Dentistry Today — May 2022

Inside this issue

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

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   DENTISTRY TODAY CONTENTS MAY 2022 · VOLUME 41 · NO. 4 LASERS 49 A Roadmap to Success in Managing Early to Severe Peri-implantitis Drs. Samuel B. Low and Paul Chang look at multiple peri-implantitis scenarios and discuss treatment modalities from monitoring (watch and wait) to replacement with a new implant fixture. Several treatments are discussed, including erbium laser therapy for decontamination, degranulation, and decorication. IMPLANTS 56 Immediate Implant Placement and Provisionalization for Type II Sockets: A Case Report Dr. Brian J. Jackson discusses the clinical management of a deficiency of the facial plate of bone and shares a case that…

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   Out of Time May brings us to a seemingly calmer time of the year: getting rid of winter remnants, thinking about booking that trip in the summer and what will the children do for those 2 months. Of course, this all depends on what stage of life you are in. No matter what, you should sit back right now, put your office worries on a temporary shelf, and think about where you are and, in fact, why you are working so hard. We are pretty much caught up with patients who fell through the cracks over the past 2 years.…

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   The Great Resignation and The Path Forward Throughout the pandemic, dentists and professionals in their practices have provided crucial care while facing once unimaginable circumstances. Today, many are exhausted, stretched thin, and in need of relief. The good news is that although there is no silver bullet—think technology alone is not the answer—there is a path forward. In the beginning of the pandemic, when the threat of COVID-19 was raw and unknown, our centers at Solutionreach experienced a 500% increase in call volume as dentists shuttered their practices. At first, we all assumed it was a short-term situation, but as…

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   VIEWPOINT continued from page 8 on Dental Practices core results for the week of December 13, 2021, that more than half of dentists (51.4%) either "definitely" or "may" hire more staff in the next 3 months. That last point can be read as a step to alleviate the pressure placed on staff in their practices or, alternatively, as one to replace those who are burned out, need a break, found a new job, or decided to leave the dental field. Regardless, one thing is clear: There is going to be more competition for skilled dental clinicians and administrators. So even…

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   In-house Laboratory Technicians Paul Feuerstein, DMD, editor-in-chief of Dentistry Today, talks with Michael Verber, DMD, chairman and CEO of the Verber Dental Group, and Brett Mays, CDT, technology manager at VerTrue Dental Lab, to discuss hiring an in-house lab tech. Q: What drove you to create this business model? Dr. Verber: When the local dental lab that my father and I had used for decades sold to a larger corporation, we recognized a need for a patient centered, team driven lab component to our Dental Health System (DHS). Some of the more complex interdisciplinary implant and reconstructive cases in particular…

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   DirectaDentalGroup DIRECTA topdental ORSING parkell physics forceps RØNVIG TrollDental Sendoline CONTACTEZ TrollDental FOCUS TrollDental was established in 1972 in TrollHättan, Sweden and was acquired by Directa AB in May of 2020. TrollDental is known for its innovative and high-quality products such as TrollMounts, TrollFoil, TrollBags and TrollByte digital sensor holders. Today, we are proud to announce our new Bio-Product line to meet the demand for environmentally friendly products. Troll Foil Flagship products TrollFoil Occlusal adjustments are critical and often time-consuming in restorative dentistry. Misleading markings can lead to occlusal disturbances and unnecessary adjustments. TrollFoil offers very precise markings in clinical…

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   Panoramic System Compatible With Most Practice Management Software ROSLYN, NY-The I-Max Ceph 2D Panoramic Unit and the I-Max Ceph 3D Panoramic Unit from Owandy Radiology can easily switch between 3D and 2D modes at the touch of a button. The systems share the following features, including (1) a small footprint; (2) an ultra-sensitive sensor with short exposure time; (3) standardand reduced dose ceph exam options; (4) an intuitive and user friendly interface; (5) compatibility with most practice management software; and (6) a 5-year warranty. The I-Max 2D cone beam and I-Max Ceph 3D (3-in-1 unit) include the following additional features:…

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   Imaging System Provides Intuitive Scanning Experience SAN JOSE, Calif.- The iTero Element 5D Plus imaging system from Align Technology in cart configuration is a powerhouse of capabilities designed to improve the practice and patient experience with state-of-the-art computing power, elegant design, and ideal ergonomics. Enhanced, more detailed visualizations with wider viewing angles provide an unmatched patient experience. Powerful computing advancements enable a smoother and more intuitive scanning experience. The system is ergonomically designed to conform to how practices scan. The integrated intraoral camera eliminates the need for a second device while enhancing the patient experience and communication. Near-infrared technology aids…

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   Patient Chair Combines Technology of Electronics With Smooth Movements of Hydraulics SAN ANTONIO—Upgrade your practice with Ritter Dental USA's in Ritter Dental's most popular German engineered Vanguard dental unit. The left and right 360° and Vanguard Smart dental packunit can be very easily switched ages. The Vanguard combines the from right-hand use to left-hand technology of electronics and the use. The patient chair is synchrosmooth movements of hydraulics. nized 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…

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    In-Office CAD/CAM Systems Align Technology The iTero Element 5D Plus imaging system in cart configuration is a powerhouse of capabilities designed to improve the practice and patient experience with state-of-the-art computing power, elegant design, and ideal ergonomics. Enhanced, more detailed visualizations with wider viewing angles provide an unmatched patient experience. Powerful computing advancements enable a smoother and more intuitive scanning experience. The system is ergonomically designed to conform to how practices scan. The integrated intraoral camera eliminates the need for a second device while enhancing the patient experience and communication. For more information, call (800) 577-8767 or visit itero.com. FREEinfo,…

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    PRODUCT FOCUS exocad America ChairsideCAD is the first open-architecture CAD software platform for single-visit dentistry. It's based on exocad's leading DentalCAD lab software, renowned for its reliability and robustness. ChairsideCAD supports various indications, dental restorations and appliances and can be upgraded with numerous add-on modules. A wide range of intraoral scanners, production systems, and materials is supported. For cases not produced in the practice, users can take advantage of the integrated communication platform dentalshare to easily collaborate with labs of their choice. For more information, call toll-free at (855) EXO-4CAD (396-4223) or visit the website located at exocad.com/chairsidecad. FREEinfo, Planmeca…

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    Dental Industry SA is Committed to Reliability, Customer Service, and Competitive Prices Factory Site of DMP Dental Industry SA. DMP employees taking part in the Athens Marathon with some of their children. Quality Control at DMP Laboratory. Maria and Vassilis Prantsidis. From left to right, Rania, Vassilis, Dimitris, and Maria Prantsidis. DMP research team with the company owners. History of DMP Dental Industry SA DMP was established in 1985 by Dimitris Prantsidis, who graduated from school in the UK with degrees in biochemistry and pharmacology. He was joined by his wife, Rania, (a graduate of Birmingham University), where he met…

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    DMP DENTAL 35+ Years of Clinical Excellence DISCOVER OUR UNIQUELY FORMULATED IMPRESSION MATERIALS BONA-BITE & BONASCAN BITE-AIR Can Your Bite Material Stack Up Like This? Unique formula uses advanced molecules to create a very stiff, yet not brittle network with physico-mechanical properties that are hard yet flexible. Test your bite today and see if you can make a slump-free cone like you see here in our BONA-BITE Air image. Higher Tear Strength: 40-50% higher tear strength to withstand forces applied during removal Superior Dimensional Stability: for a more accurate bite Faster Reached Final Shore A Harness: prevents distortion during intraoral…

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    The Story of Munce Discovery Burs C. John Munce, DDS Well into the early 2000s, no endodontist/typically inspiring long/stiff/narrow-shafted trough-ing bur existed. In 2003, to meet my own clinical needs, I began modifying the shafts of existing latch-type, slow-speed round carbide burs by pecking them down at the chairside as needed for a specific clinical case (Figures 1 and 2). Figures 1 and 2. The lack of a long/stiff/narrow-shafted troughing bur led to shared bleachner to meet the need. In a lecture at the anesthesia meeting of the 2005 American Association of Endodontists (AAE) Annual Session in Dallas, I demonstrated…

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    COMPANY PROFILE 27 (Figure 4). Target area: The place where the head of the bur is to perform its work. The target area becomes much more visible because of the longer/narrower shaft as mentioned above (Figure 1). Shaft stiffness: This is a necessary feature of the position control provided by these burs. Other long-shafted burs have shafts that are too narrow, sacrificing control and leading to "noodling" of the shaft under toughing and other operations (Figure 5). Noodling: This is not a feature of the Munce Discovery Burs. This undesirable feature was specifically designed out of the Munce Discovery Bur…

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    Wireless Scanner Provides Convenience Without Worrying About Any Interruptions SEOUL, South Korea-Medit's new i700 wireless scanner upgrades the already popular i700 with wireless technology to make scanning easier than ever before. What's so innovative about a wireless version of an existing product? The i700 wireless uses powerful 5G Wave technology that's used in the latest smartphones to securely transmit uncompressed 4K images on a 60-GHz frequency band. This means one can enjoy the convenience of one of the most lightweight wireless devices without worrying about retakes due to interruption. There's no need to worry about battery time, thanks to the…

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    Iodine Oral Rinse Provides Rapid Breath Freshening BOCA RATON, Fla–Iotech International's ioRinse RTU Soft Mint is the latest generation of molecular iodine oral rinses. This new formulation features all of the efficacy of iotech's previous rinses and incorporates a "hint of lingering mint" flavor. In regional taste panels, it was judged best in class for its subtle, yet lasting, minty freshness. It was the flavor of choice for most of the taste panelists. It also received commendations for its ultra-rapid breath freshening and because it incorporates xylitol (rather than saccharin) in its formulation. The ioRinse RTU Soft Mint is available…

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    Cordless Endodontic Motor Offers Customizable Rotary Settings LAS VEGAS—Meidenta's ACE Advanced Cordless Endodontic motor is a compact, continuous, and reciprocating ergonomically designed cordless base cordless motor with an accurate built-in apex locator. It's a silent, brushless motor with a 6:1 mini slim neck contra-angle and Proprietary Genius AutoSense technology that helps to avoid file separation. The ACE also features 8 customizable rotary settings and 3 reciprocation and preset file programs for easy use. It offers a lot of auto safety features. For more information, call Medidenta at (800) 221-0750 or visit medidenta.com. FREEinfo, Calcium Silicate Protects Dental Pulpal Complex SCHAUMBURG,…

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    Innovative Products From Medidenta in 2022 iClean Automatic Lubrication Maintenance Unit The iClean Automatic Lubrication Maintenance Unit is an easy-to-use automatic lubrication unit that will save office time and extend the life of handpieces. It was designed in response to dentists' requests. Its user-friendly interface simplifies the process of cleaning handpieces. It takes just 15 seconds to clean and lubricate each handpiece and less than one minute for 3 at a time. In order to improve user experience, the iClean includes these exceptional details: (1) an LCD Screen, (2) a simple dis-assembled front door, (3) an exclu-sive chuck care system,…

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    Industry News Smile Generation Partners With charity: water Smile Generation and charity: water partner for campaign, which will benefit Uganda. Smile Generation and its nationwide network of trusted dental practices has launched a 2-month fundraising campaign to support charity: water, a non-profit organization that brings clean, safe drinking water to people in developing countries. The campaign, "Give Water. Make Someone's Life More Beautiful," started running April 1 and will continue until May 31. It is expected to raise at least $600,000. All funds raised will go toward providing clean drinking water to vulnerable populations in Uganda through the construction of…

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    Periodontitis and ED... continued from page 37 which provided an increased statistical power of 88%. The followup went from January 2015 to March 2020. A dentist reviewed the hospital medical records of each patient to obtain data about newly diagnosed comorbidities and the occurrence of any major cardiovascular events. Also, telephone calls were placed to each patient to obtain confirmation and further information, if available, regarding any major cardiovascular events in all the study participants. The major cardiovascular events were found to occur, on average, 4 years after the sexual dysfunction was diagnosed. Even though the research was not meant…

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    DENTISTRY TODAY 10th ANNUAL 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. 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 of up to 5 mm—no need for layering or expensive dispensing…

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    Readers' Choice Top 25 Aesthetic/Restorative Products BISCO Dental Products TheraBase is a dual-cured, calciumand fluoride-releasing, self-adhesive base/liner. It combines MDP chemically bonds to tooth structure, and utilizes THERA nology. It is radio-opaque, allowing for effective identification on radiographs. Its dual-cure ability ensures the material will cure even in deep restorations where light cannot reach. Developing innovative restorative solutions for practitioners is always the goal of the BISCO team, and nothing epitomizes that more than the Thera family line of products. The Thera family is an award-winning line of products that simplifies procedures for clinicians while providing the added benefit of…

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    Readers' Choice Top 25 Aesthetic/Restorative Products Align Technology Invisalign G8 with SmartForce Aligner Activation was created thanks to the company's foundational biomechanics for clear aligners and its database of more than 12 million Invisalign patients. It optimizes tooth movements and further improves predictability for frequently treated crowding, open bite, and deep bite cases. With SmartForce Aligner Activation, select areas of the aligner surface are specifically contoured to apply optimal forces to the tooth surfaces to control the location, directions, and intensity of the force to produce the desired outcome and minimize unwanted movement. Specific, strategic contact areas between the aligner…

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    Readers' Choice Top 25 Aesthetic/Restorative Products DMP Dental Bright Temporary C&B is a self-curing composite for temporary crowns, bridges, inlays, and onlays. It is a unique combination of nanosized particles and ideally sized glass filler that provides enhanced composite strength. Its elastic properties provide easy, glaze-free placement with the added advantage of the company's Chameleon Effect that matches shade, opacity, and fluorescence for a natural look. It offers 2 significant benefits, including (1) a short trim and finish time of 3 minutes, which eliminates the need for glazing and polishing, and (2) its convenience, which provides a 1:1 ratio that…

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    Premier Dental ZR Cem is an innovative, self-adhesive, universal resin cement with unique features that can make it a great choice for definitive cementation. The adhesive monomer 10-MDP facilitates a strong bond to all crown and bridge materials, especially zirconia. It also features a novel catalyzing system that is benzoyl peroxideand amine-free, which helps ensure excellent color stability and eliminates the need for refrigerated storage. To help dentists prevent overcuring during the critical clean-up phase, ZR-Cem's dual adhesive resin cement allows a tack-cure window of up to 3 seconds on the buccal and lingual surfaces. For clinicians who do not…

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    Readers' Choice Top 25 Aesthetic/Restorative Products Clinician's Choice Whatever one's technique or indication is, Evanesce Universal Restorative is designed for truly natural, lifelike aesthetics. Evanesce nanohydrid composite's non-sticky formulation is easy to manipulate and highly adaptable, and, once placed, it is easily sculpted without slumping to save on finishing time. It is available in 30 VITA shades and 3 opacities and polishes to an ultra-high, long-term shine in seconds. High-strength Evanesce E-Stick blend boasts a high compressive strength, low wear, and low shrinkage to provide confidence for anterior and posterior restorations. For more information, call toll-free at (800) 285-3448 or…

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    Roadmap to Success in Managing Early to Severe Peri-implantitis INTRODUCTION With the significant number of endosseous root form implants placed each year (approximately 3 million in the United States), there continues to be a direct proportional increase in peri-implantitis cases. The number varies per study, with reports of 26% in patients.¹ Likewise, there are multiple opinions on the etiology of implant disease that vary from the always mentioned biofilm-induced to restorative-related issues to today's theories, including the theory of titanium implant corrosion. The American Academy of Periodontology now includes a classification of implant disease. It suggests that the definition is…

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    Figure 1. The patient presents on examination with significant recession, bleeding, and suppuration on probing around an implant in the maxillary left central area. Figure 2. A radiograph demonstrates bony resorption around the implant with the appearance of angular defects. Figure 3. Vertical incisions were made for access, sparing interdental papillae, and the removal of granulation was accomplished with an all-tissue laser (Waterlase Express [BIOLASE]) utilizing a radial firing tip. Figure 4. To detoxify/decontaminate the titanium surface, a unique sapphire right-angle tip was aimed into the pitch of the threads and cleaned the surface for future re-osteointegration. Figure 5. An…

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    Figure 11. The patient presented with a gingival abscess around a maxillary left canine with bleeding on gentle probing and substantial suppuration on palpation. The pocket depths were in excess of 10 mm. Figure 12. The radiograph demonstrated major osseous resorption circumferentially around the implant with a large 3-wall defect on the mesial site. Figure 13. Vertical incisions were performed to provide access to the implant site. Significant granulation tissues were associated with the bony defect. Figure 14. The Er,Cr:YSGG laser with a radial firing tip was utilized to remove the granulation tissue. The side-firing tip directed energy at right…

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    Immediately Loading Implants and Site Preparation This issue of Dentistry Today provides some practical information to our readers on the advantage of immediate implant placement and prosthodontation from Dr. Brian J. Jackson. In this age of quick gratification from fast food to Amazon Prime, our patients often present requesting teeth the same day. This is sometimes a challenge depending on the particular circumstances we face. The amount of available hard tissue following extraction, loss of facial plate, anatomic anomalies that make implant replacement defying, and infection are only a few issues. Emergent profile and smile esthetics are critical factors in…

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    Immediate Implant Placement and Provisionalization for Type II Sockets: A Case Report INTRODUCTION The discipline of implant dentistry has grown dramatically over several decades because predictable outcomes have been demonstrated. Successful outcomes have been exhibited in the areas of osseous integration and aesthetics. The conventional, delayed implant approach was based on a stress free period to establish integration.¹ Immediate implant placement and provisionalization (IIPP) is a minimally invasive approach that combines several implant principles to reduce treatment times and eliminate removable partial dentures.² Clinicians agree that challenges exist in attempting to achieve ideal aesthetics.³ Knowledge of hardand soft tissue responses…

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    Immediate Implant Placement and... continued from page 56 radiograph was taken to confirm an accurate fit (Figure 11). An accurate fit was not achieved, and the Zr abutment was removed. Local anesthesia (one carpule of 2% Lidocaine [8 mg] with 1:100,000 epinephrine) was administered in a buccal and palatal infiltration manner. A 15c blade and a double ended molt curette were utilized to incise and debride the hyperplastic sulcular tissues. The abutment was reseat ed, and a periapical radiograph was taken to confirm an intimate fit between the Zr abutment and the implant platform (Figures 12 and 13). The retaining…

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    Successful Implant Integration INTRODUCTION Implants are already recognized as essential to enhancing a patient's quality of life. To ensure successful integration of the oral implant in the patient's edentulous area, implants are now being developed in all different sizes, shapes, and widths, with various grooved surfaces and designs. This facilitates prosthetic restoration and the return of function. However, to achieve successful implant integration, aesthetic enhancement must be considered as an added possibility, along with phonetic improvement, when needed. The practitioner's goal is for a patient to be able to enjoy improved mastication as well as to speak with confidence. The…

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    Figure 3. Tooth No. 31 (LR second molar) with the temporary crown off, showing caries and broken tooth structure. Figure 4. Tooth No. 30 with its temporary crown off, exposing poor remaining tooth structure, and poor prognosis for both teeth Nos. 30 and 31. Figure 5. Tooth No. 30 crown portion divided into 2 halves. Figure 6. All 4 root sockets and even the osseous septum of tooth No. 30 were preserved by luxating mesial-distally. Figure 7. All 4 of the roots were easily luxated out. Figure 8. Blood clots seen in the No. 30 and 31 sockets. Figure 9.…

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    IMPLANTS cal cantilever—ie, a prosthesis that is overextended locally to ensure correct occlusion—but this would put undue stress on the implant. During extraction, our goal should be to preserve as much bone as possible by averting bone loss, especially the buccal osseous plate. Mesial-distal Hoexter Luxators have been developed for use using extractions for the specific purpose of preserving as much bone as possible and have been utilized for many years. The Hoexter luxators, distributed by Hu-Friedy, (Figure 1), are designed to be used expressly in a mesial distal motion to avoid any buccal pressure. The design of the instruments…

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    Instant and Accurate Detection of Early Occlusal Caries Conserve Tooth Structure, Grow Your Practice, and Increase ROI INTRODUCTION Would you want your dermatologist to just monitor a suspicious skin lesion or to conduct a definitive biopsy? Dentists face a similar challenge when diagnosing a suspicious occlusal lesion with no evidence of cavitation from radiographs or that is inconclusive from visual examination. Is it a stain, is the lesion confined to the enamel, or is it cavitated and progressing into the dentin? Do we watch and wait or proceed with a restoration? Telling the patient "let's watch this until the visit"…

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    Instant and Accurate Detection of... continued from page 64 (Figure 2) into the bottom of a pit or fissure, and the ECD will provide a digital reading from 0 to 100 and an audible beep if caries are detected. CASE REPORTS Case 1 In this case, a 38-year-old female was examined during a routine dental exam. Teeth Nos. 20 and 21 displayed discoloration, possibly due to staining. Radiographs were taken, and there was no sign of cavitation (Figure 3). Prior to preparation, the ECD provided caries scores of zero for tooth No. 21 and 8 for tooth No. 20 (Figure…

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    Endodontic Disinfection: Balancing Predictability, Possibility, and Practicality INTRODUCTION It is globally accepted that 3D cleaning and disinfection are central to endodontic success and that bacteria are ubiquitous in endodontically failing teeth. Yet, there is ongoing controversy regarding the very clinical methods used that directly influence eliminating these microbial invaders. The role of bacteria in the pathogenesis of endodontic disease is well established, and therefore, it is critical to eradicate these pathogens by employing the highest level of presently developed standards.1 The goals of contemporary endodontics are directed toward shaping canals, 3D cleaning, and filling root canal systems—often referred to as…

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    Figure 1. This radiographic image demonstrates that shaping canals facilitate the 3D cleaning and filling of root canal systems. hydrodynamic phenomenon, which results when a vibrating tip generates fluid activation and intracanal waves. Random waves fracture, resulting in the formation of bubbles that oscillate within any given reagent. These bubbles are unstable due to heat and pressure, expand, and then collapse and implode. Each implosion generates up to 300,000 shockwaves that serve to powerfully penetrate, break up potential biofilms, and wipe surfaces clean. Frequency and Amplitude The frequency is the interval of time it takes a vibrating tip to move…

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