Dentistry Today — May 2021

Inside this issue

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

1. Page 6

   Attacking the 'Spare Time' Stack As I am finally settling into this new position, and as a practicing dentist, I have had a chance to sit back and actually read all of the articles. I like many of you, receive a variety of dental periodicals and put them in a stack for "later." I used to say that if I were home sick for a while, I would go through the past issues and catch up. We all know that if you are legitimately home ill, the last thing you want to do is read anything. Much to my pain-time…

2. Page 8

   Pandemic or Not: Seven Habits to Adopt in 2021 INTRODUCTION The pandemic has created chaos and upheaval in dentistry and in most of the world. In 2020, we experienced industry-changing events, including a shutdown, a reopening, pent-up demand, practice fatigue, patients not returning, personal protective equipment (PPE) and infection control protocols, a dip in hygiene schedules in November, and a production slowdown after pent-up demand ended. While the effects of COVID-19 are still impacting our personal and professional lives, it's important in 2021 to remember that pandemic conditions will end. During this transition period, it will be beneficial for dentists…

3. Page 9

   ...it's important to remember that pandemic conditions will end. Most practices had less than one month of cash in reserve when the pandemic shutdown occurred early last year. It is worth the peace of mind to set aside at least 4 months—and even better, 6 months—of cash as protection for the future. 6. Create a detailed strategic plan. If you're not doing this one thing, you need to start. There is a reason that the best businesses, including those that have nothing but success, do annual strategic planning. Strategic planning is an intense process utilized by the most successful companies…

4. Page 10

   Living Authentically in the Field of Dentistry Maggie Augustyn, DDS, discusses how to rid the instinct to compare and to move forward in authentically living out your own true story. Q: Why are we driven to compare? A: The modern western culture seems to be driven by our own self imposed and, dare I say, destructive comparison to others; it may have become an art form of sorts. Terms such as "keeping up with the Joneses" or "the grass is greener on the other side" spill out into daily conversation and are frequently associated with pop culture. As I, myself,…

5. Page 14

   The Ritter Spiral Implant A prospective study on the survivability of 100 consecutively placed implants in healed sites with a one-stage approach. Evaluation and followup at 1 year post-final restoration. A multi-center study. Abstract Purpose: To assess implant success and survivability of 100 consecutively placed Ritter Spiral Implants placed between 2016 and 2019 in a private practice setting. Materials and Methods: Over a 3.5-year period, 70 patients underwent single-tooth implant placement in post-extraction sockets or healed sites. Implants were placed in a one-stage approach with healing abutments placed at the time of surgery. Clinical and radiographic measurements of vertical bone…

6. Page 16

   Ritter Spiral Implants displayed a high survival rate and success rate after one year of functional load when utilizing standard delayed loading implant protocols in intact and healed ridges throughout the oral cavity. continued from page 14 placement as well as a diagnostic wax-up to allow for a prosthetically driven treatment plan. 2.3: The Implants. The implants used (Ritter Implants, Germany) were Grade 5 titanium, internally hexed, roughened and tapered root form implants with SB/LA, grit-blasted/large particle acid-etched macro-surfaces of 20 to 40 μm and micro-surfaces of approximately 2 μm. The roughened micro-surface of the Ritter Spiral Implant is created…

7. Page 18

   Figure 2. (a) A healed ridge post-extraction in the mandibular molar region. (b) Placement of 6.0-mm x 11.5-mm Ritter Spiral Implant through a flapless approach. (c) Radiograph taken at one year after final restoration. (d) One year following final restoration of the implant. continued from page 16 placed at the time of surgery). 2.5: Outcomes of the Study. During each follow-up visit (2 weeks post-implant placement and approximately every 4 months thereafter) and until the conclusion of the study (one year following placement of final restoration), a clinical and radiographic assessment of the implants, peri-implant tissues, and prostheses were carried…

8. Page 20

   SPECIAL ADVERTISING SECTION continued from page 18 at one year were also analyzed. Any noticeable color changes of the soft tissue were assessed via photographic and clinical inspection. Results In total, 70 patients were enrolled in the present study. The mean age of these patients was 53 years. A total of 100 implants were inserted in this study. All were placed in previously grafted sites in multiple private practice clinical settings. With regard to the position of the implants, 41 were placed in the anterior region, 35 were placed in the premolar region, and 24 were placed in molar sites.…

9. Page 22

   Figure 4. (a) PA radiograph of the healed ridge in a maxillary molar site. (b) Placement of a 4.2-mm x 11.5-mm Ritter Spiral Implant through tissue in an incisionless approach. (c) PA radiograph after a one-stage placement with a healing abutment. (d) Three-years post-op PA radiograph. continued from page 20 load when utilizing standard delayed loading implant protocols in intact and healed ridges throughout the oral cavity. This success was achieved in all areas and under various clinical conditions, such as healed extraction sites and grafted sites, including previously grafted sinuses and narrow ridges in combination with osseous augmentation and…

10. Page 24

    SPECIAL ADVERTISING SECTION continued from page 22 Dr. Tadros started his dental journey at Georgia Regents University in August of 2010 and had obtained his DMD degree by May 2014. Upon graduation, he received "Best of the Best in Prosthodontics" award. Dr. Tadros was also awarded first place in the esthetic competition at the "Digital Smile Design Mania" Spear Week" conference in 2014. His prosthodontic expertise and his great chairside manner led him to pursue a 3-year residency program that specialized in prosthodontics at Augusta University. At Augusta University, his main practice is also involved in the Ronald Goldstein Center…

11. Page 26

    Social Robot Alleviates Patients' Stress During Medical Treatments GLENDALE, Calif.–Robin the Robot from Expper Technologies is a social robot designed to support children during medical treatments and alleviate stress and anxiety by fostering meaningful connections. Robin utilizes AI-based peer-to-peer interactions, empathic conversations, and various therapeutic techniques to support children undergoing medical treatments and decrease stress. From children to adults, Robin has the ability to transform a friend, learning the person's name and relating to him or her through exciting conversations about his or her favorite movies, toys, and future dreams. Robin is also a great educational and motivational tool, helping…

12. Page 28

    Teledentistry Platform Boasts Extensive Video Features METUCHEN, NJ–TeleDent from MonthWatch offers 3 main enhancements, including improved video conferencing, integrated provider chat, and a robust patient portal. The platform now offers multi camera support for intraoral images. This allows webcam video and intraoral camera video to be streamed into the same video conference session. It also offers the ability to create freeze-frame video images. With this feature, clinicians can quickly capture still images from a video feed and save them right into the patient's records. Also, entire video conferences can now be recorded, shared, and replayed. The system is secure and…

13. Page 30

    Chair Combines Technology of Electronics and Movement of Hydraulics SAN ANTONIO–Upgrade your practice with Ritter Dental USA's German engineered Vanguard and the Vanguard Smart dental packages. The Vanguard combines the technology of electronics and the smooth movements of hydraulics in Ritter Dental's most popular dental unit. The left and right 360° unit can be very easily switched from right-hand use to left-hand use. The patient chair is synchronized and also offers a 30° swivel. This package comes standard with an upgraded LED operating light and all of the quality and features that you have come to expect from Ritter Dental.…

14. Page 32

    Desensitizer Enables Mineralization to Occur, Resulting in Sealing of Tubules EDGEWOOD, NY-Parkell's Predicta Bioactive Desensitizer is changing the way clinicians treat dentin hypersensitivity by using the elements that are naturally found in the tooth (calcium and phosphate) and restoring them to the tooth in the form of hydroxyapatite plugs that quickly block the open dental tubules. Then, as calcium and phosphate ions continue to release, mineralization occurs to further seal the tubules. Predicta Bioactive Desensitizer is also considered highly biocompatible as there are no metal lates of soft tissue-irritating chemicals used during production. Additionally, it's easy to use, no-mix gel…

15. Page 34

    Face Shield Provides Effortless Adjustments in Length and Angulation CHICAGO–Gazooli has designed a protective face shield specifically for those clinicians who wear larger, longer-barrel loupes and mounted light systems. Frustrated with other products on the market that proved unusable or ineffective, this face shield was dentist designed and tested to ensure easy accommodation of all brands and sizes of loupes and lights. The durable, 100% optically clear, replaceable shields can be adjusted in length and angulation. Lengthening the shield is effortless and does not sacrifice interior room up front. Crafted to meet modern demand for both comfort and durability, the…

16. Page 36

    Polishing System Delivers Consistent Performance BROOKFIELD, Conn.–The A.S.A.P. Dailies polishing system from Clinician's Choice Dental Products is designed for multiple uses in a single day, delivering consistent performance after a minimum of 3 sterilization cycles, as well as providing fast, efficient, and effective polishing. Diamond impregnated A.S.A.P. Dailies create a high luster on most restorative materials, such as composite, zirconia, and lithium disilicate, eliminating the need for stocking inventory of multiple systems to polish different substrates. The A.S.A.P. Dailies technique is fast and simple and does not require the use of a polishing paste. For more information, call Clinician's Choice…

17. Page 38

    In-Office CAD/CAM Systems Benco Dental OneVisit brings lean production to same-day dentistry. It is open, affordable, efficient, and consistent. The OneVisit CAD/CAM portfolio comprises profession-leading intraoral scanners, chairside mills, blocks, and 3D printing solutions that work together to create a seamless digital workflow. Benco Dental boasts a manufacturer lineup with products from 3M, Align Technology, Amann Girrbach, Carestream Dental, EnvisionTEC, Formlabs, Glidewell, Roland, Straumann, and VITA. For more information, call (800) BENCO or (462-3626), option 5, then press 1, or visit benco.com. FREEinfo, Align Technology The iTero Element 5D Plus imaging system in cart configuration is the latest generation of…

18. Page 40

    Industry News Delta Dental Awards $500,000 Grant to Meals on Wheels The Delta Dental Community Care Foundation and Meals on Wheels San Francisco will partner to improve the oral health of the Bay Area's most vulnerable seniors, the organizations said, with a $500,000 grant to support operations and begin planning future work. Seniors face unique oral health challenges but are unfortunately overlooked, Delta Dental said, noting that getting older should not mean that one has to live with oral health issues or tooth loss. "Improving the oral health of older adults is a priority for the Delta Dental Community Care…

19. Page 42

    The New BruxZir Lifetime Warranty As a statement of Glidewell's ongoing confidence in BruxZir Zirconia, the company is extending the warranty of all BruxZir restorations produced at Glidewell Laboratories from 7 years to the lifetime of the patient. This new BruxZir Lifetime Warranty enables clinicians to have their BruxZir cases remade for free should the restoration fail during the patient's lifetime. PRESCRIBE BRUXZIR WITH CONFIDENCE Intended to give clinicians extra peace of mind, this no-cost dental warranty extends to any BruxZir Zirconia restorations made at Glidewell, including crowns, bridges, veneers, inlays, onlays, screw retained crowns, and full arch implant prostheses.…

20. Page 44

    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. MouthWatch TeleDent is an award-winning teledentistry solution that helps dentists encourage patients to seek and continue treatment in a post-pandemic world. Thanks to new features, such as an intuitive, mobile-friendly patient portal; text messaging; and an online patient uptake form, TeleDent is the smart choice when it comes to connecting with patients in the safe and convenient way they need—and that many now demand. New…

21. Page 46

    Top 25 Aesthetic/Restorative Products Advantage Dental Products After 20 years of clinical success, chlorhexidine is still proving to be a more effective antimicrobial than glutaraldehyde, as reconfirmed in the laboratory by DENTAL ADVISOR in 2019. Ideal as a cavity cleanser and desensitizer in all direct and indirect bonding and cementation procedures, even in deep lesions, Hemaseal & Cide is glutaraldehyde-free and cannot burn soft tissues. Tested and highly rated by CRA, DENTAL ADVISOR, REALITY, and Catapult, the product is economically priced and available in bulk bottles or convenient, hygienic unit-dose vials. Free samples are available on Advantage Dental's website. For…

22. Page 48

    Top 25 Aesthetic/Restorative Products Align Technology SmartTrack material is Align Technology's patented technology designed exclusively for Invisalign clear aligners. It is based on 8 years of research and development, engineering, and testing of more than 260 candidate materials using the company's significant expertise in biomechanics and materials science. SmartTrack material is designed to optimally deliver the desired force systems and provide greater predictability of tooth movement in simple to complex cases. Compared to aligners made from single-layer polymeric material, Invisalign aligners, made of patented SmartTrack material, straighten teeth with 75% more predictability. They provide better fit, better comfort, have lower…

23. Page 49

    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 KóR 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 KóR 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…

24. Page 50

    Top 25 Aesthetic/Restorative Products Tokuyama Dental America OMNICHROMA is the true universal composite that matches every patient's tooth shade, from A1 to D4, with a single shade of composite. Rather than relying on dyes or pigments to achieve a certain shade, this unique composite utilizes a phenomenon called structural color. OMNICHROMA's Dichrom suprabright spherical fillers are the precise shape and size necessary to generate a red-to-yellow color. As ambient light reflects off the surrounding dentition and passes through the composite, it creates a perfect match. This revolutionary technology has been developed through the culmination of 35 years of research and…

25. Page 51

    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 pass, easy placement up to 5 mm—no need for layering or expensive dispensing devices. The company's unique Smart Contrast Ratio Management matrix results in superwear resistance and excellent polish retention, as well as increased opacity without sacrificing depth of cure. Available in 5 shades, Filtek One Bulk Fill Restorative enhances 3M's…

26. Page 52

    Selfie Culture, Young Adults, and Cosmetic Dentistry Snapchat Dysmorphia Creates New Aesthetic Demands From Teenagers and Young Adults INTRODUCTION Social Media has arguably become a global obsession. For teenagers and young adults, Facebook, Twitter, Instagram, Snapchat, and TikTok have become the most common platforms for communication. If you have ever felt your teens feeling bad about yourself, you are not alone! Selfesteem often takes a hit when one starts comparing him or herself to other people too much, which in turn undermines social media seems to be made for. Social media presents a unique set of challenges for those who…

27. Page 54

    Figure 1. Preoperative photo: A 14 year old girl was unhappy with her appearance due to her dental diastema. Figure 2. Heavy labial frenum above the diastema. Figure 3. Postoperative photo: The patient was treated with a frenectomy, whitening, and a direct composite resin. The confidence and esteem in this 14-year-old's smile. Figure 4. Pre-op photo: A 16 year old was disappointed with her smile post orthodontic treatment due to shade, white spot lesions (WSLs), and a gummy smile. Figure 5. WSLs were removed with resin infiltration. Gingival sculpting with a Gemini Laser (Ultradent Products) shown with the left side…

28. Page 56

    Figure 11. Pre-op photo: This 28-year-old had rotated teeth that would have required significant reduction for the veneers she requested. Figure 12. Limited orthodontics were performed prior to the restorative work so that minimal preparation of the teeth could be done. Figure 13. Post-op photo: Upper contrals and laterals, veneered after preprestora-tive, limited orthodontics. CASE 2: GINGIVAL SCULPTING, RESIN INFILTRATION, WHITENING Post orthodontic treatment, a 16-year-old was disappointed with the appearance of her teeth. Although her orthodontics resulted in good occlusion, she did not have confidence in the appearance of her teeth. Her smile was a bit gummy; WSLs were…

29. Page 57

    AESTHETICS 2 weeks later. The patient was very pleased with the results (Figure 10). CASE 4: PRERESTARATIVE LIMITED ORTHODONTICS, MINIMAL-PREP VENEERS, WHITENING This 28-year-old female patient's chief complaint was the appearance of her smile — in particular, her upper anterior teeth. Her dentition was generally healthy with no restorations. Her periodontium was healthy. The teeth were misshaped and chipped, and the central incisors were rotated mesially (Figure 11). Treatment options included: 1. Orthodontic treatment alone. This option was ruled out because even if the alignment was corrected, veneers were indicated to improve proportion and restore wear to meet the patient's…

30. Page 58

    Innovations to Maximize Implant Results This issue of Dentistry Today has a few awesome clinical implant cases describing the most innovative and productive methods of idealizing dental implant placement, immediate loading with full arch prostheses, and the use of digital scanning tools for final impression making. Guided surgical protocols have become all the rage in implant dentistry. The ability to visualize the placement of implants and also the prosthetic design using CBCT analysis and CAD/CAM software helps the practitioner gain confidence in understanding vital anatomy and final tooth positions. To achieve this, Dr. Paresh Patel contributed "Fully Guided Full Arch…

31. Page 60

    Fully Guided Full-Arch Implant Reconstruction The ongoing global pandemic has put healthcare professionals around the world at the front lines against unprecedented challenges. Consequently, many in the dental field are striving to keep their practices operating safely during such crucial times, being able to assist patients with the same efficiency while maintaining the required safety measures. For implant cases, the importance of a streamlined computer-guided surgery workflow has significantly increased as a means to meet such high standards of infection control without compromising efficiency. In this case study, we will demonstrate how adopting the latest guided surgery techniques can make…

32. Page 63

    Figures 12 to 14. Digital design of the abutment guide, along with the 3DDX Abutment Guide being placed for inspection and placed clinically with multi-unit abutments adjusted into correct orientation. Figures 15 to 17. Digital design and fit of the hybrid restoration, clinical try-in, and relining of the maxillary provisional were done. The provided custom-made polyvinyl siloxane gasket was placed to prevent the restoration from locking on during the pickup procedure. Figures 18 and 19. The finished maxillary restoration and final result. Figure 20. The patient's before and after photos. ...assist patients with the same efficiency while maintaining the required…

33. Page 64

    Continued Innovation for Full-Arch Immediate Loading Small Access Hole Technology INTRODUCTION Full arch, implant-supported restorations have become an essential treatment option for patients who wish to have a fixed prosthetic replacement.¹ Technological advances enable clinicians to provide implant supported restorations via comprehensive, 3D planned guided surgery protocols for immediate loading and delivery of transitional prostheses on the same day.² The ability to link restorative planning with the surgical placement of dental implants has been made possible with a combination of software applications and improved hardware components for both the surgical and restorative phases of implant reconstruction. Many of these concepts…

34. Page 66

    Continued Innovation for Full-Arch... continued from page 64 ceramo-metal restoration and areas of significant bone loss and pathology can be visualized in both arches on the panoramic reconstruction view taken from the CBCT scan (CS 9600 [Carestream Dental] [Figure 1]). The intraoral retracted photo revealed poor oral hygiene as well as swollen and edematous gingival tissue (Figure 2). The procedures were reviewed with the patient, and after hygiene visits, the patient was ready to receive a dual arch reconstruction using the CHROME GuideSMIL (patent-pending) methodology. As per the procedures described in our 2019 Dentistry Today article,1 all implants were carefully…

35. Page 68

    Continued Innovation for Full-Arch... continued from page 66 DISCUSSION Full arch, implant-supported reconstruction is a proven treatment alternative for patients with terminal dentitions or those who are already in an edentulous state. As each patient's anatomical presentation is unique and different, a thorough preoperative 3D evaluation is required to understand each case's pre-existing bone and soft-tissue conditions. Planning for guided surgery treatment modalities allows for a total appreciation of the patient's occlusion and the desired functional and aesthetic outcome. The dilemma, however, has often been how to relate the prosthetics to the planned position of the implants at the time…

36. Page 70

    Impression Making of Implants Made Easy INTRODUCTION Surgical placement of dental implants has become routine for many general practitioners. With the advent of CBCT diagnosis and treatment planning, critical anatomy is understood and evaluated. Endosseous dental implants have come a long way with design improvements that perform at a high level and create excellent long-term prognoses. The surgical burs used to form the osteotomy sites are precise and predictable. With proper education and training, the GP can perform many surgical procedures to restore form and function to patients. Dental implants are simply pieces of titanium, which is a biocompatible material…

37. Page 72

    IMPLANTS final screw-retained zirconia crown (BruxZir [Glidewell]) is seated and torqued to 35 Ncm. The access hole is covered with a composite resin (Figure 7). The final digital radiograph illustrates a complete seating of the implant-retained crown. Note the plate-form switch design of the prosthesis (Figure 8). A second implant (Hahn) is placed in a previously grafted site. A healing abutment is torqued into the implant (Figure 9). The healing abutment again provides for the Figure 3. The healing abutment provides for tissue cuff formation and the elimination of a secondary uncovering of the implants. Figure 4. Upon removal of…

38. Page 73

    Digital scanning provides a cost-and time-effective alternative to conventional impression techniques. INTRAORAL SCANNING Choosing the right intraoral scanning tool for predictable digital impressions can be a challenge. There are many high-quality products available that improve productivity using this technology. However, there needs to be a discussion on the return on investment.¹ Certainly, conventional impression techniques are adequate to create crowns and bridges over our dental implants, but digital scanning may have advantages for the practitioner. Items to consider include the initial investment of the armamentarium, time savings during the procedure, the ability of the dental team to accept the technology…

39. Page 74

    IMPLANTS in our patients' mouths creates the patients' positive response." Intraoral scanners have become a modern method of directly capturing crown and bridge and denture impressions. The rationale for their use includes accuracy, time efficiency, and simple clinical protocols that minimize discomfort for the patient. Accuracy is immediately determined, and the information is used for chairside milling or for virtual deposition to a dental laboratory. Digital designs can be created and approved. It is imperative that the site be digitally impressed and blood free. Very deep margins can be challenging to duplicate. These optical impressions may reduce working time as…

40. Page 76

    Whitening Systems IN-OFFICE WHITENING SYSTEMS Philips Oral Healthcare Philips Zoom WhiteSpeed is the No. 1 patient-requested professional whitening brand in the United States (data on file). The light-accelerated, in-office whitening treatment is clinically proven to whiten teeth up to 8 shades in 45 minutes with safe and effective customizable options to address individual sensitivity and stain levels. Three lamp-intensity settings, with advanced blue LED light-accelerated whitening, offer clinically superior results and efficacy compared to other professional whitening alternatives. For more information, call (800) 422-9448 or visit philipsoral healthcare.com. FREEinfo, DenMat The LumiShade White In-Office Professional Whitening System whitens a patient's…

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