Dentistry Today — September 2016

Inside this issue

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1. Page 6

   Technology Impacts Today's GP In this issue of Dentistry Today, we are focusing on technology as it relates to the delivery of clinical dentistry. Technology advancements are being made at a pace that continues to move the needle as to how dentistry is delivered. Behind the scenes, research to meet practice and business demands drives the development of better and more cost-effective delivery concepts. Our exciting article lineup in this issue showcases new technologies that are available today for the practitioner to put into immediate use. Dr. Robert Ritter, in our full coverage selection, demonstrates how he, as a GP…

2. Page 8

   The Occlusion Myth What is it about occlusion that gets dentists so worked up? Occlusion is a subject in which many dentists have had any kind of advanced training since they left dental school. Many dentists have invested thousands of dollars in advanced training based on one occlusal philosophy that then becomes the basis of all their treatment delivered to patients. I completely understand the challenge—once a huge investment of time and money has been made, it may make it difficult to have a broader view of what occlusion's real role is in dentistry. Truthfully, it is even ridiculous to…

3. Page 10

   VIEWPOINT continued from page 8 exist at approximately 8 US dental schools. What do they teach when it comes to occlusal philosophy and the role that occlusion plays in the treatment of TMJ and orofacial pain? I think the answer might surprise you. I'll frame it this way: I know dentists who have gone through the full 2-year orofacial pain residency and in that entire time, they never once picked up a high-speed handpiece to adjust anyone's occlusion for the treatment of headaches, migraines, or TMJ/orofacial pain. These residencies also spend an incredible amount of time looking at evidence based…

4. Page 14

   FOCUS ON: Translucent Zirconia Rella Christensen, PhD, discusses new findings critical to successful use of zirconias. Q: Other than better aesthetics, is translucent zirconia different from non-translucent zirconia? A: Yes! It is important to realize that translucent zirconia has a different formulation which results in entirely different physical properties. It is not as tough and strong as low translucent zirconia. In our newest clinical study, including several brands of both the original low-translucent and the new higher translucent formulations, we have found that the new higher translucent zirconias are more likely to fracture if substantial chairside adjustment or endodontic access…

5. Page 16

   NEW PRODUCTS VPS IMPRESSION MATERIAL Dentsply Sirona Aquasil Ultra+ Smart Wetting Impression Material, a completely redesigned VPS final impression material, addresses critical performance areas. Market-leading intraoral hydrophilicity and tear strength complement speed and delivery to help clinicians avoid trapping fluid and ensure dental remains intact. For more information, visit the website aquasiliultraplus.com or call (800) 832-2855. FREEinfo, HEMOSTATIC AGENT Vista Dental Products Containing proprietary surface modifiers that allow for better penetration in the affected area, more efficient coagulation of red blood cells, and better dispersion of active agents within the wound, Quick-Stat FREE, a viscous, clear hemostatic agent containing no…

6. Page 18

   From the June 2016 Issue RESIN CEMENT Dentsply Sirona Restorative Excess cement cleanup is now a snap with Calibra Universal Self-Adhesive Resin Cement. Dentists can benefit from the swiftness of tack-curing without the stress of overcuring. Calibra Universal Cement offers a wide tack-cure window of up to 10 seconds and an extended 45-second gel phase, providing dentists with the ability for a more thorough and effective cleanup. Calibra Universal cement offers predictable cleanup, exceptional strength, and beautiful aesthetics. For more information, call (800) 532-2855 or visit calibracement.com. FREEinfo, LED LIGHT DentLight The new Nano Freedom LED Light is engineered to…

7. Page 19

   HAVE YOU EXPERIENCED KAHNG SIGNATURE IMPLANTS YET? by LSK121 Oral Prosthetics Dental Laboratory IMPRESSION SYSTEM Ivoclar Vivadent The AccuDent XD Alginate Impression System, representing the evolution of the time-proven Accudent Impression System, includes (1) two dual-phase alginate materials (tray and syringe) for improved accuracy and precision and (2) a thermoplastic, heat-moldable tray system for both dentate and edentulous impressions. The secret behind the XD system is the unique relationship between the 2 impression materials. For more information, call (800) 533-6825. In Canada, call (800) 263-8182. FREEinfo, PANORAMIC SYSTEM Air Techniques From a single exposure, only ProVecta SPR captures 20 layers…

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   Test 201 dentalCEtoday.com PHARMACOLOGY Chemotherapy Agents and Dentistry This article discusses the types of chemotherapy agents used to treat diseases (especially cancer), the side effects of such agents, and the dental management of patients undergoing chemotherapy. The therapy for any particular type of cancer is becoming more and more sophisticated, and patients are living longer and are even surviving these ordeals. Chemotherapy is a broad term and is often confused when used to relay the information that the patient is taking medication to combat a particular disease process. Typically this is a cancer. By definition, then, chemotherapy is the treatment…

9. Page 21

   Figure 1. Oral side effects of chemotherapy: oral ulcers. (Courtesy of Dr. Indraneel Bhattacharyya, University of Florida College of Dentistry, Gainesville, Fla.) Figure 2. Oral side effects of chemotherapy: dental caries. Figure 3. Oral side effects of chemotherapy: stomatitis/mucositis. medications in this group work on all phases of the cell cycle.1 Examples of this group of antitumor antibiotics agents include: Adriamycin, Daunorubicin, Epirubicin, and Idarubicin. Drugs such as Mitomycin, Actinomycin-D, Bleomycin, and Mitoxantrone are types of antitumor antibiotics but are not in the anthracycline group. Topoisomerase Inhibitors These drugs interfere with a specific type of enzyme in the nucleus called…

10. Page 22

    Digital Implant Dentistry Reducing Treatment Time, Cost, and Manual Skill Development Paul A. Schmitman, DDS, MSD Dwayne I. Escobar, DDS, MMS Sergio Florencio, DDS Soomin Jung, DDS, MMS Andreas Radics, CDT INTRODUCTION Today, clinical implant treatments require years of manual skill development on the part of the surgeon, restorative dentist, and dental technician. This can be accomplished using digital technologies to aid plan and place a restorative driven implant and its restoration in just 2 patient visits. The significance of this approach is a reduced learning curve, coupled with minimization of manual skill development and the use of open digital…

11. Page 24

    Digital Implant Dentistry... continued from page 22 Appointment 2: Implant Placement and Restoration Delivery The patient was in good health. He was premedicated with amoxicillin 2,000 mg one hour before surgery; a Medrol dose pack was begun in morning one day prior to surgery; chlorhexidine rinse after breakfast and before sleep with 15 cc for 30 seconds one week before implantation; and alprazolam 0.5 mg at bedtime the night before surgery. Prior to surgical implant placement, the inspection windows on the surgical template were checked for a gap free fit in the patient's mouth (Figure 6). Local anesthesia was obtained…

12. Page 26

    Digital Implant Dentistry... continued from page 24 and milled restoration using Dentsply Sirona's Sirona workflow. Using Sirona software and equipment, the implant position and guide can be planned; however, the restoration cannot be planned until the implant is in place, resulting in the patient spending a Figure 8. (a) Implant placed, occlusal view. (b) Implant placed, buccal view. Figure 9. (a and b) Fitting temporary crown over temporary cylinder. (c) Autopolymerizing polymethyl methacrylate (Temporary Bridge Resin [Dentsply Sirona Restorative]) was flowed in the spaces surrounding the temporary cylinder. long waiting period in the office following surgery for the restoration to…

13. Page 27

    Figure 14. (a) Emergence profile in the digital planning. (b) Digitally milled implant restoration. (c) Retine restoration. abutment, both were removed, and a small space between the shoulder of the temporary abutment and the cervical area of the crown was filled with PMMA and polished (Figure 4.4). However, since the emergence profile is subgingival, this presents the restoration try in prior to the sutures. For this patient, it proved not to be a limitation. Today, the major shortcoming of this method is that the software programs are not integrated along all aspects. For example, the restoration for implant planning lacks…

14. Page 28

    28 . 1 TECHNOLOGY Spotlight Image Tracking Software Helps Promote Practice Growth ELDORADO HILLS, Calif.- Your patients want to be shown, not told, what needs to be done. Join more than 35,000 dental offices that have said yes to Digital Doc. Follow a simple plan to create a patient experience that will result in double-digit growth. NightHawk Image Tracking Software tracks how many images are taken and the scheduled production per provider, proving return on investment. Remember, the number of images is directly related to an increase in production. Utilize NightHawk to (1) track the number of images per provider,…

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    Versatile Appliance Ideal for Solving a Variety of Clinical Challenges COCONUT GROVE, Fla—Nevo Smile, powered by First Fit Technologies, is a versatile appliance that is ideal for solving a variety of clinical challenges and can be used long term or as a transition to more extensive cosmetic and restorative procedures. Among its applications are using it (1) as an aesthetic provisional for implant restorations, (2) as a vehicle for raising vertical dimension, (3) as movable partial dentures, and (4) as a long-term smile enhancement solution for implant and prosthetic cases. In fact, research has shown that 40% of patients who…

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    Featuring Controlled Memory Technology, Files Are Ideal for Challenging Canals SAVANNAH, Ga.–Featuring Brasseler USA's patented new Controlled Memory Technology, KontrolFlex NiTi rotary files are the ideal choice for challenging canals as well as for hard to reach areas of the tooth due to calcification. The technology strengthens the files to allow them to be procured yet highly resistant to cyclic fatigue, unlike other "controlled memory" files on the market that can experience a drastic reduction in cutting efficiency as a result of softened metal. An extensive range of tip sizes and tapers is offered. For more information or to schedule…

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    Occlusal Appliance Cited As Solution to Uncomfortable, Poor-Fitting Splints TONAWANDA, NY- Offered by Great Lakes Orthodontics, the Rhea Occlusal Appliance is the solution to uncomfortable, poor-fitting splints. Significantly different than existing appliances that use heat-softening materials, it will actually reform to subtle differences in the patient's dentition and compensate for slight variances in impressions and for deformities caused by plaster expansion. The Rhea is custom-formed to original models; as a result, chairside sealing is only necessary to fine tune fit and compensate for minor variations. It is available as a Wearguard, Flat Occlusal Plane, or Full Contact with Anterior Guidance.…

18. Page 34

    Lasers George Freedman, DDS Fay Goldstep, DDS Dental lasers are one of the newest technologies in dentistry. Kind to tissues and excellent for healing, they have begun to make a significant dental impact. While dental lasers have been commercially available for several decades, the profession has only slowly incorporated this modality into the mainstream practice. Lasers are extensively documented in academic and clinical dental literature, as well as on the podium, but practitioners have cited several objections: limited in intraoral applications, too complicated to use, and the high cost. Throughout the years, lasers have become far more intuitive, and their…

19. Page 36

    NON-DIODE LASERS BIOLASE Waterlase iPlus is a minimally invasive dental laser with expanded and enhanced capabilities to help you give your patients the best possible experience and give your practice an opportunity for growth. Waterlase iPlus 2.0 includes SureFire YSGG Delivery System, which is the gold standard in ergonomics and clinical precision. Also, the powerful REPaiR perio protocol is available as an app from the award winning touchscreen user interface. For more information, call (888) 424-6527. FREEinfo, Fotona The advanced Lightwalker ATS Dual Wavelength dental laser offers an unrivaled 2w of Fo:tiun for fast and precise cutting of hard and…

20. Page 38

    Dentsply Sirona Thanks to wireless battery operation, you can move among rooms all day without a hitch. With the included extensive equipment package and the optional foot control, SIROLaser Advance leaves nothing to be desired. It can be configured with preset therapy programs, a help menu, and 24 freely programmable applications. It comes with access codes for 6 users, 2 handpieces for alternating operation, hotkeys for 12 favorites, treatment documentation, and a rechargeable battery for mobile use. There is even an optional wireless foot control. For more information, call (800) 659-5977. FREEinfo, DenMat The NV Microlaser delivers the full power…

21. Page 40

    40 . 1 INNOVATIONS Spotlight CAD/CAM Block's Force Absorption Feature Yields More Successful Implant Treatments YORBA LINDA, Calif.- VITA North America introduces the VITA ENAMIC Implant Block (S1 block). VITA features theinically proven force absorption for more successful implant treatments. And with no furnace required post processing, VITA ENAMIC IS also decreases chair time by up to 50% for greater practice profitability. Studies show that VITA ENAMIC crowns absorb 7 1% more mastication forces than zirconia restorations as well as absorb higher force levels than either glass ceramic or gold alloy. They also show an increase in survival rate of…

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    Implant Tool Kit's Carefully Designed Drills Reduce Overdrilling and Potential Complications BEACHWOOD, Ohio—Zuga Medical's Implant Tool Kit features carefully designed drills with automatic stop guides that reduce overdrilling and potential complications. The company's implant process is a drill based foundation that simplifies the procedure into 6 easy steps. Bone level implants are designed to maintain crestal bone heights and retain soft tissue for a more natural and aesthetic result. A conical, low-angle taper design offers a tight, secure position of the abutment, allowing the implant to achieve higher fatigue strength while preventing leakage. For more information, call Zuga Medical at…

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    Digitally Connected Power Toothbrush Features App That Helps to Improve Brushing Technique STAMFORD, Conn.–The Philips Sonicare FlexCare Platinum Connected Power Toothbrush is the first digitally connected product from Philips Sonicare designed specifically for adults. Featuring the latest Bluetooth wireless technology, its accompanying app–with its personalized coaching tips, and alerts–helps improve brushing technique, while its patented sonic technology removes up to 10 times more plaque than a manual toothbrush. Utilizing the FlexCare Platinum Connected app, patients will never leave another spot unbrushed. The FlexCare Platinum Connected's app features a unique 3-D Mouth Map that provides 100% visibility of trouble spots. It…

24. Page 48

    NEWS/TRENDS Industry News A-dec Announces Managerial Promotion Scott Parrish, president and CEO of Newberg, Ore-based A-dec, a dental office furniture and equipment manufacturer, announced recently the promotion of Marv Nelson to executive vice president and COO. Mr. Nelson's career with A-dec began in 2006. For the past decade, he has served as A-dec's vice president of information and CFO. He also coleads the company's corporate strategy and is instrumental in maintaining dealer relationships. Mr. Parrish will continue as A-dec's president and CEO, focusing more of his time on portfolio development and expanding leadership roles within the community. [Photo of Marv…

25. Page 50

    NEWS/TRENDS Flossing Controversy continued from page 48 decade, focusing on 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss. Their findings noted that the evidence for flossing is "weak, with unreliable," of "very low" quality, and carries "a moderate to large potential for bias." When NPR noted that flossing had lost its place among federal recommendations for daily health, some dentists took exception to the decision. Other findings gleaned from two 2015 studies noted that "the majority of available studies fails to demonstrate that flossing is generally effective in plaque removal," and…

26. Page 52

    Teledentistry continued from page 48 could be financially viable in the Denti-Cal system. Further lauding the project's success, Dr. Glassman said, "Our eyecar demonstration project confirms that this is a safe, effective way to bring care to people who need it. Basing a virtual dental home in a school, a nursing home, or other community setting allows dental hygienists to prevent oral the majority of oral health problems on site and also brings Benefits of Dental Sealants Reaffirmed A new systematic review and updated clinical practice guidelines from the ADA and American Academy of Pediatric Dentistry show that dental sealants…

27. Page 56

    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. Calibra Ceram Dentsply Sirona The cleanup of excess cement after crown or bridge placement is always a chore. All too often, this task is delegated. On one hand, it is a tedious procedure at the end of a long series of clinical steps when the practitioner is typically pressed for time; on the other hand, even minute specks of residual cement can compromise the soft tissue sue and condemn the restoration to failure. One of…

28. Page 58

    iLumi Super Fiber Posts iLumi Sciences The dental profession is increasingly successful in its efforts to have patients retain their natural dentition for a lifetime. Many dental infections that would once have resulted in tooth extraction are now treatable endodontically. As a result, mandatory post endodontic restoration has become a major part of many practices. The process is straightforward for the practitioner and comfortable for the patient, often requiring no local anesthetic. Super Fiber Posts from iLumi Sciences, microfiber cores thermally coated with low refractive index optical glass, are an innovative and comprehensive addition to the restorative armamentarium. They are…

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    60 2016 Product Awards DIRECT RESTORATIVES SECTIONAL MATRIX Composi-Tight 3D XR Sectional Matrix System +++++ Garrison Dental Solutions | (888) 437-0032 | garrisondental.com Why we chose this product: • "Blue rings are intricate and stable on teeth." • "Original 3-D was a good product, but the new blue face is even better." • "Great contours and contacts." The Composi-Tight 3D XR Sectional Matrix System is designed to create tight, anatomical contacts on Class II composite restorations. The system's rings are produced with Soft Face silicone to enhance matrix band adaptation and improve contacts, reducing flash and finishing time. The 3-D…

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    2016 Product Awards COMPOSITE: UNIVERSAL Estelite Sigma Quick Tokuyama Dental America | (877) 378-3548 | tokuyama-us.com COMPOSITE-UNIVERSAL: MULTILAYER Filtek Supreme Ultra Universal Restorative ++++1/2 3M | (800) 634-2249 | 3m.com/dental Why we chose this product: • "The enamel shades give good depth for most anterior multilayer/stratification restorations." • "Composite stays where placed and is easy to sculpt." • "Good color match and very nice surface finish." Filtek Supreme Ultra Universal Restorative, a composite indicated for anterior and posterior restorations, is filled 63% by volume with a combination of 4- to 20-μm and loosely bound clusters of these particles, 0.6 to…

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    CEMENTS: AESTHETIC RESIN Variolink Esthetic +++++ Ivoclar Vivadent | (800) 533-6825 | ivoclarvivadent.com Why we chose this product: • "Complete kit with everything needed." • "I was able to get precise shade matching." • "Easy cleanup." • "Shading system is different, but it makes sense." Variolink Esthetic is an adhesive luting composite for the permanent cementation of ceramic and composite restorations. Based on its predecessors, Variolink II and Variolink Veneer, it combines features of both and is available in light-cure and dual-cure versions. It contains the patented light initiator, Iocerin, which is 100% amine-free for enhanced shade stability. FREEinfo, CEMENTS:…

32. Page 70

    "Great images!" "Camera is lightweight, with a slim head." "Lights are bright but do not wash out the colors in the images." IRIS, an intraoral camera that features (1) a user-friendly, multistop focus wheel and (2) a unique USB connector, is a precision optical instrument with streamlined features and a narrow, soft tip. Superior image quality and sharpness are supported by brilliant 8-point LED lighting and Sony's high-resolution CCD. The camera is designed for rightor left-handed convenience, enabling any dental team member to easily capture images. FREEinfo, PANORAMIC IMAGING SYSTEM CS 8100 Carestream Dental | (800) 944-6365 | carestream.dental.com ENDODONTIC…

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    2016 Product Awards DYNAMIC MIXER Dynamix Speed Heraeus Kulzer | (800) 431-1785 | heraeusdentalusa.com BEST VALUE PRODUCT MIXPAC T-Mixer TM ++++ Sulzer MIXPAC | +41 81 772 20 00 | sulzer.com Why we chose this product: • "Homogeneous mix and less waste." • "I found the tips to be an excellent product, providing a savings to the office without changing procedures." • "Got a good mix every time." MIXPAC T-Mixer automix tips are designed to minimize material waste while providing a consistent, high-quality mixed result. Their innovative design allows for a more compact shape by incorporating a higher number of…

34. Page 76

    76 2016 Product Awards base layer in posterior restorations, xtra base can be cured in 4 mm-thick layers. The final occlusal layer should be finished with a minimum of 2 mm of universal posterior composite. Compatible with any bonding agent, xtra base is available in Universal and A2 shades. FREEinfo, LED CURING LIGHT Bluephase Style +++++ Ivoclar Vivadent | (800) 533-6825 | ivoclarvivadent.com Why we chose this product: • "Lightweight and ergonomically friendly." • "Easy to get in tight spaces." • "Easy, stable docking." Bluephase Style is a cordless LED curing light designed with "polywave" broadband spectrum technology, making it…

35. Page 79

    2016 Product Awards GREEN PRODUCT BioPure Bio-Pure Products | (888) 596-6546 | biopureproducts.com AMALGAM CONTAINMENT SYSTEM HG Containment Series Anterior Quest | (877) 750-4347 | anteriorquest.com SMILE SIMULATION SOFTWARE SNAP Software Snap Imaging Systems | (866) 987-7627 | snapdental.com HEMOSTATIC DRESSING Surestop Impact Medical Sales and Supply ORAL SURGERY INSTRUMENT Luxator ++++½ Directa Dental | (800) 284-3368 | directadental.com Why we chose this product: • "I loved the sharpness of the blade." • "This is really easy to use." • "The handle fits great in my hand." Luxator instruments are periodontal ligament knives that aid in atraumatic extractions. The fine-tapered…

36. Page 80

    Anterior Tooth Replacement Made Easy A Conservative and Predictable Direct Technique Sam Simes, DDS Often, patients and referring orthodontists have a preconceived idea that a cosmetic solution to a problem, such as congenitally missing lateral incisors, will be a very complex and clinically involved challenge. Furthermore, it is often thought of as being a very expensive ordeal to solve. In many cases, when clinically indicated and if the appropriate materials and techniques are employed, nothing could be further from the truth! The following article will focus on a real-world clinical example that demonstrates how a conservative and predictable direct restorative…

37. Page 82

    Anterior Tooth Replacement Made... continued from page 80 timeline, procedure outline, and any final questions from Rachel were addressed. A preliminary vinyl polysiloxane (Vinyl Polysiloxane [Alginx X (Dentsply Sirona)) impression was taken of the upper and lower arches along with a bite registration (BlueMousse [Parkell]). These would be used to create a wax up of the new lateral incisors, and also for the fabrication of an initial/lingual putty (Sil-tex) (ov-clear (Vivadenti) matrix to be used chairside during the restorative process. Two weeks prior to the restorative work to be done, a one-hour, in-office whitening (Zoom [Phillips Oral Healthcare]) was accomplished.…

38. Page 83

    Figure 17. The final outcome. portion of the preps to the lingual contour of the adjacent tooth (Figure 3). Next, the incisal/lingual putty matrix is tried in to ensure a proper seal. In order to establish the lingual border, place flowable composite into the lingual of the putty matrix and position the matrix, then light cure it from the buccal for 20 seconds (Figure 10-12). Position the pontic button on the gingiva leaving approximately 1-2 mm of space between the 2 adjacent abutment teeth (Figure 13). Remove the putty matrix and begin building the buccal portion of the restoration starting…

39. Page 84

    The Future of Implant Dentistry Michael Tischler, DDS As clinicians, we are replacing teeth that have evolved and changed throughout thousands of years. Maxillary molars, for example, have 3 roots instead of 2, because the bone is softer and the forces are greater in the posterior of the mouth. It has already been one year since the Implants Today section was first published. I want to thank Damon Adams, our editor-in-chief, Dr. Damon Adams, for the invitation to be the editor of the implant section and for helping us create a shared vision that will take us all on this…

40. Page 85

    years. The future of successfully replacing what nature has created—and then sometimes fails—with implants requires the latest technologies, techniques, materials, and continued education (CE). FUTURE TECHNOLOGIES As computer technology advances, there is a direct impact on implant dentistry and the potential for increased success. There are a growing number of companies that offer CBCT machines and software planning programs. Better resolution, faster scans, and the availability of virtual planning are examples in the arena of technology development. More sophisticated Internet technology at higher speeds has allowed clinicians and laboratory teams to share treatment planning information and to foster better collaboration…

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