Dentistry Today — September 2013

Inside this issue

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

1. Page 6

   Expanding Your CE Opportunities Beginning with this month's issue of Dentistry Today, we are adding more opportunities to earn continuing education (CE) credits for reading selected clinical articles. Each month, you can choose from any of the CE selections clearly marked with the blue CE logo. Next, simply read the article as you would normally do, then go online to dentalCEtoday.com to register and pay for the course. After you successfully complete a short quiz (online only for these selections), you will receive your CE certificate. New selections, marked with the blue CE logo, will be added every month to…

2. Page 8

   Are You "Into" Your Patients? A few months ago, I was chatting with a new patient. He was a very nice and very affable gentleman. After a few minutes of conversation, I felt comfortable enough to ask him (with his permission, of course) if he would share with me why he had left his previous dentist with whom he had had a long-standing relationship. He seemed comfortable with the question, so I felt assured that I hadn't overstepped any boundaries. He proceeded to tell me that, while nothing terrible had happened, he just had the sense that the dentist wasn't…

3. Page 10

   VIEWPOINT continued from page 8 That is a discussion for another time, but for now you should know that I disagree. Nobody disavows human contact. SCHEDULING THE TIME NEEDED? Now, back to the main point: You can be the model of efficiency, or you can schedule your patients in such a way that allows for you to really be into them. Yes, that means not expecting every last drop of production out of each day, and if your goal in life is perfect efficiency and the highest return on investment are you odd when you hear about colleagues who produce…

4. Page 12

   Dentistry Today.com Providing you with news and information from the industry leader in clinical content. Visit Our Site Today! DENTISTRY TODAY RENEW TODAY! For 2014 Technique of the Week Root Canal Therapy William Nudera, DDS, a board-certified endodontist from Bloomingdale, Ill, demonstrates his root canal therapy (RCT) featuring the WaveOne reciprocating instrument from DENTSPLY Tulsa Dental Specialties. In addition to showing the WaveOne in a challenging molar case, Dr. Nudera also points out other key steps that he follows for long-term RCT success. For more information, and to watch the video, visit . William Nudera, DDS DENTSPLY TULSA DENTAL SPECIALISTS…

5. Page 14

   FOCUS ON: Removable Prosthodontics Joseph J. Massad, DDS, discusses the uses of removable prosthodontics. Q: Is the need for complete, removable dentures and overdentures decreasing? A: On the contrary, I see a definite rise in this area of prosthetic dentistry. Indicators from the manufacturing sector point to affirming this statement. This increase was projected by Dr. Chester Douglas from Harvard University a decade ago when his research findings indicated that an increase in the need for new and replacement complete dentures would continue through the year 2020. Another indicator supporting this trend is the type of edentulous cases fabricated in…

6. Page 16

   From the June 2013 Issue TEMPORARY C&B MATERIAL DENTSPLY Caulk Integrity Multi + Cure Temporary C&B Material, a dual-cure 10:1 bis-acrylic material with improved flexural strength, yields up to 30% faster procedure times when using the light cure option. Alternatively, it can self-cure in 5 minutes. It is available in a 76 g cartridge delivery system with 5 refill shades—A1, A2, A3, B1, and BW. For more information, call (800) 532-2855 or visit integrityMulticure.com. FREEinfo, PULP PROTECTANT/LINER BISCO Dental TheraCal LC is a light-cured, calcium silicate-filled restorative material designed for use in direct and indirect pulp capping and as a…

7. Page 18

   NEW PRODUCTS NI-TI INSTRUMENTS JS Dental The Mity Roto T4 (.04 taper) and the Mity Roto T6 (.06 taper) higher-taper Ni-Ti instruments are designed for mechanical removal of dentin using your current variable-torque slow-speed handpiece. The T4 has yellow stops and the T6 has blue stops for easy identification. Both are available in 21- and 25-mm lengths in sizes 15 to 40, as well as assorted. For more information, call (800) 284-3368. FREEinfo, FIBER REINFORCEMENT Ribbond Ribbond's thinnest fiber reinforcement, Ribbond Ultra provides fracture toughness for periodontal splints, directly bonded bridges, composite restorations, and more. Its transverse fibers let axial…

8. Page 20

   Placing Posterior Restorations Simply and Efficiently: Ivoclar Vivadent's Tetric EvoCeram Bulk Fill With Ivocerin Amanda Seay, DDS Direct posterior fillings are the most commonly performed dental procedure, but when the restorations are placed with direct composites, the protocol can be time consuming. Meticulous attention to placing and curing layers of composite is necessary to ensure complete polymerization and prevent microleakage and post-op sensitivity. Dentists today can use bulk fill composites that reduce technique sensitivity, lessen the chances of shrinkage-induced failures, and demonstrate excellent handling and adaptability. As a result, posterior restorations can now be placed faster, easier, with more aesthetic…

9. Page 22

   Spotlight New Matrix System Features Transparent Matrix That Offers the Advantages of Metal Malleability SOUTH JORDAN, Utah-Trident and Ultradent Products introduce the V4 Matrix System featuring the ClearMetal Matrix with microwindows. ClearMetal is the only transparent matrix with the advantages of metal malleability. Hundreds of microscopic, resin-filled windows allow light to pass through the stains less steel, so curing composite in a Class II restoration can be initiated laterally and interproximally as well as occasionally while leaving no imprint on the composite. The V4 System creates natural contours with ease, and the added benefit of ring, matrix, and wedge transparency…

10. Page 24

    Spotlight New Dental Chair and Delivery System Combines Versatility With Elegance NEWBERG, Ore.—The new A-dec 400 dental chair and delivery system combines versatility with elegance. Emphasizing flexibility, access, and comfort, it satisfies the need for less complexity and more style at a competitive price point. Offered in a wide range of designer color options, the A-dec 400 offers a truly ambidextrous configuration to accommodate doctor preferences. The Radius delivery and support modules quickly and easily rotate around the chair for complete left/right compatibility. And to increase treatment room proficiency and enhance access to the patient, the A-dec 400 optimizes ergonomics…

11. Page 26

    Spotlight Apex Locator's Digital Signal Processing Enables Optimal Canal Preparation CHERRY HILL, NJ—Designed to work with most handpieces, the ApexNRG-Rider and the ApexNRG-Blue apex locators measure canal length in real time with a precision of 0.1 mm, allowing for quicker canal preparation without frequent manual verification stops. While other aggressive files increase the possibility of apex perforation, Medicinrg's devices use Digital Signal Processing to enable optimal preparation of the canal all the way to the apical constriction. This can be done without fear of perforation or penetration of the periapical tissues caused by the lag time of reading the file…

12. Page 27

    Modeling Instrument Designed for the Nonstick Placement of Composite AMHERST, NY-Iocular Vivadent's OptraScalp Pad modeling instrument features foam pad attachments designed for the nonstick placement of composite materials, allowing them to be placed and shaped with ease and efficiency. It is particularly well suited for the placement of Class III, IV and V restorations and direct veneers. Utilizing OptraScalp Pad, composite filling materials can be shaped and contoured without pull-back or unwanted marks. Natural-looking results can easily be accomplished in anterior and cervical restorations due to its special pad attachments, made of highly flexible synthetic foam material that optimally adapts…

13. Page 28

    Spotlight World's First and Only True Universal Adhesive in a Unit-Dose Delivery System Introduced BRIARCLIFF MANOR, NY-VOCO introduces Futurabond U, the world's first and only true universal adhesive in a unit-dose delivery system. Its 2 main advantages are (1) its universal indications for all adhesive procedures without the need for additional activators or primers and (2) its ability to prevent solvent evaporation, a well-documented challenge for adhesives dispensed in a bottle. Futurabond U's versatility allows it to be used in self-, selectiveor total etch mode—without any additional primers or activators—on virtually all substrates. It achieves total etch bond strength levels…

14. Page 30

    Kit Hailed as a Complete Cementation System for Lithium Disilicate Restorations SCHAUMBURG, Ill A complete system for cementation of lithium disilicate restorations, BISCO's eCEMENT kit features high-strength, radiopaque resin cements formulated to provide aesthetics at the margin. Light-cure and dual-cure resin cements are offered, ensuring that all lithium disilicate restorations will have exceptional long-term retention of singleor multiple-unit restorations. The eCEMENT kit provides simple and strong placement of lithium disilicate veneers, inlays, onlays, crowns, small bridges, and all CAD CAM blocks and pressable inlays made of lithium disilicate. Included in the kit are eCEMENT resin cement, SELECT HV ETCH, PORCELAIN…

15. Page 32

    Spotlight Partial Denture's Framework Material's Performance Advantages Cited SAN FRANCISCO - MicroDental Laboratories' VisiClear Partial Dentures feature VisiClear framework material that offers dentists and their patients performance advantages over traditional flexible and metal framework options. It is flexible yet fracture-resistant, which makes it comfortable and functional; it is easy to repair, polish, and adjust; and it is thin and translucent, making it an aesthetic option. VisiClear, an advanced thermoplastic material, is emerging as an option for partial denture frameworks. More water resistant than alternative flexible framework materials, it is also less prone to staining and odor. MicroDental Laboratories is offering…

16. Page 34

    Complete Composite System Offered THE VILLAGES, Fla-DMP water sorption, solubility, rounding teeth in a seeming- Dental's Complete Composand polymerization shrinkly invisible fashion. ite System features (1) Naage create restorations that The Bright Posterior comnoCeram universal, a lightresist deterioration and proposite's flow allows users to curing nanohybrid composite vide longevity, high marginal bulk fill posteriors without for all direct anterior and posintegrity, and minimal postoverfilling and wasting time terior restorations, (2) NanoCeoperative sensitivity. Also, grinding back the layering of ram Flowable, and (3) microleakage is virtually heavier composites. The flow Bright Posterior. They are ofeliminated. is such that it virtually elimifered…

17. Page 36

    Mini High-Speed Handpiece Now Offered With New Coupling Option SAVANNAH, GA- Small in size but big in performance, Brasseler USA's MINI high-speed handpiece offers a super-miniature head size that provides maximum access and visibility, and now—in addition to a quick disconnect model for brasseler couplings—a KaVo style coupling option is available. Complementing the handpiece is a new range of Brasseler MINI Burs. Shorter than conventional short-shank friction-grip burs, they offer unprecedented access when combined with the handpiece. For more information, call Brasseler USA at (800) 841-4522 or visit the Web site brasselerusa.com. FREEinfo, Endodontics by B&L Biotech, USA To all…

18. Page 40

    Material Dramatically Improves Productivity and Aesthetic Outcomes SAN MARCOS, Calif.–Offered by Shofu Dental, One Shot Uni-Layer HT Porcelain, an extension to the popular Vintage MP and ZR product lines (shown), is a revolutionary next generation ceramic material that dramatically improves productivity and aesthetic outcomes with a simplified, single powder build-up process. Just one baking cycle provides a flawless color match for any VITA shade. The densely packed homogeneous material yields vastly reduced shrinkage versus multiple firing cycle techniques while allowing one powder to build to full contour. For more information, call Lab Customer Service, Shofu Dental, at (800) 827-4638, extension…

19. Page 42

    In First Impressions, George Freedman, DDS, gives readers a brief summary of products that have recently been introduced to dentistry, based on his clinical experience. V4 ClearMetal Matrix System Ultradent Products Most posterior interproximal restorations are undercut. The metal of the matrix is an all-reflective barrier to the polymerizing rays of the curing light. Matrix are transparent but cannot reliably create an anatomical posterior surface or contact. The ideal posterior Class II matrix system must offer the benefits of a thin metal material and the transparency for curing irradiation. Ultradent Products has recently introduced its pioneering V4 ClearMetal Matrix System…

20. Page 44

    NEWS/TRENDS Industry News Jeff Golub-Evans, DDS 1941-2013 Jeff Golub-Evans, DDS, renowned cosmetic dentist, past president of the American Academy of Cosmetic Dentistry (AACD), and founder of the New York Center for Cosmetic Dentistry died August 1. He was 72. A 1966 graduate of the NYU College of Dentistry, Dr. Golub-Evans was one of the country's most revered cosmetic dentists. People magazine lauded him as the "Guru of Cosmetic Dentistry," and he traveled the world teaching his brand of high-art cosmetic dentistry. "The AACD and the dental professional as a whole are shocked and saddened by the recent passing of Dr.…

21. Page 46

    NEWS/TRENDS OSAP Developing Web-Based Tool Kits on Emerging Infectious Diseases Tool Kits' Targeted Educational Material Designed to Ensure the Dental Community Is Prepared As the world braces to understand the impact of emerging infectious diseases, the Organization for Safety, Asepsis, and Prevention (OSAP) is developing tools to ensure the dental community is equipped to respond to these threats. It has created free, Web-based tool kits, available for download at osap.org, that provide targeted educational material. OSAP's goal: to provide instruction for the safe and infection-free delivery of oral healthcare. load at osap.org, that provide targeted educational material designed to help…

22. Page 74

    Celebrating 30 Years of Service to the Profession In an interview facilitated by Dr. Damon Adams, Dentistry Today's editor-in-chief, Drs. John M. Powers, John W. Farah, and Sabiha S. Bunek candidly expresses their thoughts on current topics affecting the profession. Congratulations on your 30th year! What were the inspiration and reason for starting THE DENTAL ADVISOR? Dr. Farah: The inspiration began with a trip to the Chicago Midwinter Meeting in 1977. I had always been a fan of Consumer Reports magazine. The large number of vendors, dental products, and equipment left me with a lasting impression, but more importantly, with…

23. Page 78

    INTERVIEW clinical result will be. Although we regularly report on differences in products, there seems to be a need to focus on basics: What should I use, where should I use it, and what is the long-term success? As new products are introduced, I think the dental professional relies on independent, third-party evidence to determine the efficacy of a product. Clinicians need a reason to switch products. Where does the funding for your research projects come from for THE DENTAL ADVISOR? Dr. Powers: Our income is from manufacturers and subscriptions. We work and communicate with manufacturers all over the world…

24. Page 80

    Test 165 dentalCEtoday.com Confronting Controversial Issues in Dental Implant Therapy, Part 2 This 2-part article focuses on 5 subjects related to implant dentistry with the goal of helping to clarify certain controversial issues. Part 1 discussed the topics of abutment tilts of dental implant-supported prostheses, and increased crown-to-implant ratios (CRs). Part 2 discusses the topics of angulated abutments, connecting teeth to implants, and bone adaptation to stress. The objectives of this 3-part series is to summarize the critical salient facts as found in the literature and provide clinical guidelines to enhance patient outcomes. Gary Greenstein, DDS, MS John Cavallaro, DDS…

25. Page 82

    Confronting Controversial Issues... continued from page 80 Concluding Remarks Based on available data, several conclusions are drawn: 1. Angulated abutments result in increased stress on the implants and adjacent bone. 2. When compared to straight abutments, angulated abutments have not decreased the survivability of implants or prostheses or increased bone loss. 3. There does not appear to be additional screw loosening associated with angulated abutments. 4. It is reasonable to use angulated abutments to achieve parallelism between teeth and adjacent structures. 5. Often, angled abutments can help provide adequate occlusal relationships and would nced for bone augmentation procedures to ideally…

26. Page 84

    Confronting Controversial Issues... continued from page 82 teeth and implants are connected is typically within a range of tolerable bone change around implants that are free standing.33-33,38-46 The following results were reported with respect to bone loss adjacent to TISPs: no bone loss,33-36,41 bone loss was the same as an ISP,34,43 bone loss was within normal limits.37-43-46 Technical Issues Most studies noted only minor technical problems associated with TISPs.33-38,43-46 When TISPs and ISPs were compared intra individually,36-38,41 in general, the data indicate that use of rigid connections between teeth and implants in TISPs usually reduces mechanical complications to a level…

27. Page 85

    Table 4. Clinical Recommendations for Fabricating Tooth-Implant Supported Restorations22 1. Choose structurally sound teeth, nonmobile, periodontally healthy and in dense bone. 2. No stress breakers, no telescopic crowns, no copings. 3. On abutment teeth, create retention form with a small taper of axial walls and improve resistance form with boxes and retention grooves when the clinical crown is not long. 4. Parallel the tooth preparation to the implant abutment in order to use a rigid connection. 5. No screw retention or temporary cementation—emplpoy permanent cementation. 6. Bridge length ought to be short. If possible, put one pontic between 2 abutments.…

28. Page 87

    Test 165 Expiration date of this CE article is September 1, 2016. To submit Continuing Education (CE) answers, use the answer sheet below. Or, use our easy online option at dentaltoday.com. This article is available for 2 hours of CE credit. The following 10 questions were derived from the article "Confronting Controversial Issues in Dental Implant Therapy, Part 2," by Gary Greenstein, DDS, MS et al on pages 82 to 86. Learning Objectives: After reading this article, the individual will learn: (1) that there are abundant data to indicate that despite increased stress associated with certain types of prosthetic constructs,…

29. Page 88

    dentalCEtoday.com Go online to earn credit for reading this CE article.* IMPLANTS Small-Diameter Implant Placement: A Case Report Managing the Thin Knife-Edged Mandibular Ridge With Bone Grafting INTRODUCTION How often do patients arrive at your office so dissatisfied with their lower denture that they are carrying it in their purse or shift pocket? Whether is a full or partial denture, a poorly fitting mandibular prosthetic can generate a variety of quality-of-life concerns. Fear of the denture becoming loose or falling out may lead to avoidance of certain foods as well as insecurities about laughing, smiling, or even talking. These issues…

30. Page 90

    Figure 3. Lower arch, following extraction of teeth and roots. Figure 4. Periodontal flap reflected and mandibular alveolar ridge exposed. Figure 5. A coarse football diamond bur (No. 379-023 [Brasseler USA]) was used to flatten the knife-edged ridge. Figure 6. A No. 4 round bur was utilized to make small indentations in the cortical bone to create "stops" for the pilot drill. Figure 7. Pilot holes were drilled through the cortical plate. Figures 8a to 8c. Small-diameter implants (SDIs) (MDI Mini Dental Implants [3M ESPE]) were placed into the pilot site using the implant (a), followed by a finger driver…

31. Page 92

    Figure 10. Bone and blood harvested with a (sterile disposable) curved cortical bone collector (Safescraper Twist [Osteogenics Biomedical]). Figures 11a and 11b. Cortical plate perforations followed by a mixture of autologous and xenograft bone graduals. Figure 12. Resorbable membrane (BioCollect HMTEC, a 3M Company) in place to cover the bone graft. ...this step ensures there is adequate space in the denture base to accommodate the housings when they are seated on the SDIs.... Figure 13. Gingival tissue sutured passively back into place. Figures 14a and 14b. Clinical (a) and radiographic (b) examination revealed healthy tissue and bone structure as well…

32. Page 93

    IMPLANTS 93 denture delivery appointment versus psychologically tolerate in-office procepleased with the final results (Figure Curved version. osteogenics.com/v/productprocessing the housings into the dendures and follow-up treatment, as well 18) of her treatment. After 2 years, she group/SafeScape/1W3T(GenovaInc). ture base in the laboratory prior to as cessation of home care from support a successful outcome. remains confident and satisfied, say- Accessed March 17, 2013. delivery. The concern is that if the housing that she is able to eat the foods she Geistlich. Biomaterials. Natural bone regeneraings are not pulled at the final appoint- CLOSING COMMENTS enjoys, never worries about talking or…

33. Page 94

    dentalCEtoday.com Go online to earn credit for reading this CE article.* PROSTHODONTICS Duplicating the Posterior Extension of an Existing Denture Won-suk Oh, DDS, MS Ju-mi Park, DDS, MS, PhD INTRODUCTION The posterior extension of a maxillary complete denture (CD) should accommodate the patient's physiologic and neuromuscular function of the tongue and the palate while ensuring the retention of the prosthesis.1 To comply with the patient's dentition, the posterior end of the denture base commonly presents a sunken and rolled border of a beador butterfly shaped postpalatal seal, along the vibrating line of the soft palate.2 A record base is a…

34. Page 95

    This method of duplicating the posterior extension of an existing denture proven in the mouth is simple.... by means of a border molding when making a final impression for a maxillary CD. However, the posterior extension of the denture base should be determined to be compatible with the neuromuscular function of the soft palate and the tongue.1,3,4 The use of a record base is the most common method of transferring the vibrating line to the cast indicating the posterior extension of the denture base.5 This procedure can be carried out when registering the maxillomandibular relationship record or evaluating the teeth…

35. Page 96

    Dental Lasers George Freedman, DDS Fay Goldstep, DDS Most dentists do not thrive on the multiple challenges of brand new, high-tech, high-stress technologies. The diode laser, however, holds promise to be different. It can become clinically useful after appropriate in-office or online instructions. The easiest entry points for the laser tyro are gingival troughing for impressions and hemostasis. Online and lecture follow up training enhance both the clinicians' and auxiliaries' comfort level and competency for other procedures that involve tissue removal. Lasers are an innovative technology, which can be uniquely kind to tissues, and potentially exhibit excellent post-op healing, and…

36. Page 98

    Sirona Dental Systems The high-quality SIROLaser family operates in the 980-nm soft-tissue category and offers unique intuitive user navigation with customizable settings, integrated finger switch, and award-winning designs. The lasers come with presets in endodontics, periodontology, tissue management, and surgery. The SIRO Laser Advance is the complete solution with battery operation, programmable user access, history files, and 14W peak power, while the SIROLaser Xtend offers an advantageous price point solution and is upgradeable to the SIROLaser Advance. For more information, call (800) 659-5977. FREEinfo, Zila Pharmaceuticals The NV Microlaser puts diode laser technology in your hand with a convenient, cordless…

37. Page 102

    Six Ways to Improve a Patient's Health and Your Profits How to Enhance Your Practice's Financial Health When you have a periodontal patient seated in your chair, what is your first reaction? Do you get excited about the opportunity to improve your patient's oral and systemic health? Do you feel privileged for landing a case that will contribute significantly to your practice's bottom line? Or, do you cringe at the thought of losing money from potential cancellations and the patient's limited insurance coverage? Unfortunately, for many dentists, the latter answer is common. While an ideal periodontal treatment plan and subsequent…

38. Page 104

    Six Ways to Improve a Patient's Health... continued from page 102 your patient was in need of more than just a prophy appointment. Be vigilant of when you need to pick up the periodontal probe before proceeding with a curete. I have also seen three reasons combined: many insurance companies won't cover 4 SPT appointments per year, and the dental office skips periodontal assessments (or even treatments), only providing a glorified prophy. The problem: how, then, does the dental team know whether this patient needs more periodontal therapy? When periodontal patients fall off the radar, not only does your hygiene…

39. Page 106

    Six Ways to Improve a Patient's Health... continued from page 104 the balance point for future SPT visits. This is the first of future periodontal maintenance appointments. If a patient with no risk factors begins treatment during the early stage of periodontal disease, the patient's periodontium has the greatest chance to quickly heal and halt the progression of further progression of diseases after Phase I is complete (Table 2).5 As part of early intervention and subsequent periodontal maintenance appointments, removal of biofilm and microbes is a key preventive measure.6 Periodontal pathogens will repopulate a healthy and recently scaled sulcus as…

40. Page 107

    Table 4. Once a Perio Patient, Always a Perio Patient? The answer is yes, but on some occasions it may be appropriate to perform and report a prophylaxis (D1110) after periodontal maintenance has been performed. When can you change from periodontal maintenance to a prophy? If the treating dentist determines that a patient's periodontal health can be augmented by a routine prophylaxis, delivery of this service and reporting with code D1110 may be appropriate. Please make note that some insurance companies will deny future payment if this patient returns for treatment of periodontal disease. The problem with this is that…

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