Dentistry Today — May/June 2020

Inside this issue

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

1. Page 4

   What's New on Caries Management Online Survey Enter to Win a $250 Amazon Gift Card Dentistry Today and infinix are conducting an online survey at survey based on the question "Is it time to rethink caries management in my practice?" The common clinical response to cavities is to place a restoration, but merely restoring decayed teeth is not a solution to the problem—it's a Band-Aid. There are new alternatives available to help facilitate long term success. To connect you to information and resources best suited to your current caries management protocol, answer 5 quick questions by visiting survey. TEN @…

2. Page 6

   What Planet Are We On? Well, if any of you feel like you woke up in the middle of an odd episode of The Twilight Zone, or have been beamed to another planet in a not-so-pleasant and upside down parallel universe, you are certainly not alone! The only word that can continually come to my mind throughout these past couple of months is surreal. We are blessed in our work here at Dentistry Today during this crisis because our team is able to work from home, thanks to our amazing and connected digital world that allows us to successfully continue…

3. Page 8

   Ethics Meets Artificial Intelligence INTRODUCTION Dr. Teck has been passionate about prevention, hygiene, and diet since dental school. Over the years as his practice grew, he and his office team explored and tried many caries detection and prevention methods—chemical tests of saliva and blood; imaging devices; patient questionnaires about habits, diet, and medications; careful examinations of dental anatomy, tooth positions, and previous restorations; etc. Eventually, his customary approach came down to Caries Management by Risk Assessment (CAMBRA). However, OraCoat XyliMelts and XyliGel for dry mouth Keep patients' teeth protected: use non-acidic XyliMelts and XyliGel for safe dry mouth relief. OraCoat…

4. Page 10

   VIEWPOINT continued from page 8 tools. The first issue is the most obvious: namely, whether the AI tool itself actually provides better or at least equally dependable diagnostic data to the dentist and whether the dentist properly uses the AI diagnostic tool itself so that the information it provides is correct within the statistical limits of the tool. In order to use an AI diagnostic tool in an ethical manner, the dentist needs to understand enough about how the tool achieves its results to be assured that its results are dependable and needs to use it in such a way…

5. Page 11

   ADVERTISING SUPPLEMENT PRODUCT PROFILE MouthWatch's TeleDent Connects Dentists to Patients During and After COVID-19 Shutdown TeleDent by MouthWatch, the all-in-one teledentistry platform, is enabling dentists to stay in close contact with their patients—especially those who require emergency care during the coronavirus pandemic. According to MouthWatch CEO Brant Herman, "TeleDent is so much more than telephone triage or video conferencing. Instead, it is a professional-grade, HIPAA-compliant teledentistry solution that is perfectly suited for conducting virtual evaluations for determining the need for emergency care or being available to patients to address less urgent but still crucial concerns." Thanks to the easy-to-use messaging…

6. Page 12

   Laser Dentistry for the General Practice Ron Kaminer, DDS, focuses on advances in laser technology relevant to the general practitioner. Q: You have a long history of using dental lasers. How did you happen to get started using dental lasers so early in your career? A: It's a long story, but to summarize, I went to dental school for 5 years instead of the usual 4 years. Due to a mismatched class schedule, I ended up with some free time on most days. One of my instructors and mentors, Dr. Chuck Leibow, pushed me to do laser research. So for…

7. Page 14

   Infection Prevention in 2020 Editor's Note: We are pleased to have Dr. John Molinari, an expert in infection control, and one of our own distinguished members of the Dentistry Today Advisory Board, present the following timely comments to preface our special infection control section as the profession works through the many challenges brought on by the SARS-CoV-2 pandemic. COVID-19 threatens to rank among the worst global health crises ever. Current case and death totals reported by many countries have created both a major public health emergency and economic consequences from shutting down much of world's economy. Unfortunately, the full extent…

8. Page 15

   INFECTION CONTROL PRODUCTS NITRILE GLOVES Aurelia Sonic Nitrile Gloves are a great option from the maker of Amazing Gloves. These gloves are made from a customized formulation to adapt seamlessly to the way your hands move throughout the work day and night. Sonic gloves also deliver a striking indigo blue to keep you looking your best no matter the circumstances. They come eco-packed with 300 pieces per box. For more information, call (877) 283-5461. FREEinfo, SURFACE CLEANSER DenMat Formulated with 1.5% bleach and a powerful surfactant for removing dirt and grime, the Hard Surface Cleanser is safe and effective in…

9. Page 18

   The 'New Normal'? Navigating... continued from page 16 (SBA) loans (the Paycheck Protection Program and Economic Injury Disaster Loan). Our entire office staff was placed on "leave of absence" so that our employees could receive short-term unemployment benefits from our office unemployment account rather than utilizing their personal unemployment insurance (UI) accounts. It was going to be a race between receiving SBA benefits or unemployment benefits. Anxiety levels were high. Each employee was assured that his or her position within the team was secure. Letters from our law attorney verified their statuses for their applications to the UI state office.…

10. Page 19

    INFECTION CONTROL 19 ...we needed to upgrade the "Universal Precautions" to "Transmittable Disease Standards...." and when existing after treatment.² 5. All patient magazines and books have been removed from all operatories. 6. Patients are provided with a long, disposable drape in the operatory, rather than the smaller, traditional bib. 7. Patients pre rinse for 60 seconds with 1.5% hydrogen peroxide, as advised by the ADA, to decrease viral and bacterial loads.³ 8. A patient mask/eye shield is used, whenever possible, during treatment. 9. All surfaces are routinely disinfected before and after patient contact (door handles, counter tops, pens, etc).⁴ 10.…

11. Page 20

    Shade-Matching System Delivers Quick, Repeatable Color Analyses ORMOND BEACH, Fla.- Enterprise International's Rayplicker QuickShade by Borea is a fully integrated shade-matching system that delivers quick, repeatable color analyses from video of a patient's teeth by digitally giving the correct shade reading. The reading is then transferred to the clinician's lab via a DigitalRx. With a high-end scanning handpiece and custom software, this is a real-time solution that takes the guesswork out of shade reading that is currently the norm when using analog shade guides. Featuring many great benefits, the Rayplicker QuickShade is set to take dental offices and laboratories by…

12. Page 21

    Adapter Removes High Percentage of Infectious Aerosols MUSKEGON, Mich.—Ascentcare Dental Products' newest product is an illuminated HVE adapter for isolation mouthpieces that helps remove 90% of infectious aerosols. Simple, portable, and affordable, the VacuLUX Illuminated HVE Adapter was designed to solve problems associated with other high-performance isolation systems while reducing bioaerosols produced during routine procedures. It allows one to reduce aerosols without the complicated installation of costly equipment. The VacuLUX adapter attaches to any existing HVE valve at any dental chair in a clinic. Simply plug in the adapter and attach it to the mouthpiece for easy isolation and proper…

13. Page 22

    Scan Bodies Constructed to Automatically Create Exact Dimensions CARLSBAD, Calif.–Zest Dental Solutions' Scan Body for the LOCATOR Attachment System was designed to automatically create the exact dimensions and undercut required to retain the LOCATOR denture attachment housing within a 3-D printed or milled prosthesis. The precise location of the LOCATOR and implant are captured through the scan, either intraorally or in a lab setting, for easy case planning and design. The overdenture is then 3-D printed or milled with the recess for the LOCATOR housing, allowing for easy and quicker pickup. The LOCATOR Scan Bodies are made of a durable…

14. Page 24

    Surface Disinfectants Kill Human Coronavirus Without Damaging Common Surfaces, Instruments ALSIP, ILL—GC America introduces COEfect MinuteWipes and COEfect MinuteSpray, which are EPA registered (Nos. 88494-1 and 88494-2, respectively). These one-step surface disinfectants are specially formulated with a low toxicity rating and will not damage common surfaces, instruments, and/or equipment found in dental offices. These disinfectants feature (1) a one-minute kill rate, which improves efficiency with infection control protocol; (2) no foul odor for staff or patients to experience; and (3) surface compatibility that will not harm or discolor most surfaces found in operatory. The disinfectants are EPA-registered, enabling them to…

15. Page 28

    DENTISTRY TODAY EIGHTH ANNUAL 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. Parkell Predicta Bioactive Bulk is a dual-cure, bulk-fill resin composite that releases fluoride, sodium, and phosphate ions to stimulate mineral apatite formation and enhance mineralization at the material-tooth interface. The material's innovative ability to recharge fluoride ions provides a unique combination of physical and chemical properties. It is dimensionally stable, with excellent strength, time-efficient handling, and optical characteristics close to those…

16. Page 29

    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…

17. Page 30

    Top 25 Aesthetic/Restorative Products VOCO Admira Fusion is the world's first all-ceramic-based, universal, direct restorative material. Its fillers and matrix are based purely upon silicone oxide. This offers several advantages that include up to 50% lower polymerization shrinkage (1.25% by volume) than today's conventional composites, as well as up to 50% lower shrinkage stress. Admira Fusion features extremely high color stability, a perfect balance of translucency and opacity for enhanced aesthetics, as well as high surface hardness and edge strength. The ORMOCERs (Organically-Modified CeRamics) in Admira Fusion make it highly biocompatible as it contains no classic monomers and is 100%…

18. Page 32

    Top 25 Aesthetic/Restorative Products Ultradent Products The VALO Grand curing light uses a custom, multi-wavelength LED for producing high-intensity light at 385 to 515 nm through an optimally collimated beam of polymerizing all light-cured dental materials, including porcelain and underlying resin cements. The VALO Grand light features a 12-mm lens and its extremely durable, slim, ergonomic shape allows unprecedented access to all restoration sites. It is available in cordless and corded models, featuring either a medical-grade international power supply that is suitable for power outlets from 100 to 240 V or rechargeable batteries and a battery charger suitable for power…

19. Page 33

    PROVEN PERFORMANCE ◆ AWARD-WINNING QUALITY DMP Composites DENTISTRY TODAY'S TOP Innovative Products 2020 DMP Dental NANOCERAM-BRIGHT: Universal and Flowable 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. 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 composite for Class I to IV restorations. NANOCERAM-BRIGHT out-performs the competition, achieving superior physical and aesthetic results. Adaptive chameleon-like technology achieves excellent color matching, high polishability, and a lifelike translucency, allowing the restoration to blend into the natural tooth…

20. Page 34

    Top 25 Aesthetic/Restorative Products Pulpdent ACTIVA BioACTIVE-RESTORATIVE is the first bioactive restorative material with an ionic resin matrix, a shock-absorbing resin component, and bioactive fillers that mimic the physical and chemical properties of natural teeth. The patented rubberized resin absorbs shock and stress and resists fracture and chipping. This eliminates the brittleness found in traditional materials. ACTIVA BioACTIVE is a smart material that responds to pH spikes in the mouth. During low-pH demineralization cycles, ACTIVA BioACTIVE releases more phosphate and calcium ions. These ions have the ability to reside in the pellicle layer or saliva and be available to interact…

21. Page 35

    Another "Crowning Achievement" FROM ADVANTAGE DENTAL 3M 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. There's no need for layering or expensive dispensing devices. For more information, call (800) 634-2249 or visit 3m.com/filtkone. FREEinfo, KaVo Kerr OptiBond eXTRa Universal is built on its predecessor, OptiBond XTR. It combines the reliability of patented OptiBond GPDM technology with the peace…

22. Page 36

    Top 25 Aesthetic/Restorative Products SDI Pola Office+ is an in-office tooth whitening system with a unique formulation that allows for minimal chair time and patient comfort. SDI introduced an applicator brush tip into the Pola Office+ kits in 2019. The applicator brush has been designed for smooth and easy application of gel onto the patient's teeth. The applicator brush has been added to the accessories bag in the Pola Office+ kits and is also available to purchase separately. The Pola Office+ kits also have a sticker, placed on the front of the box, indicating these are new and improved, allowing…

23. Page 37

    The Right Stuff: A Requirement for Success Lori Trost, DMD, a well-known practitioner and lecturer, shares her experience, advice, and opinions related to choosing equipment and technologies to build a successful cosmetic dentistry practice with our editor-in-chief, Damon Adams, DDS. You recently began a new practice. How did you arrive at that decision? Dr. Trost: Once we successfully got past this crisis involving COVID-19, I felt that we will once again be able to say that there has never been a better time to practice dentistry! I decided to create a new practice after selling my former practice of many…

24. Page 38

    INTERVIEW I cannot begin to tell you how many times we used markers and tape to map movement and traffic patterns. We took into consideration the size and requirements for specific equipment/technologies, such as chair footprints, a 3-D imaging unit as a panoramic unit, and even noise reduction from the compressor/vac room. We also considered possible additions and secured wiring and support backing for any possible future mounts or add-ons. During this phase, a "Master Dreams List" was compiled and prioritized. There is always a difference between practicality and a dream list, but the key is to strike a balance…

25. Page 40

    The Right Stuff: A Requirement for... continued from page 38 dentistry and want to be involved in their treatment. They also want to understand all their options. As dental professionals, we must show, tell, and engage them. However, we often do not know how to do this. As a new patient enters any practice, he or she immediately begins to make comparisons regarding his or her own prior dental experiences. The key is to capitalize on using digital tools to create a customized diagnostic approach for the patient. In essence, the exam captures the patient's dental story. We start by…

26. Page 42

    Ridge Augmentation Understanding the Power and Potential of Particulate Grafting INTRODUCTION The field of restorative dentistry has been through a paradigm shift since the introduction of implants has changed the prospects for reconstruction of severely compromised dental cases. The use of dental implants in most treatment plans today offers the possibility of restorative success in many situations that would have previously been impossible. This success has been largely related to the advent of bone augmentation techniques that allow for the regeneration of an ideal ridge form and placement of implants in their ideal functional and aesthetic positions.1-3 As attempts to…

27. Page 44

    IMPLANTS CASE 1 Figure 1. (a) A ridge defect with serious horizontal resorption. (b) The heads of tenting screws in the recipient site defined the desired ridge contours. Note the autogenous particles around the screw shafts on the left side of the photo. (c) MinerOss Freeze Dried Cortico-Cancellous Mineralized Bone Allograft (BioHorizons) covered the autogenous bone, and the allograft was fixed carefully. (d and e) The regenerated ridge 5 months later with regeneration to the level of the screw heads. Note the density of the bony ridge and the lack of a granular surface consistency. CASE 2 Figure 2. (a)…

28. Page 46

    IMPLANTS CASE 3 Figure 3. (a) A severe horizontal and vertical ridge defect. (b and c) Tenting screws were positioned for facial horizontal space, vertical support on top of the tooth No. 10 region, and palatally for additional ridge width. Notice the advantages of positioning individual screws for specific bone development in local sites. (d) Autogenous bone was placed primarily in the region of teeth 9 and 11, with only Minercis in the No. 10 position. (e and f) The developed ridge 5 months later. Although the ridge had been regenerated, the density of the bone was more granular than…

29. Page 47

    IMPLANTS height over long periods of time in regions where large vertical ridge defects have been generated. The use of allografts without autogenous bone is a common practice because it eliminates the need for a secondary donor site where the autogenous bone is harvested. Although eliminating the autogenous particulate is where large amounts of autogenous bone were used. There was a reduction of autogenous particles used in Case 3, and it was concluded that the granulation was directly attributed the lack of substantial amounts of autogenous bone and the smooth graft every time frame. The specific barrier used in major…

30. Page 48

    Streamlined Protocol for Full-Arch Implant Restorations INTRODUCTION The fixed full-arch implant restoration is among the most rewarding type of treatments in dentistry. The clinician is able to provide patients who present with terminal dentition or unstable dentures a fixed solution with the same function, stability, and aesthetics of natural dentition.¹ In addition to replacing the patient's teeth, this implant solution dramatically improves patient comfort, self-confidence, and quality of life.² Clinicians who provide this service for their patients have commonly encountered a complex clinical procedure requiring numerous appointments and considerable chair time in order to produce the optimal prosthetic design. This…

31. Page 50

    PROSTHODONTICS FIGURE 1. The patient presented for the restoration of 5 maxillary implants and requested a fixed prosthesis. The implants were correctly positioned around the arch to support a full-arch implant restoration, and intraoral examination revealed that there was adequate restorative space. A B-oint Implant Prosthesis (Glidewell) was selected for the restoration for its long-term durability and lifetime appearance. FIGURE 2. A preliminary open-tray impression was made to begin the restorative process. Shown here, the impression tray was tried in to ensure the transfer copings emerged through the holes that were cut in the tray chairside. FIGURE 3. A duplicate…

32. Page 51

    PROSTHODONTICS 51 Figure 8. After working with the patient to properly place his jaws in centric relation, care was exercised to record an accurate bite registration. By performing this step correctly, the likelihood of occlusal errors arising later in the process is reduced. Figure 9. (a) At the next appointment, the wax setup was seated and connected to the implants with relative ease due to the use of multi-unit abutments. The form, function, and occlusion of the wax setup were confirmed, and a few minor adjustments were made. (b) The midline was verified and found to be accurate. Figure 10.…

33. Page 52

    Modern Materials and Digital Technology The Keys to a Predictable Hybrid Workflow INTRODUCTION Since the introduction of the implant retained denture principle in 2004, there has been an exponential increase in patient awareness and demand for these types of procedures. Studies have shown this protocol to be a very successful long-term restoration option²; however, over the last few years, its predictability has come under scrutiny. This is especially true in upper arch applications where peri-implantitis, caused by ridge-lapped designs, has been identified as the probable cause of implant failures. Many articles address the restorative value of prosthetically driven surgical plans…

34. Page 54

    DIGITAL DENTISTRY FIGURE 1. Scan flags were placed, and the hybrid was digitized. FIGURE 2. Digital STL file of the scanned opposing arch and bite. FIGURE 3. PMMA-printed hybrid replica. FIGURE 4. The replica was split between implants, and a transfer tray was fabricated. FIGURE 5. The replica was placed in segments. FIGURE 6. The units were luted together. FIGURE 7. The bite was checked, and the required adjustments were made. FIGURE 8. Impression material was flowed into the intaglio of the replica. FIGURE 9. The double-cross-linked PMMA prototype was tried in. FIGURE 10. Digital scan of the prototype for…

35. Page 55

    DIGITAL DENTISTRY thetic questions before transitioning to the final prosthesis. Prototype to Final Prosthesis Once patient approval with the prototype is acquired, the prototype will be used to copy mill the final prosthesis. Modern-day digital workflows incorporated with advanced, high-strength translucent zirconia materials, offer a huge advantage to the restorative team. This workflow allows for no data loss and, thus, extremely predictable final deliveries. In the past, data gathering was negated by layering ceramics over zirconia frames. With today's advanced zirconia materials, the need for layering ceramics has been eradicated by producing a flawless copy process of what the patient…

36. Page 60

    Managing Your Dental Practice Amid the COVID-19 Crisis Dinesh Sinha, BDS, PhD, interviews Joseph Willardsen, DDS, on practice management during the COVID-19 pandemic. Figure 1. Dr. Willardsen's dental practice in Las Vegas. Dinesh Sinha, BDS, PhD, Senior Technical and Marketing Manager, Dental Division, Kuraray America Joseph Willardsen, DDS Q: Dr. Willardsen, can you provide a brief background on your dental practice? A: I have 2 dental offices in Las Vegas. One is dedicated to cosmetic dentistry, and the other focuses more on general dentistry. I have an in-house dental laboratory as well. Q: How are you managing your practice, and…

37. Back Cover

    Glidewell 4141 MacArthur Blvd. • Newport Beach, CA 92660 800-854-7256 • Fax 800-411-9722 Confronting Adversity Dear Doctor, Wherever you are, you've likely been grappling with the pressure and uncertainty spawned by the COVID-19 pandemic. Most of you have complied with the ADA recommendation to postpone elective procedures for several weeks. And we respect and applaud both those who've taken drastic action to halt the spread of this disease, and those who've soldiered on in order to meet the urgent needs of select patients. Some have asked me to predict what lingering impact this is going to have on the dental…