard S. Glazer, DDS The use of vinyl polysiloxane (VPS) materials has become routine because they are easy to use, accurate, and faster setting than impression materials dating back to the age of rubber base. The primary function and design of any impression material is to transfer information from the chairside clinician to the laboratory technician, who will fabricate the restorations. Consequently, as I have often remarked, the "best" clinician with the most ideal preparation in combination with the "best" technique using the finest porcelain is at the mercy of the impression process. Our laboratory…

36. Page 81

    dentalCEtoday.com AESTHETICS 81 Test 137 Congenitally Missing Maxillary Lateral Incisors: Treatment Jae Hyun Park, DMD, MSD, MS, PhD Dong-Ae Kim, DDS, MS, PhD Kiyoshi Tai, DDS Congenitally missing maxillary lateral incisors are the second most common dental agenesis, exceeded only by third molars.1,2 Hypodontia, the absence of one or a few teeth, arises from a disturbance early in the tooth formation process during initiation or proliferation of the tooth bud. As a rule, if a tooth is absent, the most distal tooth of a type will be affected. Tooth malpositions result from these disturbances during the differentiation stages of dental…

37. Page 82

    Figure 3. (a) Recontouring (red area) of the maxillary first premolar is shared interdentally. (b) Existing contour (blue area) of the maxillary first premolar for canine substitution. Figure 4. (a) Recontouring (red area) of the prominent labial edge of canine before canine substitution. (b) Existing contour (blue area) of the labial surface is reduced (blue area) to establish a normal incisor contour. (c) To make the canine appear less curved and more like a lateral incisor, the bracket is positioned more distally. sor replacement, the other treatment options are sometimes preferred. As with the permanent canine in moved distally to…

38. Page 84

    Congenitally Missing Maxillary... continued from page 82 accumulation in these embrasures.18 Open gingival embrasures are influenced by the direction of tooth movement and by the biological thickness of the supporting bone and soft tissue after orthodontic treatment. In order to eliminate or reduce open gingival embrasures, it is recommended that the root movement of substituted maxillary canines be adequate to converge roots after palatal closure. In addition, restorative reshaping of the crown may be indicated. Orthodontic Treatment for Space Closing The decision whether to close space and substitute maxillary canines for lateral incisors or to open space for restoration of…

39. Page 85

    Three Types of Tooth-Supported Prostheses There are 3 basic types of tooth supported prostheses available today. They are a resin bonded fixed bridge, a cantilevered fixed bridge, and a conventional full crown fixed bridge. The primary consideration among these treatment options is conservation of tooth structure. Ideally, the treatment of choice should be the least invasive option that satisfies both aesthetic and functional objectives for the patient. Resin Bonded Fixed Bridge—This is the most conservative method for replacing a missing lateral incisor with a tooth-supported prosthesis. The success rate with this type of prosthesis varies widely from 46% over 11…

40. Page 87

    Test 137 Expiration date of this CE article is May 1, 2013. To submit Continuing Education answers, use the answer sheet on page 80. Circle the letter corresponding to the answer you believe is correct, detach the answer sheet from the magazine, and mail to Dentistry Today Department of Continuing Education, or use our easy online option at the Web site dentalcedtoday.com. This article is available for 2 hours of CE credit. The following 16 questions were derived from the article Congenitally Missing Maxillary Lateral Incisors: Treatment by Jae Hyun Park, DMD, MSD, MS, PhD, et al, on pages 81…

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