Dentistry Today — September 2018

Inside this issue

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

1. Page 6

   Technology Changes Everything! This month, in several of our clinical articles and in our full-cover-featured interview with Dr. Rella Christensen, who is in charge of TRAC Research (which is the human studies section of Clinician's Report (CR)), we are showcasing advances in dentistry that are related to innovations and/or improvements in technology. In my discussion with Rella, she shares her expert opinions and perspectives on some of the existing, new, and emerging technologies that are or soon will be, impacting dentists and their patients in many positive ways. Over the years, Drs. Rella and Gordon Christensen have been kind and…

2. Page 8

   Dental Sleep Medicine: The Future is Now! The American Dental Association (ADA) has helped to further define the future of dental sleep medicine (DSM). DSM pertains to the management of sleep related breathing disorders (SRBDs). These airway disorders that occur during sleep include snoring caused by soft-tissue vibrations; obstructive sleep apea (OSA); partial complete airway obstruction accompanied by a reduction in airflow and blood oxygen desaturation; and upper airway resistance syndrome (UARS), an intermediary condition where sleep architecture is disturbed due to the effort required to breathe through a narrowed airway. SRBDs, caused by anatomical airway insufficiencies and altered respiratory…

3. Page 10

   VIEWPOINT continued from page 8 prolong the health and lives of our patients." According to the new ADA policy, passed by the ADA House of Delegates at ADA 2017, the dentist's role in the management of SRBDs includes, but is not limited to, the following: • Dentists are encouraged to screen patients for SRBDs. • Patients should be referred, as needed, to the appropriate physicians for proper diagnosis. • In children, if risk for SRBDs is determined, intervention through medical/dental referral or evidence-based treatment may be appropriate to help treat the SRBD and/or develop optimal physiologic airway and breathing patterns.…

4. Page 12

   FOCUS ON: 3-D Printing DENTAL ADVISOR's Sabiha S. Bunek, DDS, speaks with Mr. Juan Montealegre of Apex Dental Milling about 3-D printing technologies. Q: What benefits does 3-D printing offer the field of dentistry? A: Three-dimensional printing, which has only recently taken off in the dental industry, is a form of additive manufacturing that has been around since the 1980s. Additive manufacturing joins materials together to create a 3-D object. Examples in dentistry are dental models, temporary crowns, and removable appliances, including denture bases. Three-dimensional printing usually works by putting down a material layer by layer to build up a…

5. Page 14

   Practicon The lightweight, pen-style CO2-S LED Curing Light delivers up to 2,500 mW/cm² for fast curing of all light-activated materials. Seven operating modes address a variety of clinical applications, while the collimated beam concentrates curing power exactly where needed. The low-profile, right-angle head improves access to hard-to-reach areas, and the membrane-covered control panel makes cleanup with disinfectant wipes easy. For more information, call (800) 959-9505 or visit the website practicon.com. FREEinfo, DENTAL CART ASI Dental This fill indicator upgrades ASI Dental's line of mobile, self-contained dental carts. These dental carts feature a built-in air compressor, water supply, and suction system…

6. Page 16

   From the May and June 2018 Issues LOW-SHRINK COMPOSITE Shofu Dental Beautifil II LS (Low Shrink) is available in syringes, tips, and 14 dentin and enamel shades and has been developed to minimize polymerization shrinkage and shrinkage stress. Featuring Shofu Dental's proprietary Giomer chemistry, and clinically proven in 8- and 13-year recall studies in international bench studies, this groundbreaking material demonstrated a volumetric shrinkage of 0.85% and polymerization shrinkage stress of 2.72 MPa. For more information, call Shofu Dental at (800) 827-4638 or visit shofu.com. FREEinfo, PERIODONTAL LIGAMENT KNIVES Directa Dental Luxator instruments are periodontal ligament knives used to aid…

7. Page 17

   CAD/CAM SYSTEM Dentsply Sirona CEREC AC with Omnicam is a chairside solution designed to accomplish single-visit restorations, digital orthodontics, and integrated implantology. Designed with the dentists' and patients' comfort in mind, the small, rounded, handheld camera is ideal for rotation in the intraoral space and captures lifelike 3-D scans without the use of powder or impression material. The camera system, PC, and screen comprise one mobile unit. For more information, visit Dentsply Sirona's website located at dentsplysirona.com. FREEinfo, COMPOSITE Parkell HyperFIL HAp is a dual-cure, bulk-fill restorative composite containing nano-hydroxyapatite. It is the perfect choice for creating quick and easy…

8. Page 18

   Welcome to the Machine Paul Feuerstein, DMD ...several dental units...are physically guided by systems similar to a GPS. Many of these are used in teaching institutions but...could evolve into smaller chairside units. In Stanley Kubrick's film 2001: A Space Odyssey, the HAL 9000 said, "I'm sorry, Dave. I'm afraid I can't do that way, Mr. Armor. The good series is the most reliable computer ever made. No one computer has ever made a mistake or distorted information. We are all, by any practical definition of the words, foolproof and incapable of error." This quote still stands as a mantra for…

9. Page 20

   Enhancing Zirconia Restoration Workflow Implementation of Stand-Alone Scanners Sam Simos, DDS INTRODUCTION Today, an increasing number of dental practices are transitioning to a digital workflow, from digital radiographs and intraoral photographs to completely digital patient records inclusive of oral care history and insurance records. Many digital processes are now commonplace throughout the dental office. However, to fully maximize the benefits of a digital dental workflow among all contributors to a patient's care—including dentists, front office staff, collaborating specialists, and dental laboratory teams—other information should also be captured and transferred digitally. Among this information are impressions, models, restoration designs, and fabrication…

10. Page 21

    use with other technologies, including in-office patient record systems. Similar to traditional impressions, the innovative optical technology of the Aadva IOS scanner captures details of hard and soft tissues, but in a simpler, faster, and more precise manner. However, unlike with traditional physical impressions, Aadva IOS scans enable verification of the preparation, definition of margin lines, evaluation of the bite registration, and the creation of a 3D model. The simulated model can then be ...many digital processes are now commonplace throughout the dental office. used to create indirect restorations, such as veneers, inlays, onlays, single crowns, and fixed partial dentures…

11. Page 22

    Figure 3. An accurate and detailed intraoral scan of the preparations was taken (Aadva iOS 100 Scanner [GC America] in lieu of taking traditional impressions). Figure 4. Intraoral photographs of the preparation of tooth No. 30 were also taken. Figure 5. Photographs of the buccal bite view of the preparation were taken to ensure the creation of a proper occlusion in the final restoration. Figure 6. The same buccal bite perspective was also captured digitally via an intraoral scan using the Aadva iOS 100 Scanner. Figure 7. Intraoral photographs were taken of the opposing teeth in the maxillary arch. Figure…

12. Page 23

    TECHNOLOGY 23 Figure 15. At the dental lab, a digital model was created based upon the intraoral scans for use in designing the full-coverage crown. Figure 16. The digitally designed restoration was then virtually articulated on a digital model against the opposing arch to verify the occlusal scheme. Figure 17. A view of the crown after milling and before sintering the zirconia. Figure 18. A view of the zirconia crown restoration, after sintering. Figure 19. The postoperative view of the definitive zirconia crown (Ottawa Zirconia Translucent [Ottawa Dental Laboratory]) immediately following cementation. Intraoral scanners contribute to greater efficiency, accuracy, and…

13. Page 24

    Practice Management Carestream Dental The new Care Management Platform follows a software-as-a-service model that maximizes practice revenue and increases office efficiency. This solution enables users to capture and view patient records and treatment plans all in one glance, while innovative business intelligence tools help practice owners optimize their business goals. Since the platform is cloud based, there's zero footprint and no installation needed. That also means sensitive patient data is encrypted at the source. For more information, call (800) 944-6365 or visit caredental.com. FREEinfo, DENTECH by Softech With more than 34 years of experience, DENTECH proves to be a solid…

14. Page 26

    DentiMax DentiMax is a technology leader with the knack for making software that is extremely easy to use. The software tightly integrates with digital x-rays, allowing you to easily view x rays and treatment plans from the same screen. And the software flows just like your office, from capturing new patient info with a tablet, to electronically prescribing medication, to texting appointment reminders, DentiMax mirrors your practice's actual workflow. These easy-to-use but powerful features make DentiMax an easy choice. For more information, call (800) 704 8494 or visit dentimax.com. FREEinfo, Henry Schein One Dentrix provides award-winning clinical tools and connected…

15. Page 27

    PRACTICE MANAGEMENT 27 (800) 944-6646, option 2 or visit mogo.com. FREEinfo, Digital Doc 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. For more information, call (800) 518-1102 or visit the website digidoc.com. FREEinfo, Suzy Systems…

16. Page 28

    Spotlight Abutment Retains Advantages, Allows for Modification of Angulation of Screw Channels IRVINE, Calif.- TruAbutment expands its innovative solutions with the addition of the Angulated Screw Channel (ASC) to its custom abutment products. Even though screw-retained solutions have become the standard with the advent of CAD/CAM technology, it has been largely limited to posterior restorations due to the design challenges in the anterior region. The pioneering concept of the ASC Ti bases has allowed users to deal with these challenges by providing a restoration that is aesthetic and convenient. But the launch of TruAbutment ASC will further advance the concept…

17. Page 30

    Curing Light Comes With Transilluminator for Detecting Fractures and Residual Caries RACINE, Wis—In a sea of blue curing lights, Vista Dental Products differentiates with a unique technology. Using pink light, a combination of near infrared and standard blue light, VALIANT PINK significantly improves microhardness of composite restorations and generates less heat than standard curing lights. VALIANT dual wavelength curing lights are capable of polymerizing all light-cured dental materials, making them some of the most versatile curing lights on the market. VALIANT precision optics and a unique arrangement of LEDs produce a uniform beam of high intensity light. A uniform beam…

18. Page 31

    Spotlight Anesthesia Provides Two Formulations, Offering Options for Patients and Procedures LANCASTER, Pa.–Discover what Septodont's Septocaine can do for your patients and you. It is consistently the No. 1 branded anesthetic in the United States (data on file). Septocaine is indicated for local, infiltrative, or conductive anesthesia in simple and complex dental procedures. It is available in 2 formulations, so you can decide which epinephrine concentration is right for the patient and the procedure. For more information, call Septodont at (800) 872-8305 or visit septodontusa.com. FREEinfo, Curing Light Displays Consistent Light Irradiation Regardless of Battery Power FAIRFAX, Va.–The small head…

19. Page 32

    Motor Offers Adjustable Torque, Ability To Be Used in Many Areas WOODINVILLE, WASH.—A product with 30 years of motor manufacturing experience, Aseptico's 7000 Series Motor is one of the most powerful and comprehensive dental motors on the market today. It features adjustable torque and can be used for implant, surgical, and endodontic applications. Aseptico's worldwide reputation for building strong, dependable dental equipment guarantees reliability and performance for years. Many other features set the 7000 Series Motor apart from the rest, including a dynamometer calibration system that ensures the motor's torque output is always accurate. Six programmable preset buttons allow for…

20. Page 40

    40 2018 Product Awards ALGINATE Cavex Cream Alginate Cavex Holland BV | +31 (0)23 530 77 00 | cavex.nl/nl FREEinfo, PROVISIONAL: UNIVERSAL Visalys Temp Kettenbach LP | (877) 532-2123 | kettenbach.com Why we chose this product: Visalys Temp was loved by our clinical evaluators due to its excellent fit and minimal shrinkage after setting. A noticeable difference was in the lack of an air-inhibited layer. Consultants' Comments • "Great handling—easy to finish and polish." • "Minimal air-inhibited layer." • "This is my new favorite provisional material." FREEinfo, PROVISIONAL: AESTHETIC Luxatemp Fluorescence DMG America | (800) 662-6383 | dmg-america.com Why we…

21. Page 52

    Spotlight Material Allows Dentists To Perform Relining Process in One Short Application ENCINITAS, Calif.–Soreliner Tough from Tokuyama Dental America is a multiple award-winning, self-cured, chairside and laboratory denture reline material based on silicone. It is quick and easy to use, allowing dentists to perform the entire relining process in only one short, mess-free application. As the only denture reline material developed to retain a consistent level of softness throughout the lifetime of the reline, Soreliner Tough ensures lasting comfort for up to 2 years. It is available in 2 options: Soreliner Tough (Soft) is recommended for use with sensitive or…

22. Page 54

    Rotary File System Offers Heat-Treated, Premium NiTi Construction With Flexibility BURNABY, BC, Canada—DiaDent's Dia X Rotary File System offers heat-treated, premium NiTi construction with extreme flexibility and durability. The resistance to cyclic fatigue is at least 143% greater compared to other nonheated rotary files. With its progressive taper design and superior cutting efficiency, these files offer precision, safety, and reliable clinical results. Dia X Rotary File has a convex triangular cross section while reducing rotational friction and contact with canal wall. The heat-treated surface is also coated, providing high corrosion resistance. Dia X Rotary File's handle has a length of…

23. Page 55

    Pin's Wide Pitch Thread Provides Excellent Retention DENTISTRY TODAY TOP 100 PRODUCTS 2015 DENTISTRY TODAY TOP 100 PRODUCTS 2016 DENTISTRY TODAY TOP 100 PRODUCTS 2017 DENTISTRY TODAY TOP 100 PRODUCTS 2018 STABILOK -the gold standard for dentin pins MIAMI-Fairfax Dental's Stabilok Pin is designed to achieve 2 criteria: self-shearing with maximal reliability and insertion with maximal ease. The wide pitch thread provides excellent retention for the pins, which are available in either the purest commercially available titanium or stainless steel. The pins and drills are dispensed from the box through apertures. For more information, call Fairfax Dental toll-free at (800)…

24. Page 56

    NEWS/TRENDS Industry News DMG America Cofounder Herb Wolfe Passes Away Herb Wolfe, who was one of the founders of DMG America, died on August 8, 2018, in New York City. Father of current DMG America president George Wolfe, Herb started Foremost Dental, the parent company of Dental at the time, with his partners in 1983. In 2009, Foremost became DMG America. Wolfe's career began with a sales position at an early age, and he tirelessly worked his way up through the ranks as he made a name for himself as founder and president of Sultan Dental Products and as a…

25. Page 57

    NEWS/TRENDS HfO₂ Nanoparticles Identify and Eliminate S Mutans In this illustration, nanoparticles attach to or are taken up by the bacteria cells. Pan and his students are the first group to demonstrate that early detection of dental plaque in the clinic is possible using the regular intraoral x-ray machine, which can seek out harmful bacteria populations. Researchers at the University of Illinois have devised a practical nanotechnology-based method for detecting and treating the bacteria that cause plaque and other detrimental conditions. "Presently in the clinic, detection of dental plaque is highly subjective and only depends on the dentist's visual evaluation,"…

26. Page 58

    NEWS/TRENDS Harvard... continued from page 56 ganizations such as the Metropolitan Council for Educational Opportunity, so we can contribute to MEDscience, MGH/Revere Cares, Reactions in Action, the National Student Leadership Conference, Seeds of Hope, and Indian Island School to bring students who likely would not be exposed to career opportunities in dentistry to HSDM to introduce them to the field. Students who express an interest in dentistry can participate in further pipeline programming with jobshadowing opportunities with local dentists. "While we have the students with us, we also teach them about oral health and oral hygiene practices so we can…

27. Page 62

    Long-Term Oral Bisphosphonates Delay Healing After Tooth Extraction It is controversial whether bisphosphonate withdrawal is necessary prior to invasive procedures such as tooth extraction to prevent bisphosphonate-related osteonecrosis of the jaw (BRONJ). A study published in Osteogenesis International evaluated the clinical safety of continuing oral bisphosphonate therapy in patients undergoing tooth extraction. The study prospectively enrolled 132 patients (6 men, 126 women) who were receiving oral bisphosphonates for the prevention or treatment of osteoporosis and required tooth extraction. All patients were managed using an identical protocol that included preoperative antibiotic prophylaxis and did not necessitate complete wound closure. The subjects…

28. Page 63

    Smoking Cessation Has Positive Impact on Periodontitis A systematic review by Leite et al estimated the effect of tobacco smoking cessation on the risk for periodontitis compared to the risk among never-smokers. It also evaluated the effect of tobacco smoking cessation on the clinical outcomes of nonsurgical periodontal treatment. Only original prospective longitudinal observational and interventional studies that investigated the association between smoking cessation and periodontitis onset or progression were included. Meta-analyses were conducted to summarize the evidence. A total of 2,743 articles were identified in electronic searches. Only 6 were included in the meta-analysis. Pooled estimates showed the risk…

29. Page 64

    Technology: An Essential in Dental Care! Simply stated, dental treatment would be virtually impossible without many technologies supporting it. Even the earliest dental treatment (tooth extraction) required creative thought by humans designing instruments to facilitate it. Many of the most clever, useful, and enduring dental technologies have originated in the minds of dentists, dental laboratory technicians, hygienists, and assistants to fill unmet clinical needs. In the current onrush of new technology competition, where are we now in 2018? Damon Adams, DDS, editor-in-chief of Dentistry Today, led a discussion with Rella Christensen, RDH, PhD, to find out. What do you think…

30. Page 66

    Figure 1. Light polymerized materials and a cordless curing light in action. Technology: An Essential in Dental... continued from page 64 But I believe all of these challenges are surmountable. Watch and see! You mentioned CAD/CAM. What are your thoughts on the future of CAD/CAM in-office and in laboratory technologies for restoration fabrication? Dr. Christensen: Well, it is obvious that CAD/CAM technology used in-office by the dentist and staff, and especially that which is used in commercial laboratories, has swept through the profession worldwide and just about eliminated technologies that had been used for many, many years, such as all-metal…

31. Page 67

    INTERVIEW I believe the best approach, wherever possible, is to try to share purchase and upkeep costs with colleagues. tant we might otherwise have missed. This is a good example of the way technology can support and improve delivery of care. Clinicians who learn to use loupes and head lamps generally feel uncomfortable and insecure if forced to return to unaided vision during a procedure. In our research in dental materials and dental caries, we simply cannot operate without magnification that includes loupes, head lamps, and operating microscopes. In fact, magnification has become the norm in some clinical areas today—…

32. Page 68

    Grafting for Implant Dentistry Michael Tischler, DDS It has been said, "The bone sets the tone, and the tissue is the issue." The underlying available, or grafted, bone is the foundation for the soft tissue. Through contouring underlying bone, and grafting deficient areas needed for implant or aesthetic support, adequate soft tissue can be supported. This month, I would like to briefly discuss softand hard tissue grafting for implant dentistry. The success of one or more dental implants is dependent on both the soft tissue and hard tissue surrounding the implant. While many other factors come into play, soft and…

33. Page 70

    Tooth Extractions and Bone Grafting Dentistry Today's Implant Editor, Michael Tischler, DDS, conducts an interview with Timothy Kosinski, DDS. Tim, I know that you place a lot of dental implants and that you promote the importance of sitting the foundation for implants with proper preparation of the bony sites with bone grafting procedures. Please tell us a bit about your own experience with implant dentistry and the state of implant dentistry as it relates to the general practitioner (GP). Dr. Kosinski: Well Michael, I have been placing dental implants since 1985 and have now documented the placement of more than…

34. Page 72

    Tooth Extractions and Bone Grafting... continued from page 70 established. This is the working end of the instrument. The bumper is placed as high up (or as low into the vestibule as possible. This is not the working end of the instrument, but, rather, it serves as a fulcrum or center of rotation. It allows the clinician to rotate the instrument with wrist motion only (no squeezing) and to create tension on the lingual or palatal aspect. This creates a physiologic response that breaks down the periodontal ligament (PDL), allowing the tooth to come unaided out of the socket using…

35. Page 73

    IMPLANTS forms. The particulate material is in a powder-like form that is hydrated with sterile saline or sterile water. Another proper form is what is referred to as a bone graft putty. This has the same allograft materials embedded in a moldable collagen material, making the material soft to allow for nice control during placement of the graft. What are the processes for bone growth? Dr. Kosinski: Osteogenesis is the ability to create viable bone cell development; osteoinduction is the ability to stimulate those cells capable of formulating bone cells, BMPs, and PDGF; and osteocondution is a structure that is…

36. Page 74

    IMPLANTS and not a dense ceramic hydroxy apatite. It is bioactive, controls invagination of soft tissue, and forms a strong bond with bone as it resorbs. The clusters are packed and intertwined and form a hydrophilic matrix that absorbs blood. It is also radiopaque on the day of placement, becoming radiopaque once the bone has turned over and the material has been replaced by the host's bone. The graft and collagen combination fulfills a primary purposes of a membrane in socket preservation. It contains the graft material and restricts migration of connective tissue through both a physical and chemical barrier.…

37. Page 75

    ease. This lack of attached gingiva often results in discomfort to the patient on brushing, maintenance problems, and potential bone loss around the site. When doing any implant procedures, I remain conscious of the mucogingival line. I know at least a 2-3mm band of healthy attached gingiva is required on the facial aspect of the implant. When infiltrating the surgical site with local anesthetic, the mucosa will bubble up, and the mucogingival line can be easily delineated. If I don't have that band of attached gingiva, an incision is made on the lingual or palatal aspect of the ridge, and…

38. Page 76

    Broken Instrument Removal The Endodontic Challenge Clifford J. Ruddle, DDS, MSD [Image a shows a preoperative film of a maxillary first molar demonstrating a broken instrument in the apical one-third of a mesial root. Note the furcal lesion.] [Image b shows a post-treatment film demonstrating that the broken file has been removed and the root canal systems have been filled. Note the furcal canal.] Every clinician who has performed endodontics has experienced a variety of emotions ranging from the thrill of the filling to the profound regret likely the procedural accident of breaking an instrument. Fortunately, when a file breaks,…

39. Page 78

    Broken Instrument Removal: The... continued from page 76 The guidelines for radicular access are the same as if there was no broken instrument and emphasize creating a smoothly flowing funnel, which is largest at the orifice and narrowest at the obstruction. This can be accomplished with Glidden (GG) drills sizes 1 to 4, which have maximal diameters of 0.5, 0.7, 0.9, and 1.10 mm, respectively. GGs are used in a crown-down manner, at about 100 to 500 rpm, and are confined to the straightaway portions of a canal. GG-4 is used in a brushing motion to flare a coronal aspect…

40. Page 79

    ENDODONTICS majority of these traditional devices and removal methods are scaled far too large to safely use within mod appropriate canal shapes. Even though better scaled technologies have emerged, they still require developing adequate access, creating a staging platform, and utilizing trephining procedures to expose the head of a file. Although innovative, recently her added, yet fragile, loop head has not eliminated the difficulties of the original "Lasso & Anchor" technique first described 35 years ago. As such, a removal method will be described that provides anatomically sealed, durable, and innovatively designed microtubes for removal. The File Removal System The…

And 23 more pages — read the whole issue.