Dentistry Today — September 2014

Inside this issue

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

1. Page 10

   Personal Perspective I will never forget when I got the call from Dr. Phil Bonner, the CE editor and former editor-in-chief of Dentistry Today, telling me that I would be taking over the editorial helm of this prestigious magazine. That exciting news was received nearly 7 years ago, and the ride since has been very rewarding, both professionally and personally. During the first few months on the job, while adjusting to the publishing world, I started to increase the variety and scope of topics presented in a way that would clinically benefit all and the same time, pique reader interest.…

2. Page 12

   The Mobile Implant Practitioner When my colleagues ask me where my practice is, and I tell them that I work in many practices because I am mobile, they give me a blank stare. They usually follow up by asking, "What do you mean you are mobile?" My answer to this point would be this: "I practice one point about 12 to 15 different offices, doing implant-based surgery; I am a mobile implant practitioner." The next response one would give is how interesting and unique this type of practice model is. Colleagues then want to know about how I got involved…

3. Page 14

   VIEWPOINT continued from page 12 with regard to implantology, if a practitioner would like to limit his or her practice to dental implantology, this can be quite difficult due to all the competition and cross-discipline involvement. In my opinion, it is due to this overall business environment that we have seen a new trend in the growth of the mobile implant practitioner. DEFINING THE MOBILE IMPLANT PRACTITIONER What do I mean by a "mobile implant practitioner"? These practitioners limit their practices to dental implantology and do not have traditional fixed-location practice offices. They are strictly mobile, traveling in and out…

4. Page 16

   Scheduling Institute Transforming Thousands of Dental Practices Each Year...It All Starts With New Patients! As a writer, I've worked extensively in the dental industry for more than 20 years. I've closely observed the kind of success dentists were experiencing before the recession and what happened after it. And I've watched dental consultants step into the fray, promising to "cure" practice issues overnight, often with very mixed results. I've seen it all—or so I thought. While I had heard of Jay Geier's Scheduling Institute (SI) and the claims they make about transforming practices and the opportunities of the "new patient generation,"…

5. Page 17

   Dr. Ben Johnson and his team after a day of doing free dentistry for their local community. the following statement: "I am overall a more complete person and a better leader in my practice, in my personal life, and in my community." This renewed commitment to patients and families is concomitant with SI success stories. In a profession that is about helping people, this is a good thing to witness. CASE STUDY: DR. MICHAEL LANDRY, HOUSTON Maintaining Success—and a Work-Life Balance Dr. Landry remembers something that occurred in dental school that altered his perspective on his career. Patterson Dental did…

6. Page 18

   FOCUS ON: Aesthetics Versus Cosmetics Ross W. Nash, DDS, reviews the differences between cosmetic and aesthetic dental procedures, discussing tools and techniques to help draw more fee-for-service patients. Q: What is the difference between cosmetic dentistry and aesthetic dentistry? A: Cosmetic procedures are those performed for appearance only and are elective in nature. Aesthetic procedures are those that are needed to improve health and function but also mimic natural teeth in appearance as well as form. Elective procedures should be performed in the absence of dental disease and in the presence of dental health. Aesthetic dentistry is used to correct…

7. Page 20

   Visit Our Site Today! Technique of the Week Endodontic Therapy In this video, leading endodontist and renowned lecturer, Allan Deutsch, DMD, describes the benefits of using Piezo Ultrasonic Tips in endodontic therapy. Sit down with Dr. Deutsch in his office as he reviews benefits and clinical cases involving various endodontic ultrasonic techniques. He reviews all tools to be used for the procedure, highlighting the advantages of each. To view the entire video, visit the Web site . Allan Deutsch, DMD ADA Meeting 2014 Coverage From the Show Floor Come with us to San Antonio for this year's ADA Annual Session.…

8. Page 22

   From the June 2014 Issue PROVISIONAL CEMENT Ultradent Products ClearTemp LC is a cement developed specifically for provisional veneers, offering exceptional retention and a highly marginal seal. Most importantly, its translucent shade is ideal for provisional anterior veneers. It does not create an opaque show-through with the temporaries. The cement is light polymerized, providing the additional retentive strength necessary to keep provisional veneers in place and allowing marginal flash removal prior to curing. For more information, call (800) 323-7063 or visit the Web site ultradent.com. FREEinfo, WHITENING SYSTEM Philips Oral Healthcare With Philips Zoom, there's a solution for every patient—and…

9. Page 24

   NEW PRODUCTS CURING LIGHT DENTSPLY Caulk The SmartLite Focus Curing Light has been designed to ensure reliable curing all the way to the floor of the proximal box, the most vulnerable interface in a Class II restoration. Its collimated light beam reduces light divergence for a dependable cure over larger distances, and its homogeneous beam profile delivers uniform performance within the curing area. Add Smart Recharge Technology that checks battery conditions and initiates the proper charging mode and experience dependability and simplicity at its finest. For more information, visit smartlitefocus.com. FREEinfo, MULTIVITAMIN American Tooth Industries The OnePro Diet Multivitamin is…

10. Page 26

    Venturing Into Anterior Aesthetics Using In-Office Digital Dentistry Charles L. Regalado, DDS While digital dentistry has been gaining in popularity and ease of use, most clinicians have remained comfortable using the technology for posterior use only. Many dentists are venturing out into the area of anterior aesthetics while this has typically been the domain of experienced laboratory technicians. While there is no doubt of the value of well-trained lab technicians in creating the lifelikeness of natural tooth structure, there are times when a dentist can use CAD/CAM-generated anterior restorations with great competence. Even implant crowns can be created using in-office…

11. Page 28

    Spotlight Device Provides the Fastest, Easiest Way to Measure Tooth Shades Attend a 45-Minute Webinar and Receive $400 Rebate BREA, Calif.–With its cutting-edge measurement technology and durable LED components, Vident's VITA Easyshade Advance 4.0 provides the fastest, easiest way to measure tooth shades in any lighting condition, giving you the ability to conquer the trickiest shade challenges instantly and accurately. Removing the guesswork inherent with shade matching while reducing remakes and increasing valuable chairtime, it precisely measures VITA 3D-Master and Classical shades as well as ADA-recommended bleaching shades 1 through 29 for tracking bleaching regimens. Through September 30, Vident is…

12. Page 30

    Loupes' Ergonomics and Strength Ensure Lightweight Comfort and Long-Lasting Life DUNCANVILLE, Tex.–Q Optics' Prism Loupes redefine the standard in surgical and dental loupes. Advaced materials and nose-relief design combine to create the most lightweight and ergonomic prism loupes ever introduced, and machined titanium unibody housing allows lenses and prisms to be aligned and affixed in a unique optical cage. Carbon-fiber shrouds provide extreme weight reduction and nose relief for the steepest ergonomic angles, and strength and rigidity of construction ensure light weight comfort and long-lasting life. For additional information, contact Q-Optics at (800) 858-2121, ext. 3675, or visit q-optics.com. FREEinfo,…

13. Page 33

    TECHNOLOGY 33 Next-Generation Scanner Offers Faster, Easier Scanning and Superior Accuracy Among the Device's Features, the Smallest Wand on the Market ST. PAUL, Minn.–Offered by 3M Digital Oral Care, the next-generation 3M True Definition Scanner features a new wand with a profile so slim that it's the smallest on the market. The scanner will be released this fall in tandem with 3M True Definition Scanner Software 5.0, which supports faster, easier scanning with superior accuracy. The 3M True Definition Scanner was built for fast scanning: once a field is prepared, an adept user can scan a diagnostic arch in as…

14. Page 34

    Ivoclar Vivadent's Adhese Universal Simplifies Restorative Cases Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8. Todd Ehrlich, DDS Direct composite restorations are among the daily procedures clinicians perform. Because these procedures can be time-consuming and technique-sensitive, clinicians must rely on advanced materials to ensure an aesthetic, predictable outcome that meets a patient's functional and aesthetic desires. Patients may feel hesitant about expressing their concerns over material choices, even if they experience adhesive sensitivity after these restorative procedures, so it behooves clinicians to select materials that they and their patients feel confident using.…

15. Page 36

    INNOVATIONS . 1 Spotlight Dental Profession's First CAD/CAM-Milled Obstructive Sleep Apnea Device Introduced DUBLIN, Calif.- MicroO2, the dental profession's first CAD/CAM-milled obstructive sleep apnea device, is FDA-cleared and offers dentists an innovative option for treating the growing number of patients diagnosed with obstructive sleep apnea. Utilizing a PMMA material that is cured under controlled conditions, allowing it to be small yet strong, precise, and predictable, the MicroO2 does not require patients to manage any mechanical adjustments, such as turning screws or changing positions with elastics. Instead, it comes with one pair of upper and lower arches set to the prescription…

16. Page 38

    Spotlight Practice Performance Analysis Empowers Dentists to Grow Their Practices OWINGS MILLS, Md.-Offered by Levin Group, Practice Performance Analysis is a diagnostic business evaluation that provides dentists with the critical information they need to grow their practices. As a dentist, you know that the first step toward solving a problem is diagnosis. Only then can you design an appropriate treatment plan for the patient. That's how Practice Performance Analysis works. Similar to a new patient exam, the analysis is an in-depth assessment of your business systems conducted at your office by a Levin Group Certified Practice Analyst. In less than…

17. Page 41

    Natural Antiseptic Mouthwash's Germ-Killing Capabilities Cited MORRIS PLAINS, NJ–LISTERINE Naturals Antiseptic Mouthwash is a natural mouth wash that is equally as effective and safe as Original LISTERINE Antiseptic Mouthwash; the difference is that its active ingredients, flavors, and sweetener are sourced from nature, and its formula is dye-free. It has the same active ingredients as Original LISTERINE Antiseptic Mouthwash and kills 99.9% of germs that cause bad breath, plaque, and gingivitis. For more information, visit listerineneprofessional.com. FREEinfo, E-Style Contra-Angle Offered LAS VEGAS–Offered by Medidenta, the affordable Interprox e-style contra-angle is ideal for any procedure that requires a basic and smooth…

18. Page 45

    Paste Protects Against Demineralization and Erosion BRIARCLIFF MANOR, NY—Containing hydroxyapatite (calcium and phosphate), fluoride (1,450 ppm), and xylitol, VOCO's Remin Pro offers triple protective dental care, protecting against demineralization and erosion. Hydroxyapatite, found in the natural tooth structure, fills superficial enamel lesions, impairs bacterial plaque adhesion, and restores mineral balance. Fluoride seals open dentin tubules and resists naturally occurring acid attacks; and xylitol, a great sugar substitute, has cariostatic properties and cannot be converted into harmful lactic acid. Also, because of this triple protection combination, there is no risk of prophylaxis allergies. Offered in 3 flavors—melon, mint, and strawberry—Remin Pro…

19. Page 46

    In First Impressions, Georac Freedman, DDS, gives readers a brief summary of products that have recently been introduced to dentistry, based on his clinical experience. MirrorImage Cosmedent Provisional restorations must be strong and aesthetic yet easy to remove for final cementation. They must be easy to fabricate (particularly by an auxiliary where permitted) and simple to trim and polish. Ideally, a single provisional material should serve for both single and multiple unit indications. Working with practitioners, Cosmedent has recently developed MirrorImage, an advanced, component provisional in cartridges based on multifunctional methacrylate resin chemistry. Its physical properties allow thin, translucent, aesthetic…

20. Page 47

    Uveneer Dental Art innovations Practitioners are often called upon to restore the facial surfaces of teeth. Whether the treatment is an extensive Class IV, direct veneer, or an can be used with any composite. Unlike prefabricated composite veneers, Uveneers are undoable and reusable, not limited by sizing or shade. Two central incisors restored with Uveneer. immediate implant provisional, the size, the color, and the 3-D contour must all be perfectly developed to align with the parameters of the existing dentition. The dentist's major challenge is to accomplish these tasks freehand. The customary clinical procedure is to overbuild the restoration, then…

21. Page 48

    NEWS/TRENDS Industry News Manufacturer Announces Revitalization/Rebranding George Taub Prod ucts & Fusion Com pany, manufacturer of dental consum able products, announced recently a major revitalization initiative that involves corporate rebranding, a new name, and new products. TAUB Products, as the company will now be known, has a new corporate logo and mar keting approach and will soon be announcing several new products. The effort is part of the lec ity. NJ based company's commitment to (1) continue to transform and upgrade all systems and standards, (2) utilize 21st-cen tury technologies, (3) streamline operations and increase productivity, and (4) provide unsurpassed…

22. Page 50

    NEWS/TRENDS Technology Hailed as Major Breakthrough in Oral Care Israel Kleinberg, DDS, PhD, DSc, Distinguished Professor in the Stony Brook University School of Dental Medicine's Department of Oral Biology and Pathology and director of its Division of Translational Oral Biology, has spent decades investigating the chemistry and physiology of human mixed bacterial communities, especially those in the mouth that interact with saliva in supporting oral health. His findings and subsequent research have led to the development of AlkaGen Technology, hailed as a major breakthrough in oral care by Mitchell Goldberg, president of Ortek Therapeutics. The technology is utilized in Ortek's…

23. Page 51

    NEWS/TRENDS Cold Case... continued from page 48 mining and the use of leaded gasoline, so there's a clear distinction between modern and historical human exposure. Using this information, archaeologists can identify early European bodies in New World settings. "You can go back in time, look at archaeological sites, and try to reconstruct human migration," Dr. Kamenov said. "And modern American teeth are like no others in the world, according to Dr. Kamenov. Whereas data for areas such as South America overlaps with European data, American teeth can be identified anywhere due to usage of ore with lead signals that are…

24. Page 82

    Goldstein, Garber, and Salama: A Legacy Lives A written interview requested and directed by our editor-in-chief, Dr. Damon Adams, with Ronald E. Goldstein, DDS; David A. Garber, DMD; Maurice Salama, DMD; and Henry Salama, DMD; on the unique history of one of the most successful and innovative practices in North America as well as the future of dentistry. You're a partnership that has endured in excess of 50 years in the case of Drs. Ronald Goldstein and David Garber, 23 years since Dr. Maurice Salama joined you, and 18 years since Dr. Henry Salama joined the team in Atlanta. That's…

25. Page 84

    Goldstein, Garber, and Salama... continued from page 82 Dr. Goldstein, explain to our readers how your primary concern, which is patient care, benefits from the teaching endeavors in which all the team members are actively involved. Dr. Goldstein: Teaching requires one to constantly stay up to date with the latest science and technology, which has accelerated dramatically during the last 30 years. The team's teaching, as well as research initiatives, have made them leaders in the field and constantly on the cutting edge of comprehensive therapy. This prominent profile has generated professional and patient inquiries, and interest from all over…

26. Page 86

    Goldstein, Garber, and Salama... continued from page 84 other digital technologies and therapies rapidly decreasing into more manageable price ranges. I believe this trend will continue as it has in many other areas of technology. In addition, the software is becoming progressively more user friendly. As opposed to proprietary architecture, the open source paradigm in software is permitting the efficient sharing of information and data across the board. Today, digital technology in all its different forms is essential to making dentistry, in general, and implants, in particular, safer and more accessible for a higher percentage of the population. Similarly, most…

27. Page 88

    Goldstein, Garber, and Salama... continued from page 86 Kingdom," and "Team South Africa" are a few that come to mind and have been featured on the site as well as a special issue of the The American Academy of Cosmetic Dentistry Journal that was in partnership with DentalXP, and, had Maurice as the editor. In February 2013, DentalXP had their first "brick and mortar" Global Symposium in Las Vegas. As someone who has attended many meetings throughout the years, what made this one stand out for you? Dr. Henry Salama: Combining the different forms of education—"seeing," "hearing," and the "supervised…

28. Page 89

    ClubXP meetings in collaboration with DentalXP's leading educators designed to fit the individual club's specific needs in any topic using a platform that combines both live speakers as well as online follow-up. It is also exciting to see so many effective teachers using dentalxp.com to constantly add ideas, tips, or new techniques daily. The hope even more clinicians will utilize this mode of sharing, teaching, and learning together, and enjoy being part of a global community with personal relationships that can be started simply with a click on any computer, tablet, or smartphone. Dr. Garber: Dentistry is evolving far more…

29. Page 90

    ce Test 177 dentalCEtoday.com IMPLANTS MAC and ZAC: Clinical Protocols for Predictable Implant Aesthetics A long recognized complication in implant dentistry, and most notably having the greatest effect on the aesthetic potential of dental implants in the anterior aesthetic zone, is the coronal loss of bone. A common sequella to this is the loss of gingival tissues, most notably in the papillary area and on the distal aspect. This "cupping" effect begins at the time of implant uncovering, at removal of the cover screw, and proceeds through the healing abutment phase and placement phase impression abutment, and definitive prosthetic abutment…

30. Page 92

    IMPLANTS FIGURE 2. Hopeless tooth No. 7. Note fistula apical to the gingival zenith. FIGURE 3. Periapical radiograph of tooth No. 7. Horizontal fracture between prosthetic crown and natural root structure. FIGURE 4. Implant treatment planning image viewed on Anatomage's InvioS software. FIGURE 5. Incisal edge index in GC America's Pattern Resin. FIGURE 6. Immediate nonfunctional provisional restoration immediately postop after implant placement. Incisal edge index has been utilized to position clinical crown on provisional abutment. FIGURE 7. Definitive restoration of implant No. 7. FIGURE 8. Periapical radiograph of implant No. 7, one year post-op. simple procedure. Adhering to the…

31. Page 94

    MAC and ZAC: Clinical Protocols... continued from page 92 in the habitual occlusion (maximal intercuspal position) but also in all exclusive pathways. If this provisional restoration is to be retained with cement, considerable care must be utilized during the cementation procedure in order to avoid the inadvertent trapping of subgingival excess material. Conversely, the provisional restoration can be designed to be screw retained with some additional alterations. After the appropriate healing time for this newly placed implant/provisional restoration, the first abutment dis/reconnection occurs during the impression procedure. The provisional restoration/abutment units are moved, an impression coping placed, and an impression…

32. Page 96

    MAC and ZAC: Clinical Protocols... continued from page 94 The tooth can now be atraumatically removed (Figure 13) and the implant immediately placed into the fresh socket environment (Figures 13 and 14). The precision of placement with the surgical guide is not only for the buccal lingual, mesial distal, and coronal apical dimensions, but it also predicts the timing of the implant in the alveolus and the abutment are indexed, and these indices must mate with precision to facilitate the exact abutment positioning, and hence the exact provisional position. The three-dimensional resistance to torque must be evaluated, as this will…

33. Page 97

    Test 177 Expiration date of this CE article is September 1, 2017. 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 come derived from the article "MAC and ZAC: Clinical Protocols for Predictable Implant Aesthetics" by E. Dwayne Karatkeev, DDS, on pages 90 to 96. Learning Objectives: After reading this article the individual will learn: (1) the complications in achieving predictable implant aesthetics in the anterior aesthetic zone, and (2) the 2 clinical protocols for enhancing…

34. Page 98

    ce dentalCEToday.com Go online to earn credit for reading this CE article. IMPLANTS Success With Screw-Retained Zirconia Bridges, Part One Treatment Planning Concepts Michael Tischler, DDS Scott D. Ganz, DMD Claudia Fitch, DMD INTRODUCTION When a patient presents with the need for full-arch tooth replacement supported by dental implants, it is important for all members of the team to understand the various fixed or removable prosthetic alternatives. Factors that can affect the treatment plan include the available bone, type of bone quality, adjacent vital structures, pathology, the number of potential implants, smile line, and aesthetic demands. Once a patient has…

35. Page 100

    Success With Screw-Retained... continued from page 98 (Figure 9). Adequate vertical space can also be accomplished through an increase in vertical dimension of occlusion (VDO), or via modification of the opposing arch. Reducing alveolar crest bone allows an FP's prosthesis based on the Misch Classification.² An FP's prosthetic design has increased prosthetic space, which requires area of "pink" artificial gingiva to close the vertical space. An advantage of the FP's prosthesis is that the pink gingival area can be controlled based upon the patient's smile line, and can result in a very aesthetic appearance, and will maintain itself without the…

36. Page 101

    IMPLANTS the informed consent process, and as each option is presented, the pros and cons of each are reviewed. The advantages and disadvantages of the alternative implant-supported options need to also be presented and documented as part of the patient chart. A CT/CBCT scan is recommended to plan for the correct implant positions, to diagnose existing pathology, and to avoid iatrogenic damage to vital anatomy (Figure 14). CBCT scans offer low radiation and interactive 3-D planning through many available software programs. Third-party diagnostic imaging services are now available for any clinician to gain access and assistance in treatment planning for…

37. Page 102

    IMPLANTS ing major oral reconstruction, and are reliant on the treatment facility to simplify the process while providing a level of comfort. It is recommended that an organized protocol be utilized when presenting treatment options, treatment sequences, financial ramifications, and documentation. This organized protocol can consist of team (staff) roles for each presentation step, specific books or videos to explain options, and organized folders for the needed paperwork.13 It is recommended to organize and simplify the process as much as possible. This will be individualized for each office's situation, but should be repeatable, smoothly executed. From a financial and communication…

38. Page 104

    Three Breakthrough Implant Procedures MICROEVOLUTION OF IMPLANT DENTISTRY Brady Frank, DDS The world of dental implants has seen many changes since Dr. Brånemark placed the first implant in 1965. Historically in the United States, implantology was mainly considered to be territory of the specialists. In the early 2000s, with implants gained a great deal of popularity among general practitioners (GPs) due to the minimally invasive nature of the surgery and, furthermore, with the ability to integrate these procedures into the practice in a very streamlined manner. It is this movement that has provided the basis for the most recent minimally…

39. Page 106

    Three Breakthrough Implant... continued from page 104 variety of implant cases on a monthly basis. The following is a brief overview of the 3 procedures that can transform your practice, if you choose to learn more about them. The 3-in-1 Implant Procedure The first procedure I will describe to review is called the 3-in-1 Implant Procedure (Figure 1). Many GPs call this the "5-minute implant, abutment, and crown" procedure. This procedure allows a patient to place his or her time in the dental chair to receive an implant, abutment, and crown, up to 3 appointments. It is a huge benefit…

40. Page 107

    IMPLANTS 107 tion takes more time to complete than the implant procedure. In many practices, about 50% of extractions have transformed to extraction and implant cases using the No-Drill Implant Procedure. Studies support the success of immediate placement flapless procedures which result in no crest bone loss and show high success rates. In a study titled, "Flapless Single-Tooth Immediate Implant Placement," researchers found a favorable implant success rate related to the flapless immediate implant placement protocol.3 The 1-Drill Implant Procedure The third and final procedure that can help GPs with placing implants more efficiently is the OsteoReady 1-Drill Implant Procedure…

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