Dentistry Today — November 2018

Inside this issue

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

1. Page 8

   Support Teamwork for Success! Our cover-featured author this month is Dr. Tyler Wynne. I first met Tyler at a meeting of the American Society for Dental Aesthetics (ASDA) in Miami. He and I, along with a good number of other Dentistry Today authors and Dentistry Today's Leaders in Continuing Education, belong to the ASDA and benefit from the heartfelt continuity and shared learning experiences at the meetings. I was immediately impressed with Tyler's zeal for dentistry and soon recognized that his focus was on making a real difference for all of his patients. His article in this issue outlines the…

2. Page 10

   Predicting the Future of Your Practice Dentistry has gone through significant changes since the 2008 to 2009 recession. In addition to fewer patients and increased competition, the dental industry has been affected by widely varying levels of dental insurance coverage/reimbursements and unprecedented dental school debt. Unfortunately, it's almost impossible to look at these overall changes in the dental profession and discern what will happen to an individual practice. The good news is that it's certainly possible to determine the leading indicators that may affect your office. By determining and continually evaluating these leading indicators, you will have a sense of…

3. Page 12

   How would YOU like to be featured in... DENTIST OF THE MONTH? Beginning January 2019, Dentistry Today will be running a new feature that will be known as "Dentist of the Month." This feature will showcase a local dentist from a different region of the country each month to highlight an interesting and unique professional story about his or her experience in dentistry. DENTISTRY TODAY If chosen, you will be contacted and asked to provide a headshot and additional information that will be needed to participate in the feature. To be eligible to participate, please visit todaysdentist and fill out…

4. Page 14

   If the Crown Doesn't Fit, Adjust it Mitchell Parke One of the longest standing issues in dentistry is crowns that do not fit. Making a crown fit perfectly between adjacent teeth is hard work. The problem is knowing exactly where the contact point is located to make the adjustment. Guessing or eyeballing to adjust the crown is time consuming and does not guarantee a good—let alone perfect—fit. A poorly fitting crown is very uncomfortable and could be problematic for the patient. And an unsatisfied patient could be problematic for you. Certain methods have been developed to combat poorly fitting crowns,…

5. Page 16

   FOCUS ON: Artistry in Dentistry Larry Rosenthal, DDS, discusses the role of dentistry in facial aesthetics and overall health. Q: Has the role of aesthetic dentistry changed in regard to facial aesthetics? A: Yes! Aesthetic dentistry is now the quarterback of both health and beauty for the lower third of the face. For years, cosmetic/aesthetic dentistry was viewed as a simple solution to whitening and lengthening teeth, and widening the smile. The dramatic shift has been toward enhancing overall facial aesthetics as well as facial support via the teeth. This can be done both horizontally and vertically. We call this…

6. Page 18

   CLINICAL REVIEWS DENTAL ADVISOR IRIS Intraoral Camera ★★★★★ (96%) Digital Doc | (800) 518-1102 | digi-doc.com Consultants' Comments • "Great images" • "Camera is lightweight with a slim head." • "Easy to operate." • "Lights are bright but do not wash out the colors in the images." • "Captures detail of all intraand extraoral structures." • "Barrier sheath fits well and does not affect image quality." • "The ring flash is good but it will not replace my SLR camera." Description IRIS is an intraoral camera that features a user-friendly, multistop focus wheel and a unique USB connector. The IRIS…

7. Page 20

   Get Ready Paul Feuerstein, DMD If an office has no system or an old, outdated one, a cloud system...would allow an office to get started without a server or a complex computer installation.... Dentists who are nearing retirement are trying to decide on the future of their practices and perhaps sell the results of their years of hard work. Some have the good fortune of having children who have gone to dental school and will (hopefully) join and take over the practice. Others will look at options being presented by some of the DSOs. Some, of course, will be looking…

8. Page 22

   Combining Adaptability, Strength, and Aesthetics in a Bulk-Filled Posterior Class II Restoration: G-ænial BULK Injectable Sam Simos, DDS Several factors can affect the predictability and longevity of posterior Class II restorations, particularly when direct composites are used. Among these factors are the historically technique-sensitive layering procedures required for the material's proper placement, as well as less-than-ideal material characteristics, such as difficult handling, polymerization shrinkage, and low wear resistance. As a result, clinicians often face numerous challenges when providing these treatments to ensure proper adaptation of the material to cavity and preparation walls, shaping and sculpting the material, and, ultimately, the…

9. Page 24

   Spotlight Laser's Advancements Provide Unprecedented Performance, Significant Software Upgrades NEEDHAM, Mass.–Convergent Dental announces the next generation of Solea. The latest advancements provide unprecedented performance, significant software upgrades, improved ergonomics, increased accessibility, and a smaller footprint. Solea earned its reputation for enabling dramatic practice growth and reduced stress for dentists and patients by taking anesthesia, bleeding, sutures, and discomfort out of the dental experience. Before the launch of this new platform, Solea dentists reported doing 4 to more procedures per day while feeling like they were doing less work. With this new generation, Solea dentists will benefit from even more growth…

10. Page 26

    Pocket-Size Laser's Single Charge Offers Enough Power To Perform Numerous Procedures LOMPOC, Calif.–DenMat's latest evolution in cordless, soft-tissue lasers enables one to deliver the benefits of laser dentistry to each patient while increasing practice production across all departments. The pocket-size, wireless NV Microlaser is completely portable yet just as powerful as conventional soft-tissue lasers. Weighing only 1.9 oz and measuring at 6.9 in., this innovative, handheld design provides unprecedented freedom in the office and the operator. The plug-and-play system comes with 12 preset procedural settings optimized for the entire periodontal, restorative, and orthodontic treatment needs one may have. The NV…

11. Page 27

    Motor Provides Breakthrough Canal Treatment Technology IRVINE, Calif.— J. MORITA USA's Tri Auto ZX2 is a compact, cordless motor with a built-in apex locator. Redesigned with breakthrough canal treatment technology, this unit simplifies procedures while protecting the patient with intuitive safety features. It may be used for achieving apical patency and creating a glide path with the new Optimum Glide Path function. Responsive, the handpiece allows subtle and delicate manipulation of the file, facilitating faster and safer treatment in even the most difficult cases involving constricted or extremely curved canals. Rotary files sized as small as a #10 may be…

12. Page 28

    Spotlight Company Helps Practices Improve Online Visibility RYE BROOK, NY–DoctorsInternet.com, a company founded and operated by dentists, helps doctors grow their practice's revenues by improving online visibility, generating reviews, managing their online reputations, and providing a unique recall and confirmation program that's called "the perfect recall system." DoctorsInternet.com is a leader in successful website optimization. The goal of optimization is to have a practice placed on page one of Google searches for keywords important to that practice in its local area—and to track the resulting new patient phone calls. The company can work with a doctor's existing website or can…

13. Page 29

    Portable LED Curing Light Offers High-Capacity, Lithium-ion Battery LAS VEGAS-Steri-Shield's BEAM LED Curing Light is competitively priced and portable while offering a high-capacity, lithium-ion battery. It features 3 easy-to-program curing modes with independent time-setting selections from 5- to 40-second increments. An enhanced optical condenser light guide transmits a blue light wavelength between 420 and 480 nm with a light intensity of 1,200 to 2,000 mW/cm². It is suitable for all curing composites with a minimum of 2-mm cure depth by 8-mm area. It provides up to 80 thirty-second cure cycles between charges with auto shutoff and a low battery alarm.…

14. Page 30

    Delivering a Single-Visit Restoration With the glidewell.io In-Office Solution FIGURE 1. The patient presented with a cusp fracture on tooth No. 19 and lost marginal integrity on an amalgam restoration. A full-coverage, same-visit crown was the desired treatment. FIGURE 2. The iTero Element 2 Intraoral Scanner (Align Technology), which integrates seamlessly with the glidewell.io In-Office Solution (Glidewell Laboratories), was used to digitally scan the prepared tooth and create a virtual model for restoration design purposes. FIGURE 3. A digital scan of the preparation was taken using the iTero Element 2 Intraoral Scanner, and a virtual model was generated. Glidewell Laboratories…

15. Page 31

    strength of the Bruxzir NOW material ensures a long, durable life for the restoration so the patient can move forward with confidence. BENEFITS OF USING THE glidewell.io IN-OFFICE SOLUTION The components of the glidewell.io system contain a number of intuitive, automated features that ensure accurate results with minimal adjustments required. These features include: Simple Scanning. The iTero Element 2 Scanner is intuitively designed for easy digital scans. It's programmed to confirm that scans are complete, and it displays color-coded flags to alert the user of any areas with missing data so they can be rescanned. In this case, where scanning…

16. Page 32

    Improving the GP-Endodontist Relationship The Use of CBCT to Enhance Communication Ronald E. Goldstein, DDS Kenneth P. Goldstein, DMD Communication is one of the cornerstones of major companies such as Amazon, Walmart, and Costco. A breakdown in communication can decrease a company's production, which could ultimately affect its most important assets: employees and customers. On a much smaller scale, communication is also the key to the general (restorative) dentist-endodontist relationship. According to Cymeraman,2 the general practitioner (GP) needs to communicate any restorative needs to the endodontist before initiation of the endodontic treatment and vice versa. The endodontist needs to do…

17. Page 34

    The GP-Endodontist Relationship continued from page 32 back to the referring dentist with the instruction to place a full crown on the endodontically treated tooth. This may well be the wrong advice, especially if the treated tooth has more than adequate tooth structure. Once the interaction dynamics between the general dentist and endodontist are clear, the next step is to determine how best to deliver and receive patient information. In the Beginning In 1895, the standard radiograph was discovered by Wilhelm Conrad Roentgen. These small radiographs were the only source of communication between the endodontist and general dentist. The radiograph…

18. Page 35

    TECHNOLOGY 35 Figure 6a. A pre-op radiograph of the lower right second molar that was painful to pressure. Figure 6b. On 3-D reconstruction of the same tooth, the distal root has external resorption that is not depicted in 2-D imaging. Figure 7a. A pre-op radiograph of the lower left first premolar with a large apical lesion. Figure 7b. The measuring tool can denote the size of the apical lesion. view (FOV) CBCT should be used for diagnosis in patients with "non-specific clinical signs and symptoms associated with untreated or previously treated teeth." Therefore, using 3-D imaging in limited FOV, images…

19. Page 36

    DenMat—Uniquely Positioned To Meet a Practice's Needs Award-winning SplashMax VPS impression material coming off the production line. Dr. Peter Harnois, instructing the ADA CERP Continuing Education platform with industry leaders. DenMat Lab offers superior service, specializing in Lumineers and the Snap-On Smile. Founded in 1974, DenMat has grown its dental offerings from a handful of restorative products to a wide range of aesthetic solutions, including products ranging from industry-recognized impression materials to award-winning surgical lasers, high-end dental laboratory, and practice management services. It is also a certified continuing education provider. In the beginning, DenMat's Rembrandt Shade Modification kit provided dentists…

20. Page 38

    Spotlight Flowable Composite Offers Benefits Associated With Less Viscous Ones Cement Enables Quick and Easy Cleanup of Excess Material ENCINITAS, Calif.–Estelite Universal Flow from Tokuyama Dental America is a new, suprafilled flowable composite available in 3 viscosities (high, medium, and super low) to provide clinicians with the ideal flow for a range of indications. Estelite Universal Flow has a higher filler content than traditional flowables and offers the benefits expected from less viscous composites, such as great cavity adaptation and easy handling, without compromising strength. Estelite Universal Flow helps clinicians reduce inventory and save costs because one composite blend beautifully…

21. Page 40

    Impression Material Allows Dentists To Capture Details in Matter of Minutes ST. PAUL, Minn—With 3M's new Impregum Super Quick Polyether Impression Material—the first true superfast polyether—dentists are now able to capture every detail in just 2 minutes. This next-generation polyether is specifically formulated for capturing single-unit restorations, such as crowns, implants, inlays/onlays, and smaller bridges up to 3 units. The new tray and wash materials result in a setting reaction of only 2 minutes, and combined with a significantly improved material taste, it leads to increased patient comfort. The material's inherent hydrophilicity provides excellent wettability with remaining oral fluids and…

22. Page 42

    Self-Adhesive Cement Saves Time Without Sacrificing Reliable Bonding CUYAHOGA FALLS, Ohio—COLTENE's SoloCem self-adhesive cement saves time without sacrificing reliable bonding. MDP and 4-MET(A) monomers ensure good bonding values on a range of different materials (ceramic, metal, and composite) and for a variety of indications (crowns, bridges, inlays, onlays, endodontic posts, and implant abutments). The composite-like formulation of SoloCem contains antibacterial zinc oxide and is highly radiopaque. Low shrinkage contributes to a high-quality bond and durable restoration. Simple to apply, SoloCem dentins, white opaque, and translucent shades are delivered via Automix syringes with ready-to-use mixing tips. Intraoral processing time is approximately…

23. Page 43

    Spotlight Zirconia's Manufacturing Process Provides Natural-Looking Vitality BALA CYNWYD, Pa.- Nacera Q3 ultratranslucent, multilayer, 600 MPa zirconia has been designed and manufactured by the same companies responsible for high-strength, precision zirconia parts found in BMW, Mercedes, and Bugatti automobiles. Relying upon color spectrometers to verify shades and translucency, the precise manufacturing methods provide natural-looking vitality and make full contour zirconia not only one of the most predictable ceramics available but now one of the most aesthetic. Unlike other materials, Nacera Q3 is manufactured with a natural shade transition from the gingival to the occlusal/incisal where the shade simultaneously lightens and…

24. Page 44

    Spotlight Whitening Toothpaste Avoids Grinding Enamel Away CINCINNATI—Curaprox USA's Black Is White toothpaste contains activated charcoal as opposed to the chemical bleaching agents most whitening pastes contain. So it is black—truly black—and, above all, it does not grind the enamel away. Instead, the activated char coal absorbs precisely those particles that cause discoloration, especially tea, coffee, nicotine, and red wine. Black Is White is enamel friendly as well. This is because the hydroxylapatite actually touches the tooth enamel as a thin film. As a result, it protects the enamel and even fills in small holes. This whitening toothpaste is exactly…

25. Page 46

    How to Extract Teeth as Atraumatically as Possible: Root Sectioning Dale R. Rosenbach, DMD, MS Radoslaw Jadack, DDS Microcopy's NeoBurrs provide multi-use quality with a single-use price to permit advanced and effective extraction techniques that won't break the bank. With the preponderance of published data demonstrating compelling reasons to remove teeth as minimally invasively as possible, the burden of finding and utilizing effective methods of atraumatic exodontia falls upon the clinician as never before. By working in regions with thin plates of bone and thin overlying soft tissue, a shift in thinking has developed to promote tooth removal procedures that…

26. Page 47

    (6a and 6b) If the sectioning channel is formed microsurgically instead of biologically, fracture damage to the facial plate is likelier to occur when fracturing the tooth. This technique ought to be reserved for premolars, in which the facial plate is usually much thicker than in anterior sites. (7) After fracturing, the tooth will possess a larger segment (including the apical region) and a smaller segment. It may not be entirely evident which side (mesial or distal) is which. (8) The smaller segment should be teased and elevated from the proximal wall with a straight elevator. Alternatively, a thinner instrument…

27. Page 48

    Industry News Coltene Hosts KOL Symposium in Montreal Coltene hosted its second North America Key Opinion Leader Symposium in Montreal in September, bringing together more than 60 dental experts from the United States, Canada, and Europe along with the company's North American sales and marketing insiders. The 2-day event explored advances in technology and trends in preservative dentistry for both endodontic and restorative practices. The September 21 session focused on "Digital and Bioactive Technologies in Endodontics." Speakers reviewed NiTi instruments, interdisciplinary endodontics, surgical treatment, and 3-D workflows. A panel discussion included a question and answer session between the speakers and…

28. Page 50

    Th17 Immune Cells... continued from page 48 tract where germs first make contact with the body. They provide a barrier to thrust but are also linked to psoriasis, colitis, and other inflammatory diseases, suggesting they play dual roles in health and disease. In the study, these cells were much more prevalent in the gum tissue of humans with periodontitis than in the gums Removing bacteria by dental care controls inflammation, but not permanently... of their healthy counterparts. Also, the amount of Th17 cells correlated with disease severity. Similarly, mice Th17 cells accumulated in the gums of mice with periodontitis compared…

29. Page 51

    NEWS & TRENDS 89% of Dentists Fear Getting Sued by Patients According to Dental Protection, 89% of its dentist members in the United Kingdom are increasingly fearful of getting sued by their patients. And of them, 74% feel that this fear is impacting the way they practice, with 64% saying this fear has resulted in them making more referrals. Dental Protection says this fear isn't without foundation, as 43% of the public believes there are now more marketing campaigns by "no win, no fee" law firms compared to 5 years ago to increase the number of claims. Plus, 98% of…

30. Page 52

    NYU Event Spotlights Global Need for Oral Health Policy Accelerating global progress in oral health was the focus of an event hosted by the New York University (NYU) College of Dentistry and its World Health Organization (WHO) Collaborating Center, together with the NYU College of Global Public Health, on Friday, September 28, after the UN's Third High-Level Meeting on Noncommunicable Diseases (NCDs) on September 27. Oral diseases affect half of the world's population, yet they are rarely included in NCD prevention efforts, according to the organizers of the event, which pro-moted the integration of oral health in all efforts to…

31. Page 53

    Dental School Honors Lost Students on Day of Service DEAH DAY at the UNC-CH School of Dentistry honors the memory of Yusor Abu Salha (left), an incoming member of the class of 2019, and Deah Barakat, a member of the class of 2017, who were shot and killed along with Yusor's younger sister Razan in February 2015. More than 400 students, staff, and faculty members of the University of North Carolina at Chapel Hill (UNC-CH) School of Dentistry provided 16.4 hours of volunteer work on the school's fourth annual day of service on September 22. The school canceled classes and…

32. Page 54

    Chairside Screw-Retained Temporary Implants Made Easy David F. Ouellet, DDS Implants continue to be a large part of the general dentists' restorative requirements. While posterior implants are incorporated infrequently, anterior implants are temporized in varying ways. Some of these temporary techniques include acrylic removable partials, Essex composite Dentic clear aligners, bonded composite bridges, or the use of a Titanium Base (Ti Base) for a screw-retained temporary. The purpose of this article is to demonstrate a simple way to fabricate a screw-retained temporary implant restoration chairside using a Ti-Base. PREAT Corporation offers a variety of Ti-Bases that can be used in…

33. Page 58

    Gum Disease Treatment May Improve Symptoms in Cirrhosis Patients Routine oral care to treat periodontitis may play a role in reducing inflammation and toxins in the blood (endotoxemia) and in improving cognitive function in people with cirrhosis. Complications of cirrhosis can include infections throughout the body and hepatic encephalopathy, a buildup of toxins in the brain caused by advanced liver disease. Symptoms of hepatic encephalopathy include confusion, mood changes, and impaired cognitive function. Previous research shows that people with cirrhosis have changes in gut and salivary microbiota that can lead to gum disease and a higher risk of cirrhosis-related complications.…

34. Page 60

    Top 50 Technology Products . 1 Bien-Air AIR-DRIVEN HANDPIECE Thanks to its compact head, which is 10.8 mm in diameter and 12.1 mm in height, "Tornado" offers improved visibility in the working area. The reduced size of its head also facilitates access to medial areas, ensuring optimal patient comfort. Despite its small size, it offers exceptional power output. Like the Tornado turbine, the "Tornado" is equipped with Bien-Air SteadyTorque technology. With its 24 W power output, it is simply one of the most powerful turbines with a compact head. The remarkably efficient new Bien-Air turbine reduces the length of operations,…

35. Page 62

    Top 50 Technology Products Patterson Dental PRACTICE MANAGEMENT SOFTWARE EagleSoft can help run a practice more efficiently. From patient scheduling and insurance claim tracking to paperless charting and digital image manipulation, EagleSoft is the solution for the entire practice. At the front desk, create efficient, productive, and profitable work schedules using EagleSoft's flexible scheduling tool. In the operatory, capture, save, and enhance digital x-rays from the advanced imaging window. When you're working on a patient, EagleSoft makes it easy to post transactions, apply payments in person, and submit insurance claims and patient statements electronically. EagleSoft 20 streamlines workflows by introducing…

36. Page 64

    Top 50 Technology Products . 1 Glidewell Laboratories RESTORATIVE SYSTEM The glidewell.io Office Solution is a chairside restorative ecosystem that simplifies the restorative process, making single-appointment dentistry easy, flexible, and affordable. With the glidewell.io system, clinicians gain access to the extensive digital resources of Glidewell Laboratories. Create restorations in the office, send them to the lab, or call upon Glidewell for support and guidance—all from a single interface. With the glidewell.io system, clinicians can create restorations using BruxZir NOW, the No. 1-prescribed brand of full-contour zirconia (data on file) or from a variety of other industry-leading materials. The tools that…

37. Page 66

    Top 50 Technology Products Video Dental Concepts DIGITAL SENSOR QuickRay Direct USB dental sensors offer pristine, high-resolution radiographs and produce patient comfort. Available in sizes 1 and 2, the sensor comes with a free 7-year replacement plan against accidental damage, which is a first in the profession. QuickRay is Macand Windows-compatible and integrates with various software. For more information, call (800) 323-2690 or email sales@videodental.com. FREEinfo, 3Shape DIGITAL SCANNING SYSTEM TRIOS MOVE includes a 3Shape TRIOS 3 scanner, a PC, and a full-HD touchscreen. Now, one can easily share digital scans, images, and treatment plans with patients. It's also possible…

38. Page 68

    Top 50 Technology Products . 1 NDI CURING LIGHT Putting you in control for the right cure every time, the SiriusMax Advanced Curing Light features a powerful, elegant, all-aluminum design that is built for durability and efficiency. Its 90° swivel head functionality and ultrathin profile mean better ergonomics, easier access, and more precise placement; its optical dual-lens technology collimates the light beam for deep, even curing; and its new-generation battery and charging system provides up to 500 cures on a single charge. An easy-to-set, brilliant LED display and customizable menu offer multiple output intensity and duration options from 3 power…

39. Page 70

    Top 50 Technology Products Air Techniques VACUUM SYSTEM The Moyeah 3 dry-vacuum system is designed to provide operational performance with low operating costs and virtually no maintenance, all in a compact footprint. It uses a low-noise, high-performance pump, along with an independent, motor-driven air/water separator. This provides unprecedented power to a compact and quiet appliance. It's 50% smaller than typical dry vacuums with a potential energy savings of 85% compared to conventional liquid ring systems. It also offers (1) a sound-reducing impeller design; (2) a three-phase motor that generates higher torque and less heat; (3) extended, heat-resistant motor bearings; (4)…

40. Page 72

    Top 50 Technology Products Millennium Dental Technologies LASER Immediate profitability and increased patient satisfaction come with the world's first and only laser FDA cleared for True Regeneration—with new cementum, new PDL, and new alveolar bone. The bone-building LANAP protocol with Millennium Dental Technologies' PerioLase MVP-7 has the power to reverse gum disease with a simple, sutureless procedure developed by general practitioners for general practitioners and preferred by patients. The PerioLase MVP-7, which is an optimized, free-running Nd:YAG laser, is designed specifically to perform the high return-on-investment LANAP and LAPIP periodontitis and peri-implantitis treatment protocols, as well as a range of…

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