Dentistry Today — October 2023

Inside this issue

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

1. Page 6

   Dream On As I write this, fall is almost upon us. After the hottest summer in years, it will hopefully be a relief. In our practices, we are on the end-of-the-year run to meet those expectations that started in January. It is also time to make some end-of-year decisions for your larger equipment purchases. If you have been following the authors all year, you probably have seen some new tricks and tips and gotten some ideas from the technology available. There is also still time to catch a few CE courses to add to your knowledge base. This issue has…

2. Page 8

   Where Will Our New Practitioners Come From? The traditional path to becoming a dental professional has often been limited to a narrow demographic. However, to truly address the oral health disparities in underserved communities, we must challenge this status quo and actively seek to diversify our dental workforce. By doing so, we can ensure that our dental workforce is reflective of the diverse populations we aim to serve. But where will these much needed practitioners come from? I strongly believe that the solution to this pressing issue lies in mentorship and collaboration. Encouraging Mentorship Programs Many dental professionals will attest…

3. Page 10

   VIEWPOINT continued from page 8 best practices for increasing the enrollment of historically under-represented racial and marginalized (HURAM) students in dental schools and enhancing their entry into the dental workforce. Many of these programs target middle and high schools that provide academic support, mentoring, enrichment experiences, and other resources. According to the American Dental Education Association's 2020 Survey, less than half of the graduating Class of 2020 responded that the choice to pursue dentistry was made before entering college rather than while in college. For HURAM pre-dental students, an impressive 51% made this decision before college, surpassing the overall response…

4. Page 12

   Novel "Connected" Aligner System Allowing Remote Case Monitoring David Little, DDS Clinical oversight is critical to the success and safety of patients undergoing orthodontic treatment. Proper oversight goes beyond monitoring the progress of the prescribed movements. It requires visually confirming the continued health of the hard and soft tissues throughout the oral cavity. Clinicians face multiple challenges to achieving their ideal level of oversight, with one being that the vast majority of treatment occurs outside a clinician's office. Another is the significant time period that oversight is required. On average, it takes 20 months to complete orthodontic treatment with fixed…

5. Page 14

   Cello-Playing Dentists Brothers Emil and Daniel Liakhovetski are unique dental students. Emil is in his second year of periodontal residency at the University of Kentucky, and Daniel is in his third year of dental school at the University of North Carolina, class of 2025. You may have seen their cello performances on America's Got Talent (AGT), and they are opening the ADA SmileCon meeting this year in Orlando. We talked to them about their shared passions of music and dentistry. Q: How did you get your start in music? Daniel: Our introduction to music and playing the cello came first,…

6. Page 16

   Improve Profitability and Achieve Predictable Results in a Shorter Amount of Time With SureSmile Clear Aligners Dr. Trent Smallwood discusses the benefits of clear aligner therapy and why SureSmile from Dentsply Sirona provides a better treatment experience. [Photo: Trent Smallwood, DDS] Q: Why did you switch to SureSmile? A: I've been offering clear aligners for 15 years, using one of the leading brands for most of that time. About 2 years ago, I started looking at SureSmile (Dentsply Sirona) and the success it was having. I realized it was an opportunity to provide a better treatment experience, so I switched.…

7. Page 18

   CandidPro Clear Aligners Make Top-Notch Treatment Easier SANFORD, NC-CandidPro believes that dental professionals deserve more when it comes to clear aligners. That means the company is more than a lab. Developed by top tier orthodontists, its process makes high-quality treatment easier and more accessible through a combination of advanced aligner technology, remote CandidMonitoring, and some of the highest diagnostic standards in the industry. Whether someone is a clear aligner case expert or is just getting started, this platform can give one's practice more control, more convenience, and more happy clear aligner patients. CandidPro is also a true partner in a…

8. Page 19

   Ultradent Products Device Optimizes Expression of Various Impression Materials SOUTH JORDAN, Utah–The BFC3 impression gun is Ultradent Products' first cordless, handheld, motorized tool to express dental impression material. Designed for efficiency, precision, and convenience, it streamlines dental impression procedures and chairside material dispensing. Featuring an ergonomic design, the BFC3 impression gun is compatible with standard .25, .50, and .75 mL or 21 automix cartridges. It has an adjustable flow rate that optimizes the expression of various impression materials, allowing clinicians to be in full control of the amount of material needed for each procedure. The BFC3 impression gun's anti-drip feature…

9. Page 20

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

10. Page 22

    Electric Handpieces Bien-Air USA From the moment Bien-Air started designing the NOVA handpiece, it had one ambition: not to compromise, and, thanks to the slim head, its lightness, its low noise level, and its extreme durability, it is quite simply one of the most advanced handpieces on the market. Drawing on 60 years of expertise, Bien-Air is on a constant quest for practical innovation, optimal ergonomics, and extreme reliability. Bien-Air believes that the quality and reliability of its instruments underpin the quality and precision of one's work. For more information, call (800) 433-BIEN (2436) or visit bienair.com. is a versatile…

11. Page 24

    Bien-Air USA System Offers Full Range of Treatment Options Integrated Into Dental Chair IRVINE, Calif.—Whether you are planning to upgrade your dental practice with the latest technology or you are just about to start your professional career, iOptimalNT is an all-in-one solution offering the full range of treatment options seamlessly integrated into your dental chair. There is no need for additional equipment anymore because the iOptimalNT lets you perform restorative procedures; endo treatments (including reciprocating mode); and surgical procedures, including implant placement. A piezo scaling function is included as well. Installed directly into the existing dental unit, the system is…

12. Page 26

    Owandy Radiology CBCT System Includes Simple Face-to-Face Patient Positioning ROSLYN, NY–The i-Max 3D Pro CBCT unit includes many distinguishing features. It offers a new generation of CMOS sensor for exceptional image quality. Its higher resolution features 2 µ voxels for 3D HD volumes. There are optional integrated AI powered software modules for accurate ceph analysis and implant placement. The system provides simple face to face patient positioning. It boasts a footprint at 93 lbs less than the original unit, uses more recycled materials, and emits less carbon dioxide. There is also a dynamic reduction of metal artifacts via Owandy's AutoMAR…

13. Page 32

    Industry News Great Lakes Dental Technologies Announces MDSAP Recertification Great Lakes Dental Technologies is proud to announce that it has obtained MDSAP (ISO 13485:2016) certification through SGS North America Inc, effective August 31, 2023. Certification to MDSAP (ISO 13485:2016) signifies that Great Lakes Dental Technologies' quality processes, management systems, and practices align with the requirements of the MDSAP—Medical Device Single Audit Program. The Quality Management System implemented at Great Lakes Dental Technologies not only addresses the needs of customers and stakeholders but also ensures compliance with all statutory and regulatory requirements for all products and appliances. Since its inception as…

14. Page 36

    The products selected for Dentistry Today's First Annual Editors' Choice Awards were chosen based on their compelling features, which were determined by its editors. Dentsply Sirona Intraoral Scanner Features Smart Pixel Sensor and Intelligent Processing Primescan is an intraoral scanner that allows one to step into digital dentistry with an open and versatile approach, allowing for growth and expansion. Its smart pixel technology includes smart pixel sensor and intelligent processing that scans 1.5 million 3D data points per second, making it one of the most accurate intraoral scanners in digital dentistry. Primescan can scan the full arch (upper, lower, and…

15. Page 38

    EDITORS' CHOICE AWARDS 2023 Tokuyama Dental America Flowable Composite's High Strength, Wear Resistance Suitable for Range of Indications OMNICHROMA Flow is the world's first one-shade flowable composite able to aesthetically shade match any tooth color from A1 to I4. Its high strength and wear resistance make it suitable for a wide range of indications beyond cavity lining and minor restorations, giving clinicians the freedom of choice for any direct restoration. OMNICHROMA products, with 3 viscosities to choose from, are the first line of universal composites to utilize Smart Chromatic Technology and structural color to shade match all 16 vital classical…

16. Page 40

    EDITORS' CHOICE AWARDS 2023 K6R Whitening Whitening System Produces Amazing Results K6R Whitening offers cost-effective solutions, from phenomenal home whitening for severe cases to astonishing treatment of tetracycline cases—and everything in between. Dual-Activated, Tri-Barrel Hydrogen Peroxide technology and continuous refrigeration of the whitening gels from the manufacturing process through delivery to the dental office make it a powerful, complex system capable of dramatically whitening any case. K6R Whitening systems include (1) K6R Home, (2) K6R MAX, (3) K6R Ultra, (4) K6R Ultra-T, and (5) K6R In-Office Power Whitening. For more information, call (866) 763-7753 or visit korwhitening.com. s Make High-Quality…

17. Page 42

    EDITORS' CHOICE AWARDS 2023 DentiMax Sensor Works With Virtually All Imaging Software Due to the high-priced nature of digital sensors and the ongoing effects of inflation, many clinicians limit the number of sensors they use in their operatories. This has caused bottlenecks and inefficiencies with how their clinical staffs treat patients. DentiMax recently released its high-quality and low-cost Open Sensor to address this issue. The Open Sensor works with virtually all imaging software, and once it's dialed in, it's dual and play. According to Clinicians Report, it exhibits excellent image quality and resolution with a lower price than many leading…

18. Page 44

    EDITORS' CHOICE AWARDS 2023 CHROME GuidedSMILE Surgical/Restorative Guide Allows Clinicians to Focus on Optimizing Results CHROME GuidedSMILE is the leading, patented, stackable All-on-X guide on the market. Adopted by general dentists, specialists, and institutions, it has become the international guide of choice for thousands of doctors. CHROME was developed for dentists who desire a predictable, safer, faster, smaller, stronger full-arch immediate surgical and restorative solution. Each step, from bone reduction to implant placement to delivery the final prosthesis, is preplanned and guided so clinicians can focus on optimizing their results, giving their patients a premium experience. Enhanced visibility and stability…

19. Page 46

    EDITORS' CHOICE AWARDS 2023 TruAbutment Custom Abutment Overcomes Issues Stemming From Challenging Angles and Positions The Custom Overdenture Abutment (T.L) is designed to be used with removable dentures to hold the natural aesthetic smile while accounting for angular deviation of mastication. Dedicated to improving the evenly distributed pressures for removable dentures, the T.L Solution sets itself apart from most denture attachments with its customized emergence profile and height. It addresses issues with challenging angles and positions for a precise fit across the fixture, the abutment, and the denture. This design allows the user to retain the advantages of perpendicular force…

20. Page 48

    EDITORS' CHOICE AWARDS 2023 Directa–A Division of DirectaDentalGroup Periotomes Perform Range of Critical Functions With Finesse Luxator periotomes represent a pinnacle of dental instrument design, catering to the precise needs of modern dental practices. These periodontal ligament knives feature meticulously crafted, fine-tapered blades that perform a range of critical functions with finesse. They delicately compress the alveolar bone, incise the membrane, and gently facilitate tooth extraction, all while minimizing tissue damage. The Luxator extraction instrument range elevates the already exceptional array of high-quality extraction tools they offer. In the context of contemporary dental techniques, particularly implant procedures, Luxators are indispensable.…

21. Page 49

    . 1 EDITORS' CHOICE AWARDS 2023 Glidewell Solution Provides Convenience of Same-Day Restorations The glidewell.io In-Office Solution provides clinicians everywhere with a user-friendly, accessible digital workflow. With the ability to deliver fully sintered BruxZir NOW crowns and bridges in less than 45 minutes, this CAD/CAM system gives clinicians the ability to provide patients with the convenience of same-day restorations. The glidewell.io In-Office Solution is an open system and can be used with the scanner you already own. Designing a crown can be completed in just a few clicks thanks to the AI-backed algorithm of the fastdesign.io Software and Design Station,…

22. Page 50

    EDITORS' CHOICE AWARDS 2023 CJM Engineering Endodontic Burs Provide Ideal View Corridors of Target Area Munce Discovery Burs are the world's first endodontic troughing burs, and the Munce Discovery Bur line is a key element of the Munce Discovery Bur line. The unique, long narrow shaft and tapered diamond tip design make the TruGrit Trough Refiner the perfect companion to the Munce Discovery Burs and an important part of the answer to troughing challenges. Once the isthmus is identified under magnification and troughed with the Munce Discovery Burs, the TruGrit Trough Refiner can do precisely what its name implies—refine the…

23. Page 52

    EDITORS' CHOICE AWARDS 2023 Owandy Radiology CBCT System's New Generation of CMOS Sensor Produces Exceptional Image Quality The i-Max 3D Pro CBCT unit includes many distinguishing features. It offers a new generation of CMOS sensor for exceptional image quality. Its higher resolution features 72 µ voxels for 3D HD volumes. There are optional integrated AI-powered software modules for accurate graft analysis and implant placement. The system provides simple face-to-face patient positioning. It boasts a reduced environmental footprint at 93 lbs less than the original unit, uses more recycled materials, and emits less carbon dioxide. There is a dynamic reduction of…

24. Page 53

    EDITORS' CHOICE AWARDS 2023 DiaDent Universal Bonding Agent Provides Adhesion to Variety of Surfaces, Substrates Dia-X Bond Universal is a new, advanced eighth-generation universal bonding agent. It is a true universal bond, providing adhesion to a variety of surfaces and substrates for direct (resin-based composite, resin-modified glass ionomers, core buildup, resin cement, etc.) and indirect restorations (metal, zirconia, glass ceramics, alumina, etc.). It is versatile and can be used with all etching techniques, including self-etch, selective-etch, and total-etch. It is stable and hydrophilic with a long shelf life. Its single-bottle delivery, convenient flip cap, exceptional handling, and low 2-μm film…

25. Page 54

    EDITORS' CHOICE AWARDS 2023 NSK Dental Handpieces Ensure Superior Degree of Smoothness During Cutting Operations Ti-Max Z Premium Series Air-Driven High-Speed Handpieces offer a steady, powerful performance. The higher power ensures a superior degree of smoothness during cutting operations. Operability and visibility are significantly improved by the slimmer, sleeker design. The solid titanium body is 30% lighter than stainless steel and comes with scratch-resistant DURAGRIT Contamination reduction is provided with the DualDefense system with its clean head system and the antitraction valve. The handpieces are equipped with cellular glass optics, ceramic bearings, push-button chuck, and quattro spray. There is a…

26. Page 55

    EDITORS' CHOICE AWARDS 2023 Dentsply Sirona Aligners Offer Predictable Results Clinicians, Patients Expect In a recent 3-year retrospective analysis by Dentsply Sirona of more than 150,000 cases completed, SureSmile Clear Aligner cases showed that 75% of those cases required no refinements (data on file). Reducing refinements could have a positive impact on overall patient satisfaction and dental practice productivity by limiting chair time due to bringing patients back into the practice for refinements. Doctors may feel that refinements are just part of supplying clear aligner treatment, but with 3 out of 4 of those patients not needing refinements, SureSmile Clear…

27. Page 56

    The Benefits of Single-Visit, In-Office 3D Printed Ceramic Resin Restorations INTRODUCTION Three-dimensional printing in dentistry has seen accelerating growth over the past several years with emerging applications in definitive restorations. Not only is the technology becoming increasingly cost effective and user-friendly, but novel photopolymer resins are beginning to rival conventional materials in their durability and aesthetics, with some printed materials exceeding the mechanical properties of milled ceramics and hybrids. Printed restorations are a progressive solution to perform conservative indirect quadrant dentistry using inlays and onlays in a single visit. Partial coverage restorations enable conservation of the remaining tooth structure, providing…

28. Page 58

    Figure 1. Clinical presentation of a failing MOD composite in tooth No. 20, and DO amalgams in No. 19, and a large MO amalgam in No. 18. Figure 2. Clinical picture following removal of the failing restorative material and decay with preparation for inlay restorations on Nos. 18 and 20 with an onlay on tooth No. 19. Figure 3. Virtual model of the prepared teeth ready for virtual design of the restorations in preparation for 3D printing. Figure 4. The planned restorations have been virtually designed on teeth Nos. 18 to 20. Figure 5. Buccal view of the individual restorations…

29. Page 59

    AESTHETICS margin to the area noted at the central fossa. Tooth No. 20 had an MOD composite restoration with dark shading on the distal occlusal and marginal breakdown on the mesial portion (Figure 1). The patient indicated that she would be traveling in a few days and inquired if the treatment could be done that day and completed before her trip. Based on the clinical findings, the patient opted for single-visit delivery of inlay/onlays on teeth Nos. 18 to 20 utilizing in-office 3D printing. She was informed that the crack on tooth No. 19 may necessitate a larger restoration, but…

30. Page 60

    Figure 11. The restorations following 3D printing, with the supports present after separation from the plate, and ready for finishing. Figure 12. Restorations to the prepared teeth following luting and finishing of the margins after occlusal adjustment. Figure 13. Radiograph of the luted restorations. completed and ready to be printed (Figures 5 to 8). The exported STL files for these restorations were imported into Ray Ware Cloud (SpringRay), where automated algorithms determined the print layout and support structures in 100-μm layers in crown mode using the crown kit, which would allow printing of the restorations in 10 minutes (Figures 9…

31. Page 62

    Alternative Dental Implant Treatment Options The concept of All-on-X has become a prominent and popular mode of dental implant reconstruction. This normally entails removing all remaining natural dentition and reducing the available bone height to accommodate multi-unit abutments and the screw-retained, implant-retained prosthesis. The literature states that about 3 to 6 mm of interosseal space is needed per each arch for this type of fixed dentition. As teeth are lost, the available hard tissue shrinks both vertically and horizontally. In the posterior maxilla, the sinus floor may collapse following loss of root support. This creates some challenges for the implant…

32. Page 64

    Alternative to All-on-X: A Conservative Approach? INTRODUCTION Implant dentistry has become a prominent treatment modality in many of dental practices. Advances in engineering, design, and manufacturing have created fixtures that are both predictable, functional, and aesthetic. To become proficient in diagnosing and treatment planning, the practitioner must understand vital anatomy and the limitations to these popular modes of therapy. Diagnosing alveolar visualization in 3 dimensions, maximizing implant placement to maximize the final restorative results.2 Modern implants are used to replace single teeth and multiple missing teeth and certainly aid in supporting partial or complete removable appliances. Full arch, fixed prosthesis…

33. Page 65

    The limited bone availability may make implant placement challenging or unpredictable. Grafting procedures allow regeneration of bone at sites where deficiencies arise. Bone grafting techniques are an essential part of the implant dentist's skill set. Autogenous grafts, or those harvested from another site in the patient's mouth, may be the gold standard but require an invasive approach. Allograft materials, harvested from the bone of human donors, are popular since a secondary surgical site is not required. Cortico/cancellous particulates are processed to prevent disease transmission and antigenic responses. Internet searches by our patients are creating a high awareness of the benefits…

34. Page 66

    The patient presented a severe Class III occlusal relationship and with a deep underbite (Figure 1). CBCT analysis demonstrated significant collapse of the right and left posterior sinuses and inadequate bone height and width to support dental implants (Figure 2). Because of the maxillary sinus collapse, in order to surgically place dental implants with a positive prognosis, the maxillary right and left sinuses were augmented using the Caldwell Luc procedure, and the remaining maxillary dentition was temporized. The arch was opened, and the severe underbite was corrected to a more Figure 4. Proper positioning and spacing of the posterior implants…

35. Page 67

    Fully or partially edentulous patients are often resigned to a minimized quality of life. Function is most critical in individuals missing teeth, but creating aesthetics, emergence profile, and smile design may be equally important in their eyes. Those with natural teeth often find it challenging to imagine wearing denture teeth or losing their teeth totally, regardless of their conditions. Tooth loss results in bone loss over time, as has been discussed here. Bone loss may also occur around dental implants depending on many factors, so maintaining available hard tissue intuitively results in some semblance of insurance for any future treatment…

36. Page 68

    Ceramic Implants and Dental Implant Rehabilitation, Part 2 Full-Arch Removable Treatment INTRODUCTION In part 1 of this series, in the March 2023 issue, we discussed single and multi-unit restorations. This is part 2 of the series, which will focus on implant-retained and supported full-arch removable treatment with ceramic dental implants. Background As the baby boomer population is entering into the senior phase of their lives, there is a large number of edentulous adults in the United States seeking treatment. According to the American College of Prosthodontists and the National Center for Health Statistics, "there are 36 million completely edentulous adults…

37. Page 69

    low (71.9% for titanium and 55% for ceramic). Part of the reason for these low success rates can be attributed to the small sample size as well as the fracture of 2 ceramic implants in the maxilla. The implant literature has demonstrated a slightly higher failure rate of dental implants in the maxilla. It has been 10 years since that study, and thanks to material engineering and advanced manufacturing protocols, there have been significant changes and improvements in load-bearing ceramic implant material toughness, flexural strength, and overall composition. To the best of the authors' knowledge, no studies are available on…

38. Page 70

    Figure 3. Preoperative photo of the edentulous ridge showing adequate bone volume and keratinized tissues. Figure 4. Pre-op panoramic radiograph used to identify vital structures and virtually plan the implant placement. Figure 5. Pure 2 piece ceramic implant (Straumann). Figure 6. Intraoperative radiograph to confirm implant parallelism and also showing the use of drill stoppers for depth control. Figure 7. Clinical photo immediately after implant placement showing the minimally invasive approach. Figure 8. Final panoramic radiograph of all 4 implants after placement. Figure 9. The PUREIoc plan abutment was used to determine the correct height of the final locator type…

39. Page 71

    IMPLANTS 71 that are 5-plus millimeters in diameter and have locator-type abutments. CONCLUSION The evolution of zirconia materials has allowed for a better prosthetic variety, including the fabrication of LOCATOR-type abutments that allow for full-arch solutions. This case demonstrates the successful use of ceramic implants in order to rehabilitate a fully edentulous maxillary arch. As material science advances, we also expect the production of multi-unit type abutments that will allow for an abutment-level, fixed, full-arch solution (All-on-X) with ceramic implants. That said, since the majority of 2-piece ceramic implants currently available are tissue-level, a fixture-level All-on-X solution is also currently…

40. Page 72

    Traumatic Ulcerative Granuloma With Stromal Eosinophilia: A Case Report INTRODUCTION Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a relatively rare, benign granulomatous ulcerative oral mucosal lesion. TUGSE occurs more commonly among women compared to men. The propensity and appearance is that of a slow-healing ulcer with an elevated border, which is a similar clinical appearance to oral squamous cell carcinoma (OSCC). Therefore, a biopsy procedure is necessary to rule out (or rule in) OSCC. The condition is known to persist from one week to one year before resolution. The lesion tends to heal in a relatively quick fashion after…

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