Dentistry Today — May 2018

Inside this issue

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

1. Page 6

   Aesthetics: A Cerebral Challenge This month, we are proud to have Dr. Wynn Okuda, from the very beautiful and aesthetic state of Hawaii, sharing a discussion on two important innovative thinking is to successful cosmetic outcomes. Wynn served as the president of the American Academy of Cosmetic Dentistry (AACD) from 2003 and is a prestigious board-accredited member and Fellow in this prestigious organization. Having worked with Wynn on his months submissions, I can tell you that he is a kind gentleman with an obvious, "aloha spirit" at the heart of his work and relationships! This can be found in his…

2. Page 8

   Insurance Industry Spin and Hype There is no question that dental insurance has had a positive influence in availing the public to dental healthcare services. Unfortunately for dental consumers, the insurance industry's primary responsibility is profit generation for shareholders. This is in direct contrast to a doctor's primary obligation of placing patient interests to the fore. Like any capitalist business, the insurance industry will compete to serve the needs of their customers, who are generally not patients who require healthcare or doctors who provide healthcare services. Patients and doctors are ancillary parties in the process of serving entities that purchase…

3. Page 10

   VIEWPOINT continued from page 8 revenues to be paid on the premium dollars collected. They also mediate the disputes of patients and doctors who contend that carriers reneged on authorized payments, per their contracts. Unfortunately for the public welfare, state insurance commissions are frequently filled by members whose primary interest is serving the insurance industry. These posts are staffed by individuals appointed by a governor who, again, may be overly influenced by lobbyist funding. Staffing may also be intentionally under-filled to render the agency ineffective. When a specific business group assumes control over a governmental regulatory agency, it is called…

4. Page 14

   FOCUS ON: Dental Service Organizations R. Dustin Dixon, DMD, discusses DSOs—what they are and how to grow your dental practice with the support of one. Q: What is a dental service organization (DSO)? A: Please allow me to answer this, and the following questions, from my own experience working with a DSO, Aspen Dental Management, Inc (ADMI). Aspen Dental is a brand name for dental practices owned by local dentists that have a business relationship with a DSO called ADMI. The easiest way I can explain it is as follows: If you were Dr. John Smith and wanted to bring…

5. Page 18

   America COEffect MinuteWipes can be used to clean and disinfect a dental operatory, sterilization bay, or other potentially contaminated areas in less time compared to other products that have longer "kill" rates or outdated formulations. This one-step surface disinfectant features an ethanol base, low toxicity, and a pleasant nonfragrance. It has been tested and is EPA registered as an effective bactericide, virucide, tuberculocide, and fungicide for one minute of "kill time" for 25 pathogens. For more information, call (800) 323-7063 or visit gcamerica.com. FREEinfo, AUTOMATIC TOOTHBRUSH Amabrush Amabrush is a revolutionary, hands-free toothbrush that simultaneously brushes all teeth in a…

6. Page 19

   Convergent Dental The new Solea Software (SW) 3.2 update is the latest in a series of updates that have continually improved its performance since its launch in 2013. Consistent with previous updates, this one offers a significant increase in cutting speed, smoother surface finishes, and Solea's industry-renowned analgesic effect. It simplifies the user interface with a single mode that cuts any tissue in the oral cavity. For more information, call toll-free at (844) GO-SOLEA (467-6532) or visit convergentdental.com. FREEinfo, GRAFTING MATERIAL GoldenDent GoldOss is made using proprietary, market-leading technology that utilizes an advanced science designed to preserve native bone morphogenic…

7. Page 20

   From the January and February 2018 Issues FLOWABLE COMPOSITE Tokuyama Dental America Estelite Bulk Fill Flow is a flowable bulk-fill composite that is aesthetic and efforts all on its own—no capping layer is needed. Further improving on the speed offered by other flowable bulk-fills, it requires no additional composites for outstanding aesthetics and strength. It offers faster and simpler single-placement restorations up to 4 mm. It provides more natural-looking bulk-fill restorations via higher shade-variety, with opaque, and polishability than other products. For more information, call (877) 378-3548 or visit tokuyama-us.com. FREEinfo, CARBIDE BUR Medidenta The Dynacut line of operative, surgical,…

8. Page 21

   Air Techniques Acadia's small footprint allows for a snug fit and it can be installed freestanding or wall-mounted. No additional electricity, wires, or plumbing are needed, and rotatable connections ensure your plumbing stays intact. Available in a single, smartly designed model, Acadia supports up to 10 operatories. For more information, call (800) AIR-TECH (247-8324) or visit airtechniques.com. FREEinfo, CARBIDE BUR Johnson-Strident Johnson-Strident is one of the largest manufacturers of carbide burs and offers more than 300 different types of burs. The burs feature high-quality tungsten carbide tips that are brazed onto the neck of a stainless steel shank. They are…

9. Page 22

   TheraCem ★★★★★ (97%) BISCO Dental Products | (800) 247-3368 | bisco.com Consultants' Comments • "Excellent cement and super easy to use." • "It tack cured quickly. Cleanup was perfect and there was no sticky residue." • "The simplicity made it a pleasure to use. I like not needing the steps of etching bonding, as well as the product's consistency." • "Super thin viscosity and film thickness made it easy to dispense and spread along margins." • "I liked the calcium and fluoride release." • "No postoperative sensitivity." • "It was too opaque or creamy for some cases." Clinical Tips •…

10. Page 24

    It's a Family Affair Paul Feuerstein, DMD Over the years, A-dec has continued to follow the Austins' philosophies by focusing on the real-world problems of the dental team and delivering reliable, creative...solutions. A-dec has been one of the most popular brands in all of dentistry for more than 50 years. When I was setting up my very first office more than 40 years ago, I was looking for the best units with durability and ease of repair. I chose A-dec Micro-Carts for all 3 of my treatment rooms. They moved offices with me and finally ended up in my garage,…

11. Page 26

    Spotlight Handpiece Allows for Firm Grip Regardless of Conditions HOFFMAN ESTATES, Ill—NSK Dental features an ultra-premium line of air turbines, the Ti-Max Z2 handpiece line. The handpieces are engineered for maximal durability, consistent performance, smooth cutting, and optimal access to all areas of the mouth. The standard-head Ti-Max Z900L delivers a professional-leading 45W of power and operates between 330,000 and 400,000 rpm. A proprietary, specially shaped turbine makes these power outputs possible and enables fast cutting for reduced treatment time. There's also a smooth, consistent cutting feel for comfortable operation. The handpieces feature solid titanium bodies. The ergonomic shape and…

12. Page 28

    Spotlight Lithium Disilicate CAD/CAM Block Produces Outstanding Beauty and Aesthetics FAIRFAX, Va.–HASS BIO America's Amber Mill is a highly aesthetic and innovative lithium disilicate CAD/CAM block for digital dentistry. Its excellence in opalescence and fluorescence results in outstanding beauty and aesthetics that represent natural teeth in its best way. Plus, you are able to differentiate the translucency of the result by altering the temperature of toughening heat treatment. Determine whether the outcome will be HT, LT, or MO with a single block. This helps you enhance the efficiency of your inventory management for millable blocks. For more information, call HASS…

13. Page 30

    Interchangeable Head Offers Ability to Detect Interproximal Caries MELVILLE, NY–The new Proxi head for Air Techniques' CamX Triton HD is the third interchangeable head that will be offered for this camera system. It currently has an intraoral cam head and a Spectra caries detection head. The new Proxi head enables practitioners to reliably and easily detect and diagnose interproximal caries. This powerful diagnostic tool enables the detection of interproximal caries without the use of x-ray radiation—especially useful in pediatric and pregnant patients. For more information, visit Air Techniques' website at airtechniques.com. FREEinfo, FILPOST restoration retention system Better by design Easy…

14. Page 31

    Software Gives Clinicians Opportunity To Analyze Every Patient's Model ATLANTA - Carestream Dental's CS Model+ software is giving clinicians back an important step in the treatment planning process: the ability to automatically segment, set up, analyze, and present digital models within minutes. The manual process of analyzing models and creating treatment steps is valuable, yet time consuming. By eliminating the most tedious parts of the process, CS Model+ lets doctors analyze every patient's model with the same dedication and attention to detail that was once reserved for only the most complicated on unique cases. CS Model+ automatically detects, segments, and…

15. Page 32

    Curing Light's Performance Remains Steady Regardless of Battery Power Level FAIRFAX, VA - The small head of B&L Lite's allows the clinician to properly position the curing light in all areas of the mouth with better visibility and without any discomfort to the patient. It comes with 5 modes: general composite filling, fast polyatomic composite filling, soft start, orthodontic mode-1, and orthodontic mode-2. The 2-second curing ability is one of the best time-saving functions overall for pediatric and orthodontic patients. The battery power level does not affect the performance of the B&Lite's. Even if the battery is low, the quality…

16. Page 34

    Spotlight Wipes Clean and Disinfect Contaminated Areas in Less Time ALSIP, ILL—COEfect Minute Wipes from GC America can be used to effectively clean and disinfect a dental operatory, sterilization bay, or other potentially contaminated areas in less time when compared to other products that have longer "kill rates" or outdated formulations. This one-step surface disinfectant features an ethanol base, low toxicity, and a pleasant spearmint aroma. It has been laboratory tested and is EPA registered as an effective bactericide, virucide, tuberculocide, and fungicide for one minute of "kill time" for 25 pathogens. Additionally, the larger size (9 x 7 in)…

17. Page 36

    Diamond Disc Offers Efficient Way to Successfully Perform IPR VANCOUVER, Wash.–Inspired by the demand for speed and safety with motorized IPR, Supra IPR, a division of ContactEZ, has unveiled its latest product, SupraDisc, which is a safe-edged diamond disc. Designed for use with Invisalign, ClearCorrect, eCligner, Six Month Smiles, and other orthodontic treatments, SupraDisc offers orthodontists and general dentists a fast, safe, and efficient way to successfully perform IPR, which has often been a worrisome, stressful procedure. Made in Germany using only the highest quality materials, the unique design and technology of diamond coating leaves the outside of the disc…

18. Page 37

    Spotlight Full-Contour Zirconia Produces Natural Shade Transition BALACYNWYD, Pa.- Nacera Q3 ultratranslucent, multilayer, 600-MPa zirconia has been designed and manufactured by the same engineers who are responsible for the high-strength, precision zirconia parts found in BMW, Mercedes, and Bugatti automobiles. Relying upon color spectrometers to verify shades and translucency, the precise manufacturing methods provide natural-looking vitality and make full-contour zirconia not only one of the most predictable ceramics available but also now one of the most aesthetic. Unlike other materials, Nacera Q3 is manufactured with a natural shade transition from the gingival to the occlusal/incisal, where the shade simultaneously lightens…

19. Page 38

    Spotlight Adhesive Offers Unique Blend of Technologies Soft Chews Trigger Month's Natural Processes for Protecting Teeth ROSLYN HEIGHTS, NY—Ortek's BasicBites soft chews are clinically shown to maintain enamel health. Sugar-free BasicBites contain revolutionary, patented microbiome technology developed at Stony Brook University School of Dental Medicine. BasicBites contain arginine bicarbonate and calcium carbonate. These vital, saliva-based nutrients trigger the month's natural processes to protect teeth. Just 2 BasicBites per day nourish and activate pH-raising bacteria discovered in oral biofilms, counteract plaque acids, support mineral resin, and help maintain oral homeostasis. BasicBites are recommended for patients with dry mouth and those who…

20. Page 39

    Spotlight Periodontal Ligament Knives Ease Tooth from its Socket NEWTOWN, Conn.–Directa Dental's Luxator instruments are periodontal ligament knives used to aid in atraumatic extractions. The fine-tapered blade compresses the alveolar bone, cuts the membrane, and eases the tooth from its socket. The handle is designed for tactile control while minimizing force during use. The tip is thin and sharp, so it inserts easily between bone and root with minimal damage to the tissues. The instrument handles are color-coded, and numbers are marked on the shaft for identification. For more information, call Directa Dental at (203) 491-2273 or visit directadental.com. FREEinfo,…

21. Page 42

    Obturator and File System Work Together to Reduce Patient Chair Time TULSA, Okla.-Dentsply Sirona Endodontics has combined 2 proven systems to create a convenient, single-system solution with the introduction of its new GuttaCore for WaveOne Gold system. It brings together the hybrid predictability of WaveOne Gold canal shaping with the 3-D fill of GuttaCore. GuttaCore for WaveOne Gold obturators are sized and color-coded to precisely match the WaveOne Gold reciprocating file system. GuttaCore for WaveOne Gold allows clinicians to effectively obturate challenging cases using the same technique with the ease of a single insertion. GuttaCore obturators matched to the WaveOne…

22. Page 44

    NEWS/TRENDS Industry News Restorations Earn Accolades from THE DENTAL ADVISOR THE DENTAL ADVISOR has selected Ivoclar Vivadent's IPS e.max Press lithium disilicate glass ceramic as one of its 2018 Top Award Winners in the Long-Term Performers category following a 5-year study. With 671 IPS e.max Press restorations placed during that period, 381 were evaluated at their recall. Most were anterior and posterior crowns, as well as inlays and onlays. According to Ivoclar Vivadent, 97% of the restorations received a 5-star or excellent rating. Many of the patients remarked positively about the aesthetics of the restorations. Only 6% of them were…

23. Page 46

    Lab Explores the Role of D Oralis in Periodontitis There are about 700 bacterial species in the oral microbiome, with varying effects on oral health. Researchers at Oak Ridge National Laboratory (ORNL) in Oak Ridge, Tennessee, though, are focusing on the role that Desulfobulbus oralis plays in periodontitis. By integrating genomic and metabolic techniques with classical microbiology, the researchers combined single-cell genomic with microbiological tricks, including using a complex "soup" made by other oral microbes, to grow the bacterium in the lab. By isolating D oralis, researchers hope to better understand how the microbes may have adapted and evolved to…

24. Page 47

    NEWS/TRENDS Smart Tooth... continued from page 44 The researchers will work toward monitoring peptides related to bone breakdown in periodontitis. A wireless ultrasound device would then read the peptide levels and connect to the medical data cloud. But chemistry remains one of the biggest challenges. "You only have a finite number of 'bio-recognition elements' conjugated to the transducer if you are using an antibody that is specific to these peptides," said Srikanth Singamaneni, MS, PhD, associate professor of mechanical engineering and materials science. "They get saturated fairly quickly. The question is how do you refresh those sensors? That's one of…

25. Page 49

    MEETINGS/SEMINARS Orlando Hosts NDA 2018 The 102th meeting of the National Dental Association (NDA) is set to be held from July 11 to July 13 at the Rosen Centre Hotel in Orlando. The theme for this year's meeting is "Remember the Past, Embrace the Present, Enhance the Future," and the conference is expected to draw between 1,500 and 1,700 attendees. Meeting highlights include the Product and Resource Center, featuring product presentations and a CE course on technologies and services dentists can use in their practices. For more information, visit ndaonline.org. This Pairs Well With Wine CLINICIAN'S CHOICE Dental Products and…

26. Page 50

    Does Diabetes Increase the Risk of Periodontitis? The literature is conflicting on the association between diabetes and periodontitis. A systematic review that was published in Acta Diabetologica assessed whether poorly controlled diabetes was associated with periodontitis onset or progression. Electronic searches were performed in the PubMed, Scopus, and Embase databases. Hand search was carried out in the reference list of all articles included. Gray literature was investigated with a Google Scholar search. Prospective longitudinal studies on the association between diabetes and periodontitis were considered for this review. Studies needed to have presented at least 2 measurements of periodontal conditions over…

27. Page 51

    Sealants Prevent Caries With or Without Fluoride A multi-centric split-mouth randomized clinical trial published in Caries Research assessed the effectiveness of 2 resin based sealants with and without fluoride in a population with high caries risk. The study assessed sealant effectiveness in preventing carious international Caries Detection and Assessment System (ICDAS) 3–6 lesions within a 2-year follow-up, along with retention rates and the caries risk factors related to their outcomes. The study included 663 tooth pairs in 400 children (aged 5 to 15 years) considered to be at high individual caries risk (ICR) and presenting permanent molars free of caries…

28. Page 52

    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. He can be reached at (416) 473-0045 or via email at freedman@cpdot.com. Premier Implant Financing LendingClub Patient Solutions While patient financing is not a dental material or technology, it is certainly a very important tool for the dental practice. Patients generally want to have the treatment they need, and dentists are similarly ready to provide it. In fact, this is how they make their living. When insurance plans are available, they provide coverage for routine…

29. Page 54

    DENTISTRY TODAY READERS' CHOICE TOP 25 AESTHETIC/RESTORATIVE PRODUCTS Dentistry Today's Readers' Choice Top 25 Aesthetic/Restorative Products, selected on the basis of lead generation, represent some of the profession's most innovative Aesthetic/Restorative products. The products appear in no particular order. DMG America TempoCem ID delivers standout performance by blending in. This aesthetic-oriented, temporary cement is invisible when you want it to be, yet detectable when you need it to be. Formulated for optimal transparency, it will never impact the shade of your provisional, making it an ideal choice for position and anterior restorations alike. Unlike other clear temporary cements, the innovative…

30. Page 56

    Top 25 Aesthetic/Restorative Products Ivoclar Vivadent With its optimized formulation and easy cleanup, SpeedCEM Plus, a self-adhesive, self-curing resin cement with a light-curing option, is especially suited for (1) restorations made of zirconium oxide and metal ceramics, and (2) cementation of restorations on implant abutments. Not every restoration allows complete and uniform light cure. Strong self-curing capabilities provide an additional measure of safety when seating restorations are opaque or impervious to light. It achieves a high bond strength to zirconium oxide, nonprecious metals such as titanium, and dentin without exposure to light. SpeedCEM Plus establishes a reliable bond on dry…

31. Page 58

    Top 25 Aesthetic/Restorative Products VOCO America IonoStar Plus is a fast-setting, radiopaque glass ionomer restorative that offers immediate packability, nonstick handling, and enhanced physical properties. Designed to reduce or remove many of the headaches associated with glass ionomer restoratives, IonoStar Plus comes in a new, easy-to-use direct application capsule that fits virtually all branded glass ionomer applicators. As it is dispersed into the restoration, it offers 2 shapes of consistency that initially provide ideal wettability for perfect marginal adaptability, and then immediate packability with nonstick handling for condensing and shaping. With an abbreviated working time of one minute and a…

32. Page 60

    Top 25 Aesthetic/Restorative Products Water Pik The unique hourglass shape of the ClearView universal retaining ring allows more visibility and access to the site, enabling outstanding restorations with tighter contacts. When placed prior to and left on during cavity preparation, ClearView rings help create the approximate space required for sectional matrix placement. They retain strength over time for consistent, predictable restorations, and the innovative gripping lines are designed to eliminate springoff and reduce flash. For more information, call (800) 525-2020 or visit clearview.waterpik.com. FREEinfo, Pulpdent ACTIVA BioACTIVE-RESTORATIVE is a highly aesthetic, bioactive composite that delivers all of the advantages of…

33. Page 62

    Top 25 Aesthetic/Restorative Products COLTENE SoloCem self-adhesive cement saves time without sacrificing reliable bonding. MDP and 4-MET(A) monomers ensure good bonding values on a range of different materials (ceramic, metal, and composite) and for a variety of indications (crowns, bridges, inlays, onlays, endodontic posts, and implant abutments). The composite-like formulation of SoloCem contains antibacterial zinc oxide and is highly radiopaque. Low shrinkage contributes to high-quality bond and durable restoration. Simple to apply, SoloCem dentin, white opaque, and translucent shades are delivered via Automix syringes with ready-to-use mixing tips. Intraoral processing time is approximately 60 seconds, and excess material may be…

34. Page 64

    Top 25 Aesthetic/Restorative Products 3M Filtek One Bulk Fill Restorative is a simple, one-step placement restorative material. Designed for the posterior, its unique optical properties and increased opacity allow for the simplicity of one-step placement without compromising aesthetic results. With excellent adaptation and handling, it can be placed in one fast, easy increment up to 5 mm—no need for layering or expensive dispensing devices. 3M's unique Smart Contrast Ratio Management nanotechnology results in superior wear resistance and excellent polish retention, as well as restorative polish without sacrificing depth of cure. Available in 5 shades, Filtek One Bulk Fill Restorative enhances…

35. Page 66

    Top 25 Aesthetic/Restorative Products . 1 Glidewell Laboratories With more than 14 million units prescribed since 2009, BruxZir Solid Zirconia has spearheaded the industry's shift from full-cast and porcelain-veneered dental restorations to all-ceramic CAD/CAM crowns and bridges. Now, after continued advancements from Glidewell Laboratories, this revolutionary material is available for select chairside milling systems in the form of BruxZir NOW milling blocks, enabling clinicians to deliver fully sintered posterior crowns with proven BruxZir strength in just a single appointment. Available in 14 shades that correspond to the VITA Classical shade system, restorations produced with BruxZir NOW blocks can be designed,…

36. Page 70

    An Innovative Approach to Complex Cosmetic Dentistry Wynn H. Okuda, DMD As I celebrate my 30th year practicing cosmetic and restorative dentistry, I reflect on the evolution of my clinical approach to complex cosmetic cases. In the beginning, I used a traditional approach to treat these complex cases. For example, for the correction of gummy smiles, I performed traditional periodontal crown lengthening to reduce the gummy look and create a uniform appearance of the gingival architecture. This traditional approach led to extensive surgical procedures, painful healing, and lengthy healing times. Now, with an innovative approach to his type of correction,…

37. Page 72

    Figure 4. Marking a new free gingival margin location. Figure 5. Analyzing the impact of the new gingival free margins in the patient's smile line. Figure 6. Verifying periodontal measurement through osseous sounding. Figure 7. Using the Okuda Closed Flap method to re-establish new free gingival margins. Figure 8. Temporary prototypes were created to meet the aesthetic needs of the patient and support the gingival tissues for calculated healing. Figure 9. The porcelain veneers were artistically hand sculpted to match the patient's physiognomy and to accentuate her unique facial features. Figure 10. Using the latest materials for state-of-the-art porcelain veneer…

38. Page 73

    AESTHETICS 73 Figure 14. The pretreatment view of the smile shows excessive gumminess and a lack of good proportion in the patient's smile. Figure 15. The post treatment view shows a profound change in the patient's smile. Figure 16. Proper aesthetic correction, using a same day closed-flap surgical technique and porcelain veneers, can lead to predictable results. gingival surgical procedure.¹ In addition, a facebow measurement (Denar Slidematic Facebow [Whip Mix]), and records (Blu-Mousse [Parkell]), and internal shades were also taken. Based on the diagnostic wax-up, hand-sculpted temporary provisioneer veneers were created (Turbo Temp 3 [Zest Dental Solutions]) to support the…

39. Page 74

    The Architect of the Smile A Midline Diastema Closure Tyler Wynne, DDS INTRODUCTION One of the most common aesthetic procedures encountered by general dentists today is diastema closure. A midline diastema can be the result of a single or multifactorial etiology of tooth-size-to-arch discrepancies, supernumerary teeth, labial frenal attachments, and oral habits. The interproximal spacing between 2 maxillary central incisors causes a visual disruption and is often regarded as unesthetic, affecting the entire face. But what is it exactly that causes this space, regardless of how narrow or wide between the maxillary central incisors, to so strongly influence aesthetics? The…

40. Page 76

    Figure 4. The 0.5-mm depth cuts were identified with a permanent marker. Figure 5. An exact 0.5-mm depth reduction was achieved once the permanent ink markings were removed with a round-ended diamond (no. 112-5161 [Henry-Schein]). Figure 6. A 0.3-mm depth cut was identified using a permanent marker. Figure 7. After the permanent marker markings were removed, a uniform 0.8-mm total facial reduction was obtained. Figure 8. The incisal edge was reduced by 1.5 mm. Figure 9. A polishing cup (Shofu Dental) was used to smooth and polish all line angles. Figure 10. The occlusal view of the finished veneer preps.…

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