Dentistry Today — May 2024

Inside this issue

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

1. Page 6

   Light Up My Life This month has an interesting array of articles from different facets of our treatment options. The cover story comes from Dr. Dimple Desai, an AACD accredited member, Kois Institute graduate, and all-around excellent restorative dentist. She shows us how a patient, who had a challenging dental past, was able to receive a great outcome, addressing several esthetic issues as well as TMJ pain. Using various modes of diagnosis based on technology, as well as some traditional methods, the beautiful result speaks for itself. And the compassion of Dr. Desai added another dimension to treating this grateful…

2. Page 8

   Intraoral Indications of Dermal Filler Adverse Events INTRODUCTION: WHAT EVERY DENTIST SHOULD KNOW Even if you don't place dermal fillers, every dentist should be aware of filler complications that can manifest in the oral cavity. In fact, when a patient presents with unexplained intraoral tissue slough or necrosis with a recent history of dermal filler treatment, vascular compromise should be included as a differential diagnosis. It is well-established that filler vascular events respond best to early intervention, and the correct diagnosis is the first step in achieving an optimum outcome.¹ The dentist is poised to play a pivotal role in…

3. Page 10

   VIEWPOINT continued from page 8 branches (Figure 1). This artery is a branch of the external carotid. Generally speaking, early evidence of an evolving FIVO is most often detected by localized skin blanching in the immediate and/or adjacent areas. The internal carotid artery mainly supplies the brain and eyes and is, therefore, less commonly involved in FIVOs. However, there are multiple areas where the internal and external carotid blood supplies are indirectly commingled (Figure 2). The potential for intracranial involvement in filler vascular events is real and well documented. Moreover, there are several physiologically intentional vascular connections that provide a…

4. Page 12

   Focus On: Teledentistry Brant Herman, founder and CEO of Mouthwatch, LLC, discusses the benefits of teledentistry for doctors and patients. Q: During the pandemic, there was a spike in teledentistry adoption. How did teledentistry perform during this trial by fire? A: Although teledentistry has been around for 25 years, there was a tremendous spike in its adoption during the pandemic-related closure of dental offices. As dentists scrambled for ways to stay in touch with their patients and keep them out of hospital emergency rooms, the technology proved itself to be a highly effective and reliable communications and triage tool. Of…

5. Page 16

   TECHNOLOGY SPOTLIGHT exocad Software Offers Automation, Speed, and Intuitive Workflows WOBURN, Mass.—DentalCAD is one of the leading dental CAD software programs with thousands of licenses sold each year. The newest release, DentalCAD 3.2 Elfsina, offers more automation, speed, and intuitive workflows. The new preparation margin repair tool enables users to make the most out of imperfect intraoral scans—users can fix margins to get an acceptable result despite artifacts or holes in the scan. Also included is a new integration of compact milling machines. Users can select their preferred block and start production seamlessly from within their CAD software and switch…

6. Page 18

   BrandMax LED Ultrasonic Cleaner Features Custom Cycles JASPER, GA—The Tri-Clean U-8LH is a new ultrasonic cleaner that features a 4.3-in color touchscreen, USB cycle data export capability, an automatic lid, all stainless steel construction, a 2-gal capacity, superior power, a free heating element, a free stainless steel basket, and best-in-class customer support. In addition, custom programmable cycles, one touch foil test cycle operation, and one-touch degassing cycle operation are valuable features included at no extra cost. For more information, call (844) 874-2532 or visit brandmax.us. tures Cloud-Based Portal METUCHEN, NJ—TeleDent enables dental professionals to reach and serve patients like never…

7. Page 20

   Ritter Dental Dental Chair Includes Double-Articulating Headrest SAN ANTONIO—The Vanguard Dental Unit features a seamless hydraulic lift with adjustable speed and has the ability to withstand 400 lbs. The unit is ambidextrous with a 30° swivel that provides easy access for the patient and increased mobility for the clinician. The Vanguard includes Dentist and Assistant Delivery. The assistant side features up to 4 instruments and an integrated control panel. The dentist side features up to 5 instruments, including 3 active handpiece positions and an integrated control panel. The Vanguard is available with or without cuspidor. Some additional features the Vanguard…

8. Page 22

   Ergonomic Techniques for Predictable and Accurate Tooth Preparations Joseph Blaes, DDS Have you ever experienced pain in your hand or wrist, a pain that ranges from acute to an ache that never seems to go away? It can lead to carpal tunnel syndrome, hand surgery, and early retirement. Do you know why? We hold an air-driven handpiece by pinching it tightly close to its head. This causes the muscles of the thumb and forefinger to contract over long periods of time. If you grip your air-driven handpiece like you are going to cut a tooth, you will notice that if…

9. Page 24

   Dental Plus USA Restorative Material Suitable for Array of Dental Restorations SOUTH JORDAN, Utah—G-CAM is specially designed for permanent dental structures and offers an ideal combination of strength, aesthetics, and longevity, making it an excellent choice for a range of dental applications. With its simplified fabrication process, it presents significant time-saving benefits to dental professionals. Its monolithic nature eliminates the complexity of layering techniques, reducing the time spent on restorative cases. This streamlined workflow translates into increased patient throughput and potential cost savings. In addition, G-CAM boasts extraordinary strength, rivaling that of conventional metal-based restorations. Its remarkable flexural strength ensures…

10. Page 26

    DiaDent Curing Light Offers Several Versatile Modes BISCO Calcium Silicate Helps Protect Dental Pulpal Complex BURNABY, BC, Canada—D-LUX+ is a high-performance, dual-wavelength, cordless LED curing light. It is durable yet lightweight and elegant yet ergonomic. Its high-intensity output of 2,400 mW/cm² and four 10-W LED lamps can efficiently and uniformly polymerize all light-cured materials in the wavelength range of 385 to 515 nm. It comes with a built-in light-intensity sensor to provide peace of mind and an innovative wireless inductive charger to eliminate any potential charging contact issues. Designed for comfort, the light probe has an optimal 10° angle to…

11. Page 29

    Universal Restorative Material Reduces Shrinkage and Shrinkage Stress INDIAN LAND, SC–Further enhancing the aesthetics of its universal nano ORMOCER (Organically Modified CERamic) material, Admira Fusion RXL brings the total number of available shades for this material to 19. These shades is available in 0.2 g caps and 3 g syringes. Admira Fusion is a universal nano hybrid ORMOCER restorative material that provides extremely low shrinkage (1.25%), immediate and long-term aesthetics, easy handling, and superior biocompatibility without any BPA or traditional monomers (BisGMA, UDMA, TEGDMA, UDMA, and HEMA). It is a universal restorative material indicated for Class I to Class V…

12. Page 30

    Sensor Prioritizes Patient Comfort and Durability QUAKERTOWN, Pa.—Elevate your 2D imaging experience with the Ti2 sensor, the next generation of DEXIS sensors. It's designed to prioritize patient comfort and durability, elevating diagnostic capabilities with AI powered software (available through a direct integration with DTX Studio Clinic) and real-time monitoring to ensure smooth operation in your practice. With twice the durability of previous sensors, Ti2 was engineered to deliver long-lasting performance and the strength needed to capture high-quality images. Utilize AI features through the DEXIS imaging suite software or DTX Studio Clinic to easily identify up to 6 dental findings, providing…

13. Page 32

    Cleansing Power of Oil Pulling Over the past couple of years, GuruNanda Pulling Oil has gained popularity as a natural adjunctive tool to enhance oral hygiene routines. GuruNanda has developed an oral rinse free of alcohol and chemicals, consisting solely of pure oils and vitamins. The base of GuruNanda's Pulling Oil is MCT oil, which contains constituents known for their antimicrobial properties. When utilized in oil pulling, MCT oil may assist in reducing harmful bacteria in the mouth, potentially contributing to improved oral hygiene. An excess of pathogenic bacteria in the mouth increases the risk of developing ailments associated with…

14. Page 34

    In-Office CAD/CAM Systems Align Technology The Teno Element 3D Plus imaging system is a powerhouse of capabilities designed to improve the practice and patient experience with state-of-the-art computing power, as well as an elegant design and ergonomics. Powerful computing advancements enable a smoother and more intuitive scanning experience. The Teno heir 3D imaging technology aids in the diagnosis and monitoring of interproximal carious lesions above the gingiva. For more information, call toll-free at (800) 577-8767 or visit itero.com. AD/CAM is open, affordable, efficient, and consistent. Unlike closed systems, OneVisit lets one close digital at his or her own pace, adding…

15. Page 35

    IN-OFFICE CAD/CAM SYSTEMS Glidewell With seamless practice integration, easy-to-use technology, and an affordable price, DGSHAPE makes same-day dentistry simple. It is engineered to fit milling needs for same-day restorations thanks to (1) its open architecture, (2) its intraoral scanner compatibility, and (3) included CAM software. For more information, call (800) 542-2307 or visit rolanddga.com. USE FREE info card, GLIDEWELL.IO™: THE CHAIRSIDE MILLING SYSTEM THAT PAYS FOR ITSELF Deliver fully sintered BruxZir NOW restorations in just one appointment with the glidewell.io In-Office Solution. Combining AI-powered, one-click designs and ongoing training and support, this CAD/CAM system offers the easiest way to optimize…

16. Page 36

    Ecosite One: It Simply Matches—Always Ecosite One from DMG is the newest member of the Ecosite restorative composite family. It is an aesthetic, nano-hybrid layering composite for posterior restorations that comes in one shade, with a fantastic chameleon property to accurately match the color of the surrounding tooth structure. There are 2 major differentiating properties of Ecosite One as compared to other one-shade composite materials. The first is the material's push-and-flow effect. At first it may seem a bit dense but once you begin modeling and packing the material, you'll see (and feel) how it nicely fills in all the…

17. Page 38

    DENTISTRY TODAY 12th 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 endodontic products. The products appear in no particular order. BISCO TheraBase is a dual-cured, calciumand fluoride-releasing, self-adhesive base/liner. TheraBase contains MDF, which chemically bonds to tooth structure, and utilizes THERA technology. It is radiopaque, allowing for differentiation 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…

18. Page 40

    TOP 25 Aesthetic/Restorative Products Dentsply Sirona Realign expectations for clear aligner treatment and discover a better experience with SureSmile Aligners for the predictable results doctors and patients expect. A 3-year analysis by Dentsply Sirona showed that 75% of SureSmile Clear Aligner cases required no refinements, according to internal analysis. Reducing refinements could have a positive impact on patient satisfaction and dental practice productivity. Plus, treatment planning has never been so easy with support from the SureSmile Digital Lab and software that works with most intraoral scanners, including PrimeScan. SureSmile Aligners provide outstanding patient value with the complete case, which includes…

19. Page 41

    TOP 25 Aesthetic/Restorative Products Glidewell The BruxZir Zirconia family of materials offers a solution to dentistry's everyday challenges. Engineered with the practitioner in mind, BruxZir Zirconia delivers beauty, speed, and confidence—with just 3 days in-lab for digital cases. Available in 2 distinct formulations, BruxZir Zirconia is a preferred choice whether the restoration is indicated for the anterior, posterior, or both. Use BruxZir Full-Strength for the most functionally demanding cases and BruxZir Esthetic for anterior cases requiring an elegant appearance. Clinical evidence and independent studies support the same conclusion: BruxZir restorations consistently demonstrate superior quality. Furthermore, BruxZir Zirconia offers the utmost…

20. Page 42

    TOP 25 Aesthetic/Restorative Products Kuraray America PANAVIA Veneer LC is an advanced, light-cured resin cement with excellent color stability and high wear resistance. It provides ample working time and offers fast and easy cleanup. It is indicated for permanent cementation of aesthetic veneers and can also be used for inlays and onlays less than 2 mm thick. Offering an ideal consistency for easy and secure application across the intaglio surface, PANAVIA Veneer LC does not stick to the application tray due to its unique nano-filler technology. This technology consists of spherical silica fillers in the cement to provide stability and…

21. Page 43

    . 1 DMP Dental Bright Temporary C&B is a self-curing composite for temporary crowns, bridges, onlays, and onlays. It is a unique combination of nano-sized particles and ideally sized glass filler that provides enhanced composite strength. Its elastic properties provide easy, failure-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 on venience, which provides a 1:1 ratio that is compatible with…

22. Page 44

    TOP 25 Aesthetic/Restorative Products GC America G.CEM ONE is a universal, self-adhesive resin cement that simplifies all cementation procedures. It brings together high bond strength with a variety of substrates and excellent self-curing ability for a wide range of indications in one product solution. As a result, it reduces the inventory and increases the efficiency in a practice. It offers the flexibility of using either Adhesive Enhancing Primer or G-Premio BOND for extra bond strength challenging clinical situations. G.CEM ONE, in combination with Adhesive Enhancing Primer, displayed the highest bond strength to enamel and dentin among the cements tested by…

23. Page 45

    TOP 25 Aesthetic/Restorative Products Assured Dental Laboratory Z-Brux is a 100% full-milled, high-translucency zirconia restoration with no porcelain overlay, resulting in no porcelain fractures. Clinicians can offer Z-Brux with confidence because it is a high-performance restoration that meets patient aesthetics expectations. The benefits of this proprietary product include 1,250 MPa flexural strength, translucency, offering an aesthetic alternative to gold restorations and PFM, being less than half the price of gold crowns, excellent marginal fit, and conventional chamfer prep and cementation. For more information, call (877) 283-5351 or visit assuredentallab.com. re NANO is a dual-cure, radiopaque composite material for core buildup…

24. Page 46

    Eliminate Third Molar Complications With 3TBA TriAgenics' fully guided tooth bud ablation treatment (3TBA) is designed to eliminate problems associated with current third molar management strategies. Leigh Colby, DDS Managing complications associated with third molar removal is an enormous challenge for clinicians, and it's painful and costly for patients. Historically, practitioners have had just 2 grim choices for managing third molars: (1) wait for the teeth to form and then prophylactically remove them before pathology develops or (2) monitor and treat patients after pathology advances sufficiently to become detectable. To address inherent problems with both strategies, TriAgenics is developing Zero3…

25. Page 51

    Why Learn Supragingival Minimally Invasive Adhesive Dentistry? Because when used properly, adhesive dentistry breaks every rule, and it makes dentistry more minimally invasive, healthier, faster, and easier than ever before. Most dentists don't use adhesive dentistry to its true potential and continue to spend time creating proximal boxes, retentive walls, and other geometric preparation efforts and packing cord and fighting bleeding gums. Also, supragingival adhesive dentistry can go hand in hand on every restorative procedure, from a simple composite filling to a minimally invasive veneer and only rehabilitation. When you implement these techniques, you can say goodbye to cord packing,…

26. Page 52

    Resolving Long-Standing Problems in a Full-Mouth Rehabilitation Case INTRODUCTION From early childhood to later stages of life, many dental patients experience a variety of treatments, ranging from basic fillings for cavities, to more complex procedures like crowns and bridges. Throughout their lives, they may require specialized care from endodontists, orthodontists, or periodontists to maintain their oral health at any age. With an average lifespan of 77.5 years for both sexes,¹ and the percentage of older adults retaining their natural teeth on the rise,² the dental profession in the United States is seeing an older patient population presenting for treatment who…

27. Page 54

    Resolving Long-Standing Problems... continued from page 52 appointment, the deprogramming device was fitted, and the patient was instructed to wear it 24 hours per day for 2 weeks except when eating. Two weeks later, the patient reported that she was free from pain and that she could now open to 45 mm. Scans of both arches of the deprogrammed jaw and a bite relation photo (Figure 9) were taken and sent to the laboratory for fabrication of a diagnostic wax-up and a putty matrix for provisionalization. Restorative Treatment The patient's excessive gum display was addressed on the fourth appointment in…

28. Page 55

    RESTORATIVE 55 restorations were seated (Variolink Esthetic DC for crowns and Variolink Esthetic LC Neutral for veneers [Ivoclar]), and the patient was pleased with the final outcome. A month later, she returned for a follow-up appointment, and final photos were taken of the case outcome (Figure 23). CONCLUSION Often, patients present to the practice disappointed by past dental work and have lost faith and trust in the profession in treating long-standing problems. Taking them to the point of accepting treatment involves rebuilding that trust and helping them overcome their fear of the process. Approaching these patients with concern and compassion…

29. Page 56

    SDF Action in Proximal Caries Lesions INTRODUCTION Silver diammine fluoride (SDF) solution is easily applied to caries lesions that meet the eye of the dentist. However, lesions that develop on approximal surfaces of contacting posterior teeth and are detected radiographically pose a unique challenge. Croll and Berg2,3 have suggested the use of soft dental picks dipped in 38% SDF solution to soak such caries lesions to attenuate progression of the caries incisions. Since 2015, we have much white-wing radiographic evidence that the soft dental pick SDF application method is successful in abating the progression of beginning Class II caries lesions.…

30. Page 58

    Improving Dental Implant Prognosis Ideal situations may present themselves in our dental practices that provide the opportunity to effectively restore our patients to dental health and improved quality of life. Dental implants are certainly in the mainstream of treatment modalities and have proven to be an outstanding alternative to conventional crown and bridges and removable appliances. As more implants are placed, some complications may arise, and knowing methods to discuss and evaluate these technical impediments are critical to immediate success and long term positive prognoses. Our dental implant submission in this issue discusses a novel approach to the viability of…

31. Page 60

    Early Implant Restoration Through Photofunctionalization INTRODUCTION Osseointegration, as defined by Brånemark, is a direct structural and functional connection between ordered, living bone and the surface of a load-carrying implant.¹ The process of osseointegration is very much dependent on the quantity and composition of osteoblast attachment to the implant surface. The quantity of osteogenic cells in contact with the titanium surface directly correlates to the amount of peri-implant bone and, as a result, the percentage of bone to implant contact (BIC). Extracellular proteins such as fibronectin are integral in the attraction and attachment of osteoblasts to the titanium surface.² The aging…

32. Page 62

    Early Implant Restoration Through... continued from page 60 under a restoration she had received years ago. Tooth No. 19 was extracted without complication, followed by ridge preservation using demineralized corttico-cancellous bone allograft (AllOss [ACE Surgical Supply] 7 months prior to implant placement surgery (Figure 1). A full maxillary and mandibular CBCT scan was acquired (3D Accuitomo 170 II Morita) (Figure 2) as well as intraoral scans (Emerald S Figure 3. The implant workup from the DIOnaxi dental laboratory (DIO Implant). Figure 4. Surgical guide fabricated for the case. scanners [Planmeca], and the case was worked up in Romexis (version 6.3)…

33. Page 64

    Collaborating on 3D Printed Temporaries for All-on-12 Full Dentures INTRODUCTION Advances in digital dentistry have greatly enhanced what dentists can do for their patients in the clinical setting by increasing efficiency and ensuring more predictable, favorable clinical outcomes. For example, the use of computer-aided design/computer-aided manufacturing (CAD/CAM) systems in dentistry, such as Dentsply Sirona's CEREC CAD/CAM system for same-day single tooth restoration, has increased dramatically during the last decade. Our office started moving in the digital direction in 2014 when we began using CEREC for single-tooth, fixed restorations. More recently, we have stepped outside of using an-office systems just for…

34. Page 66

    Collaborating on 3D Printed... continued from page 65 fully retracted, full face digital photograph and one full-face smiling digital photograph, were sent to the lab along with the preferred shade for the immediate dentures that would be 3D printed. Dentures would be printed preoperatively to be used as immediate dentures by the patient starting the day of the surgical extractions and implant placement. In preparation for designing and printing the temporary full dentures, the images were superimposed into the 3Shape design software. This process enabled the lab technician to correct everything from the necessity of shifting or uprighting the midline…

35. Page 67

    PROSTHETICS 67 ing implants (5/4 and 4/3), 6 in each jaw, were immediately placed after encasing the free-hand guide created in the lab. Multi-unit abutments (MUA) were placed on the implants on the day of surgery for ease in restoring the case. This helps the tissue to heal and adapt around the MUA and eliminates the need for a more involved, subsequent "uncovery" appointment, which may include the potential need to graft tissue. When the patient awoke from sedation, 2 temporary immediate dentures were ready to be converted into hybrids and fixed in the mouth (Figures 8 to 12). The…

36. Page 68

    Advances in digital dentistry have greatly enhanced what dentists can do for their patients.... system is that the head of the screw uses a proprietary screwdriver that allows torque to be achieved without causing stripping of the head. Another favorable aspect of this change in protocol is that it is less catastrophic if an issue requires removing the prosthesis. For instance, if a Ti base debonds, the prosthesis must be removed and recemented chairside, and that is if the prosthesis did not break. If a screw fractures, it would be within the implant, whereas if a screw fractures in this…

37. Page 72

    Strategy for Material Selection and Cementation Dinesh Sinha, BDS, PhD, interviews Jae Seon Kim, DDS, MSD, a board-certified prosthodontist, about his preferred strategy for handling prosthodontic cases. Dinesh Sinha, BDS, PhD Jae Seon Kim, DDS, MSD Q: Can you tell us about yourself and your dental practice? A: I received my prosthodontic training from the University of Washington School of Dentistry. Then I worked as an assistant professor at the Dental College of Georgia at Augusta University, educating dental students, residents from numerous specialties, and other general dentists. Now I have my own private practice in Seattle and also work…