Dentistry Today — May 2019

Inside this issue

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1. Page 6

   Evolving Fast! Don't Blink! I recently had the pleasure of lecturing at the Greater Long Island Dental Meeting, and I will soon present the same course, entitled "Trends, Innovations, Controversies, and Clinical Tips," for attendees at the Ontario Dental Association's Annual Spring Meeting. As is the case with any dedicated teachers' preparation protocol, much time and effort is put forth to continually update the content to reflect the fast-evolving world that dental professionals are experiencing. In my lecture, an emphasis is placed on dental material innovations and the growing interest in practicing minimally invasive dentistry techniques. A few of the…

2. Page 8

   Mentoring the Next Generations There is a growing dilemma in the United States. The face of dentistry is changing, and our profession is in jeopardy of losing the identity it has created over its history. Since the Great Recession, significant things occurred that have brought us to our present state. Following that economy shock in 2008, a tremendous ripple effect showed the forward progress of private practice dentistry nationwide. In addition, the growing debt of recent dental graduates altered the ability of the next generation of dentists to follow in the footsteps of the older and experienced dentists who, historically,…

3. Page 10

   VIEWPOINT continued from page 8 anesthetic injections. 4. The skills required to avoid inflicting pain and undue discomfort during dental procedures. Two of these are related to knowledge in practice management skills, and the other 2 are learned and practiced clinical skills. Learning to develop these essential requirements for success are, in part, some of the benefits of participating in an associateship/mentorship program. The Great Recession of 2008 Since the Great Recession, there has been a domino effect with negative consequences for private dental practices. From 2008 to 2012, critical performance measures (such as practice revenue collections, the number of…

4. Page 12

   Bio: Lawrence N. Wallace, DDS, is a board-certified oral and maxillofacial surgeon and founder and CEO of the Larell One Step Denture system. Short Story: After practicing oral and maxillofacial surgery for 25 years, I decided to change the direction of my life and career and concentrate on replacing the thousands of teeth I removed while in practice. People were devastated at the loss of their teeth and its emotional, physical, and financial aspects. The need compelled me to find a day for a more affordable, efficient, and aesthetic way to provide dentures to replace those missing teeth. Access and…

5. Page 14

   Beautifil II LS ★★★★★ (96%) Shofu Dental | (800) 827-4638 | shofu.com Consultants' Comments • "Easy bubble-free placement, non-sticky, packs well, and easy to sculpt." • "Works like a charm." • "The caps on syringes were great. You cannot lose or drop them!" • "Good sculptability and easy to shape the material, without slumping or pull-back afterward." • "The tip of the capsule was very beneficial in reaching areas in the box that would have been easy to pack with universal composite." • "I like that it releases and recharges with fluoride and has minimal shrinkage." • "Excellent, natural-looking artistic…

6. Page 16

   FOCUS ON: A Failing Model Michael W. Davis, DDS, discusses failings of our current medical model and why dentistry should avoid those same traps. Q: How is our medical model of patient healthcare delivery failing? A: Formerly, patients could depend on the doctor/patient relationship (a legal contract). Physicians held their patients' interests foremost. Outside entities in prior times were not lawfully permitted to dictate or direct patient care, especially without the knowledge and consent of the patient (the disadvantaged party in the doctor/patient contract). Q: How does that happen? A: In large part, physicians no longer own or control their…

7. Page 17

   RESERVATIONS CURRENTLY BEING ACCEPTED FOR THE FINAL THREE DENTAL SLEEP MBA™ OPEN ENROLLMENT OPPORTUNITIES OF THE YEAR - DISCOVER THE ONLY PROVEN METHOD FOR SUCCESS IN DENTAL SLEEP MEDICINE: Can You Really Build a Million Dollar Practice Working Just 4-6 Hours Per Week? Building a million dollar practice in dentistry working only 4-6 hours per week is virtually impossible. Achieving that result (or better) in dental sleep medicine, however, is not only possible, but quite realistic. Dentists fail in sleep medicine because they struggle to get patients and have no idea how to navigate actually getting paid for their work.…

8. Page 18

   EsteCem II: A Versatile, State-of-the-Art Adhesive Resin Cement Edwin McDonald, DDS Materials technology has significantly advanced in many areas of contemporary restorative practice. This includes the cementation of indirect restorations, leading to improvements in the procedure and better results for our patients. Recently, Tokuyama Dental has developed 3 new resin-based products: Tokuyama Universal Bond, a self-cured adhesive, and EsteCem II, a dual-cure cement. Used together as a system, they offer unique features and superb performance. Tokuyama Universal Bond (Figure 1) is activated by mixing one drop of Bond A with one drop of Bond B. The fluoride catalyst creates a…

9. Page 20

   Spotlight Handpiece Produces Less Wrist Stress, Better Access to Hard-to-Reach Places HOFFMAN ESTATES, Ill–NSK Dental's engineering delivers comfortable and smooth polishing in a handpiece that is light, quiet, steady, and cordless. Weighing only 9 g, the iProphy Mobile produces less wrist stress and gives better access to those hard-to-reach places. Clinicians and patients will agree the 57.8 dBA that the handpiece produces makes it easy on the ears. Going cordless results in stress-free treatment achieved by removing the foot control and providing stable rotations throughout the procedure. The iProphy Mobile has a powerful 2.0 Ncm torque and offers 2 ways…

10. Page 22

    Spotlight Ultrasonic Cleaning System Provides Generous Capacity CUYAHOGA FALLS, Ohio-COLTENE's BioSonic UC150 is built for versatility, efficiency, and convenience. It offers a stainless steel tank with a 1.5 gal use capacity. It is designed with a small footprint while providing generous capacity. The unit can accommodate multiple cleaning configurations, including beakers, baskets, and up to 4 medium-size instrument cassettes. The UC150 can be used as either a countertop unit or a recessed unit, allowing for flexibility in any sterilization center setting. An easy-to-use, multilingual touchscreen allows full functionality with a gloved hand. The UC150 touchscreen features customizable temperature settings, run…

11. Page 24

    Spotlight Cloud-Based Phone System Ensures Excellent Performance and Voice Quality LORETTO, Minn.–XLDent's new cloud-based phone system provides a simple solution for dental offices to be more efficient. XLDent has partnered with Mango Voice to offer the best in time-saving and cost-effective features to make one's practice run better. This solution is great for any size practice and helps one easily manage a single location or connect multiple locations seamlessly. State-of-the-art infrastructure ensures excellent performance and voice quality. When paired with XLDent practice management software, smart caller ID automatically retrieves patient information and outgoing calls are easily made with one click.…

12. Page 25

    Technique and Materials for Predictable and Accurate Crown and Bridge Impressions Troy Schmedding, DDS Perhaps no dental procedure done on a routine basis contains more uncertainty and yet holds more importance than that of the dental impression. Every dentist and dental team has, at some point, anxiously awaited to see if the fruit of their labor has been captured correctly in the negative form of an impression. There are certainly many variables that go into a successful outcome, but, ultimately, material choice is the one that influences all others and perhaps can make the biggest difference. The development of digital…

13. Page 26

    Spotlight CAD/CAM Zirconia Block Offers Optimal Blend of Strength and Aesthetics ST. PAUL, Minn.–3M's Chairside Zirconia is a new CAD/CAM zirconia block optimized for the fast-sintering CEREC SpeedFire Furnace. The new block offers an optimal blend of high strength and aesthetics to along with a fast sintering time of approximately 20 minutes for a thin-walled crown. For easy shade matching, the material is available in 8 shades and 2 block sizes designed for crowns and 3-unit bridges to match the VITA classical shades. Additionally, due to its low minimum wall thickness of 0.8 mm, dentists are able to carry out…

14. Page 28

    Spotlight Occlusal Contact Spray Assures Proper Fit of Crowns and Bridges NASHUA, NH-Bausch's Arti-Spray is used to test occlusal contacts and assure the proper fit of crowns and bridges. It is extremely user friendly. It applies thinly and moves easily with just water, leaving no residue due. It is available in 4 colors, including white, red, blue, and green. For more information, visit Bausch's website located at bauscpaper.com. FREEinfo, Gel Fights Harmful Bacteria and Inflammation in Gums LANCASTER, NH-Dental Herb Company's PerioSpot is a powerful gum therapy gel designed to fight harmful bacteria and inflammation directly at the spot. Formulated…

15. Page 30

    Universal Composite Provides Single Shade for Every Shade of Tooth ENCINITAS, Calif—Tokuyama Dental America's OMNICHROMA is the first universal composite that matches every patient's tooth shade, from A1 to D4, with a single shade of composite. This revolutionary composite has been developed through the culmination of 35 years of research and development experience by Tokuyama. OMNICHROMA's innovative technology utilizes structural color to match every tooth shade. Its 260-nm fillers are the precise shape and size necessary to generate red-to-yellow structural color as ambient light passes through the composite. The red-to-yellow color combines with the reflected color of the patient's surrounding…

16. Page 32

    Better than Gluma? Yes.* Total Elimination of Bonding Sensitivity HEMASEAL & CIDE™ WITH 4% CHLORHEXIDINE *Studies available @ www.advantagedentalinc.com "I have used this desensitizer primarily for direct bonding procedures, and for crown preparations. It works as well as the better-known brands like Gluma, and at a third of the price, especially in the 10ml bulk bottle size. This by far offers the most value and cost efficiency of all desensitizers on the market." BRIAN GRAY, DMD, Washington, DC "I like products that are easy-to-use, and better for the patient, like my old friend Hemaseal & Cide. In one bottle, it…

17. Page 33

    Periodontal Ligament Knives Aid in Atraumatic Extractions 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. call Directa Dental at (203) 401-2273 or visit directadental.com. FREEinfo, Prop System Maintains…

18. Page 34

    Class II Anesthesia-Free Dentistry With the Solea Dental Laser Performing a Deep Class II Restoration on Tooth No. 12 DO, Anesthesia Free and Pain Free Timothy Andersen, DDS Class II restorations and the dental experience for dentists and patients have a close connection. From the dentist's point of view, this type of procedure can be challenging and time consuming. On the patient's part, there is always anxiety that accompanies sitting in the chair for an extended period of time and, of course, the needle. Recently, a 42-year-old patient came in for a routine visit. During his oral examination, we noticed…

19. Page 36

    Industry News Aspen Opens Two New Corporate Facilities ADMI has opened a practice support center location in Chicago, which serves as a hub for operations in the Midwest and houses a new learning and development center. Aspen Dental Management Inc (ADMI) has opened 2 new facilities, located in Chicago, the first will serve as a hub for operations in the Midwest and house a new learning and development center that will host clinical and leadership development programs for hundreds of dentists, hygienists, and other team members each year. The second, just outside of Phoenix, will be home to the company's…

20. Page 38

    Plant Cellulose... continued from page 36 growth at the 3-week mark and 50% more bone growth at the 12-week mark compared to the controls. "These findings show, for the first time in a lab setting, that a cellulose nanocrystal aerogel can support new bone growth," said coauthor Emily Cranston, PhD, a professor of wood science and chemical and biological engineering at UBC. The implant should break down into nontoxic components in the body as the bone starts to heal, added Cranston. Psychological Techniques... continued from page 36 "Shaping how health information is presented to our patients appears to influence their…

21. Page 42

    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. BISCO Dental Products TheraCal LC is a radiopaque, light-curable, flowable composite containing "apatite-stimulating" calcium silicates to protect and stimulate pulpal and dentin repair. It is the ideal replacement to calcium hydroxide glass ionomer-based or RMGI materials due to its excellent handling, ease of placement, and enhanced reminerative properties. TheraCal LC performs as a barrier and protectant of the dental pulpal complex. With high physical properties…

22. Page 43

    CHAIRSIDE WITH DR.K THE SECRET TO MORE EFFECTIVE WHITENING No two patients are exactly the same. So why use just one whitening protocol to treat them all? At KöR Whitening, we recognize that each patient presents a different whitening challenge and that's why we developed a full line of whitening systems to meet your patient's individual need. And KöR Whitening is the first whitening system in the world to maintain potency of its entire line of whitening gels by constant refrigeration from the instant of manufacture until being received cold-packed at your office. Dr. Rod Kurthy #1 Proper Product and…

23. Page 44

    Top 25 Aesthetic/Restorative Products Ultradent Products Mosaic Universal Composite balances beauty and performance to yield lasting, lifelike restorations. It can be used for all restorative purposes, whether basic or complex, and its well-balanced nanohybrid formula produces restorations of the highest quality. Combining the strength required for posterior use with the aesthetic characteristics desired for anterior use, Mosaic ensures superior results, both visually and functionally. Its smooth, pliable consistency allows for total control during manipulation and, once shaped, it won't flow or slump. Available in 20 intuitive dental and enamel shades, Mosaic provides predictable shade matching using single-, double-, or multiple-layer…

24. Page 46

    Top 25 Aesthetic/Restorative Products Glidewell Laboratories The BruxZir Solid Zirconia family of restorative materials offers clinicians high-performance solutions that exceed patient aesthetic expectations. It benefits from proprietary processing methods, which result in restorations with best-in-class translucency, enhanced shade-matching, and extraordinary strength. Available in 2 distinct formulations, BruxZir Solid Zirconia provides solutions for virtually any indication. Choose BruxZir Full-Strength for the most functionally demanding cases, or BruxZir Esthetic for situations that require a premier appearance. BruxZir restorations have been proven by independent researchers and clinicians alike. The research arm of the Gordon J. Christensen Clinicians Report concluded that BruxZir demonstrates excellent…

25. Page 48

    Top 25 Aesthetic/Restorative Products . 1 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, chips, onlays, endodontic posts, and implant abutments). The composite-like formulation of SoloCem contains antibacterial zinc oxide and is highly radiopaque. Low shrinkage contributes to a 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…

26. Page 49

    3M Oral Care Filtek One Bulk Fill Restorative is a simple, one-step placement restorative material. Designed for the posterior, its 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 a single increment up to 5 mm—no need for layering or expensive dispensing devices. For more information, call (800) 634-2249 or visit 3m.com/filtek. FREEinfo, Septodont Backed by more than 10 years of research and development, Biodentine, hailed as "dentin in a capsule," offers clinicians a material with optimal biocompatibility and proven bioactivity that preserves…

27. Page 50

    Top 25 Aesthetic/Restorative Products USE FREE info Card on pg. 1 Kuraray America CLEARFIL MAJESTY ES Flow is a light-cured, universal, flowable composite that can be used for all direct restorations for all cavity classes. It can also be used (1) as a cavity base/liner, (2) to repair tooth erosion and wear, and (3) for intraoral repair of fractured restorations. It is exceptionally easy to polish. It only requires wiping the cured resin with an ethanol-soaked gauze or cotton roll. CLEARFIL MAJESTY ES Flow contains special submicron fillers that are treated with a proprietary silane coupling agent, giving the product…

28. Page 51

    With NANOCERAM-BRIGHT's adaptive chameleon-like technology, one can easily and confidently create long-lasting, natural-looking restorations that patients won't stop smiling about. For more than 30 years, DMP has developed an innovative manufacturing process that integrates a unique blend of microand nano-fillers into the resin matrix, creating an easy-to-sculpt nanohybrid composite for Class I to IV restorations. Adaptive chameleon-like technology achieves excellent color matching, high polishability, and lifelike translucency, allowing the restoration to blend into the natural tooth structure and surrounding area. NANOCERAM-BRIGHT outperforms the competition with extremely low water sorption properties, minimal polymerization shrinkage, and high flexural/comprehensive strength. This provides a…

29. Page 52

    Top 25 Aesthetic/Restorative Products Kerr Harmonize begins with Adaptive Response Technology (ART), which is a nanoparticle filler network that helps you achieve lifelike restorations with more ease and simplicity than ever. With better blending capabilities and enhanced structural integrity, the ART of Harmonize provides you restorations with exceptional strength and unmatched aesthetics. The special controlled size and spherical shape of the ART nanoparticle filler network allows for light diffusion and reflection similar to human enamel. This leads to an enhanced chameleon effect for better blending and improved aesthetics overall. Furthermore, the adaptive viscosity of Harmonize allows easier handling and shaping…

30. Page 53

    PULPDENT DENTAL INNOVATION SINCE 1947 DenMat Splash Max is a high-quality VPS impression material that offers users distortion-free impressions, resulting in quality margins, fit, and function for every case. Featuring (1) instant hydrophilicity, (2) maximum tear strength and elasticity, (3) excellent dimensional accuracy, (4) high-contrast color, (5) thixotropic consistency, and (6) ideal flow properties, this premium VPS impression material ensures maximal performance while fewer retakes, saved valuable chairside time and money. Independent testing reveals that Splash Max achieves a lower contact angle within seconds and much higher tear strength than leading competitors. Its low contact angle, combined with high tear…

31. Page 54

    The Dawn of Injection Molded Composite Dentistry Dentistry Today's editor-in-chief, Damon Adams, DDS, leads a discussion with Jihyon Kim, DDS, on why techniques for placing direct composites need to change. What is injection molded composite? Dr. Kim: Historically, many advances in science and technology have been spurred by perspectives gained from the cross-pollination of ideas across industries. A recent example might be the conceptualization of 3-D printing and its cross-over from additive manufacturing to current uses in medicine and dentistry that has led to commercially successful products, such as Truetooth from Dental Education Laboratories. Similarly, the concept of injection molding…

32. Page 56

    The Dawn of Injection Molded... continued from page 54 What is the Bioclear Method, and how does injection molding fit in? Dr. Kim: There are 4 cornerstones to the Bioclear Method: (1) biofilm disclosing and removal with aluminum trihydroxide to allow intentional excess of composite onto clean uncut enamel; (2) clear, anatomic Bioclear matrices capture and mold heated composite resin into monolithic shapes with mylar finishes in the inaccessible gingival and interproximal areas; (3) multiviscosity composite resins are heated for better flow and adaptation; and (4) Bioclear's trade-mark Rock Star polish—a simplified polishing method to create mylar finishes of the…

33. Page 58

    Figure 6a. Tooth No. 9 with deep caries, labial and palatal views. (Case courtesy of Dr. Reza Moezzi, Vacaville, Calif.) Figure 6b. Tooth No. 9 caries removal. An A101 matrix (Bioclear) on the mesial and an A102 matrix (Bioclear) on the distal, ready for injection molding. Figure 6c. Tooth No. 9 after injection molding and polishing, labial and palatal views. Figure 7a. Teeth Nos. 4 and 5 preoperatively with discoloration solution by visual buildup. (Case courtesy of Brandon Walker.) Figure 7b. Selective caries removal and disease-driven cavitations. Preparations were cleaned and biofilm was removed with aluminum trihydroxide in a Bioclear…

34. Page 62

    Tips on Creating an Implant-Focused Practice Randolph R. Resnik, DMD, MDS, shares some valuable thoughts with Dentistry Today's implant editor, Michael Tischler, DDS, based on his experience as an implantologist. What role do you think general dentists will play in implantology in the future? Dr. Resnik: In my opinion, general dental practitioners (GPs) are going to play an even more significant role in the future of implant dentistry. Statistics show that the number of GPs in the United States who are placing dental implants continues to increase every year, but it remains well behind the number of dentists placing implants…

35. Page 64

    Tips on Creating an Implant-Focused... continued from page 62 improved implant prosthesis survival rate is seen when compared to a fixed partial denture supported by natural teeth. Almost all dental implant survival and success studies report a greater than 95% success rate for den- Figure 1. A congenitally missing lateral incisor implant case: (a) the preoperative view, (b) final postoperative clinical image, and (c) final post-op radiograph. Figure 2. A mandibular posterior implant case: (a) a failing mandibular posterior prosthesis (teeth Nos. 17 to 20), (b) implant placement, (c) the final prosthetic abutments, and (d) the final posterior implant prosthesis.…

36. Page 66

    Treating a Patient With Inadequate Restorative Space Joseph Massad, DDS Swati Ahuja, DDS Russell Wills, DDS Charles J. Gosdacre, DDS INTRODUCTION A consideration of available restorative space is critical when fabricating implant-supported overdentures. These prostheses are frequently involved in higher functional loading compared to conventional complete dentures, rendering them susceptible to fatigue degradation and fracture. A minimum denture base thickness for implant overdentures should be approximately 2.0 mm, and the minimum denture tooth height should be approximately 3.0 mm. A reduction in denture base dimensions to accept the attachment components render the prosthesis more susceptible to fracture. The incorporation of…

37. Page 68

    Figure 2. Radiographic markers incorporated in the maxillary cameogram. Figure 3. Radiographic markers were incorporated in the mandibular cameogram. Figure 4. A CBCT scan (Dentri [HDX WILL NORTH AMERICA]) of the patient with the cameogram placed in the patient's mouth. (a) Frontal view; (b) profile view. Treating a Patient With Inadequate... continued from page 66 denture base. Additional labial/buccal restorative space was not available for the mandibular prosthesis. Radiographic markers were incorporated in the maxillary and mandibular cameograms (Figures 2 and 3) above the location of the teeth and on their gingival surfaces and the dual cone beam computed tomography…

38. Page 70

    IMPLANTS 70 Treating a Patient With Inadequate... continued from page 68 4 weeks for evaluation and maintenance. She was asked to return after 3 months for the fabrication of the definitive prostheses. Fabrication of Definitive Restorations The implants were allowed to heal for 4 months. The patient presented with good tissue health and with no apparent trauma caused by the transitional denture. Primary impressions, definitive impressions, the maxillo-mandibular jaw relationship (Figure 7), and neutral zone records (Figure 8) were completed. The patient was able to adjust to the increase in OVD in the transitional dentures, which aided in gaining mandibular…

39. Page 73

    Test 233 dentalCEtoday.com IMPLANTS Optimizing Aesthetic Zone Implant Outcomes: A Case Report This case report describes the treatment planning and modalities that were employed to obtain optimal aesthetic and functional results for a patient in whom anterior implants were placed. Luis Brea, Jr., DDS, is an adjunct assistant clinical professor in the Department of Cardiology and Comprehensive Care at the New York University College of Dentistry and directs the occlusion course for the Program in Advanced Esthetic Dentistry for International Dentists. He can be reached at lnb19@nyu.edu. Steven B. David, DMD, is an adjunct clinical professor in the Department of…

40. Page 74

    Figure 1a. A periapical radiograph reveals a failing tooth No. 7 and a poor-fitting bridge on teeth Nos. 8 and 9. Figure 1b. A retracted view, showing a fistulous tract at tooth No. 7, open margins, and metal exposure to tooth No. 10. Figure 2. The full smile, revealing the low lip-line. a very low lip-line (Figure 2). Considering the fractured tooth No. 7 and the fistulous tract, some associated loss of the buccal plate was anticipated. A computed tomography (CT) scan revealed that the extensive bone loss at the site of the missing tooth No. 9 would have to…

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